STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH First Appeal No.191 of 2024 Date of institution : 17.04.2024 Date of Reserve : 18.03.2025 Date of Decision : 09.04.2025 Kulwant Kaur, W/o Satnam Singh, S/o Prem Singh, aged about 42 years, R/o Sant Nagar, Amritsar Road, Moga-142 001.

…….Appellant/Complainant Versus Star Health and Allied Insurance Company Limited, through its Manager, SCF 12-13, Improvement Trust Market, above ICICI Bank, G.T.Road, Moaga-412 001.

…...Respondent/Opposite Party First Appeal under Section 41 of the Consumer Protection Act, 2019 against the Order dated 14.12.2023 passed by the District Consumer Disputes Redressal Commission Moga in CC No.20 of 2023.

Quorum:-

Hon’ble Mrs. Justice Daya Chaudhary, President Ms. Simarjot Kaur, Member Mr. Vishav Kant Garg, Member

1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No

2) To be referred to the Reporters or not? Yes/No

3) Whether judgment should be reported in the Digest? Yes/No Present :-

For the appellant : None For the respondent : Sh.Ravinder Arora, Advocate SIMARJOT KAUR, MEMBER M.A.No.521 of 2024 (Delay)

There is a delay of 85 days in filing of the Appeal, which is supported by an affidavit.

Reply to the Application has been filed by the Counsel for the Respondent and contesting the same.

For the reasons mentioned in the Application and reply thereof filed by the Respondent, the delay of 85 days in filing the Appeal is condoned. Main Case This Appeal has been filed by the Appellant/Complainant under Section 41 of the Consumer Protection Act, 2019 (in short ‘The Act’) being aggrieved by the impugned Order dated 14.12.2023 passed by the District Consumer Disputes Redressal Commission Moga (in short ‘the District Commission’) whereby the Complaint of the Complainant had been disposed off.

2. It would be apposite to mention that hereinafter the parties will be referred, as had been arrayed before the District Commission.

3. Briefly, the facts of the case as made out by the Complainant before the District Commission are that the husband of the Complainant namely Satnam Singh had purchased a health Insurance Policy bearing No.P/211222/02/2022/000252. The OP had issued policy containing two pages only. They had not provided the terms and conditions of the policy. In the above said policy, the Complainant was the nominee by her husband. Unfortunately, the husband of the Complainant had expired due to snake bite on 11.09.2021. The insured had remained admitted in Harbans Nursing Home at Kot Ise Khan for treatment w.e.f. 09.09.2021 to 11.09.2021. During his treatment, he had expired in the hospital. After the death of the insured, the Complainant had lodged the claim with the OP for the release of benefits/claim under the policy. The Complainant had submitted all the original documents required by the OP to settle the claim. The factum of the death was duly registered with the Registrar of Births & Death, Punjab. Further she had stated that as an illiterate person she only knew how to sign in Punjabi. Therefore, at the time of lodging of the claim all the relevant forms/documents were filled up by the officials of the OP. She had disclosed the correct facts to the officials of the OP and had supplied the documents as sought them. Thereafter, the Complainant kept on contacting the office of the OP to know about the status of the claim on account of death of her husband, but no satisfactory reply was given by the OP. It was alleged that the OP Company kept on delaying the matter on one pretext or the other. Finally, the OP had rejected the claim of the Complainant. The repudiation of the claim by the OP was illegal and against law. Hence, the Complaint was filed by the Complainant by seeking direction to be issued to the OP to release the amount of sum assured alongwith other benefits of the policy on account of death of the husband of the Complainant.

4. Upon issuance of notice, OP had appeared and filed its written statement by rai