Sri Shyamal Gupta, Member

Aggrieved with the decision of the Ld. District Forum passed in the complaint case filed by the Appellant, this Appeal is moved u/s 15 of the Consumer Protection Act, 1986.

The complaint case was filed over repudiation of Appellant’s claim for reimbursement of the his treatment cost amounting to Rs. 5,20,456/-.  The Respondent Insurance Company justified its decision contending inter alia that the patient was suffering from pre-existing ailment which was not disclosed by him at the time of opting for the mediclaim policy in question.

As it appears, the Ld. District Forum thrashed the contention of the Respondent Insurance Company by passing a speaking order and directed the Respondent Insurance Company to reimburse the treatment cost along with litigation cost for a sum of Rs. 10,000/-. However, since the Ld. District Forum did not award any compensation in favour of the Appellant, aggrieved with such decision, this Appeal is moved.

Thus, the short point for consideration in this Appeal is whether the Appellant deserves any compensation or not.

In this connection, both sides were heard at sufficient length.  Besides, we have also gone through the material on record.

Ever increasing health care costs have made it imperative to opt for mediclaim policies in India. When it comes to health care, everyone wants to opt for best in class healthcare services. However considering the steep price rise in this sector, many of us are pushed to opt for a relatively lower quality of healthcare. But with a mediclaim policy, an individual is able to opt for the best type of medical healthcare, without having to worry about arranging large sums of money. Therefore, if one’s legitimate claim is turned down by the Insurance Company unfairly, it frustrates the very purpose of having a mediclaim policy.

We find that the Ld. District Forum in categorical terms held that the repudiation was not valid and legal and further that the Insurance Company demonstrated a gesture of deficiency of service in repudiating the claim of the Appellant.

Against such backdrop, not awarding any compensation in favour of the Appellant does raise eyebrows.  It is the sacrosanct responsibility of a Court of Law to see that justice is done to the sufferer appropriately.  When legitimate claims are repudiated on flimsy grounds, it does create tremendous mental pressure, agony, anxiety to a bona fide claimant. As a consumer, one certainly does not deserve all these hassles.  

Considering all aspects, we, therefore, deem it fit and proper to tweak the impugned order to some extent.

The Appeal, thus, allowed in part.

Hence,

O R D E R E D

The Appeal stands allowed on contest against the Respondent Nos. 1 & 2 in part and dismissed against the Respondent No. 3.  The impugned order is modified to the extent that the Respondent Nos. 1&2 shall pay simple interest @9% over the sum of Rs. 5,20,456/- w.e.f. 06-01-2017 till 17-07-2017 within 40 days henceforth, i.d., they shall be liable to pay additional interest @ 9% p.a. over the aforesaid sum of Rs. 5,20,456/-  from this day till full and final payment is made.