Page 81 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 81

BE-
FORE:
HON'BLE MRS. REKHA GUPTA,PRESIDING MEMBER

For the Peti-
tioner : Mohd Anis ur Rehman, Advocate

For the Respondent :

Dated : 13 Jul 2017
ORDER
REKHA GUPTA, PRESIDING MEMBER

The present revision petition has been filed against the judgment dated
st
1 August 2016 of the Chhattisgarh State Consumer Disputes Redressal Commission,
Raipur (‗the State Commission‘) in First Appeal no. 661 of 2014.
2. The facts of the case as per the petitioner/ complainant are that the petitioner
had taken an insurance policy from the respondent/ opposite parties under which the
petitioner, his wife and daughter were insured for the period 06.10.2010 to
06.10.2055. The petitioner has taken the said policy by paying the annual premium of
Rs.17,000/- to the respondent no. 1 and from the branch office of respondent no. 2.
Under this policy, an amount of Rs.2,80,000/- for separate surgery interest benefit
insurance amount and Rs.1,400/- primary daily hospital cash interest benefit was pay-
able. The wife of the petitioner Smt Shweta suddenly fell ill on 12.05.2012 and the
petitioner took her for treatment to Yashoda Super Speciality Hospital Samjiguda
Hyderabad, Andhra Pradesh where she was treated for ovarian cancer. Preliminary
check-ups were done by Dr Ranjanath R on 14.05.2012, an amount of Rs.1,25,000/-
was paid to the doctor for check-up and after the check up the doctor found the wife
of the petitioner was suffering from cancer disease. The petitioner underwent both
surgery and chemotherapy. As the policy number was not mentioned in the written
intimation given to the office of respondent no. 2 insurance company was asked to re-
submit the claim with the policy number. The petitioner, mentioning the policy num-
ber, on 24.09.2012 re-submitted the form to the respondent insurance for claiming
medi-claim amount.
3. The claim form provided by the insurance company and other medical related
form that was necessary for claiming the amount was completely filled by the peti-
tioner and submitted the same in the office of the insurance company on 15.01.2012.
The petitioner acknowledged receipt of all the claims along with the documents
through registered post on 31.10.2012 by the respondent no. 2. The petitioner was
also asked to submit all the documents certified by a gazetted officer on which the
petitioner on 22.01.2013 after getting all the desired documents verified sent the same
to the respondent no.2 through courier. Respondent no. 2 sent a letter repudiating the
insurance claim to the petitioner on 28.03.2013. Due to the non-payment of medi-
claim amount by the respondents, the petitioner suffered heavy financial difficulties
because of which the petitioner was liable to receive mental and financial compensa-

INDEX