Justice Pritam Pal, President 1. This appeal by Oriental Insurance Company- OP NO.1 is directed against the order dated 13.11.2009 passed by District Consumer Forum-II, U.T. Chandigarh whereby complaint bearing No.230 of 2009 filed by respondent No.1/complainant was allowed and appellant as well as respondent No.2 were directed to pay to the complainant a sum of Rs.1,25,274/- alongwith Rs.30,000/- as compensation for mental agony and physical harassment besides a sum of Rs.5000/- as costs of litigation. The aforesaid amount of Rs.1,55,274/- was ordered to be paid within one month from the date of receipt of its copy, failing which opposite parties were held liable to pay penal interest @ 18% p.a. from the date of order till its realization, besides costs of litigation. 2. The parties hereinafter shall be referred to as per their status before the District Consumer Forum. 3. In nutshell, the facts as set out in the complaint are that the complainant had obtained Individual Mediclaim Insurance Policy bearing No.231110/48/2009/422 covering the medical expenses incurred upon himself and his dependents. He paid Rs.6942/- as premium towards the said policy which was valid from 15.10.2008 to 14.10.2009. On 29.10.2008, the complainant fell ill and was got admitted in Inscol Hospital where he remained there from 04.11.2008 to 17.11.2008. He was found suffering from “Acute Febrile Illness Throm Bocytopenia Bilatera Bronchopneumia Ards Septicemia Respiratory Failure Leptospirosis”. A sum of Rs.1,25,274/- was spent on his treatment in the said hospital. After discharge from the hospital, he submitted his claim on 28.11.2008 along with all the relevant documents to OP-2 but his claim was repudiated by OPs vide letter dated 15.01.2009 under exclusion clause 4.2 of the insurance policy. It was alleged that neither the complainant was ever told by the agent (who issued the cover note) about the exclusion clause of the policy, nor the said terms and conditions of the insurance policy were mentioned in the cover note or the insurance policy schedule sent to him. It was averred that the terms and conditions of the policy could be made applicable upon the policy holder only if the same were communicated and got countersigned by the policy holder. Hence, alleging deficiency in service, complainant filed complaint before the District Forum seeking reimbursement of the insurance claim with interest and compensation/costs for litigation etc. 4. On the other hand, the case of OP No.1 before the District Forum was that the complainant was insured under the insurance policy in question and the said policy with the terms and conditions was supplied to the complainant. It was denied that the complainant was issued only the policy schedule dated 16.10.2008. It was pleaded that the claim of the complainant was not payable under the exclusion clause 4.2 of the insurance policy and therefore, after considering all these aspects OP NO.1 had taken a bona fide decision that the claim was not payable and this decision was also communicated to the complainant, so there was no deficiency in service on its part. A prayer was made for dismissal of the complaint. However, OP No.2 did not appear despite due service before the District Forum and it was proceeded against ex parte. 5. The District Consumer Forum after going through the evidence and hearing the counsel for parties allowed the complaint as indicated in the opening part of this judgment. This is how feeling aggrieved against the said order, Opposite party No.1 has come up in this appeal. 6. We have heard learned counsel for the parties and gone through the file carefully. The only point of arguments raised on behalf of the appellant/OP NO.1 is that the amount of compensation and rate of penal interest awarded by the District Forum are on the higher side. In the given facts and circumstances of the case and keeping in view the fact that the full insurance claim has already been awarded by the District Forum, we feel that the amount of compensation to the tune of Rs.30,000/- appears to be on the higher side and ends of justice would meet if the same is reduced to Rs.20,000/-. Hence, we order accordingly. 7. As regards the penal interest awarded by the District Forum @ 18% p.a. from the date of order till its realization, same would be payable only in case OPs fail to pay the awarded amount well in time. Thus in the given facts and circumstances of the case, to make reduction in the rate of interest doe not appear to be justified. 8. In this view of the matter, but for above modification made in the quantum of compensation awarded by the District Forum which has been reduced from Rs.30,000/- to Rs.20,000/-, this appeal is dismissed, leaving the parties to bear their own costs. Certified Copies of this order be sent to the parties, free of charge. The file be consigned to record room.
| | HON'BLE MRS. MRS. NEENA SANDHU, MEMBER | HON'BLE MR. JUSTICE PRITAM PAL, PRESIDENT | , | |
