Haryana

StateCommission

A/887/2015

LIC - Complainant(s)

Versus

RAMPAT - Opp.Party(s)

GAUARAV KHERA

03 Feb 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                        

First Appeal No  :      887 of 2015

Date of Institution:      14.10.2015

Date of Decision :       03.02.2016

1.     Life Insurance Corporation of India, Branch Office, Branch Office, Kaithal, through its Manager, Haryana.

2.     Life Insurance Corporation of India, Haryana, through its Regional Manager.

                                      Appellants/Opposite Parties

Versus

 

Ramphal son of Tek Chand, Resident of Village Sirsal, Tehsil Pundri, District Kaithal, Haryana.

                                      Respondent/Complainant

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri Diwan Singh Chauhan, Member                      

 

Present:               Shri Gaurav Khera, Advocate for appellants.

                             Shri Sandeep Goyal, Advocate for respondent.

 

                                                   O R D E R

 

NAWAB SINGH J.(ORAL)

 

By filing this appeal, Life Insurance Corporation of India (for short ‘LIC’)-Opposite Parties, have challenged the order dated August 27^th, 2015, passed by District Consumer Disputes Redressal Forum, Kaithal (for short ‘the District Forum’) in Complaint No.15 of 2014.

2.      Ram Phal-Complainant/respondent, (hereinafter referred to as ‘the insured’), purchased a Life Insurance Policy (Annexure P-2) from the LIC on July 5^th, 2012. The sum assured was Rs.1.00 lac. In the month of June, 2013, the insured fell ill. He got treatment from Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. The expenses incurred on his treatment were Rs.70,000/-.

3.      The insured filed claim with the LIC.  The LIC did not pay the amount on the ground that the insured was never hospitalized and the policy did not cover the Out Patient Department expenses.

4.      After evaluating the evidence led by the parties, the District Forum accepted complaint and issued direction to the LIC as under:-

“….we allow the complaint and direct the Ops to pay Rs.70,000/- to the complainant and further to pay Rs.2200/- as lump sum compensation on account of harassment, mental agony and cost of litigation charges. Let the order be complied with within 30 days, failing which, the complainant shall be entitled interest @ 8% p.a. on the awarded amount from the date of commencement of this order till its realization.”

5.      Learned counsel for the LIC has assailed the order of the District Forum on the ground the insured had taken OPD treatment from PGIMS, Rohtak, so the expenses incurred by him were not payable by the LIC.

6.      The contention raised is not tenable. There is nothing on the record to suggest that the expenses incurred by the insured for OPD treatment were not covered under the policy. That being so, the LIC is liable to pay the amount spent by the insured on his treatment from PGIMS, Rohtak. No case for interference is made out.

7.      Hence, the appeal is dismissed being devoid of merits.

8.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

 

Announced: 03.02.2016

Diwan Singh Chauhan Member

Nawab Singh President

CL