IMPORTANT POINT
A reasoned order passed by District Forum cannot be interfered with.

Jasbir Singh (Retd.), President—This appeal is directed against an order dated 05.10.2016, rendered by the District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (hereinafter to be called as the Forum only), vide which, it partly accepted a complaint, filed by the complainant (now the appellant).

2. As per facts on record, the appellant/complainant took Health Insurance Policy namely Easy Health Floater Standard, for two years, valid between 15.6.2014 to 14.6.2016, by paying an amount of Rs.17,433.97Ps., towards premium. The appellant had taken the said health insurance policy, whereof 2010 and except the claim, in dispute, no medi-claim was ever raised by him. On 01.04.2015, the appellant met with an accident and suffered serious injuries. For treatment, he was taken to Fortis Hospital, Mohali and was treated for the injuries, suffered on his right thigh etc. He was discharged from the Hospital on 06.04.2015. A bill for an amount to Rs.2,00,928/- was raised by the hospital, out of which, the respondent paid an amount of Rs.1,93,673/- and the balance amount of Rs.7,256/- was paid by the appellant.

3. On 25.4.2015, again the appellant was injured due to fall on the floor. He was again taken to Fortis Hospital, Mohali on 26.4.2015 and was given following treatment:-

“Fracture reduction done, old plate used and re-adjusted, five distal and five proximal screws placed, bone grafting lefts ASIS taken and grafted over fracture site, wound closure done over negative suction drain, ASD done, Slab applied.”,

For the above said treatment, the hospital raised bill of Rs.2,05,293/-. The amount was paid by the appellant, as the respondent refused to pay the said amount, on the ground that he was having history of epilepsy, more than 8 years back and above fact was not disclosed, when Medi-claim Policy was purchased. The appellant intimated the respondent that he was suffering from epilepsy, which was cured and for the last 8/10 years, he is not taking any medicine for the same. Certificate issued by the Doctor concerned, in that regard, was also sent to the respondent. However, his policy was terminated by the respondent on 05.06.2015. It was alleged by him that termination of the policy, in question, was not justified and further by not making payment of the bill, in dispute, the respondent has indulged into unfair trade practice and was also deficient in providing service.

4. Upon notice, reply was filed by the respondent. No serious dispute was raised on merits. However, non-reimbursement of amount spent on medical treatment of the appellant and termination of the policy, in question, was justified by alleging that when the policy was taken, the appellant was having history of epilepsy more than 8 years back, which fact was concealed by him.

5. In the rejoinder filed, the appellant reiterated all the averments contained in the complaint and repudiated those, contained in written version of the respondent.

6. The Forum vide order under challenge granted following relief to the appellant:-

a. To reimburse an amount of Rs.2,05,293/- to the complainant along with interest @9% per annum from the date of cancellation of the policy i.e. 05.06.2015 (Ann.C-16) till realization;

b. To pay an amount of Rs.15,000/- as compensation for causing mental agony and physical harassment to the complainant due to its deficient services;

c. To pay Rs.7,000/- towards litigation expenses.

7. It was directed that the order be complied with by the respondent within a period of 45 days from the date of receipt of its certified copy, failing which, the said amount was to entail penal interest.

8. Against above said order, this appeal has been filed by the appellant with a prayer that the order passed above, be modified only to the extent that the Health Insurance Policy valid between 15.6.2014 to 14.6.2016 be reinstated, which was cancelled/terminated by the opposite party, on 05.06.2015, with all the benefits, which would be available to the