CHANDRA PRAKASH JAIN Vs. PRINCIPAL/DIG

JUDGEMENT

(1.) By this order, we propose to dispose of the above noted revision petitions arising out of the same order.

(2.) Briefly stated, the facts relevant for the disposal of the revision petition are that late husband of respondent No. 1 in the above revision petitions was working as the agent of LIC of India (OP No. 3 in the complaint) and was member of Chairman Club since year 2000. OP No. 3 had obtained a group medical insurance policy from OP No. 1 New India Assurance Company Limited for the benefit of its agent who were members of the Chairman Club. As per the group insurance policy, the mediclaim insurance was to the tune of Rs. 1 lakh per agent. The late husband of the petitioner underwent Laproscopic Sleeve Gastrectomy (bariatric surgery) as an In-patient in Sir Ganga Ram Hospital. He remained admitted in the hospital from 13.7.2008 to 17.7.2008. After the treatment, late husband of the petitioner submitted his mediclaim for the expenses incurred on treatment to the tune of Rs. 2,50,252. The claim, however, was repudiated vide letter dated 29.8.2009 on following two counts:

(3.) Husband of the complainant unfortunately died on 20.10.2008. The complainant being nominee of the insured husband, being aggrieved by the repudiation of the mediclaim, raised a consumer dispute by filing a consumer complaint in the District Forum.