Order by:
Sh.Amrinder Singh Sidhu, President
1. Sh.Rakesh Kumar complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (as amended upto date) on the allegations that he purchased cashless policy from Opposite Party No. 2 under the name of ‘Family Health Optima Insurance Plan’ on 23.05.2017 and paid premium of Rs.19,366/- against receipt No.1431000164 . Said policy was valid for the period w.e.f. 23.05.2017 to 22.05.2018 midnight. The Complainant further alleges that on 08.07.2017 he felt a severe pain in his chest and he was diagnosed as dilated cardiomyopathy and was got admitted in Fortis Escort Heart Institute, on 25, Okhla Road, New Delhi for the period w.e.f. 10.07.2017 to 13.07.2017 where he was operated by Dr.T.S.Kler and discharged on 13.07.2017 and charged Rs.13,28,800/- for his medical treatment. Alleges that the brother of the Complainant contacted the Opposite Parties regarding the cashless treatment and then the officials of Opposite Party No. 2 raised query on pre authorization in which they demanded some documents i.e. doctor certificate of complainant’s health problem, ECG, request for cashless hospitalization for medical insurance policy, Aadhaar card of the Complainant, estimate of the expenses on the treatment and all these documents were immediately provided by the Complainant to the Opposite Parties. Thereafter, the Complainant approached the Opposite Parties for the reimbursement of the medical bill, but the Opposite Parties repudiated the claim of the Complainant on the ground of concealment of pre-existing disease. But however, it was a imaginary fact of Opposite Parties to repudiate the genuine claim of the complainant. As such, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) To pay an amount of Rs.13,28,800/- alongwith interest @ 18% per annum till the date of payment.
b) An amount of Rs.One lakh as compensation for mental tension, harassment and agony suffered by the Complainant.
c) An amount of Rs.25,000/- as litigation expenses.
d) Further direct the Opposite Parties not to cancel the above said policy of the Complainant or any other relief to which this District Commission may deem fit and proper.
2. Opposite Parties appeared through counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the Complainant had submitted its duly signed proposal form after fully understanding and deliberating upon the terms and conditions of the policy concerned; that the Complainant has filed the instant complaint with malafide intention and further to grab the public money and that the relief sought in the present complaint is in violation of the terms and conditions contained in the policy. At the time of obtaining the policy, all the exclusion clauses and the payment plan were duly explained to the Complainant/ policy holder; that the present complaint is false, frivolous, misconceived and vexatious in nature and has been filed with the sole intention to harass the Opposite Parties; that the policy was issued to the Complainant under which the dispute has been raised in governed by liability as per various clauses and without any prejudice to whatsoever has been stated in this written statement, even admitting without conceding that the company is liable to pay the claim in terms of the contract of insurance issued to the Complainant. On merits, the Opposite Parties have admitted that the Complainant was medically insured under the said policy having total sum insured at Rs.10 lakhs vide policy No. P/211217/01/2018/0000127 valid from 23.05.2017 to 22.05.2018 and before inception of the policy, all the benefits, tenure, terms and conditions were well explained to the Complainant and after being fully satisfied with the same, the Complainant had purchased the policy in question as per his own requirement. Further alleged that the treatment related to the hospitalisation of Escort Health Institute and Research Centre, New Delhi clearly speaks that the insured have LVEF 20% which revealed that the insured had severe dysfunction and said finding confirms that the insured patient was suffering with the disease prior to the inception of the medical insurance policy and it comes under pre existing disease. It is further submitted that the claim was reported in the second year of the policy, where in the amount claimed was Rs.11,84,784/-, the insured was admitted in Escort heart Institute and Research Centre, New Delhi on 09.07.2017 for the treatment of DCMP, LVEF and raised pre authorisation request for cashless treatment and the same was denied. As per the records patient/ insured was a case of dilated cardiomyopathy with severe LV dysfunction and global hypokinesia, hence, further evaluation is required to ascertain the onset of the disease. The insured had submitted claim records for reimbursement of medical expenses and on scrutiny of the claim records, as per the discharge summary, it was observed:-
* That the insured was admitted on 10.07.2017 and discharged on 13.07.2017, who was diagnosed with DCMP, LVEF 20%, CRT.D, Implantation (St.Judemedica) on 11.07.2017 LBBB.
* Procedure:CRT.D.Implanation (ST.Jude Medica) on 11.07.2017
* The ECHO report dated 08.07.2017 shows dilated LV.global bypokinesia with EF-20% which confirms chronic, longstanding lesion.
Classification of LVEF:
- Hyper dynamic= LVEF greater than 70%
- Normal= LVEF 50% to 70% (Midpoint 60%)
- Mild dysfunction= LVEF 40% to 49% (midpoint 45%)
- Moderate dysfunction= LVEF 30% to 39% (midpoint 35%)
- Severe dysfunction= LVEF less than 30%
In the instant case, the Complainant has LVEF 20% which revealed that the insured has severe dysfunction and the insured patient was having said disease prior to the inception of the medical insurance policy, hence it is pre existing disease. As per clause 3 waiting period (iii) of the terms and conditions of the policy, the Opposite Party is not liable to make any payment in respect of expenses for treatment of the pre existing diseases. As such, in terms of the said proviso of the insurance policy, the insurance company has repudiated the claim of Complainant in a proper manner, vide letter dated 28.08.2017.
3. In order to prove his case, the complainant has placed on record his affidavit Ex.C1, copy of insurance plan Ex.C2, copy of discharge summary Ex.C3, copy of bill Ex.C4, copies of receipts Ex.C5 to Ex.C7, copy of query on pre authorisation Ex.C8, copy of denial of pre-authorisation for cashless treatment Ex.C9 and Ex.C10, copy of letter Ex.C11, copy of letter Ex.C12, copy of estimate Ex.C13 and closed his evidence.
4. On the other hand, to rebut the evidence of the complainant, Opposite Parties also tendered into evidence the affidavit of Sh.N.Gopalan, Chief Manager Ex.OPs1 to 3/1, alongwith copies of documents Ex.OPs1 to 3/2 to Ex.OPs1 to 3/16 and closed the evidence on behalf of the Opposite Parties.
5. We have heard the ld.counsel for the parties and also gone through the documents placed on record. Not only this, ld.counsel for the Opposite Parties has also made statement before this District Commission that the written reply filed by the Opposite Parties may be treated as part of their written submissions.
6. Ld.counsel for the Complainant has mainly reiterated the facts as narrated in the complaint and contended that first of all, at the time of issuance of the said policy to the complainant, no term and conditions were ever explained or supplied by Opposite Parties to the complainant. Further contended that policy in question was issued in the name of the life assured after proper medical tests conducted by the doctors of the Opposite Parties and after completing all other formalities and after receiving the premium and now the Opposite Parties can not regal out from its legal liability on the false and frivolous grounds. Ld.counsel for the Complainant further contended that the Complainant had purchased cashless policy from Opposite Party No. 2 under the name of ‘Family Health Optima Insurance Plan’ on 23.05.2017 and paid premium of Rs.19,366/- against receipt No.1431000164 . Said policy was valid for the period w.e.f. 23.05.2017 to 22.05.2018 midnight. Further contended that during the policy period, on 08.07.2017 the Complainant felt a severe pain in his chest and he was diagnosed as dilated cardiomyopathy and was got admitted in Fortis Escort Heart Institute, on 25, Okhla Road, New Delhi for the period w.e.f. 10.07.2017 to 13.07.2017 where he was operated by Dr.T.S.Kler and discharged on 13.07.2017 and charged Rs.13,28,800/- for his medical treatment. Thereafter, the Complainant lodged the claim with the Opposite Parties for its reimbursement and completed all the formalities, but the Opposite Parties with malafide intention repudiated the claim of the Complainant on the false and frivolous ground of concealment of pre existing disease. Again contended that at the time of taking policy there was proper medical checkup was done and after proper medical checkup the policy was issued by the Opposite Parties after their due satisfaction & after taking premium, to the complainant, so due to proper medical check up done at their own by Opposite Parties the claim of the complainant now can not be repudiated on such false ground of pre-existing disease. However, the Opposite Parties are legally bound to pay the genuine claim of complainant.
7. On the other hand, ld.counsel for the Opposite Parties has repelled the aforesaid contention of the ld.counsel for the Complainant and contended that at the time of obtaining the policy, all the exclusion clauses and the payment plan were duly explained to the Complainant/ policy holder and that the policy was issued to the Complainant under which the dispute has been raised in governed by liability as per various clauses and without any prejudice to whatsoever has been stated in this written statement, even admitting without conceding that the company is liable to pay the claim in terms of the contract of insurance issued to the Complainant. It is however, admitted that the Complainant was medically insured under the said policy having total sum insured at Rs.10 lakhs vide policy No. P/211217/01/2018/0000127 valid from 23.05.2017 to 22.05.2018 and before inception of the policy, all the benefits, tenure, terms and conditions were well explained to the Complainant and after being fully satisfied with the same, the Complainant had purchased the policy in question as per his own requirement. Further contended that the treatment related to the hospitalisation of Escort Health Institute and Research Centre, New Delhi clearly speaks that the insured have LVEF 20% which revealed that the insured had severe dysfunction and said finding confirms that the insured patient was suffering with the disease prior to the inception of the medical insurance policy and it comes under pre existing disease. It is further contended that the claim was reported in the second year of the policy, wherein the amount claimed was Rs.11,84,784/-, the insured was admitted in Escort heart Institute and Research Centre, New Delhi on 09.07.2017 for the treatment of DCMP, LVEF and raised pre authorisation request for cashless treatment and the same was denied. As per the records patient/ insured was a case of dilated cardiomyopathy with severe LV dysfunction and global hypokinesia, hence, further evaluation is required to ascertain the onset of the disease. The insured had submitted claim records for reimbursement of medical expenses and on scrutiny of the claim records, as per the discharge summary, it was observed:-
* That the insured was admitted on 10.07.2017 and discharged on 13.07.2017, who was diagnosed with DCMP, LVEF 20%, CRT.D, Implantation (St.Judemedica) on 11.07.2017 LBBB.
* Procedure:CRT.D.Implanation (ST.Jude Medica) on 11.07.2017
* The ECHO report dated 08.07.2017 shows dilated LV.global bypokinesia with EF-20% which confirms chronic, longstanding lesion.
Classification of LVEF:
- Hyper dynamic= LVEF greater than 70%
- Normal= LVEF 50% to 70% (Midpoint 60%)
- Mild dysfunction= LVEF 40% to 49% (midpoint 45%)
- Moderate dysfunction= LVEF 30% to 39% (midpoint 35%)
- Severe dysfunction= LVEF less than 30%
In the instant case, the Complainant has LVEF 20% which revealed that the insured has severe dysfunction and hence, the insured patient was having said disease prior to the inception of the medical insurance policy, and in this way, it is pre existing disease. Hence, as per clause 3 Waiting period (iii) of the terms and conditions of the policy, the Opposite Party is not liable to make any payment in respect of expenses for treatment of the pre existing diseases. As such, in terms of the said proviso of the insurance policy, the insurance company has repudiated the claim of Complainant in a proper manner, vide letter dated 28.08.2017.
8. The first plea raised by the ld.counsel for the Opposite Parties is that
the complainant has violated the terms and conditions of the policy in question and as per the terms and conditions of the policy, the complainant is not entitled to the claim as claimed. But the Opposite Parties could not produce any evidence to prove that terms and conditions of the policy were ever supplied to the complainant insured, when and through which mode? It has been held by Hon’ble National Commission, New Delhi in case titled as The Oriental Insurance Company Limited Vs. Satpal Singh & Others 2014(2) CLT page 305 that the insured is not bound by the terms and conditions of the insurance policy unless it is proved that policy was supplied to the insured by the insurance company. Onus to prove that terms and conditions of the policy were supplied to the insured lies upon the insurance company. From the perusal of the entire evidence produced on record by the Opposite Party, it is clear that Opposite Party has failed to prove on record that they did supply the terms and conditions of the policy to the complainant insured. As such, these terms and conditions, particularly the exclusion clause of the policy is not binding upon the insured. Reliance in this connection can be had on Modern Insulators Ltd.Vs. Oriental Insurance Company Limited (2000) 2 SCC 734, wherein it is held that “In view of the above settled position of law, we are of the opinion that the view expressed by the National Commission is not correct. As the above terms and conditions of the standard policy wherein the exclusion clause was included, were neither a part of the contract of insurance nor disclosed to the appellant, the respondent can not claim the benefit of the said exclusion clause. Therefore, the finding of the National Commission is untenable in law.” Our own Hon’ble State Commission, Punjab, Chandigarh in First Appeal No.871 of 2014 decided on 03.02.2017 in case titled as Veena Mahajan (Widow) and others Vs. Aegon Religare Life Insurance Company Limited in para No.5 has held that
“Counsel for the appellant argued that copy of insurance policy was not supplied to the appellant and hence, the exclusion clause in the contract of the insurance policy is not binding upon him. He further argued that no proof of sending of insurance policy was ever produced by the respondent despite specific contention raised by the complainant that the insurance policy was never received by him. He argued that though there is an averment of the OP that the policy in question was delivered through Blue Dart Courier to the complainant. In order to prove their contention, no affidavit of any employee of Blue Dart was produced who would have made a statement to have the effect that the policy was delivered to the complainant nor any acknowledgement slip for having received the article by the complainant through courier company was produced by the insurance company. He argued that since no policy document was received by the insured and argued that the terms and conditions as alleged to be part of the insurance policy were not binding upon the insured. He argued that policy was issued in the name of deceased Sh.Vijinder Pal Mahajan with his wife Mrs.Veena Mahajan as beneficiary and the same was never refused by the OP and the proper premium for insurance was paid by late complainant. He argued that as per the specific allegations made in the complaint in para No.4, no rebuttal to that contention was specifically there in their written reply in para No.2 and para No.4 in the reply filed by OP in the District Forum. He argued that Hon'ble National Consumer Disputes Redressal Commission, New Delhi in case of "Ashok Sharma Vs. National Insurance Co. Limited", in Revision Petition No. 2708 of 2013 held in para No.8 to the point of non-delivery of terms and conditions of the policy. He also cited Hon'ble Supreme Court's decision given in the matter of "United India Insurance Co. Limited Vs. M.K.J.Corporation" in Appeal (civil) 6075-6076 of 1995 (1996) 6 SCC 428 wherein the Apex court held that a fundamental principle of Insurance Law makes it that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, "similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured and further argued that since the terms and conditions were not supplied even on repeated requests the same cannot be relied upon by the opposite party in order to report to repudiate the genuine claim of the wife of the deceased policy holder.”
9. Ld.counsel for the complainant has vehemently contended that policy in question was issued in the name of the life assured (Complainant) after proper medical tests conducted by the doctors of the Opposite Parties and after completing all other formalities and after receiving the premium of Rs.19,366/- and during the policy period on 08.07.2017 the Complainant felt a severe pain in his chest and he was diagnosed as dilated cardiomyopathy and was got admitted in Fortis Escort Heart Institute, on 25, Okhla Road, New Delhi for the period w.e.f. 10.07.2017 to 13.07.2017 where he was operated by Dr.T.S.Kler and discharged on 13.07.2017 and charged Rs.13,28,800/- for his medical treatment. Thereafter, the Complainant lodged the claim with the Opposite Parties for its reimbursement and completed all the formalities, but the Opposite Parties with malafide intention repudiated the claim of the Complainant on the false and frivolous ground of concealment of pre existing disease.
10. As mentioned above, the policy in question was issued in the name of the life assured after proper medical tests conducted by the doctors of the Opposite Parties and after completing all other formalities, but however, it also needs to be mentioned that when the policy is issued to the insured, prior investigations regarding health of the insured are duly done by the Insurance Company. If the complainant was suffering from any diseases prior to issuance of the policy, in question, the same must not have escaped the notice of the empanelled doctors of the Insurance Company. However, no such investigation record has been produced by the opposite parties. In case Bajaj Allianz Life Insurance Co. Ltd. & Ors. Vs. Raj Kumar III (2014) CPJ 221 (NC), it was held by the Hon’ble National Commission that usually, the authorized doctor of the Insurance Company examines the insured to assess the fitness and after complete satisfaction, the policy is issued. It was held that the Insurance Company wrongly repudiated the claim of the complainant.
11. Furthermore, it also needs to be mentioned that Section 19 of the General Insurance Business (Nationalization) Act, 1972 states that it shall be the duty of every Insurance Company to carry on general insurance business so as to develop it to the best advantage of the community. The denial of medical expenses reimbursement is utterly arbitrary on the ground that disease in question was pre-existing disease. It is mere an excuse to escape liability and is not bona fide intention of the insurance company. Fairness and non-arbitrariness are considered as two immutable pillars supporting the equity principle, an unshakable threshold of State and public behavior. Any policy in the realm of insurance company should be informed, fair and non-arbitrary. When the insurance policy has exclusions/conditions to repudiate the claim or limit the liability, the same must be specifically brought to the notice of the insured and are required to be got signed to show that such exclusions and conditions have been brought to his/her notice. Recently, our own Hon’ble State Consumer Disputes Redressal Commission, Chandigarh in First Appeal No. 50 of 2019 titled as Bajaj Alliance General Vs. Arjan Singh decided on 04.03.2021 also held so.
12. The need for interpreting a contract always arises in two situations, (i) when a gap is needed to be filled in the contract and (ii) an ambiguity is needed to be resolved in the contract, then to find out correct intention of the contract, spirit behind it is required to be considered. Normally, the insurance policy is a contract of adhesion in which other party is left with hardly any bargaining power as compared to the insurer. Insurance contracts are standard form contracts and are drafted by the insurance company and as such, insurance company is at higher footing than the insured. The benefit of such clause, as exclusion clause, would go to the insured unless the same is explained in clear terms by the insurer. In such circumstances, the tribunal would be more oriented towards the interpretation which goes against the party who has inserted/drafted the disputed clause in the agreement/contract. The adjudicating authority is required to look into whether the intention of the party is to exclude or limit liability has been appropriately explained to the other party or not. This Commission while interpreting insurance agreement is to honour the intention of the parties, who have signed the agreement. Even if the agreement had general exclusion/condition for misrepresentation still fraudulent misrepresentation and non-disclosure may not be there. The innocent and negligent misrepresentations are to be ignored. On the other hand, the rulings (i) Satwant Kaur Sandhu Vs. New India Assurance Company Limited, (ii) Murti Devi Vs. Birla Sun Life Insurance and (iii) Mamohan nanda Vs. United India Insurance Company Limited, cited by the ld.counsel for the Opposite Parties are not applicable and relevant to the facts of the present case.
13. Not only this, the further stand of the Opposite Parties is that as per repudiation of claim dated 28.07.2017 (Ex.Ops1 to 3/15) placed on record, reveals to the following effect:-
“It is observed that ECHO report dated 08.07.2017 shows dilated LV, global hypokinesia with EF-20% which confirms chronic, longstanding lesion. Based on these finds, our medical team is of the opinion that the insured patient has the above disease prior to inception of the medical insurance policy. Hene it is pre existing disease. The present admission and treatment of the insured patient is for the pr-existing disease.”
But to prove this factum, the Opposite Parties have failed to prove its case by examining any medical practitioner/ doctor who has treated the insured for the said disease nor the Opposite Party has filed any affidavit of any doctor who has medically treated the insured for the disease. It has been held by the Hon'ble National Commission in case New India Assurance Co.Ltd & Anr Vs. Murari Lal Bhusri 2011(III) CPJ 198 (NC) that where the Insurance company failed to produce any evidence to show that respondent was aware of any pre-existing disease at the time when insurance policy was taken, opposite party was not justified in repudiating the claim of the complainant on the ground of pre-existing disease. It has been held by the Hon'ble Supreme Court of India in case P.Vankat Naidu Vs. Life Insurance Corporation of India & Anr 2011(3) CPC 350 that where no cogent evidence was produced by the respondent to prove that insured/deceased had concealed any fact about his illness or hospitalization, it was held that no material fact was suppressed by the deceased in this respect. It has been held by the Hon'ble State Commission of Punjab in case Life Insurance Corporation of India Vs. Miss Veenu Babbar and another 2000(1) CLT 619 that repudiation on the basis of history recorded in the hospital records is illegal and arbitrary and the same could not be treated as substantive material to base any decision. Same view has been taken by the Hon'ble National Commission in case Life Insurance Corporation of India & Ors. Vs. Kunari Devi IV(2008) CPJ 89 (NC) that where no document has been produced in support of allegation of suppression of disease at the time of taking policy or revival of policy, history recorded in hospital's bed ticket, not to be treated as evidence as doctor, recording history not examined, suppression of disease not proved, insurer was held liable under the policy. It has further been held by the Hon'ble National Commission in case Sahara India Life Insurance Co. Ltd. & Anr Vs. Hansaben Deeepak Kumar Pandya IV(2012) CPJ 13(NC) that where the opposite party insurance company has failed to produce on record any evidence to show that deceased insured ever consulted doctor for taking treatment of heart disease, the repudiation of the claim on the ground of suppression of material fact is totally illegal. It has been held by Hon’ble State Consumer Disputes Redressal Commission, Chandigarh in case titled as Ashwani Gupta & Ors. Vs. United India Insurance Company Limited 2009(1) CPC page 561 that where the claim of the complainant has been repudiated on the ground that the assured had pre-existing disease of diabetes mellitus which was not disclosed- apparently, burden to prove lies upon the insurer- If assured was suffering from pre-existing disease why insurer had not checked it at the time when proposal form was accepted by its staff-Respondent has failed to fulfill this requirement before repudiating the claim and the appellant was held entitled to claim alongwith interest”.
14. On the other hand, to falsify the stand of the Opposite Parties, regarding the pre existing disease, the Complainant has placed on record Ex.C8 on ‘Query of Pre Authorization’ alongwith the certificate of Dr.T.S.Kler, M.D.D.M.MR.C.P. (U.K) FRCP, FACC, D.Sc. Executive Director (Cardiac Sciences), HOD of Cardiology Awarded “Padam Bhushan”2005 of Escorts Heart Institute and Research Centre Limited, New Delhi, in which the said Eminent Doctor has clearly mentioned that “Rakesh Kumar has been seen in his Cardialogy OPD on 08.07.2017 with newly diagnosed dilated crdiomopathy and he has no history of previous similar illness in past to best of my knowledge”. To deny and rebut the aforesaid certificate of Dr.T.S.Kler, the Opposite Parties have failed to produce any iota of evidence.
15. In such a situation the repudiation made by Opposite Parties regarding genuine claim of the complainant appears to have been made without application of mind. It is usual with the insurance company to show all types of green pesters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-
“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.
16. In view of the above discussion, we are of the opinion that the Opposite Parties have wrongly and illegally repudiated the claim of the complainant.
17. Now to come on the point of quantum of compensation. The Complainant has claimed Rs.13,28,800/- in his complaint for the reimbursement of his medical bills, whereas the policy in question was having total sum insured of Rs.10 lakhs vide policy No. P/211217/01/2018/0000127 valid from 23.05.2017 to 22.05.2018 and as such, the Complainant is at the most entitled to claim Rs. 10 lakhs subject to production on record the payment of the bills. Perusal of the bill Ex.C4 shows that the Complainant has made the payment of Rs.11,78,800/- (vide three receipts (i)Receipt dated 10.07.2017 for Rs.10,00,000/-, (ii) Receipt dated 13.07.2017 for Rs.1,50,000/- and (iii) Receipt dated 13.07.2017 for Rs.28,800/- total amounting Rs.11,78,800/-). Hence, we direct the Opposite Parties jointly and severally to reimburse the medical bill of the Complainant amounting to Rs.10 lakhs (Rupees ten lakhs only) alongwith interest @ 8% per annum from the date of filing the present complaint i.e. 04.01.2018 till its actual realization. Opposite Parties are also directed to pay the lump sum compensation to the complainant to the tune of Rs.10,000/- (ten thousands only) on account of harassment, mental tension and litigation expenses. The compliance of this order be made by the Opposite Parties within 45 days from the date of receipt of this order, failing which the complainant shall be at liberty to get the order enforced through the indulgence of this District Commission. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.
18. Reason for delay in deciding the complaint.
This complaint could not be decided within the prescribed period because the government has not appointed any of the two Whole Time Members in this Commission since 15.09.2018. Moreover, the President of this Commission is doing additional duties at District Consumer Commission Faridkot. There is only one working day in a week when the quorum of this Commission remains complete.
Announced in Open Commission.
Dated: 20.08.2021.
