STATE CONSUMER DISPUTES REDRESSAL COMMISSION PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH Date of Institution : 13.12.2022 Reserved on : 16.10.2024 Date of Decision : 07.11.2024

1. Care Health Insurance Limited (Earlier known as Religare Health Insurance Company Limited) Registered office at 5^th Floor, 19 Chawla House, Nehru Place, New Delhi-110019, through its Managing Director.

2. Care Health Insurance Limited (Earlier known as Religare Health Insurance Company Limited), 1^st Floor, Golden Plaza Mall, The Mall Road, Near Fountain Chowk, Ludhiana, through its Manager.

……..Appellants/Opposite Party No.1 & 2 Versus Ravinder Nath Gupta, R/o H.No.28-C, Moti Nagar, Ludhiana.

…..Respondent/Complainant Appeal under Section 41 of Consumer Protection Act, 2019 to challenge the orders dated 15.09.2022 passed in RBT/CC No.79 of 2018 by the District Consumer Disputes Redressal Commission, Ropar Camp Court at Ludhiana. Quorum:-

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

For the Appellants : Ms. Niharika Goel, Advocate for Sh. P.M. Goyal, Advocate For the Respondent : Sh. Ramesh Goyal, Advocate

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 JUSTICE DAYA CHAUDHARY, PRESIDENT:-

The Appellants/OPs No.1 and 2 i.e. Care Health Insurance Limited & another have filed the present Appeal under Section 41 of the Consumer Protection Act, 2019 (in short the ‘Act’) to set aside the impugned order dated 15.09.2022 passed in RBT/CC No.79 of 2018 by the District Consumer Disputes Redressal Commission, Ropar Camp Court at Ludhiana (in short the “District Commission”) whereby the CC had been allowed.

2. Briefly, the facts of the case of the Complainant as made out by the Complainant Ravinder Nath Gupta in the Complaint filed before the District Commission are that the Complainant had purchased Star Health & Allied Insurance Company Limited for the period w.e.f. 27.07.2011 to 26.07.2013 by disclosing the facts regarding his pre-existing ailment and recoveries including paralysis problem i.e. Cv3. Thereafter, he ported his policy from the said Company to OP Company and he had also disclosed all the old details to the representatives of the OPs. At the time of portability of the Policy from Star Health to OP Company, OP Company had taken into possession the entire old record of the Complainant and OPs were well aware about the same. The team of doctors of the OPs had also medically examined the Complainant during the time of portability and prior to grant of Policy. The Complainant had suffered heart problem and he had taken the treatment from DMC Hero Health Institute, Ludhiana for the period w.e.f. 16.03.2017 to 27.03.2017 and had incurred expenses to the tune of Rs.3,04,600/-. The Complainant had lodged the Claim with the OPs but it was denied on the ground of pre-existing disease. The Complaint was filed by the Complainant before the District Commission with the following prayers :-

i) To pay the claim amount of Rs.3,04,600/-;

ii) To pay Rs.1,00,000/- on account of mental tension, harassment and pain; and iii) To pay Rs.20,000/- as litigation expenses.

3. Notice in the Complaint was issued to the OPs and in response thereof, the OPs had appeared before the District Commission and filed their written response wherein certain preliminary objections were raised. Other averments made in the Complaint were also denied. It was also mentioned in the reply that the Complainant had not approached the District Commission with clean hands and certain material facts were misrepresented and concealed from the Court. Further it was mentioned that the Complaint was not maintainable and it was filed with false and frivolous allegations whereas no cause of action had arisen to file the Complaint. By mentioning wrong facts, the Complainant had made efforts to mislead the Cour