NEW INDIA ASSURANC E CO LTD OFFICE-REGINAL HEAD OFFICE Vs. CHETAN GUNWANTLAL MODH R/O MAGARWADA T-VADGAON, BANASKANTHA GUJARAT

JUDGEMENT

(1.) Challenge in this Revision Petition, under Section 21(b) of the Consumer Protection Act, 1986 (for short "the Act"), by New India Assurance Co. Ltd. (for short "the Insurance Company"), is to the order dated 22.03.2013, passed by the Gujarat State Consumer Disputes Redressal Commission at Ahmedabad (for short "the State Commission") in First Appeal No. 1798 of 2010. By the impugned order, the State Commission has affirmed the order dated, 10.11.2010, passed by the District Consumer Disputes Redressal Forum at Palanpur, Banaskantha (for short "the District Forum") in Complaint Case No. 15/10. By the said order, while accepting the Complaint, filed by the Respondent herein, alleging deficiency in service on the part of the Insurance Company in repudiating the claim preferred by him under the Mediclaim Policy 2007 for reimbursement of a sum of Rs.2,00,000/-, expended by him for the treatment undergone by him, in Shrey Hospital Private Limited, for "Hypodense at Rt semiovale", the District Forum had directed the Insurance Company to pay to the Complainant the assured sum of Rs.2,00,000/- along with interest @ 6% p.a. from the date of the application as also the costs of litigation, quantified at Rs.3,000/-. The District Forum had also directed that if the said order was not complied with within 30 days thereof, the Complainant would be entitled to interest @ 9% p.a.

(2.) Succinctly put, the facts, material for adjudication of the issued raised in the present Petition, are as follows:

(3.) According to the Insurance Company, since the afore-noted ailment was ultimately diagnosed as a benign ear, nose and throat disorder, the claim fall under Exclusion Clause 4.3 of the terms and conditions of the policy in question. The relevant portion of the said Clause reads as follows: