Delhi

New Delhi

CC/286/2008

A.K. Oberoi - Complainant(s)

Versus

M/S. Cholamandlam General Insurance Company - Opp.Party(s)

24 Nov 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI), ‘M’ BLOCK, 1^STFLOOR,

VIKAS BHAWAN, I.P.ESTATE,

NEW DELHI-110002.

 

Case No.CC/286/08                                      Dated:

In the matter of:

Sh. A.K Oberoi,

Deputy Executive Officer,

National Building Construction Corporation Ltd.,

NBCC Place, Pragati Vihar, New Delhi-110003

 

……..COMPLAINANT

      

VERSUS

 

1. M/s. Cholamandlam General Insurance Co. Ltd., 9^th Floor, Kanchanjanga Building,

Barakhamba Road, New Delhi-110001

 

2. Paramount Health Services Pvt. Ltd.,

R.O F-90/12, Okhla Industrial Area,

Phase-I, Near ESI Hospital, New Delhi-110020

 

                                         ……. OPPOSITE PARTIES

 

 

ORDER

President: C.K Chaturvedi

              

The complaint of deficiency relates to non-reimbursement for insulin pump cost in the reimbursement claim of son of complainant, who took treatment in Apollo Clinic for Type-1 diabetes. The OP does not dispute other facts but has taken a plea that it being an aid is excluded under clause 13 of the policy. The Complainant has argued that this is part of hospitalization expenses, as he can’t be administered insulin by any other method as he is suffering from variable type of it if called brittle disease. The concerned doctor has also issued a certificate dated 05.10.07 that patient requires insulin pump for glycemic and effective management of diabetes (Exh.C-7).

We have considered the rival case and submissions. It is a Type-I diabetes of a young boy of 17 years, of age unlike normal type II cases, which require no such treatment. In view of the certificate of doctor, it is essential to his management for administering insulin in variable doses time to time to save life, by saving damage to organs due to diabetes. This is not an external aid of the type in clause 13 of policy. In the circumstances, OP is directed to pay balance cost of Rs.1,59,000/- and pay Rs.25,000/- for deficiency & litigation expenses as compensation.

The order shall be complied with within 30 days of the receipt of the copy of the order; otherwise action can be taken against OP under Section 25 / 27 of the Consumer Protection Act.

File be consigned to record room.

Copy of the order be sent to the parties free of cost.

 

        Pronounced in open Court on 24.11.2015.

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

 (Ritu Garodia)

MEMBER