RAMESH CHANDER Vs. ORIENTAL INSURANCE COMPANY LIMITED
DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION
ORIENTAL INSURANCE COMPANY LIMITED
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(1.) RESPONDENT obtained a Med Safe (Health Care) policy from the appellant. During the subsistence of the policy he was admitted in Kukreja Hospital, Heart Centre (respondent No. 2) who raised a bill of Rs. 21,225. On the basis of Section 1 of the Insurance Policy, his claim was cleared to the extent of Rs. 5,250. Feeling aggrieved the respondent filed the instant complaint before the District Forum.
(2.) WHILE allowing the complaint the District Forum vide its order dated 1st August, 2006 directed the appellant to reimburse the amount of Rs. 15,000 out of the bill of Rs. 21,225 less Rs. 5,250 already received by the respondent and also pay Rs. 5,000 as compensation and cost.
(3.) DISSATISFIED with the amount of compensation and wrong application of relevant section by the District Forum while assessing the liability of the respondent -Insurance Company, the appellant has preferred this appeal.
Relevant portion of section regarding maximum liability under this scheme to be discharged by the appellant is as under : "(a) all expenses incurred for any one illness is limited to Rs. 15,000. (b) Company s liability in respect of all claims admitted during the period of insurance shall not exceed the sum insured of Rs. 30,000 per person or family as mentioned in the schedule that means these benefits can be availed individually or collectively by the member of the family during the policy period. This benefit is on floater basis.";
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