NEW INDIA ASSURANCE COMPANY LIMITED Vs. ISHU MOTWANI

JUDGEMENT

(1.) This Revision Petition, by the Petitioners, calls in question the correctness and legality of order dated 4.4.2014 passed by the Karnataka State Consumer Disputes Redressal Commission, (in short, "the State Commission") in Appeal No. 234 of 2014 New India Assurance Co. Ltd. & Anr. vs. Ishu Motwani. By the said order, the State Commission confirmed the order of the District Forum and dismissed the Appeal at the stage of Admission.

(2.) The brief facts of the case as set out in the complaint are that the complainant had taken the "Goodhealth Group Mediclaim Policy" which has been in force from 01.09.2003 and the complainant was experiencing severe pain in both knee joints and underwent treatment using Sequentially Programmed Magnetic Field Therapy (SPMF Therapy) at SBF Healthcare and Research Centre. The Opposite Parties were duly intimated regarding the treatment and a sum of Rs.1,13,089.50/- was spent for which the complainant lodged the claim on 10.01.2013. The Opposite Parties repudiated the claim vide letter dated 27.02.2013 on the ground as per clause 4.4.17 such treatment is not covered under the Policy. The District Forum allowed the complaint in part directing O.P. nos. 1 & 2 to reimburse Rs.1,13,089.50/- to the complainant together with cost of Rs. 20,000/-.

(3.) Aggrieved by the said order, the Opposite Parties preferred Appeal No. 234 of 2014 before the Karnataka State Consumer Disputes Redressal Commission, Bangalore. The delay of 39 days was condoned and the State Commission observed that the line of treatment taken by the complainant is an experimental one and the complainant has taken treatment as an outpatient for one hour every day followed by Physiotherapy for half an hour continuously for 21 days consecutively. Holding that the Insurance Company has repudiated the claim on technical grounds, the State Commission confirmed the order of the District Forum and dismissed the Appeal at the stage of Admission.