UNITED INDIA INSURANCE COMPANY LIMITED Vs. PARMINDER KAUR

JUDGEMENT

(1.) THIS appeal is directed against the order dated 13.12.2005 passed by the District Forum, Dehradum, allowing Consumer Complaint No. 207/1998 and directing the insurance company to pay a sum of Rs. 1,47,813 to the complainants within 30 days from the date of order and also to pay interest @ 8% p.a. on the said amount w.e.f. the date falling after three months from 15.5.1996 and further to pay Rs. 2,000 as cost of litigation.

(2.) THE facts of the case, in brief, are that Sh. Balbir Singh (deceased) had taken a mediclaim (Hospitalization and Domiciliary Hospitalization Benefit) policy from the appellant for the period from 4.12.1995 to 3.12.1996. The policy covered reimbursement of hospitalization and/or domiciliary hospitalization expenses for illness/disease contracted or injury sustained by the insured including surgical operation by manual or operative procedure for the correction of deformalities and defects, repair of injuries, diagnosis and cure of disease, relief of suffering prolongation of life. The policy also covered major surgical disease such as open and close heart surgery with pre and post hospitalization treatment. On 3.2.1996, the insured complained of some heart problem. His physician referred him to AIIMS, New Delhi, where he got admitted on 5.2.1996. He was discharged on 1.3.1996 and was advised by the doctors of AIIMS to continue the medical follow up. It was alleged that sum of Rs. 1,47,812.95 was spent on the treatment of the insured in AIIMS. The insurer was informed vide letter dated 14.3.1996. In reply to the said letter, the insured received a claim form from the insurer. After completing the required formalities, the documents were sent vide letter dated 15.5.1996. The insured made several visits to the insurer's office and sent reminders, but the insurer did not settle the claim. Ultimately, vide letter dated 14.3.1997, the insurer repudiated the claim. Upon, this, the insured filed the complaint before the District Forum on 25.7.1998, alleging deficiency in service on the part of the insurer. However, during the pendency of the complaint, the insured died on 2.1.2004. Therefore, the consumer complaint was contested by his widow Smt. Parminder Kaur and his children.

(3.) THE District Forum, while deciding the complaint vide order dated 13.12.2005 directed the insurer to pay the amount as stated above. Aggrieved by the said order, the insurer has preferred this appeal.