CONSUMER DISPUTES REDRESSAL COMMISSION-VII
DISTRICT: SOUTH-WEST
GOVERNMENT OF NCT OF DELHI
FIRST FLOOR, PANDIT DEEP CHAND SHARMA SAHKAR BHAWAN
SECTOR-20, DWARKA, NEW DELHI-110077
CASE NO.CC/179/21
Date of Institution:- 02.08.2021
Order Reserved on:- 31.10.2023
Date of Decision:- 07.03.2024
IN THE MATTER OF:
Mrs. Luna Azad
Plot No.162/A, Gali No.8,
Laxmi Vihar, Mohan Garden,
New Delhi - 110059
.….. Complainant
VERSUS
Star Health and Allied In. Co. Ltd.
C-8, 3rd Floor, New Krishna Park,
Janak Puri, New Delhi – 110018
New Heera Hospital
RZ-40-41, Naya Bazar, Tura Mandi,
Najafgarh, New Delhi - 110043
.…..Opposite Party
ORDER
Suresh Kumar Gupta, President
- The complainant has filed the complaint under section 12 of Consumer Protection Act (hereinafter referred to as Act) with the allegations that she has taken an online health insurance policy. She has remained admitted to hospital from 04.01.2020-08.01.2020 for the treatment of fever, vomiting, stomach ache, etc. She has incurred an expenses of Rs.31,774/-. On 20.01.2020, she has submitted the claim papers to the OP-1 but no reply was received. On 17.02.2020, she has written a letter to OP-1 but no reply was received. A legal notice dated 18.09.2020 was issued. Hence, this complaint.
- The notice of the application was given to the complainant. The OP did not file the reply as a result on 29.04.2022 the defence was struck off.
- The complainant has filed her own affidavit in evidence wherein she has corroborated the version of complaint and relied upon the documents annexed with the complaint.
- We have heard the AR of the complainant and perused the entire material on record.
- The perusal of the record shows that policy bearing No.P-161127/01/2019/006723 dated 11.01.2019 was issued by the OP-1 in favour of complainant which was valid from 11.01.2019 to 10.01.2020. The copy of the policy annexed at page no.28 of the complaint. The complainant was admitted to hospital for the treatment of enteric fever with weakness. She has undergone treatment from 04.01.2020 till 08.01.2020 at New Heera Hospital, Najafgarh, New Delhi. The discharge summary is at page no.15 of the complainant. The complainant has paid a bill of Rs.31,774/- to the hospital which is at page no.16 of the complainant. The OP-1 has not paid the amount despite the submission of claim form as well as receipt of legal notice dated 18.09.2020.
- The OP has not file the reply to controvert the claim of the complainant. There is nothing on the record to view the testimony of complainant with the aid of spectacles in the absence of any reply from the OP. The OP has not contested the case, so the evidence led by the complainant is relied upon.
- Hence, in view of our discussion, the complaint of the complainant is allowed to the effect that OP shall refund the amount i.e. Rs.31,774/- along with interest @7% p.a. from the date of legal notice dated 18.09.2020 till its realization. The complainant has undergone mental agony so she is entitled for compensation on this score also. The OP shall also pay Rs.15,000/- towards compensation on account of mental agony and harassment. The OP shall comply with the order within 45 days from the date of receipt of order failing which complainant is also entitled for interest @7% p.a. on compensation from the date of order till its realization.
- A copy of this order is to be sent to all the parties as per rule.
- File be consigned to record room.
- Announced in the open court on 07.03.2024.
