NEW INDIA ASSURANCE CO. LTD Vs. ANIL MANGLUNIA

JUDGEMENT

(1.) For the reasons stated in the application for delay, we condone the delay of three days in filing of this revision petition.

(2.) The complainant, Shri Anil Manglunia, initially obtained a Mediclaim policy from Bajaj Allianz General Insurance Co. for a sum of Rs.1,00,000/- in respect of his mother, Smt. Shanta, during the periods from 28.07.2005 to 27.07.2007 and 03.08.2007 to 02.08.2008. Thereafter, from 03.08.2008, the complainant obtained policy from the petitioner-OP-New India Assurance Co. Ltd. and the sum assured was Rs.3,00,000/- in respect of Smt. Shanta. It was renewed on 03.08.2009 for the period of 2009-2010 and the sum was increased to Rs.3,50,000/-. On 16-04-2010, Smt. Shanta was admitted to Saket Hospital in Jaipur and she underwent bilateral knee replacement surgery. After discharge, the complainant lodged a claim for her treatment with the OP through Raksha TPA. The OP repudiated the claim, on 10.05.2010.

(3.) Therefore, the complainant filed a complaint before the District Consumer Disputes Redressal Forum, Jaipur (for short, 'the District Forum'). The District Forum dismissed the complaint. Thereafter, the complainant filed first appeal before the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (for short, 'the State Commission') which reversed the order of the District Forum and held the OP insurer liable to reimburse Rs.3,52,060/-, along with interest at the rate of 9% per annum, from the date of complaint and Rs.20,000/- as costs.