NATIONAL INSURANCE COMPANY LTD. Vs. RADHEY SHYAM BALWADA

JUDGEMENT

(1.) The present Revision Petition has been filed by the Petitioner against the judgment of the State Consumer Disputes Redressal Commission, (hereinafter referred to as, 'State Commission') in FA/185/2013, whereby the Appeal of the Appellant was allowed. The Appeal was filed in the State Commission aggrieved by the order of the District Consumer Disputes Redressal Forum (in short, 'District Forum') in Complaint No. CC/120/2012.

(2.) The brief facts are that since the year 2003, the Complainant, Radhysham Baldawa took a Hospitalisation Benefit (a mediclaim) policy covering himself and his family members, for the period from 25.06.2011 to 24.06.2012. His mediclaim cover was for the sum of Rs.1,50,000/- and Rs.60,000/- as bonus, thus the total amount of the insurance policy was Rs.2,10,000/-. The policy was renewed, from time to time, since the year 2003. During the existence of the policy, the Complainant suffered abdominal pain during 25.07.2011 to 03.09.2011, and it was diagnosed that he had a stone in the gall bladder. After consultation at Hari Bhakti Surgical Hospital, Ahmedabad, the Complainant was operated upon at Sterling Hospital, Ahmedabad, on 01.09.2012, and he was discharged from the hospital, on 03.09.2011. The Complainant spent a sum of Rs.1,31,257/- on his treatment during the period. The Complainant submitted the claim form for the aforesaid amount, before the OP, but the OP made a payment of Rs.52,505/- only, as full and final payment, against the claim. Hence, a complaint before the District Forum was filed, for payment of balance amount to the Complainant. The District Forum allowed the complaint and directed the OP to pay a sum of Rs.78,752/- to the Complainant, within a period of one month.

(3.) Thereafter, being aggrieved by the said order of District Forum, the Petitioner herein, filed First Appeal No. 185 of 2013, before the Rajasthan State Commission at Jaipur.