NEW INDIA ASSURANCE COMPANY LIMITED Vs. MALEK BANO

JUDGEMENT

(1.) THIS appeal, under Section 15 of the Consumer Protection Act, 1986 , is directed against the order dated 23.2.2004 in Complaint No. 323/2003 by the District Consumer Disputes Redressal Forum, Raipur (hereinafter called the Distt. Forum for short) directing the opposite parties -appellant No. 1 and respondent Nos. 2 and 3 herein to the respondent No. 1, to jointly and severally pay the assured amount of Rs. 2,00,000/ - under the policy issued by the appellant in favour of complainant/respondent No. 1.

(2.) THE averments in the complaint stated in brief were that the complainant had obtained a Mediclaim Insurance Policy No. 48/110900/99/07089004 through respondent No. 3 Insurance Awareness Group. The premium was paid by the complainant/respondent No. 1 to the appellant through the respondent Nos. 2 and 3. A certificate of insurance dated 31.3.1999 was issued by the insurer in favour of respondent No. 1, covering the risk for the period from 1.3.1999 to 28.2.2009 for a sum of Rs. 2,00,000/ -. According to the terms of the said policy, the appellant was liable to reimburse the expenses incurred in her treatment by the complainant/respondent No. 1. It was further averred in the complaint that as was having difficulty in walking, she was advised to undergo knee replacement surgery. The surgery as above, was done at Jaslok Hospital and Research Centre where the complainant was admitted from 25.2.2003 to 7.3.2003 and had to incur a total expense of Rs. 4,50,744/ -. The complainant claimed reimbursement to the extent of assured amount of Rs. 2,00,000/ - from the appellant. However, the appellant did not make payment as above. Hence, the complainant approached the Distt. Forum by filing the complaint praying for award of Rs. 2,00,000/ - with compensation, etc.

(3.) THE appellant/insurer resisted the complaint. According to him, the said Group Mediclaim policy was issued in favour of the insured - Insurance Awareness Group . It was averred by the appellant/insurer that the said policy has been cancelled by the appellant on 1.10.2002 by sending an intimation of that date to the insured - Insurance Awareness Group . Therefore, the policy was no longer in force and the complainant cannot claim any benefit there - under. It was further averred that the complainant/insured was not entitled to any benefit under the policy.