GEETA GUPTA Vs. NEW INDIA ASSURANCE CO LTD

JUDGEMENT

(1.) THIS appeal under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 29.6.2002 in Complaint No. 34/2002 by District Consumer Disputes Redressal Forum, Raipur (hereinafter called the District Forum for short) dismissing the complaint of the complainant/appellant praying for compensation under Medi -claim policy obtained from the respondent/insurer.

(2.) UNDISPUTEDLY , the complainant obtained a Medi -claim policy No. 48 -450302 -04214 on 6.3.2000. Annual premium of Rs. 4,583/ - was paid by the complainant to the respondent/insurer. The policy covered the risk of the complainant and her husband to the extent of Rs. 2.50 lacs for each of them for the period from 6.3.2000 to 5.3.2001. It is further not in dispute that the complainant suffered heart ailment in April, 2000 and was initially treated by Dr. Ashish Malhotra at Tiwari Nursing Home, Raipur.

(3.) IT was averred in the complaint that as per advice of Dr. Ashish Malhotra, as also in view of the nature of ailment suffered by the complainant she went to Mumbai and took admission in Bombay Hospital on 2.5.2000. It was further averred that she incurred an expenditure of Rs. 1,26,967/ - during her admission in Bombay Hospital for the period from 2.5.2000 to 12.5.2000. It was also averred that after 3 months, the complainant again went to Mumbai for further check -up and incurred an expenditure of Rs. 11,000/ -. According to the complainant, though she submitted all the relevant documents of her treatment and requested the respondent/insurer for early settlement of her claim, however, the respondent/insurer repudiated her claim by its letter dated 14.8.2001. The complainant thereafter sent a legal notice to the respondent/insurer but she did not receive any response from the insurer. Hence, the complaint was lodged in District Forum praying that respondent/insurer be directed to pay her Rs. 1,37,967/ - towards expenses incurred by her, in her treatment as above, and also to pay her compensation of Rs. 10,000/ - on account of mental harassment, caused due to non -settlement of her claim.