ANIL KUMAR JAIN S/O LT KAILASH CHAND JAIN Vs. RELIANCE GENERAL INSURANCE CO LTD THROUGH ITS GENERAL MANAGER

JUDGEMENT

(1.) This Revision Petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 for setting aside the impugned order dated 22.12.2016 in First Appeal No. 835 of 2012 passed by the State Commission, Delhi (for short, 'State Commission'), whereby the said appeal was ordered to be dismissed.

(2.) The brief facts of the case are that the Petitioner/ Complainant took a medi-claim policy from the Respondent/ Opposite Party-Reliance General Insurance Co. Ltd. valid from 13.08.2007 to 12.08.2008. On 29.04.2008 during his business trip to Jaipur, he suffered some health problem and was diagnosed as a case of Prostrate Abscess at Manu Hospital and Research Centre, Jaipur. Thereafter, he was admitted in Saroj Hospital and Heart Institute Rohini, Delhi from 30.04.2008 to 10.05.2008, and treated for Prostrate Abscess Grade-1(BPH). The complainant lodged an insurance claim with the OP/respondent, but the same was denied by OP vide letter dated 19.05.2008 on the basis of the Exclusion Clause No.3 of the Policy. Being aggrieved by the unlawful repudiation of the claim, the Complainant filed a Complaint before the District Consumer Disputes Redressal Forum, North West District, Shalimar Bagh, New Delhi (for short, 'District Forum').

(3.) The Respondent/Opposite Party filed a written statement and resisted the Complaint. OP submitted that as per the terms and conditions of the Policy and exclusion clause No. 3, the repudiation was correct and there was no deficiency in service.