ORIENTAL INSURANCE COMPANY LIMITED Vs. JUGAL KISHORE PATNI
LAWS(CHHCDRC)-2010-3-2
CHHATISGARH STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Decided on March 25,2010

ORIENTAL INSURANCE COMPANY LIMITED Appellant
VERSUS
Jugal Kishore Patni Respondents

JUDGEMENT

- (1.)THIS appeal is directed against the order dated 25.2.2010 of District Consumer Disputes Redressal Forum, Raipur (hereinafter called as "District Forum" for short) in Complaint Case No.62/2008, whereby the appellant/Insurance Company, has been directed to pay Rs. 50,543 to the complainant/respondent No. 1., along with interest @ 6% p.a. w.e.f. 22.5.2008 till the date of payment and also to pay Rs. 2,000 by way of compensation for mental agony and Rs.700 as cost of litigation.
(2.)FACTS of the case, as narrated in the order of the District Forum are that, complainant/respondent No. 1 had purchased a Mediclaim Insurance Policy from the appellant. He was having some breathing problem while sleeping, so had taken treatment at Ramkrishna Care Hospital, Raipur where it was diagnosed that he was suffering from Sarcoidosis and was advised to take treatment either at New Delhi or at Mumbai at some big health centre. Then after getting himself examined at A.I.I.M.S., New Delhi, he ultimately went to Hinduja Hospital, Mumbai where he was admitted as indoor patient for some time and was examined. The appellant/Insurance Company was having a tie -up with Hinduja Hospital, so hospital had not charged anything for tests conducted there and for the treatment given. Only complainant/respondentNo. 1 was required to pay Rs. 717 to Hinduja Hospital and was required to purchase C.P.A.P. Machine, as suggested by the Physician of the Hinduja Hospital. He purchased that Machine for Rs.46,800 including Value Added Tax (VAT) Rs.1,800 (Annexure A -9) and then preferred a claim of Rs. 51,978 before the appellant/Insurance Company. The appellant/Insurance Company repudiated the claim of the complainant on the ground that the articles, which have been purchased and the amount which was paid, were not covered under the Insurance Policy purchased by the complainant/respondent No. 1. Then, a complaint was filed before the District Forum, in reply of which also the appellant/Insurance Company took the same defence that amount of claim was not covered under the terms of the policy and, therefore, amount was not payable and so the appellant committed no deficiency in service in not paying the amount of cost of C.P.A.P. Machine, as well as other amount claimed by the complainant/respondent No. 1.
(3.)LEARNED District Forum has not agreed with the arguments advanced by the Insurance Company before it and allowed the complaint by the impugned order.
We have heard arguments of both parties and perused the record of the District Forum.



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