Per Shri P.N. Kashalkar – Hon’ble Presiding Judicial Member: (1) This appeal is filed by original Complainant for enhancement of award. (2) Complaint was filed against Insurance Company and by the judgement and award the consumer Forum had directed the Insurance Company to pay the cheque of Rs.3,00,000/- towards insurance claim with interest @6% per annum and also directed to pay Rs.2,000/- for mental harassment and costs of Rs.1,000/-. Aggrieved by inadequate relief granted, the original Complainant has filed this appeal. (3) Facts to the extent material may be stated as under: The Appellant had filed consumer complaint claiming insurance claim of Rs.3,94,915.69 from the Opposite Party No.1 Insurance Company. According to him he was taking mediclaim policy from 1990 and from time to time he was renewing the policy. It was also styled as Hospitalization and Domiciliary Hospitalization Benefit Policy. In March, 2007 he had chest pain, therefore, he got admitted in Bombay Hospital. He was indoor patient for some days and after discharge from the hospital he had lodged claim of Rs.3,94,915.69/- with the Insurance Company. However, Insurance Company erroneously disallowed the claim substantially and offered an amount of Rs.1,45,000/- only towards full and final settlement of the claim. The Insurance Company repudiated full claim on the ground that nurse of the Complainant had mentioned that Complainant was having hypertension for 8/10 years and he was required to take tablet Amlodipina 2.5mg. for that purpose. (4) The written statement was filed by the Insurance Company. They pleaded that Complainant was suffering from hypertension for 8/10 years and they had settled the claim of Rs.1,45,000/- when the policy was for Rs.3,00,000/- and bonus amount was of Rs.60,000/-, the insurance company pleaded that it had rightly repudiated the claim though bill submitted was for Rs.3,94,915.69. The Forum below heard rival Counsels and held that the amount offered was pretty minimal and it directed Insurance Company to pay a sum of Rs.3,00,000/- taking back the cheque of Rs.1,45,000/- offered by the Insurance Company. Aggrieved by the inadequate claim awarded, the original Complainant has filed this appeal. (5) We heard submissions of Advocate Mr.Amol Barve, for the Appellant and Ld.Advocate Mr.A.S. Vidyarthi, for the Respondent No.1. (6) Mr.Barve, Advocate for the Appellant rightly submitted that at the time of registering the claim the amount insured was Rs.5,00,000/- and therefore, the total bills of Rs.3,94,915.69 should have been allowed by the Forum below in place of Rs.3,00,000/- as compensation awarded by the District Forum in its award. We are finding substance in the submissions made by Advocate for the Appellant. We asked Advocate Mr.Vidyarthi, if they had filed appeal against this order, the answer was negative. In the circumstances, it will have to be held that the impugned order is acceptable to the Insurance Company. The question is when insured sum is Rs.5,00,000/- and the amount spent on hospitalization charges by the Appellant was Rs.3,94,915.69, the Forum below erroneously awarded amount of Rs.3,00,000/- in place of Rs.3,94,915.69. So, by allowing this appeal partly Insurance Company will have to be directed to pay to the Appellant sum of Rs.3,94,915.69 with interest @ 6% per annum as already awarded by the Forum below in operative part (ii) of the order. Rest of the order is confirmed. Hence, we pass the following order: O R D E R (i) Appeal is partly allowed. (ii) In place of amount of Rs.3,00,000/- in operative clause (ii) of the impugned order it should be read as Rs.3,94,915.69. (iii) Parties are left to bear their own costs. (iv) Rest of the order of the Forum below is confirmed. (v) Inform the parties accordingly. |
