RAM AVTAAR SASTRY HOSPITAL Vs. MAX SUPER SPECIALTY

JUDGEMENT

(1.) This First Appeal under Section 19 of the Consumer Protection Act, 1986 (for short "the Act") is directed against orders dated 23.08.2011 and 01.03.2012 passed by the State Consumer Disputes Redressal Commission, New Delhi (for short "the State Commission") in the Complaint filed by the Appellant. By the first order, the application filed by the Appellant for condonation of delay of over one year in filing the complaint (C-228/10) had been dismissed for non-prosecution and consequently, the complaint was also dismissed as barred by limitation. By the latter order, the application for restoration of the complaint has also been dismissed in default and also on the ground that the State Commission does not have jurisdiction to entertain such an Application.

(2.) In short, the grievance of the Appellant in the complaint was that his claim, preferred on 10.04.2007, for reimbursement of a sum of Rs. 82,771.87, expended by him on his treatment for cerebro vascular attack, in Max Super Specialty Hospital, Opposite Party No. 1 in the complaint, had been illegally repudiated on 13.09.2007 by Royal Sundram Alliance Insurance Company, Opposite Party No. 2, under Medical Claim Health Policy, for which he had paid a sum of Rs. 6,989/- as premium. The claim was repudiated on the ground that at the time of taking policy, the Appellant had not revealed that he was a known case of Hypertension and Diabetes since the last 10-15 years. Alleging deficiency in service on the part of both the Opposite Parties, respectively Respondents No. 1 & 2 in the Appeal, the Appellant prayed for compensation amounting to Rs. 42,02,771.87 towards the expenses incurred on treatment (Rs. 82,771.87 [actual as per bill] + Rs. 5,65,000/-); Rs. 35,00,000/- for mental and physical pain and Rs. 55,000/- as legal and other expenses. Since the complaint was filed on 17.02.2011, after a lapse of over 3 years of the repudiation of the claim by the Insurance Company on 13.07.2007, an application seeking condonation of delay in filing the complaint was filed along with the complaint.

(3.) As noted above, the application as well as the complaint having been dismissed by the State Commission as also the application for restoration of the complaint, the Appellant has preferred this Appeal along with an application for condonation of delay of 62 days in filing the Appeal.