SURYA KANT AGGARWAL Vs. ORIENTAL INSURANCE COMPANY LTD

JUDGEMENT

(1.) Facts of this case regarding the respondent having obtained Hospitalization and Domiciliary Hospitalization Benefit Policy for himself, his wife, son and daughter in the total sum of Rs. 5,00,000 between 23.1.2001 to 22.3.2002 are not in dispute. Risk covered in case of appellant was Rs. 3,00,000, his wife Rs. 1,00,000 and both his children to the tune of Rs. 50,000 each. He remained under treatment initially at Inscol Hospital, Sector 34-C, Chandigarh and then under treatment for kidney transplant at Post Graduate Institute of Medical Education and Research, Chandigarh (PGI). First dialysis was done on the appellant on 4.6.2001. He was hospitalized for kidney transplant at P.G.I. on 18.7.2001 and surgery was done for transplant of kidney on 20.7.2001 and from Hospital he was discharged on 30.7.2001. There was some complications because of infection, therefore, he was again admitted on 12.9.2001 and was discharged on 18.9.2001. Appellant lodged claim in the sum of Rs. 3,78,281.70p. whereas on the basis of report of Mr. T.D. Chug, Investigator appointed by the appellant, he found that appellant is only entitled to Rs. 2,13,670.70p.

(2.) District Forum below dismissed the complaint while holding that appellant has been rightly paid by the respondent a sum of Rs. 2,13,670 and he was not entitled to any further amount.

(3.) Along with the appeal, M.A. No. 668/2004 under Section 151 of Code of Civil Procedure, 1908 for allowing the appellant to place the detailed bills/vouchers of balance claim of Rs. 1,64,611 deducted by respondent/opposite party on record. Details of amount are summarized at page 17 of this M.A. This application was allowed vide our order dated 31.8.2006. Respondent-Insurance Company was directed to file reply to this application. By way of evidence in rebuttal M.A. No. 668/2006, affidavit of the Sr. Divisional Manager of the appellant-Insurance Company at its Shimla Divisional Office dated 11.10.2006 along with documents was filed.