Per Sh. RakeshKapoor, President
Page 1. Order CC 125/2014
The complainant had purchased a mediclaim policy from the OP. It was valid for the period 28.1.2013 to 27.1.2014. On 31.1.2013 , the complainant was admitted in ShriBalaji Heart Institute. The claim filed by him on account of the expenses incurred on his treatment was repudiated by the OP insurance company which led the complainant to approach this forum by means of the present complaint.
A copy of the complaint was served upon the Ops by registered notice on 28.4.2014. The OP chose not to contest and was proceeded with ex-parte.
In his ex-parte evidence the complainant filed his own affidavit dated 19.1.2015 and has supported the contents of the complaint.
We have heard arguments advanced at the bar and have perused the record.
The complainant has placed on record copy of the certificate Ex. CW1/1 and Ex. CW1/2 which shows that the policy of insurance was not valid for the period 27.1.2013 to 28.1.2014. the complainant is in his affidavit has deposed that he had paid premium of a sum of Rs. 8402 /- vide cheque bearing number 513744 dated 22.1.2013. It is, therefore, clear that the complainant was hospitalized during the policy of insurance purchased by the complainant. The OP has failed to show as to why it has not paid the claim lodged by the complainant we, therefore, hold the OP deficient in hold the Ops in rendering and direct it as under:
- Pay to the complainant a sum of Rs. 1,72,170/- along with interest @10 % p.a from the date of filing of this complaint i.e. 16.4.2014 till payment.
Page 2. Order CC 125/2014
- Pay to the complainant a sum of Rs. 5,000/- as cost of litigation.
The OP shall pay this amount within a period of 30 days from the date of this order failing which they shall be liable to pay interest on the entire awarded amount @ 10% per annum. IF the OP fail to comply with this order, the complainant may approach this Forum for execution of the order under Section 25/27 of the Consumer Protection Act.
Copy of the order be made available to the parties as per rule. File be consigned to record room.
Announced in open sitting of the Forum on.....................
