JUDGMENT

Vinod S. Bhardwaj J. (Oral)

The instant petition has been filed seeking quashing of the impugned award/order dated 21.04.2022 (Annexure P-1) passed by Permanent Lok Adalat (Public Utility Services), Gurugram, whereby the application filed by respondent No.2-claimant under Section 22 -C of the Legal Services Authorities Act, 1987 has been partly allowed and the petitioner-Insurance Company has been directed to pay an amount of Rs.60,000/- along with simple interest @ 6% per annum from the date of filing of the application till its realization along with Rs.5500/- as litigation expenses.

2. Briefly summarized, the facts of the present case are that husband of the respondent No.2-claimant had availed a Mediclaim policy bearing No.215301/48/2016/3895 for the period from 17.03.2016 to midnight of 16.03.2017 in the name of Amichand. The premium for the said policy was duly paid. The respondent No.2-applicant and her husband Amichand were insured under the said policy bearing No. MA-ID- 5022909716. However, on 09.01.2017, respondent No.2 fell on the floor in the washroom and sustained injuries. She was accordingly admitted in the Paras Hospital on 10.01.2017. Since respondent No.2 as well as her husband Amichand were insured under the same policy, a claim for cashless treatment was submitted by them with the petitioner-Insurance Company. The same was, however, rejected vide email/communication dated 12.01.2017. Hence, respondent No.2 had to spend the sum of Rs.60,000/- on her treatment from their own sources. It was also pointed out that as a result of injuries sustained during fall in the bathroom, there was a minute blockage apart from several minor injuries sustained by her. This was the first claim submitted by respondent No.2 and even the same was denied despite there being no outstanding bonus/premium to be deposited.

3. Aggrieved of the repudiation of the claim, an application under Section 22 -C of the Legal Services Authorities Act, 1987 was submitted by respondent No.2 before the Permanent Lok Adalat (Public Utility Services), Gurugram.

4. On notice, reply to the application was submitted by the petitioner-Insurance Company raising various objections regarding maintainability, jurisdiction and concealment of the true and material facts. It was contended on merits that respondent No.2 was well aware of the terms & conditions of the Mediclaim policy, however, the complete facts were not disclosed. It was further claimed that respondent No.2 is seeking claim pertaining to a pre-existing disease which is barred under the Mediclaim Insurance Policy and the said aspect is evident from the discharge summary issued by Paras Hospital, Gurugram. It has also been stated in the discharge summary that the patient was admitted under neurology for further evaluation and management and further that the claim of respondent No.2 about sustaining injuries by falling on the floor of the washroom was false, frivolous and concocted.

5. Efforts for reconciliation and amicable resolution of the issue were initiated by the Permanent Lok Adalat (Public Utility Services), between the parties but they failed to arrive at an amicable settlement. Consequently, adjudication of the dispute under Section 22 -C(8) of the Legal Services Authorities Act, 1987 was undertaken. Upon consideration of the evidence brought before the Permanent Lok Adalat and evaluation of the same, the Permanent Lok Adalat partly allowed the application of respondent No.2 and directed the petitioner-Insurance Company to release the amounts noticed above.

6. Aggrieved thereof, the present petition has been filed.

7. Learned counsel appearing on behalf of th