RELIANCE GENERAL INSURANCE COMPANY LIMITED Vs. VIJAY KUMAR

JUDGEMENT

(1.) Petitioner Insurance company has invoked jurisdiction of this Court under Article 226/227 of the Constitution of India assailing the award dated 27.07.2010, passed by Permanent Lok Adalat (Public Utility Services) (hereinafter referred to as TLA PUS'), Gurgaon.

(2.) Brief facts, inter alia, are that respondent No. 1-Vijay Kumar has submitted an application at pre-litigation stage under Section 22C of the Legal Services Authorities Act, 1987 (hereinafter to be referred as 'the Act') to recover from the Insurance Company 23,726/- along with interest at the rate of 12 % per annum on account of medi-claim; inter alia, contending therein that the claimant (respondent No.1 herein) was having medi-claim No.282510413811 for the period 05.05.2009 to midnight 04.05.2010 for a sum of ?1 lac; claimant suffered from severe difficulty in breathing with high grade fever and vomiting with productive cough and was diagnosed on investigation as a case of acute bronchitis; he rushed and admitted in Park Hostipal 1, Dundahera, Gurgaon and remained admitted upto 30.11.2009 and has incurred a sum of 24,509/-on his treatment, however, Insurance company is not reimbursing the amount incurred by the claimant towards the treatment in hospital.

(3.) Insurance company has filed written statement before the Lok Adalat denying the contentions made in the claim petition and has taken specific stand that matter was thoroughly got investigated by the Insurance company and claim of the claimant was found to be bogus and not genuine. It was also stated by the Insurance company that hospital in question was indulging in issuing incorrect, false and bogus medical certificates to the claimants facilitating them to raise false claim against the Insurance Companies. In paragraph No. 10 of the reply the specific plea of Insurance company is that complaint cannot be decided by PLA PUS as lot of evidence and cross-examination would be required to justify and prove the claim of the claimant.