- (1.) THIS is an appeal by the complainant against the order dated 21.10.2004 passed by the District Forum, Dehra Dun for enhancement of compensation.
(2.) THE complainant has taken a mediclaim policy. On 4.4.2002 during the insurance period he met with an accident. He became unconscious and suffered injuries. He was admitted in Ashirwad Hospital, Dehra Dun where he got treatment and he spent a sum of Rs. 3,143.50 in his treatment. He lodged the claim with the Insurance Company. It was not allowed. He gave a notice and filed the complaint. The complaint as filed was for Rs. 3,143.50 as claim amount, Rs. 1,000/ - for mental pain and Rs. 1,100/ - for expenses of notice etc. Total claim was for Rs. 5,243.50.
(3.) THE opposite party, Insurance Company did not deny the factum of accident. It however alleged that there were no serious injuries to the complainant. The claim was rejected on the ground that in terms of the policy, it was mandatory that the complainant should have remained hospitalized for 24 hours. He was not admitted for 24 hours, therefore, the claim was rejected. From evidence it is apparent that the complainant suffered injuries on 4.4.2002. He was given treatment in Ashirwad Hospital but it is alleged that he was released the same day. Therefore, there was no hospitalization for 24 hours. The insurance policy does not show any provision of hospitalization for 24 hours, therefore, the complaint was allowed. At this stage we have not to see the hospitalization etc. because there is no appeal by the Insurance Company and the order to that extent has become final.;