Punjab

Ludhiana

CC/23/183

Tarun Sehgal - Complainant(s)

Versus

Niva Bupa Halth Insurance Co.Ltd - Opp.Party(s)

Amrik Singh

09 Sep 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No: 183 dated 05.05.2023                                                         Date of decision:09.09.2023

 

Tarun Sehgal son of late Sh. Pardeep Sehgal, resident of H. No.P-46, Basant Vihar, Near Raghunath Mandir, St. No.1, Kakowal, Ludhiana. Ph. 8561000046.                                                                             ..…Complainant

                                                Versus

Niva Bupa Health Insurance Company Ltd., Unit No.3, Plot No.88, 2^nd Floor, Kunal Tower, Mall Road, Opp. Axis Bank, Ludhiana (Punjab)-141001.                                                                                               …..Opposite Party

Complaint under section 35 of the Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH.JASWINDER SINGH, MEMBER

MS.MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Amrik Singh, Advocate

For OP                           :         Sh. V.S. Mand, Advocate

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                           The complainant has invoked the jurisdiction of this Commission by filing the present complaint and raised a consumer dispute with regard to non-settlement of the mediclaim insurance claim by the opposite party qua the expenses incurred by him on the treatment of his wife and thus he has sought direction against the opposite party to reimburse the claim along with compensation and litigation expenses etc. So, by filing the present complaint, complainant has prayed that the opposite party be directed to pay Rs.7,00,000/- along with compensation of Rs.2,00,000/-. Also to pay Rs.22,000/- as misc. expenses.

2.                Notice was issued to the opposite party and on 31.07.2023 Sh. V.S. Mand, Advocate filed power of attorney on behalf of the opposite party.  On 08.09.2023, Sh. V.S. Mand, Advocate counsel the opposite party suffered statement that as per instructions received vide mail dated 08.09.2023, the company/OP is ready to renew the policy of the complainant. However, under the policy, the PED (Pre-existing disease i.e. Hypertensive disease and its complication, cervical spondilitis and Arthrous shall be marked in the proposal form and there will be waiting period of this disease as per the policy terms. Further, counsel for the opposite party has got recorded his statement that the opposite party is ready to pay the Rs.5 lac as full and final settlement of the claim of complainant within one month from the date of order.

3.                The said offer has been duly accepted by complainant Sh. Tarun Sehgal by suffering separate statement in this regard on 08.09.2023. The complainant also suffered statement prayed to dispose of the complaint accordingly.

4.                In view of the aforesaid settlement arrived between the parties, the present complaint stands disposed of with the direction that the opposite party will pay Rs.5,00,000/- to the complainant in full and final settlement of his claim within 30 days from the date of receipt of copy of this order failing which the complainant shall be held entitled for interest @8% per annum on the said amount till its actual payment. Copy of the order be supplied to the parties free of costs.

5.                File be indexed and consigned to record room. 

 

(Monika Bhagat)           (Jaswinder Singh)         (Sanjeev Batra)               Member                       Member                         President   

National Lok Adalat    National Lok Adalat      Consumer Commission                                                                                     cum Chairman, National                                                                          Lok   Adalat       

Announced in Open Commission                                            Dated:09.09.2023.

Gobind Ram.