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VISHAV KANT GARG, DAYA CHAUDHARY, SIMARJOT KAUR
Oriental Insurance Co. – Appellant
Versus
Raj Kumar Rattan – Respondent
JUDGMENT
Vishav Kant Garg, Member.—Insurance Co., has filed the present Appeal through its Authorized Representative to challenge the impugned order dated 24.02.2025 passed by the District Consumer Disputes Redressal Commission, Barnala (in short, “the District Commission”), whereby the Complaint filed by the Respondents Nos.1 and 2/Complainants-Raj Kumar Rattan & Anr. had been partly allowed.
2. It would be apposite to mention here that hereinafter the parties will be referred, as were arrayed before the District Commission.
3. Briefly, the facts of the case as made out by the Respondents Nos.1 and 2/Complainants in the Complaint filed before the District Commission are that the Complainants had purchased PNB-Oriental Mediclaim Group Health Insurance Policy, valid for the period w.e.f. 28.02.2022 to 27.02.2023, having floater basic sum insured of Rs.5,00,000/-, on paying premium of Rs.34,890/-. They had purchased the first policy in the year 2018 and there was no break till that. At the time of issuance of the policy, the medical check-up of the Complainant No.1, his wife and daughter was done.
4. It was averred that Complainant No.2 had suffered the problem of Ruq Pain, Nausea, Vom
Contract of insurance – Since the policy was held/renewed for 5 years, the plea of non-supply of terms and conditions is not tenable; the insured should have agitated this earlier.
Insurance – PNB Metlife Mera Term Plan Policy – Repudiation of death claim on the ground of misrepresentation of material facts by Deceased Life Insured is justified.
Wrong Document – Petitioner/Insurance Company placed a wrong document before the District Forum and this Commission. Such an action is not expected from a public sector Insurance Company like the Pet....
Once there is a valid insurance policy available in favour of appellant, claim made by him for reimbursement of expenses incurred is justifiable and deserves to be paid to him.
(1) Proof of delivery - In the absence of proof of delivery, therefore, Commission cannot rely solely on the Respondent’s statement before the District Commission that it had duly supplied the terms ....
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