NEW INDIA ASSURANCE CO. LTD. Vs. RAJINDER SINGH

JUDGEMENT

(1.) This revision petition filed under sec. 21 of the Consumer Protection Act, 1986 (in short, the 'Act') assails the order dtd. 23/5/2018 of the Haryana State Consumer Dispute Redressal Commission, Panchkula (in short, 'State Commission') dismissing First Appeal No. 588 of 2017 filed against order dtd. 15/12/2016 in complaint no. 83/16 of the District Consumer Disputes Redressal Commission, Kaithal (in short, 'District Forum').

(2.) The facts, in brief, are that the petitioner had issued a 'Family Mediclaim' policy to the respondent valid from 18/6/2014 to 17/6/2015. He was migrated to a 'New India Family Floater' subsequently. On 27/4/2015 the respondent was admitted in Shah Hospital, Kaithal and thereafter in Fortis Hospital, Mohali for a cardiac ailment. An expenditure of Rs.28,732.00 was incurred on treatment in Kaithal and another bill dtd. 5/5/2015 for Rs.7,13,209.00 was also submitted from Fortis Heart Institute Multi Speciality Hospital, Mohali where he was referred for treatment of blocked arteries. The petitioner approved payment of Rs.2,70,000.00 and refused to honour the balance amount on the grounds that the Third Party Administrator (TPA) indicated that respondent was an existing patient of hypertension and diabetes and therefore the treatment undergone was for a pre-existing illness which the respondent had not disclosed at the time of obtaining the policy as per condition 5.1 and that enhancement of sum insured cannot be considered for insured persons suffering from diabetes and hypertension as per condition 5.11. The respondent filed a consumer complaint before the District Forum against this repudiation which was contested by the petitioner. The District Forum vide its order dtd. 15/12/2016 dismissed the appeal on the ground that the bill was inflated and should have been settled as per 'package charges' for implantation of a stent. Aggrieved with this order, the respondent appealed before the State Commission which on consideration of records and submissions by both parties allowed the appeal on 23/5/2018 directing the petitioner to pay the balance amount of Rs.4,41,940.00 spent on treatment with interest of 9% per annum from the date of filing of the complaint along with costs of Rs.25,000.00 towards mental agony and litigation expenses. It is this order that has been impugned by the petitioner by way of this revision petition before this Commission.

(3.) The submissions of both parties have been heard and the records perused carefully by me.