CARE HEALTH INSURANCE LIMITED Vs. HARJINDER SINGH SOHAL

JUDGEMENT

(1.) The present Revision Petition (RP) has been filed by the Petitioner(s) against Respondent as detailed above, under Sec. 58(1)(b) of Consumer Protection Act 2019, against the order dtd. 4/4/2022 of the State Consumer Disputes Redressal Commission, Chandigarh, (hereinafter referred to as the 'State Commission'), in First Appeal (FA) No. 49/2021 in which order dtd. 16/6/2021, District Consumer Disputes Redressal Commission, Chandigarh (hereinafter referred to as District Commission) in Consumer Complaint (CC) no. 598/2019 was challenged, inter alia praying to set aside the order passed by the State Commission.

(2.) While the Revision Petitioner(s) (hereinafter also referred to as OPs) were Respondents before the State Commission and OPs before the District Forum, the Respondent (hereinafter also referred to as Complainant) was Appellant before the State Commission and complainant before the District Commission. Notice was issued to the Respondent. Parties filed Written Arguments/Synopsis on 17/4/2023 (Petitioners/OPs) and 23/3/2023 (Respondent/complainant) respectively.

(3.) Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Commission and other case records are that the complainant purchased an International Medical Health Insurance Policy from the OPs, valid from 17/9/2018 to 5/3/2019, by paying a premium of Rs.17,864.00. While in Australia, the complainant experienced sudden chest pain on 29/9/2018 and underwent tests followed by a stents procedure, discharged on 3/10/2018. Further treatment including another stent placement occurred on 22/11/2018, with discharge on 23/11/2018. The complainant's claim for cashless benefits under the policy was rejected on 7/12/2018, citing non-disclosure of pre-existing conditions: Coronary Artery Disease (CAD) and Dyslipidemia. Consequently, the complainant paid hospital bills totaling 31,499/- Australian Dollars out of pocket. Upon returning to India in March 2019, the complainant submitted a claim for reimbursement, supported by relevant documentation, which was rejected on 16/4/2019 for the same reason. Subsequently, the complainant filed a consumer complaint before the District Commission.