Central Delhi


DEVENDER KUMAR - Complainant(s)



01 Sep 2023


Complaint Case No. CC/40/2021
( Date of Filing : 05 Mar 2021 )
Dated : 01 Sep 2023
Final Order / Judgement

Before  the District Consumer Dispute Redressal Commission [Central], 5th Floor                                                   ISBT Building, Kashmere Gate, Delhi

                                      Complaint Case No. 40/05.03.2021


Devender Kumar, 1624/2 Thana Road

Najafgarh , Delhi-43                                                                                    …Complainant


Max Bupa Health Insurance Company Ltd.

39, 3° Floor, Samyak Towers, Pusa Road,

WEA, Karol Bagh, New Delhi-110005.                                           ...Opposite Party

                                                                                    Date of filing              05.03.2021

                                                                                    Date of Order:            01.09.2023

Coram:  Shri Inder Jeet Singh, President

               Shri Vyas Muni Rai,    Member



Inder Jeet Singh , President


1.1. (Introduction to case of parties) - The complainant/Insured filed the complaint against his Insurer/OP by making allegations of deficiency of services of firstly - declining him cashless facility for medical bills and subsequently- declining him reimbursement of medical bills despite it were covered under Medi-claim Insurance Policy and insurance policy was also cancelled on the pretext of concealment of pre-existing disease from proposal form. The premium paid was also forfeited. Whereas, the complainant protests and denies these plea of OP besides denial of valid claim & cancellation of policy was arbitrary, illegal and without substance.

The complainant seeks reimbursement of medical bills of Rs. 75,614/- along-with interest at the rate of 10% pa, compensation of Rs.1,50,000/- on account of harassment , mental agony and sufferings, apart from litigation costs of Rs. 50,000/-, refund of premium amount of Rs. 17,570/- and other appropriate relief under the circumstances.

1.2. The OP opposes the complainant by denying allegations of deficiency of services and also justifies repudiation of claim and cancellation of policy. The pre-authorised was rightly declined by denial letter dated 30.06.2019,  the policy was cancelled by another letter dated 15.08.2019 and then claim was also declined as per terms of policy, since the complainant had suppressed material facts of blood transfusion of about 10 years back, which was never disclosed in the proposal form. Policy was also properly cancelled and premium was also forfeited, since the complainant suppressed and failed to disclose pre-existing diseased.  The policy was obtained by misrepresentation and against the principles of utmost good faith. It cannot be construed deficiency of services and complainant is not entitled for any claim/relief.

2.1. (Case of complainant) – The complainant has been obtaining medi-claim policy from time to time from the year 2015 onwards till 2019, it has been renewing continuously without any break. Lastly, the complainant was issued medi-claim policy no. 30461023201803 w.e.f. 22.09.2018 to 21.09.2019, for sum insured of Rs. 7,80,000/- against payment of premium of Rs. 17,570/- to OP, while covering the complainant, his wife and three dependent children. The complainant was neither provided terms and conditions of the policy nor he was explained anything about the coverage.

2.2.   On 30.05.2019, the complainant was taken to the emergency of Mata Chanan Devi Hospital, since he was feeling uneasiness, fever, loose motion, decreased appetite, yellowish discoloration of body and pain. He was admitted as indoor patient on 30.05.2019 and remained there till his discharge on 05.06.2019. The complainant spent medical expenses of Rs.75,614/-, which he deposited at the time of discharge. The complainant had informed OP, however,  his cashless facility was declined on illegal plea of non-disclosure of material fact. The complainant had lodged the claim and pursued it, he complied with all the instructions in filling in the claim form completely, furnishing all the record of admission, medical bills, discharge summary, testing reports.  The total bills were of amount of Rs. 75,614/-. But OP issued a notice of cancellation of policy and forfeiture of premium amount by email dated 15.08.2019 illegally on allegations of pre-existing medical condition at the time of obtaining insurance policy.  

2.3.  The complainant immediately informed the OP about his present illness, which was nothing to do with his previous illness of 2006 vis-à-vis the complainant has been taking medi-claim policy w.e.f. the year 2015 regularly and without any break, therefore, the policy cannot be cancelled arbitrarily by OP that too without any documentary evidence, but OP refused to entertain the claim. Whereas the OP, being insurer, was required to settle the claim in advance hospitalisation of complainant. The OP refused the claim by letter dated 16.09.2019 on the plea of non-disclosure of material facts of pre-existing disease clause in the policy, whereas no such clauses of the policy were provided or explained to the complainant either at the time of policy or subsequently. All these circumstances are manifesting that the OP had declined the valid claim of complainant despite it is being covered under the risks of insurance policy as well as  the insurance policy was cancelled arbitrarily, it is deficiency in services.

            The OP is taking shelter of terms of conditions of policy under flimsy grounds and letter dated 27.08.2019 given by the hospital clearly proves that OP rejected the claim on frivolous grounds, it clearly makes out case of deficiency of services. The acts of OP is nothing but fleecing general public under the garb of covering them in medi-claim policy, which were created for benefit of public at large. Those clauses of policy, being referred by OP, were never brought to the knowledge of complainant or general public at large. The complainant suffered harassment and mental agony because of such acts and deeds of OP. That is why, the complaint.

2.4. The complainant is accompanied with record of insurance policy issued, copy of discharge summary along with medical bills, copy of letter dated 03.06.2019 of denial of cashless facility, letter dated 15.08.2019 of cancellation of policy, letter/certificate  dated 27.08.2019 by treating doctor the present illness has no relation with the previous illness of 2006 , letter dated 04.09.2019 to reconsider the claim since present illness is not related with previous treatment and copy of letter dated 16.09.2019 of rejection of claim on same ground.

3.1 (Case of OP)- The OP filed detailed written statement, it is composite of preliminary objections, reply on merits [coupled with citation of case law and arguments, which are not pleading]. However, at this stage, the relevant and material facts will be referred  [as the component of arguments and case law will be dealt at appropriate stage].

3.2. The OP denies allegations of deficiency of service and it is not liable on any count towards the complainant. The complaint is false, mala-fide and abuse of process of law since an attempt is being made by the complainant to waste the precious time of this Hon’ble Commission as well as the complainant intends to avail undue advantage. There is no cause of action in his favour and against the OP.

3.3. The complainant obtained medical policy by suppressing material facts of  status of his health and that information was suppressed from the proposal form while applying for insurance policy. From the medical documents of complainant, it was revealed that he had not made full and complete disclosure at the inception of policy. Thus, based on such non-disclosure of material facts at the time of availing the policy the claim was repudiated by OP and because of concealment of facts, the policy was cancelled. That is why, the complaint is without cause of action and merits.

3.4. The contract of insurance is based on principles of utmost good faith and complainant was required to disclose every material fact, otherwise this becomes good ground for recession of contract. The complainant was very well aware of his medical terms and conditions but he choose to cheat the OP by non-disclosure of correct facts in the proposal form. The written statement further elaborates about the meaning of material fact or consequences of non-disclosure of the same, while referring  Rule 2(1)(d) of the IRDA (PPI)  Regulation 2002, wherein proposal form is also defined and obligation is put to disclose all material particulars to enable the insurer to form opinion, whether or not risk is to be undertaken. The consent of OP was unduly influenced by the complainant by misrepresenting the facts about his health in the proposal form.

3.5 The OP does not deny about the insurance policy cover issued to the complainant to cover the complainant, his spouse and three children but allegations of deficiency of services are denied as well as to justify that the policy was cancelled because of concealment of material facts from the proposal form about the status of health and ailment of complainant. titisThe complainant was admitted in the hospital on 30.5.2019 and he was discharged on 05.6.2019, he was diagnosed  of anaemia with viral hepatitis. On receipt of pre-authorization request, the OP initiated investigation and it was revealed that complainant had history of jaundice in 2006 and blood transmission about ten year back, which was prior to the policy commencement and for non-disclosure of this material fact, the claim was denied. Moreover, the cashless request was also rejected on 3.06.2019, since liability could not be shown at that juncture. In the light of these circumstances, insurance policy was also cancelled by letter dated 15.08.2019 and the claim of complainant was also repudiated by letter dated 16.09.2019.  The allegations in the complaint are without merits and complaint is liable to be dismissed.

4. (Replication of complainant) – The complainant filed replication that neither there is any concealment of any fact nor non-disclosure of any information at the inception of the policy but in order to deny the valid claim of  complainant, the OP is projecting wrongly against complainant. The proposal form was filled in by the agent of OP but complainant merely signed it. He was not explained terms & conditions of policy nor the same were provided to the complainant. The letter dated 27.08.2019 given by the hospital is already placed on record, which specifies that complainant had history of jaundice in 2006 and blood transmission about 10 year back, it has no relation with the present illness, therefore, OP is liable to reimburse the medical bills besides to pay other claims. The complaint is correct.

5.1  (Evidence)- The complainant Sh. Devender Kumar led his exclusive evidence by his detailed affidavit with the support of documents filed with complaint.

5.2. The OP also led its evidence by filing detailed affidavit of Shri Bhuvan Bhaskar, Attorney of OP,  it is replica of reply (to complaint) with documents. Moreover, affidavit of evidence is on legal page, it too small font size to read properly but it appears that in order to reproduce entire reply into affidavit (except case law), this exercise has been done by OP; it could be avoided by narrating affidavit exclusively for evidence purposes.  [Although, affidavit should contain evidence, however, it  also narrates argument].

6.1 (Final hearing)- Both the parties have filed their written arguments. At the stage of oral submissions, Sh. Lokesh Kumar, Advocate for complainant  and Sh. Suman Tripathi, Advocate for OP presented the submissions

6.2.1  The complainant fortifies his contentions while relying upon-

(i) ICICI Prudential Life Insurance Co. Ltd Vs. Veena Sharma & antr. IV 2014 CPJ 580 NC - held that the insurance company is required to prove with credible evidence that complainant was suffering from pre-existing disease and insured had knowing failed to disclose the same. The production of discharge summary card would not be enough and repudiation was also held not justified.


(ii) Om Parkash Ahuja Vs Reliance General Insurance Co Ltd. 2021 Livelaw SC 509, held  that when the insurance company issue the policy, after accepting of concealment of  disease at the time of purchase of policy, then it cannot later-on refuse further claims or renewal of policy on the same ground.


(iii) National Insurance Co. Ltd Vs Radhey Shyam Balwada & anr [(II) 2014 CPJ 201 NC] - held that insurer has also duty to act in good faith, which obliges him to enter into contract without concealing material fact like exclusion clauses.  Further, an insured is not bound by the exclusion clauses of policy, if the same is not explained to him.


(iv) In  Bharat Watch Company (through its partners) vs National Insurance Co. Ltd., Civil Appeal no. 3912/2019 in SLP(C) no. 25468/2016, it was held that in the absence of appellant being made aware of terms of exclusions, it is not open to the insurer to rely upon exclusionary clauses.


6.2.2. The OP  has fortify its contentions by deriving reasons in its support from the following cases:-

(a) Satwant Kaur Sandhu Vs.New India Assurance Co. Ltd. (2009) 8 SCC 316-
'when information on a specific aspect is asked for in the proposal form, the assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. Obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known.
Whether the information sought for is material for the purpose of the policy is a matter not to be determined by the proposer.                                   .

" a medi-claim policy is a non-life insurance policy meant to assure the policy holder in respect of certain expenses pertaining to injury, accidents or hospitalizations".

Nonetheless, it is a contract of insurance falling in the category of contract uberrimae fidei, meaning  contract of utmost good faith on the part of the assured. Thus, when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine whether the information."

(Further held in Para 29)- "Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was palpably untrue to his knowledge. There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent insurer was fully justified in repudiating the insurance contract. We do not find any substance in the contention of learned counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated."

(b)  Mithoolal NayankVs LIC AIR 1962 SC 814 & LIC Vs Asha 2001 2 SCC 160, while adjudicating on sec. 4 of the Insurance Act, 1938, it was held, three conditions for later part of section 4 are,  the statement must be on material matter, or must suppress facts which it was material to disclose, the suppression must  have known at the time of making the statement that it was false or that it was false or that it suppressed facts which was material to disclose.


(c) P C Chcko & antr Vs Chairman, LIC Ltd (AIR 2008 SC 424), held that contract of life insurance are contracts of utmost good faith, every material fact must be disclosed, other there is good ground for recession of the contract.


(d) LIC Vs Smt. G M Chanmaparsmma AIR1991 SC 392, the contract of insurance is contract of uberrimna fide and there must be complete good faith on the part of the assured. The assured is under solemn obligation to make full disclosure of material facts which may be relevant for insurer to take into account while deciding whether the proposal should be accepted or not.


(d) Lalit Kumar Garg Vs United India Assurance Co Ltd. RP no.621/2017, dod 25.01.2018, held the insurer was wholly justified in repudiating the claim since there was concealment of coronary artery disease and unstable angina.


(e) United India Insurance Co. Ltd. Vs. Subhash Chandra RP No. 469/2006 - held, principle of insurance is fundamental to utmost good faith, which must be observed by the contracting parties and utmost good faith , forbids either party from non-disclosure of the fact which parties know and either of the parties have a duty to disclose all material facts in their knowledge, failing which it amounts to deliberate suppression of material facts.


7.1 (Findings)- The rival contentions are considered by taking into account  stock of evidence of parties, the documentary record, case law presented, precedent. The rival contentions of parties need not to be reproduced, since the case of parties have already been narrated in detail in paragraphs 2 and 3 above.

7.2. It is manifest from plain reading of case of parties, that the relationship of the complainant and of the OP are of the Insured and of the Insurer, it is not disputed nor about the medi-claim policies issued from time to time, its tenure and premium paid.  It is also not disputed that the complainant was given medical treatment as indoor patient in the Mata Chanan Devi Hospital and the complainant had paid the entire medical bills from his own pocket.

7.3. However, the consumer dispute is (1)  'whether or not the complainant had pre-existing disease for the purposes of policy and he concealed it from the OP? (2) Whether or not  the complainant is entitled for insurance claim and other reliefs? (3)  Whether the complainant was provided or equipped with terms and conditions of policy? In order to decide these issues, it needs to assess the evidence, whether there was pre-existing of disease for the purposes of obtaining policy and for want of its declaration, what consequences would flow under the terms and conditions of policy. 

             From that point of view to appreciate the rival case of parties,  it is relevant to  refer law laid down in "Jagdish Vs LIC of India [FA no.1055/2003 dod 17.12.2007, decided by Hon'ble State Commission]", in which circumstances and parameters of pre-existing disease were laid down in detail, its paragraph 10 is reproduced -

"Para 10 -Our conclusions on the meaning and import of words disease, pre-existing
disease for the purpose of medi-claim insurance policy, as under:

(i) Disease means a serious derangement of health or chronic deep-seated disease
frequently one that is ultimately fatal for which an insured must have been hospitalized or operated upon in the near proximity of obtaining the medi-claim policy,

(ii) Such a disease should not only be existing at the time of taking the policy but also
should have existed in the near proximity. If the insured had been hospitalized or operated upon for the said disease in the near past, say, six months or a year he is supposed to disclose the said fact to rule out the failure of his claim on the ground of concealment of information as to pre-existing disease,

(iii) Malaise of hypertension, diabetes, occasional pain, cold, headache, arthritis and
the like in the body are normal wear and tear of modern day life which is full of tension at the place of work, in and out of the house and are controllable on day to day basis by standard medication and cannot be used as concealment of pre-existing disease for repudiation of the insurance claim unless an insured in the near proximity of taking of the policy is hospitalized or operated upon for the treatment of these diseases or any other disease,

(iv) If insured had been even otherwise living normal and healthy life and attending to
his duties and daily chores like any other person and is not declared as a diseased person as referred above he cannot be held guilty for concealment of any disease, the medical terminology of which is even not known to an educated person unless he is hospitalized and operated upon for a particular disease in the near proximity of date of insurance policy say few days or months,

(v) Disease that can be easily detected by subjecting the insured to basic tests like
blood test, ECG etc. the insured is not supposed to disclose such disease because of otherwise leading a normal and healthy life and cannot be branded as diseased person,


(vi)  Insurance company cannot take advantage of its acts of omission and commission as it is under obligation to ensure before issuing medi-claim policy whether a person is fit to be insured or not. It appears that insurance Companies do not discharge this obligation as half of population is suffering from such malaises and they would be left with no or very little business.

Thus any attempt on the part of the insurer to repudiate the claim for such non-disclosure is not permissible, nor is exclusion clause invoke-able,

(vii) Claim of any insured should not be and cannot be repudiated by taking a clue or
remote reference to any so-called disease from the discharge summary of the insured by invoking the exclusion clause or non-disclosure of pre-existing disease unless the insured had concealed his hospitalization or operation for the said disease undertaken in the reasonable near proximity as referred above,


(viii) Day to day history or history of several years of some or the other physical problem
one may face occasionally without having landed for hospitalization or operation for the disease cannot be used for repudiating the claim. For instance an insured had suffered from a particular disease for which he was hospitalised or operated upon 5, 10 to 20 years ago and since then had been living healthy and normal life cannot be accused of concealment of pre-existing disease while taking medi-claim policy as after being cured of the disease, he does not suffer from any disease much less the pre-existing disease,

(ix) For instance, to say that insured has concealed the fact that he was having pain in
the chest off and on for years but has never been diagnosed or operated upon for heart disease but suddenly lands up in the hospital for the said purpose and therefore is disentitled for claim bares dubious design of the insurer to defeat the rightful claim of the insured on flimsy ground. Instances are not rare where people suffer a massive attack without having even been hospitalised or operated upon at any age say for 20 years or so,

(x) Non-disclosure of hospitalization/or operation for disease that too in the
reasonable proximity of the date of medi-claim policy is the only ground on which insured claim can be repudiated and on no other ground.

7.4.    Since there is dispute of pre-existing disease and its concealment in the proposal form, both the issues are related with each other, they are required to be analysed together, that is why both are being taken together. By considering facts, features,  evidence of parties along-with the settled law, the following conclusions are culled out:-

(a) The complainant has filed insurance cover/medi-claim policy w.e.f. 22.09.2018 to 21.09.2019 (pages 1 to 11 of complainant's paper book). OP has also filed proposal form (Annexure-B of paper book of OP) and terms & condition policy (Annexure-C). The policy holder is complainant and beneficiary are also his spouse and dependent children.


(b)  The terms and conditions filed by OP are not part of insurance cover/policy issued to complainant & filed by him, as policy cover-note issued to complainant begins at page 01 and ends at page no.11, the terms and conditions are not part of that paper-book.  To say, the complainant was not provided with the terms and conditions of policy, it also stand proved by complainant.


            Moreover, in Manmohan Nanda Vs United- India Assurance Co. [Civil Appeal no. 8386/2013) decided on 6.12.2021 by Hon'ble Supreme Court of India has also dealt the regulations 'the IRDA (Protection of Policyholder' Interests) Regulations 2002' and  it was held (in paragraph 34 thereof) "that just as insured has a duty to disclose all material facts, the insurer must also inform the insured about the terms and conditions of policy that is going to be issued to him and must strictly confirm to the statement in the proposal form or prospectus or those made through its agents. Thus, principle of utmost good faith imposes meaningful reciprocal duties owned by the insured to the insurer and vice-versa".


© The complainant was admitted to emergency of Mata Chanan Devi Hospital and remained indoor patient. As per discharge summary, he was finally diagnosed of  pancytopenia/fever/megaloblastic anemia (B12 deficiency). In simple language pancytopenia means low level of red blood cell, white cell and platelets, patient may experience symptoms associated with low level of each type including anemia (low red blood cell), increased risk of infection (low white blood cell), excessive bruishing or bleeding (low platelets); megaloblastic anemia is  a type of  anemia characterized by very large red blood cell;  in addition to large red blood cell,  the inner content of each cell are not completely developed. This malformation causes the bone marrow to produce fewer cells, and sometimes the cells die earlier than 120 day life expectancy; Fever means condition of the body when it is too hot because of illness.

            Further, there is history of blood transfusion about 10 years back. It is also mentioned that past history is nothing significant. There is no record that the complainant had continued ailment  after blood transfusion in 2010 or after recovering from jaundice in 2006.


(d) The complainant had jaundice in the year 2006 and transfusion of blood about 10 years back. As appearing the complainant has been leading of normal after episode of 2006 or blood transfusion in 2010.  It was 30.5.2019 when all of a sudden  the complainant suffered sickness. In between he was leading normal life. Moreover, the treating doctor/hospital had issued letter dated 27.8.2019 that ailment diagnosed and treated had no relation with previous illness of 2006 etc nor it is to be construed non-disclosure, the letter has also been proved by the complainant.

            There is no other contrary evidence or documentary record by the OP that the complainant had been suffering from any disease after jaundice in 2006 or blood transfusion about 10 years back till  his hospitalisation on 30.05.2019. There is a gap of about 14 to 10 years period.

It is settled law, by case of Jagdish Vs LIC of India [FA no.1055/2003], when the complainant has been leading normal life after treatment of previous ailment ( here jaundice and blood transfusion), then it cannot be treated as pre-existing disease. At the time of filling in the proposal form, the disease should have been either in continuation or in proximate of time immediately before the proposal form, but it was also not existing so in this case nor it could be construed so pre-existing disease. Had the complainant been under continuous treatment for such ailment, then the things would have been different. Whereas, the OP had got the matter investigated but there is no such evidence or material discovered  or proved by OP that complainant had been suffering from/under treatment of  such ailments immediate prior to furnishing proposal form.


 (e)  In view of settled law and facts discussed hereinabove, the case of complainant is to be construed a case of  non-existence of previous disease, consequently the question of concealment/suppression of disease does not arise, therefore, the plea of OP that principle of utmost good faith has been breached by the complainant or there is misrepresentation of complainant to obtain policy, do not apply.  The proposal form has been proved by the OP, it does not decipher about disclosure of pre-existing disease, however, for the aforementioned conclusion, already recovered ailment long-back and want of mentioning them does not amount to concealment of disease as it is not pre-existing disease.

Thus,  it is held complainant had not concealed any fact or information or material information about pre-existing condition of complainant prior to the policy.


(f) The OP disallowed the claim vide letter dated 16.09.2019 with remarks "non-disclosure - As per the document received and investigation done by us, it has been observed that due to gross non-disclosure of material fact such as history of jaundice 2006 and blood transfusion 10 years back, the claim is denied in accordance with policy clause no.10:21".

            Since, it is not a case of pre-existence of disease, therefore, there is no logic to say that there is concealment of such disease, consequently invoking clause no.10.21 for cancellation of policy and forfeiture of premium by OP is not tenable from any quarter, whatsoever.  Therefore, it is held that cancellation of policy and forfeiture of premium by OP by its letter dated 16.9.2019 is bad in law. The policy stand restored with premium paid.


(g) The complainant has been regular subscriber of medi-claim policy, which is different from life insurance cover, however, OP has much relied upon the cases pertaining to life insurance cover.  In Padma Sundara Rao & Others Vs State of Tamil Nadu & others II 2002 SLT,  483, rule on precedent was discussed that ratio of a case is facts specific i.e. ratio of case has to be read as per the facts of a particular case and even change of a single fact can make difference to the ratio of case.


7.5.  By taking into stock of facts, features, material and record proved,  the following conclusions are drawn:-

(a)  The complainant has proved medical papers of the treatment rendered, reports, discharge summary and other medical bills are in sequence, which proves that the complainant was admitted in the hospital for seven days from 30.05.2019 to 05.06.2019, the medical expenses are pertaining to hospitalization and his treatment. The complainant has proved his valid medical claim covered against risks under the policy.


(b) Since, the circumstances are establishing case of medical treatment and expenses, which are covered within the medical policy as well as during the tenure of policy but OP failed to pay that valid claim amount of Rs.75,614/-. It is deficiency of services, when valid medical claim is not paid.


(c) The complainant made efforts for getting reimbursement of the claim, he could not succeed.  But  he faced all kind of harassment/trauma.


7.6.1  Since, the facts on record proves case of complainant that he has valid medical claim but his bills of Rs.75,614/- were not reimbursed. Thus, complainant is held entitled for reimbursement of medical claim bills of Rs.75,614/-.

7.6.2  The complainant also seeks refund of premium of Rs.17,570/-, however, the medi-claim policy has been restored along-with premium; the premium is consideration of contract of insurance.  It would be against principle of contract that on the one side the claim of complainant is being allowed by restoring the insurance policy contract and on other side to make the contract void by making refund of premium/consideration. The valid policy and consideration of policy remains together. The request of complainant to refund of premium amount of Rs.17,570/- is declined.

7.6.3. The complainant has sought interest at the rate of 10% pa, however, considering that complainant constraint to pay medical bills , consequently, he had parted with his money in paying medical bills and other expenses, therefore, interest @ 8% pa would meet both ends, interest will be computed from the date of complaint till realization of amount in favour of complainant against the OP.

7.6.4. The complainant has also sought damages of Rs.1,50,000/- towards harassment and agony, therefore, considering totality of circumstances of case of both sides especially concluded in aforementioned paragraph, damages of Rs 20,000/- is allowed in favour of complainant and against OP.  The cost of litigation is  also determined as Rs.15,000/-in his favour and against the OP.

8.   Accordingly, the complaint is allowed in favour of complainant and against the OP to pay/reimburse medical  bills amount of Rs.75,614/-along-with simple interest @ 8%pa from the date of complaint till realization of amount; besides to pay damages of Rs.20,000/-, costs of Rs.15,000/- to complainant. 

            OP is also directed to pay the amount within 30 days from the date of receipt of this order. In case amount is not paid within 30 days from the date of receipt of order, then the rate of interest will be 10% pa on amount of Rs.75,614/- (instead of 8%pa).. 

9. Announced on this  1st September 2023 [भाद्र 10, साका 1945].

10. Copy of this Order be sent/provided forthwith to the parties free of cost as per rules for necessary compliance.



[Vyas Muni Rai]                                                                       [Inder Jeet Singh]

        Member                                                                                       President







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