Order dictated by:

Sh.Anoop Sharma, Presiding Member

1.       Raj Kumar,complainant has brought the instant complaint under section 11 and 12 of  the Consumer Protection Act, 1986  on the allegations that complainant obtained mediclaim Insurance policy bearing No. 404400/48/15/8500001152 for the period from 22.1.2016 to 21.1.2017 by paying requisite premium. The complainant has been obtaining the mediclaim Insurance policy from the opposite party for the last more than 8 years continuously without any break. During the subsistence of the policy period from 22.1.2016 to 21.1.2017 the complainant obtained medical treatment regarding his right foot from Amandeep Hospital, G.T. Road, Model  Town , Amritsar and in this respect surgery was performed by the doctors of Amandeep Hospital and a bill/invoice No. 474 dated 27.12.2016 for a sum of Rs. 1,29,083/- was issued by the opposite party and a concession to the tune of Rs. 5343/- was given by the hospital. But the opposite party has only paid a sum of Rs. 93,740/- towards the mediclaim of the complainant  to the tune of Rs. 1,29,083/- and an amount of Rs. 30000/- was deducted by the opposite party illegally and the complainant was compelled to pay the said amount to the tune of Rs. 30000/-  before his discharge from the hospital. The opposite party was requested to reimburse the aforementioned amount spent by the complainant to the tune of Rs. 30000/- as well as Rs. 8500/- spent towards medicines and requisite tests i.e. total of Rs. 38,500/-  and the claim in this regard was duly lodged by the opposite party. But the opposite party repudiated the claim to the tune of Rs. 38,500/- vide letter dated 16.3.2017 on the basis of exclusion clause 4.6 only. Vide instant complaint, complainant has sought for the following reliefs:-

(a)     Opposite party be directed to pay the impugned claim of Rs. 38500/- alongwith interest @ 12% p.a.

(b)     Compensation to the tune of Rs. 25000/- alongwith litigation expenses to the tune of Rs. 11000/- may also be awarded to the complainant.

Hence, this complaint.

2.       Upon notice, opposite party appeared and filed written version in which it was submitted that as per terms and conditions of the policy the charges for the medical treatment has already been paid  and the charges for the plastic surgery are not covered and as such are not payable  and the claim has rightly been repudiated by the opposite party.  Moreover the plastic surgery was not necessary and is just for beautification which is not covered as per the terms and conditions of the policy. The terms and conditions of the policy were duly communicated and supplied to the complainant . As such the claim of the complainant has been rightly repudiated and there is no deficiency of service on the part of the opposite party. While denying and controverting other allegations, dismissal of complaint was prayed.

3.       In his bid to prove the case  Sh.Munish Kohli,Adv.counsel for the complainant tendered into evidence affidavit of the complainant Ex.CW1/A alongwith documents Ex.C-1 to Ex.C-21 and closed the evidence on behalf of the complainant and it was stated that the opposite party has credited an amount of Rs. 30000/- in the account of the complainant and has prayed only for compensation and litigation expenses.

4.       At the very outset on 7.8.2017 Sh. Munish Kohli,Advocate counsel for the complainant has closed his evidence and  suffered a statement that the opposite party has credited an amount of Rs. 30000/- in the account of the complainant and counsel for the complainant insisted that the complainant may be awarded sufficient compensation as well as cost of litigation .In our considered opinion, complainant  is entitled for compensation as well as litigation expenses because opposite party made the complainant to file the instant complaint and his grievance has been redressed during the proceedings of this complaint by the opposite party. Moreover, complainant had to engage a counsel for filing the complaint besides incurring expenses for counsel fee as well as expenses on lodging the complaint. When the grievance of the complainant were not met with, he had also suffered mental pain, harassment & inconvenience as well. However, complainant has made a request for grant of compensation to the tune of Rs. 25000/- vide instant complaint which in our opinion appear to be quite exorbitant and  excessive. It is settled principle of law that compensation has to be granted in order to   set off the loss occasioned by the complainant and no exorbitant or excessive compensation is to be granted to enrich a party at the cost of the other . In our considered opinion the grievance of the complainant shall be fully met with if he is granted compensation to the tune of Rs. 5000/-   and we grant the same accordingly. Litigation expenses are assessed at Rs. 2000/-. Opposite party is directed to make compliance of the order within 30 days of the receipt of copy of this order ; failing which, awarded amount shall carry interest @ 6% p.a. from the date of filing of the complaint until full and final recovery. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.

Announced in Open Forum

Dated : 7.8.2017