BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL

COMMISSION, EAST, DELHI

CC NO. 27 OF 2023
IN THE MATTER OF: -

DEEPAK COMPLAINANT
VERSUS
CARE HEALTH INSURANCE LTD OPPOSITE PARTY

L.D.O.H. 10-11-2024

N.D.O.H. 23-02-2024

INDEX
S. No. Particulars Pages
1 EVIDENCE OF COMPLAINANT BY 1-7
WAY OF AFFIDAVIT.

DELHI
DATE:
Complainant
THROUGH

MANOJ SHUKLA& ASSOCIATES

(ADVOCATES)
CH. NO. 593, (W. WING),
TIS HAZARI COURTS, DELHI
MOB: 8810661366
EMAIL ID: [email protected]
 BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, EAST, DELHI
CC NO. 27 OF 2023

IN THE MATTER OF: -

DEEPAK COMPLAINANT

VERSUS

CARE HEALTH INSURANCE LTD OPPOSITE PARTY

EVIDENCE OF COMPLAINANT BY WAY OF AFFIDAVIT.

I, DEEPAK AGE ABOUT 40 YEARS S/O LATE. ASHOK KUMAR

HOUSE NO.9/3913, GALI NO.6, AJEET NAGAR, DHARAMPURA,
GANDHI NAGAR, DELHI-110031, do hereby solemnly affirm and
declare as under: -
The affidavit of COMPLAINANT is EX-CW1/A on which signature
at point A and B.
1. That the Complainant is a law-abiding citizen of
India and belongs to a very poor family and working
as bike Mechanic, having family of 05 members
including old mother, has been residing at the
address mentioned in the memo of parties,
presently sick, jobless and dependent on the mercy
of his brother and relatives. It is further submitted
that deponent is a Complainant in present suit and
therefore acquainted with the facts and
circumstances of the present case and is aware of
all circumstances pertaining to the present case,
and thus is competent to sign, verify, and institute
 the present case. Copy of Aadhar card of the
Deponent is EX-CW-1/1 (OSR)

2. That the complainant had purchased a Health

Insurance Policy vide policy no.14984226 as EX-
CW-1/2 in Oct.2019 for life time period on yearly
renewal basis, for a sum assured of Rs.05 lakhs, -
(Rupees Five Lakhs Only) from OP, the premium of
Rs.21,199/- (Twenty-One thousand one hundred
ninety-nine only) paid by the complainant for the
said policy for the current tenure i.e., W.E.F. 08
Oct. 2022 to Midnight 07 Oct. 2023.

3. That the complainant is the consumer of OP and

complainant is legally entitled to take the remedy
under the Consumer Protection Act, 2019. The
consumer is defined in the act as follows:

"consumer" means any person who— (i) buys any

goods for a consideration which has been paid or
promised or partly paid and partly promised, or
under any system of deferred payment and includes
any user of such goods other than the person who
buys such goods for consideration paid or promised
or partly paid or partly promised, or under any
system of deferred payment, when such use is made
with the approval of such person, but does not
include a person who obtains such goods for resale
or for any commercial purpose; or

(ii) hires or avails of any service for a consideration

which has been paid or promised or partly paid and
partly promised, or under any system of deferred
payment and includes any beneficiary of such
service other than the person who hires or avails of
 the services for consideration paid or promised, or
partly paid and partly promised, or under any
system of deferred payment, when such services are
availed of with the approval of the first mentioned
person, but does not include a person who avails of
such service for any commercial purpose .”

4. That all the formalities including filing of form for

taking the above-mentioned policy were completed
by the Complainant.

5. That the complainant is the master policy holder

and assured for treatment.

6. That at the time of taking the above-mentioned

Health insurance policy, the complainant disclosed
all his medical history to OP so that complainant
should not face any issue. The complainant in good
faith believed on all the assurances of the OP.

7. That, accordingly the complainant completed all the

requirements of the insurance plan of the opposite
party and started paying the renewal premium
regularly to the opposite party.

8. That the complainant is a healthy and fit person

and never ever having any complication of any
diseases.

9. That unfortunately at about 0700 hrs.AM on 26 t h

November 2022 the complainant suffered with chest
pain and it was very sever same time brother of the
complainant took him to the nearest hospital i.e.,
 Jain Charitable Hospital Gandhi Nagar Delhi they
initially treated the complainant, during
investigation complainant BP was 110/80 (copy
attached on page no. 20 of complaint) vide General
OPD slip dated 26/11/22 at 07:56 AM as EX-CW-
1/3 i.e., normal but due to other complications
Doctor advised complainant to visit any Heart Care
hospital for prompt and better treatment as the
complainant was having the Health care policy from
OP so accordingly complainant visited the
INDRAPRASTHA APPOLO HOSPITAL NEW DELHI for
treatment.

10. That on 26-11-2022 at about 0915 hrs.

Complainant visited the INDRAPRASTHA APPOLO
HOSPITAL NEW DELHI, same time as per his
condition complainant was admitted vide admission
form on page no. 21and 22 of complaint as EX-CW-
1/4(colly) in the hospital for prompt treatment
and during initial investigation by DR. SK GUPTA
SPECIALIST IN CARDIOLOGY at 0915 hrs. Found
that complainant having NO HYPERTENSION vide
page 57 of complaint as EX-CW-1/5 and BP was
observed -130/70 page no. 35 of complaint as EX-
CW-1/6, again observed at 1150 hrs. BP was
122/62, vide page no. 39 of complaint as EX-CW-
1/7, on 27-11-2022 at 10:00 am BP was 122/82
vide page no. 41 of complaint as EX-CW-1/8, again
at 1500 hrs. BP was 120/80 vide page no. 42 of
 complaint as EX-CW-1/9, BP-123/76 vide page no.
46 of complaint as EX-CW-1/10, BP-120/80 on 28-
11-2022 vide page no. 24 of complaint as EX-CW-
1/11.

11. That as the complainant was having Health

Insurance Policy so subsequently the OP was
informed about the complainant condition through
Hospital and by complainant brother as well for the
approval of PRE-Authorised for Complainant copy
attached page no. 58 of complaint signed by Dr. SK
GUPTA Sr. Cardiologist as EX-CW-1/12 but the OP
has denied the approval of the complainant vide its
Denial letter no. AL no. 80856322-00 dated 28-11-
2022 on page no. 63 of complaint as EX-CW-1/13
to Hospital by mentioning the reason NON
DISCLOSURE OF MATERIAL FACTS/PRE-
EXISTING AILMENTS AT TIME OF PROPOSAL-
HYPERTENTSION.

12. That there after complainant brother and his family

members continuously approaching the OP for the
approval and claims as per the policy but opposite
parties did not respond to the complainant and
adamantly denied to provide any remedy in this
matter.

13. That complainant was having no money to pay the

hospitalization charges but to save the life of the
complainant his brother taken a loan of Rs. 3.5
 Lakhs from land lord on interest for treatment of
the complainant and paid an amount of Rs. 3,
37,576/- (Three Lakhs Thirty-Seven Thousand Five
Hundred and Seventy-six Only) on page no. 62 of
complaint as EX-CW-1/14 towards the complainant
medical bill.

14. That after the discharge from hospital complainant

approached his policy agent for help and both
complainant and agent went to the branch office at
S-13, GREEN PARK, EXTENTION, NEAR SBI BANK,
DELHI-110016 and handed over the medical
documents for claim.

15. That on 11-01-2023 claim denial letter vides CL.

No. 92829964-00 on page no. 64 and 65 of
complaint as EX-CW-1/15(colly) has been received
by the complainant from the OP, it clearly shows OP
malafide intention as now OP do not want to
provide the claim of insurance policy.

16. That the Complainant sustained mental agony,

harassment as well as financial losses by the act
and conduct of the opposite parties.

17. That complainant has every right to get the above

noted claim passed and the OP is under obligation
to provide the claim so that the complainant will
not face any further problems in future.
18. That OPPOSITE PARTY is adopting unfair trade
practices which resulted into immense mental
agony, harassment and economical loss to the
complainant.

19. That opposite party is not at all providing

appropriate response to the complainant and they
are adamant to harass the complainant, the
opposite party is not considering the application of
the claim submitted by the complainant for the
purpose of providing the claim against the
insurance policy.

20. That grievances of the complainant are still

unresolved. And cause of action still continues to
file the present complaint.

21. That Cause of action of action for filing the present

application/complainant arises each and every
moment/incident mentioned above. Cause of action
still arises in the favor of complainant and against
the opposite party.

22. That the 65B certificate of IEA, 1872 is also

attached as EX-CW-1/15

Verified at Delhi on this day Feburary, 2024, that the contents of

the affidavit and correct to my knowledge and belief and nothing
material has been concealed therefrom.
DEPONENT