NIRZAR S. DESAI
Star Health and Allied Insurance Co. Ltd. – Appellant
Versus
Kalpeshkumar Pandya – Respondent
ORDER :
1. By way of this petition, which, prima facie, this Court believes that is nothing but abuse and misuse of process of law at the hands of insurance company, the petitioner challenged the judgment and award dated 29.07.2022 passed by the Insurance Ombudsman, Ahmedabad in Complaint No.AHD-H-044-2122-0897 on the ground that the same is illegal and wrong.
2.1 In the nutshell, it is the case of the insurance company that though the policy holder, who availed mediclaim from the insurance company for a validity period upto 18.10.2020 and was subsequently renewed thereafter for a sum insured of Rs.5 Lakhs and though the period of hospitalisation of policy holder was between 26.09.2020 till 24.10.2020, when a claim was raised by the policy holder, the insurance company proceeded the claim of the petitioner only upto the validity period of the petitioner and paid a sum of Rs.5/ Lakhs.
2.2 The total bill placed by policy holder was Rs.7,06,385/-.
2.3 It is the case of the petitioner that as per the 2016 Regulations which is named as Insurance Regulatory and Development Authority of India (‘IRDA’, for short), the petitioner is not entitled to aforesaid claim.
3.1 Learned advocate for the p
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