O R D E R

PER SHRI. S.M. 

1)        .50 with interest @ 18% p.a. from 30/11/09 till it’s realization. It is also prayed that the Opposite Party be directed to pay compensation of Rs.1,00,000/- for the mental agony and stress suffered by the Complainant and to pay cost of this complaint.

2)            .50 to the Unit No. MCDO 8 of the Opposite Parties on 30/11/09. The copies of the said claim and bills receipts, discharge certificate, etc. are at Exh.‘B’.               

3)       written statement. .4, 5.5, 4.8 of the policy.       .8 of the policy. written statement.          

4)       .8 of the policy as per the letter marked as Exh.‘3’. 

5)           

6)       written statementwritten statement   written arguments. 

7)        

8)       .4, 5.5. & 4.8 of the policy.     

9)       .8 of the policy.    .8. As pointed out above in the policy document the Complainant and his wife were suffering from pre-existing diseases was within the knowledge of the Opposite Parties is brought on record by the Complainant. Furthermore, we find that the exclusion clause 4.8 as referred as cannot be applicable for the repudiating the claim made by the Complainant.        .8 of the policy is not at all justifiable.   .8 of the policy cannot be held just & proper on the part of the Opposite Parties.

10)     .4 & 5.5 of the policy documents on the part of the Complainant and therefore, the Complainant is not entitled for the claim made in the complaint also cannot be said acceptable as the Opposite Parties by it’s letter dtd.26/12/2011 informed to the Complainant that the original papers submitted by him to the office of the Opposite Parties in respect of the hospitalization unfortunately got misplaced and Raksha TPA Pvt. Ltd. processed the claim of the Complainant and the copies of the papers subsequently submitted by the Complainant on 30/09/2010. .4 & 5.5 of the policy in view of the aforesaid letter cannot be accepted. Furthermore, the Opposite Parties in the repudiation letters have not contended that as per clause no.5.4 & 5.5. of the policy is the Complainant is not entitle for the claim lodged to the Opposite Parties.  .50, the Opposite Parties are liable to pay the said claim to the Complainant alongwith interest from 30/11/09 @ 6% p.a. till its realization.   

O R D E R

i.                   Complaint No.75//2011 is partly allowed against the Opposite Parties.

ii.                The Opposite Parties are directed to pay an amount of Rs.1,17,076.50till it’srealization.

iii.      

iv.       /-(Rs.Three ThousandOnly) to the Complainant towards the cost of this proceeding. 

v.                 The Opposite Parties shall comply with the aforesaid order within one month from the date of service of this order. 

vi.              Certified copies of this order be furnished to the parties.