- (1.) S .C. Vyas, President. 1. This appeal is directed against the order dated 27.01.2011 of District Consumer Disputes Redressal Forum, Raipur (C.G.) (hereinafter called ''District Forum '' for short) in Complaint Case No.265/2008, whereby the appellant/Insurance Company, has been directed to pay Rs.3,00,000/ - to the respondent/complainant along with interest @ 6% p.a. w.e.f. 06.10.2008 till date of payment and also to pay Rs.5,000/ - as compensation for mental agony and Rs.1,000/ - as cost of litigation on account of deficiency in service committed by the Insurance Company in not paying the claim amount of Mediclaim Policy, in respect of Angioplasty and Heart Surgery of the insured / complainant.
(2.) BRIEFLY stated, facts of the case are that respondent/complainant, Dr. Deepak Raje was insured with the appellant/Insurance Company under a Mediclaim Policy for last 10 years continuously. In the year 2007 -08, on his request, the sum insured under the Mediclaim Policy was increased to Rs.3,00,000/ - and premium of Rs.9,664/ - was accepted by the Insurance Company. In that year, the insured was required to undergo Angioplasty in respect of his cardiac ailment in the hospital situated at New Delhi and he was required to spend about Rs.5,00,000/ - in the procedure of Angioplasty, admission and treatment in Max Heart & Vascular Hospital, New Delhi. He preferred a claim before the Insurance Company for payment of the amount spent by him for taking treatment in Max Heart & Vascular Hospital, New Delhi, but the Insurance Company had not accepted his claim and proposed to pay Rs.1,00,000/ - only under the Mediclaim Policy. Alleging it as deficiency in service on the part of the Insurance Company, he filed consumer complaint before the District Forum. Before the District Forum, the defence of the Insurance Company was that at the time of getting insurance cover under the Mediclaim Policy, the complainant was aware of the fact that he was a heart patient. The proposal for increasing sum insured under the Mediclaim Policy was accepted by the Head Office of the Insurance Company and it was informed that the increase would be applicable only in respect of new diseases and not in respect of the diseases, which were already existed. Thus, the complainant was not entitled of getting more amount than Rs.1,00,000/ -, for which he was initially insured. Learned District Forum, after having considered the material placed before it by both parties disagreed with the defence taken by the Insurance Company and allowed the complaint by the impugned order.
(3.) WE have heard arguments advanced by counsel for the appellant in detail and perused the record of the District Forum.;