Page 34 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 34

THROUGH ITS MD/AUTHORISED PER-
SON, HAVING ITS REGISTERED OFFICE AT
ICICI TOWERS 1089, APPASAHED MARATHE
MARG, PRABHADEVI,
MUMBAI-400025
MAHARASHTRA

BE-
FORE:
HON'BLE MR. JUSTICE AJIT BHARIHOKE,PRESIDING
MEMBER

For the Peti- Mr. Sham Lal Bhalla, Ad-
tioner : vocate

For the Respon- Mr. Praveen Mahajan, Ad-
dent : vocate

Dated : 16 Oct 2017
ORDER
This revision is directed against the order of the State Commission, Punjab
dated 25.1.2017 vide which the State Commission accepted the appeal preferred by
the respondent/insurance company against the order dated 22.1.2016 passed by Dis-
trict Forum Fatehgarh Sahib, set aside the order and dismissed the complaint.
2. Briefly put, relevant facts emerging from the record are that the peti-
tioner/complainant purchased a life insurance policy from the opposite party. The
policy was valid w.e.f. 29.6.2004 to 28.6.2009. As per the terms and conditions of the
policy apart from the life insurance the respondent/complainant was provided ex-
tended benefit under the medical illness clause. During the currency of the insurance
policy the petitioner/complainant developed some problem and he was advised An-
gioplasty. The petitioner underwent Angioplasty as per the medical advice at the cost
of Rs.2,50,000/-. The insurance claim under the critical illness clause was filed but
the opposite party repudiated the claim vide letter dated 4.1.2014 claiming that the
expenses incurred on Angioplasty were not covered under the critical illness clause of
the insurance policy. Being aggrieved of the repudiation of the insurance claim, the
petitioner filed consumer complaint in District Forum Fatehgarh Sahib wherein he
described the insurance policy purchased by him as a medi-claim policy although as
per record it was life insurance policy.
3. The opposite party on being served with the notice of the complaint filed
written statement claiming that a life insurance policy was issued in favour of the
complainant which contained the critical illness rider benefit but it did not include
Angioplasty.
4. The District Forum on consideration of pleadings and the evidence allowed
the complaint and directed the opposite party insurance company to pay to the peti-

INDEX