IN THE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 700 OF 2025 (Against the order dated 25.02.2025 in Appeal No. 761 of 2023 of the State Consumer Disputes Redressal Commission, Punjab)

WITH IA/5799/2025 (Stay)

New India Assurance Company Ltd.

Through its duly Constituted attorney, Manager, Core-Ill, Scope Minar Laxmi Nagar, District Center New Delhi- 110092 Petitioner Versus Amit Walia R/o H.No. 185, Phase-VI, S.A.S. Nagar Mohali, Pin- 160055 Respondent BEFORE:

HON’BLE MR. JUSTICE SUDIP AHLUWALIA, PRESIDING MEMBER HON’BLE DR. SADHNA SHANKER, MEMBER For the Petitioner •: Mr. C.K. Gola, Advocate (through video conferencing)

For the respondent : In Person Pronounced on : IT October, 2025

ORDER

DR.SADHNA SHANKER, MEMBER

1. This revision petition has been filed under section 58(1 )(b) of the Consumer Protection Act, 2019 in challenge to the Order dated 25.02.2025 of the State Consumer Disputes Redressal Commission, Punjab (hereinafter referred to as the ‘State Commission’) in Appeal no. 761 of 2023 arising out of an order <4 dated 09.08.2023 of the District Consumer Disputes Redressal Commission, SAS Nagar (Mohali) (hereinafter referred to as the ‘District Commission’) in complaint no. 399 of 2020.

2. We have heard learned counsel for the petitioner (hereinafter referred to as the ‘insurance company’) and respondent and perused the record including the Order dated 09.08.2023 of the District Commission, the impugned order dated 25.02.2025 of the State Commission and the petition.

3. Brief facts of the case are that on 28.05.2018 the complainant had purchased health insurance cashless policy bearing No. 350108341828000004 on 28.05.2018 from the insurance company by paying premium of Rs.21,454/-for the period from 29.05.2018 to 28.05.2019 and the same was in continuation to earlier two policies purchased by the complainant from Bajaj Allianz General Insurance Co. Ltd. for the period from 29.04.2016 to 28.05.2017 and from 29.05.2017 to 28.05.2018. Unfortunately, on 29.04.2019, the complainant became ill and was got admitted at Fortis Hospital, Mohali for emergency treatment for the first time after the purchase of the policy. The insurance company refused to entertain the initial part payment despite the fact that the policy in question was for cashless treatment. The complainant alleged that the doctors of the hospital, initially diagnosed the ailment as a heart attack, but later on after conducting many tests, it came to know that the ailment was due to pain in Pancreas. However, the insurance company denied the claim on flimsy ground that the complainant was Chronic Alcoholic. The refusal by the insurance company to make the payment to the hospital merely taking shelter of pre-

existing disease, amounted to deficiency in service on its part.

4. The complainant filed a complaint before the District Commission, claiming the release of entire expenses of Rs.3,65,075/- paid to Fortis Hospital, along with compensation of Rs. 1 lakh towards harassment with interest at the rate 18%

from the date of due amount and litigation expenses.

5. The District Commission, vide its impugned Order dated 09.08.2023, partly allowed the complaint and directed the insurance company to reimburse to the complainant an amount of Rs.3,65,075/- along with interest @ 9% p.a. from the date of repudiation along with Rs.15,000/- as compensation for mental agony, harassment as well as litigation expenses.

6. Being aggrieved by the said Order dated 09.08.2023 of the District Commission; the insurance company filed an appeal before the State

1 Commission.

7. The State Commission, vide its Order dated 25.02.2025, dismissed the appeal upholding the order of the District Commission.

8. Being aggrieved by the Order dated 25.02.2025 of the State Commission; the insurance company has filed the instant revision petition before this Commission seeking setting aside of both the orders of District as well as State Commission and allow the present Revision P