Page 83 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 83

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Stomach, Gall Bladder, Pancreas
Muscular System
Sublime Maxillary Facial Surgery System
Lupine and Urinary area
It is clear from this that the above list does not have any thing mentioned re-
garding the reproduction system. The claim was dismissed by the insurance com-
pany. The conditions of the insurance policy are equally applicable on the parties.
The District Forum and Commission cannot provide the claim amount beyond the
condition of the insurance policy. According to our opinion an incorrect decision
has been taken by the District Forum that the insurance company has done defi-
ciency in service by not paying the surgery and medical expenses of complainant‘s
wife within the insurance period to the complainant/ respondent. The District Fo-
rum on the insurance conditions and list of illness which are covered under the
plan after their perusal should have taken the decision that whether the claim
amount is payable or not by the insurance company. A payment of Rs.5,880/- was
done to the complainant under the insurance policy by the insurance company.
After consideration and decision on the facts of the complaint and after the pe-
rusal of the documents we reach to a conclusion that the appeal submitted by the
opposite parties/ appellants is eligible to be accepted therefore, it is accepted set-
ting aside the criticised order passed by the District Forum. As a result, the com-
plaint is dismissed. No order is passed in relation to the appeal cost‖.
7. Hence, the present revision petition.
8. I have heard the learned counsel for the petitioner and have carefully gone
through the record. Learned counsel for the petitioner has contended that they were
only given two pages of the policy and the terms and conditions of the policy were
not made available to them and the petitioner was unaware of the same. He further
contended that the State Commission had erred in taking cognizance of the terms and
conditions after rejecting the application for filing additional documents. On-going
through the file it is seen that the State Commission while taking cognizance of the
terms and condition had stated that the documents submitted by the insurance com-
pany in the original record were produced by them and that the copies of the terms
and conditions of the policy were submitted by the insurance company. Therefore, the
lists of additional documents being submitted separately were not required. Further, it
has also been observed that in the two pages of the policy allegedly given to the peti-
tioner, it has been clearly mentioned as under:
―We urge you to go through the conditions and privileges under the policy and
familiarize yourself with various benefits and conditions available to you and
other members covered‖.
9. Counsel for the petitioner could not explain the reasons why the petitioner
did not ask for the full documents of the terms and conditions of the policy, if he had
not received the same, even after receiving the two pages wherein it had clearly been
requested to go through the same by the insurance company. The State Commission
has correctly observed that as per the terms and condition of the policy ovarian cancer
is not one of the surgical procedures covered by the said insurance policy.
10. In view of the discussion above, I find no jurisdictional error or material ir-

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