NEW INDIA ASSURANCE CO LTD Vs. SURINDER SINGH

JUDGEMENT

(1.) The complainant/respondent obtained a mediclaim policy from the petitioner company for the period from 31.01.2011 to 30.01.2012 which was later on renewed for the period from 31.01.2012 to 30.01.2013. The complainant suffered from some heart ailment and was taken to Government Hospital Chandigarh. From there he was shifted to PGI Chandigarh in September 2012. He underwent angioplasty incurring expenses of Rs. 3,44,703/- on his treatment. The claim lodged by him which was repudiated by the letter dated 03.11.2012 written by the TPA to the insurer and filed by the complainant along with the consumer complaint. The said letter, to the extent it is relevant, reads as under:-

(2.) Aggrieved from the repudiation, the complainant approached the District Forum by way of consumer complaint. The complaint was resisted by the petitioner primarily on the ground with which the claim had been repudiated by the TPA.

(3.) The District Forum having dismissed the consumer complaint the petitioner approached the concerned State Commission by way of an appeal. Vide impugned order dated 16.01.2014 the State Commission set aside the order passed by the District Forum and allowed the consumer complaint directing the petitioner to pay a sum of Rs. 3,37,228/- along with compensation quantified at Rs. 25,000/- and the cost of litigation quantified at Rs. 15,000/-. The said amount was to carry interest at the rate of 9% p a. in case the payment was not made within 45 days of the receipt of the copy of the order. Being aggrieved from the order passed by the State Commission the insurer is before this Commission.