Decided on August 30,2013

Chief Regional Manager, New India Assurance Company Limited Appellant
Gulshan Chadha Respondents


- (1.) THIS is insurer's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 11.07.2012 passed by the District Forum, Dehradun in consumer complaint No. 214 of 2010, whereby the District Forum has allowed the consumer complaint and directed the opposite parties to pay sum of Rs. 57,622.95/ - to the complainant together with Rs. 50,000/ - towards mental agony and Rs. 10,000/ - towards litigation expenses. The above amount was directed to be paid within a period of 30 days from the date of the order, failing which the above amount was directed to carry interest @9% p.a. from the date of filing of the consumer complaint till payment.
(2.) BRIEFLY stated, the facts of the case as mentioned in the consumer complaint, are that in the year 2007, the complainant and her husband Sh. Jagdish Chandra Chadha had taken a mediclaim policy from the appellant The New India Assurance Company Limited. The said policy was valid for the period from 10.12.2007 to 09.12.2008. In the month of May, 2008, the complainant suffered severe pain in the knees of both her legs, as a result of which, she faced difficulty in walking. The complainant consulted Dr. V.K. Nautiyal of Param Hospital, 20, Balbir Road, Dehradun, who advised for operation of the knees. He also told that Dr. Mangal Parihar of Mangal Anand Hospital, Mumbai is an expert in such kind of operations and advised for operation from the said doctor. On 23.05.2008, the complainant got her left knee operated by Dr. Mangal Parihar in the hospital of Dr. V.K. Nautiyal and paid a sum of Rs. 50,000/ - for the said operation. The complainant gave intimation to the opposite parties and submitted her claim with the opposite parties. The opposite parties sought some information from the complainant, which were duly supplied by the complainant. However, the claim of the complainant was not settled by the opposite parties. Alleging deficiency in service on the part of the opposite parties, the complainant filed a consumer complaint before the District Forum, Dehradun.
(3.) THE insurance company filed written statement before the District Forum and pleaded that as per Condition No. 11 of the policy, the complainant did not submit the required documents within a period of 30 days; that the complainant did not submit any bill in support of her treatment and operation and that the claim was rightly repudiated and no deficiency in service was made by the insurance company. The District Forum, on an appreciation of the material on record, allowed the consumer complaint vide impugned order dated 211.07.2012 in the above terms. Aggrieved by the said order, the insurance company has filed this appeal.;

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