NATIONAL INSURANCE CO LTD Vs. RAMESHWAR LAL

JUDGEMENT

(1.) The present revision petition has been filed against the judgment dated 27.03.2017 of the Delhi State Consumer Disputes Redressal Commission, Delhi ('the State Commission') in First Appeal no. 67 of 2013.

(2.) The brief facts of the case are that the complainant/ respondent was the holder of medi-claim policy (policy no. 360303/ 48/ 9/ 8500000020) which was obtained from the petitioner/ opposite party/ insurance company. The respondent was undergoing treatment at the All India Institute of Medical Sciences (AIIMS), where the respondent was advised the use of CPAP (auto adjustment type with all standard accessories). It was alleged that the respondent wrote a letter to the insurance company to provide him the CPAP machine or pay him Rs.80,000/- to 90,000/- towards the cost of the machine. As the respondent was having restless night sleep which was causing irritation, memory lapse and loud snoring, a request was made by the complainant to the insurance company vide letter dated 29.07.2009 that he may be allowed to purchase the CPAP machine or he may be paid the cost of the machine. He further sent a reminder on 20.08.2009, however, no response was received from the insurance company hence, he served a legal notice on 11.09.2009 to the insurance company. Even then no reply was received from the insurance company and ultimately the machine was purchased by the complainant on 25.09.2009 for a sum of Rs.74,880/. As there was no response, the respondent filed a consumer complaint before the District Consumer Disputes Redressal Forum, District Forum III, Janakpuri, New Delhi ('the District Forum').

(3.) The insurance company contested the claim of the respondent on the ground that no formal claim has been lodged with the insurance company. However, the District Forum directed the complainant to lodge a formal claim with the insurance company and it shall be considered on merits within 30 days. The District Forum has observed as under: