AMAN KAPOOR Vs. NATIONAL INSURANCE CO.

JUDGEMENT

(1.) This Revision Petition under section 21(b) of the Consumer Protection Act, 1986 challenges the order dated 29.12.2016 passed by Punjab State Consumer Disputes Redressal Commission, Chandigarh (State Commission) in First Appeal No.600 of 2016 vide which the appeal of the respondent insurance company was successful and the order of the District Forum awarding a medical insurance claim to the petitioner/complainant was set aside.

(2.) The petitioner complainant had purchased the impugned Medical Insurance Policy of floater sum covering his family for an insured amount of Rs.5 lakh from the respondent/opposite parties-insurance company. In fact, he had held a medical insurance policy since 2007, renewing the same regularly. The impugned policy was valid for the period 13.6.2014 to 16.2015. In Nov., 2013, he was blessed with a son, Parth. He got Parth endorsed on the policy on 20.02014.

(3.) In Sept., 2014 , Parth was hospitalized in Narayana Institute of Cardiac Sciences for 'heart Ventricular Septal Defect', for the period 4.9.2014 to 19.2014. A sum of Rs.1,81,160.00 was spent. Since Parth was covered under the policy, an insurance claim, supported by all relevant documents, was filed. The same was however repudiated, on the ground that it fell under the exclusion clause 4.3 of the terms & conditions of the policy. This led to a complaint before the District Forum.