NATIONAL INSURANCE COMPANY LIMITED Vs. PUNEET BHATIA

JUDGEMENT

(1.) THIS appeal is directed against the order dated 30.3.2001 passed by District Forum, Panipat whereby while accepting the complaint of the complainant -respondent, the appellant has been directed to pay Rs. 1,00,000 along with interest @ 9% per annum from 4.4.1999 till the date of realisation. In addition, Rs. 5,000 has been awarded on account of negligent services rendered by the opposite party and Rs. 3,300 as litigation expenses. This amount was required to be paid within 45 days from the date of the pronouncement of the order.

(2.) A few facts need to be noticed in order to decide the controversy in this case. Puneet Bhatia -complainant had taken a mediclaim policy bearing No. 347729 dated 17.12.1998 for Rs. 1,00,000. He fell down in the bath -room and suffered injuries in his head. Thereafter he was taken to clinic of Dr. Bhamba on 7.1.1999, who referred him to be taken to Apollo Hospital, Delhi. Accordingly, the complainant was admitted in the said hospital and had to incur expenditure of Rs. 2,33,461 on account of treatment and hospitalization and intimation with regard to the accident was sent to the opposite party on 7.1.1999 and thereafter a claim was put up by the opposite party in respect of the above stated amount but the opposite party in its letter dated 5.4.1999 repudiated the claim by relying on Clause 4.2 of the policy as according to them, accident had taken place within 30 days of issuance of the policy. Forced by these circumstances, the complainant instituted the present complaint claiming compensation amount of Rs. one lac and Rs. 50,000 as compensation on account of mental agony and harassment and Rs. 5500 as litigation expenses alongwith interest @ 15% per annum.

(3.) IN defence, the opposite party resisted the claim. They pleaded that in terms of the exclusion Clause No. 4 of the policy, it does not cover the case of the complainant as he had not suffered injuries in an accident and for that reason justified the repudiation of the claim. They also raised plea of want of jurisdiction of the District Forum, Panipat to try the complaint as the accident had taken place at Karnal. In the re -joinder, the complainant while refuting the stand of the opposite party, reiterated his earlier plea. The District Forum taken into consideration the pleadings of the parties and the evidence adduced on record, accepted the complaint and issued the directions noticed earlier. It is against this order, the present appeal has been filed.