Delhi

New Delhi

CC/160/2013

Naresh Kumar - Complainant(s)

Versus

M/S. National Insurance Company Ltd. - Opp.Party(s)

14 Jul 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/160/13                                                                                                                                                                              Dated:

In the matter of:

Naresh Kumar,

WZ-721/A, Gali no.01,

Old Mehrauli Road, Palam, New Delhi-45

……..COMPLAINANT

       

VERSUS

1. National Insurance Co. Ltd.,

124, Jeevan Bharti Tower-II,

Connaught Circus, New Delhi-110001

 

2. Vipul Medcorp TPA Pvt. Ltd.,

515, Udyog Vihar, Phase-V,

Gurgaon, HR-122016

                         ………. OPPOSITE PARTIES

 

ORDER

President:  C.K Chaturvedi

The complaint of deficiency is in relation to non-reimbursement of expenses incurred by complainant and his wife for hospitalization under a Hospitalization benefit policy no.36/403/48/11/8500000828 from 15.0312 to 14.03.13 coverage for him and his wife. His wife was admitted for Gastroenteritis, at Sarthak Medical Centre, Palam, New Delhi from 19.04.12 to 21.04.12. Later on complainant was admitted for disclosed Hypertension from 16.04.12 to 19.04.12 at Lifeline Hospital, Dwarka. Together, thus spent Rs.9,990/- for wife and Rs.21,431/- for self. The OP rejected the claim.

The OPs are exparte. We have considered the exparte evidence and considered the policy documents, which shows that policy was issued after recording “hypertension” as disclosed disease. In such a case, no exclusion applies and OP has committed deficiency by refusing the claim. We hold OP deficient and direct it to pay Rs.31,421/- with interest of 9% from date of claim till payment. We also award Rs.10,000/- for litigation expenses.

The order shall be complied within 30 days of the receipt of the copy of the order; otherwise action can be taken against OP1 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 14.07.2015.

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

 (RITU GARODIA)

MEMBER