Page 109 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 109

For the Respon- For the Respondents : Mr.Pankul Nagpal, Ad-
dent : vocate

Dated : 04 Jul 2017
ORDER
ANUP K. THAKUR

This Revision Petition No.3265 of 2015 has been filed by the peti-
tioner/complainant – Bhupinder Kumar against the order of the Punjab State Con-
sumer Disputes Redressal Commission, Chandigarh (for Short, ‗State Commission)
dated 23.12.2014 in FA No.658/2012 vide which his insurance claim under critical
illness cover was denied.
Brief facts relevant for the disposal of this revision petition are as follows.
As per the petitioner/complainant, he has been associated with the respondent
opposite party Bajaj Allianz Life Insurance Co. since 2005, first as an insurance con-
sultant and presently as a Sales Manager. He had taken an insurance policy
No.0010996742 dt. 28.9.2005 from the respondents/opposite parties. He had suffered
a heart-attack on 29.4.2007 and was admitted in Patiala Heart Institute
from 30.4.2007 to 2.5.2007. Later, he was shifted to Dayanand Medical College and
Hospital, Ludhiana where he remained from 19.6.2007 to 20.6.2007. Angiography
was conducted and a stent was fixed. The complainant spent an amount of Rs.2.50
lakh for his treatment. He lodged his claim with the Insurance Company but till date
his claim has not been paid, despite e-mail reminders, letters. Therefore, he filed a
consumer complaint before the district forum and prayed for the following relief :-
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To pay Rs.1 lakh as compensation on account of mental agony, tension, incon-
venience, harassment and humiliation suffered by the complainant.
To pay Rs.15,000/- as litigation expenses.”
The District Forum on consideration of the pleadings before it, allowed the com-
plaint and directed the opposite parties to make payment of Rs.2 lakhs to the com-
plainant within one month with 9% interest p.a. from the date of the order as also
Rs.7,500/- as cost of the complaint.
Being aggrieved, the opposite parties – Insurance Company had filed an appeal
before the State Commission. The State Commission in its order dt. 23.12.14 allowed
the appeal and setaside the order of the District Forum.It held that repudiation of the
claim was justified and correct in terms of the critical illness policy provisions, ex-
plaining that it was not for the district forum to go beyond what was specifically pro-
vided in the policy itself.
Being aggrieved with this order, the petitioner/complainant has filed this revision
petition before this Commission.
Heard learned counsel for both parties and perused the records of the case, includ-
ing the policy covering critical illness.
It is not in dispute that the petitioner did undergo an angiography procedure in
which a stent was fixed. The issue for consideration is whether this falls within the
policy parameters which define ‗critical illness‘.

INDEX