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VINOD S. BHARDWAJ
Bajaj Allianz General Insurance Company Ltd. – Appellant
Versus
Permanent Lok Adalat, Gurgaon – Respondent
JUDGMENT
Mr. Vinod S. Bhardwaj, J. (Oral)
Challenge in the present petition is to the award dated 12.04.2017 passed by the Permanent Lok Adalat (Public Utility Services), Gurgaon, whereby the claim of respondent No.2-applicant has been allowed and the petitioner-Insurance Company has been directed to pay a sum of Rs.95,367/- to the respondent-applicant.
2. Briefly summarized the facts of the instant case are that the respondent/applicant had purchased a mediclaim policy from the petitioner-Insurance Company, which was valid for the period from 07.07.2012 to 04.07.2013 and the same was further renewed upto 04.07.2014. On 11.12.2013, however, the respondent-applicant suffered a severe pain for which she was admitted in Aarvy Hospital, Gurgaon. She underwent a surgery for removal of large stone and was discharged from the hospital on 14.12.2013. The hospital raised a bill of Rs. 42,076/-. The respondent-applicant was however re-admitted in the hospital on 30.12.2013 and she remained admitted upto 04.01.2014 causing additional expenses of Rs.53,291/- towards her treatment. A claim in this regard was lodged by the respondent with the petitioner-Insurance Company for reimbursement but the
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Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured & beneficiaries.
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Insurance Policy – Ambiguity in coverage clauses of disease – Repudiation of claim not justified.
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