STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH First Appeal No.277 of 2022 Date of institution : 11.04.2022 Date of Reserve : 24.02.2025 Date of Decision : 06.03.2025 Oriental Insurance Company Limited, 4501 Bank Street, Bathinda, through its Divisional Manager.

Now through its Manager at Regional Office, SCO No.109-111, Sector

17-D, Chandigarh.

…….Appellant/Opposite Party No.1 Versus

1. Kewal Krishnan Aggarwal, son of Des Raj, Resident of Kothi No.4, Veer Colony, Amrik Singh Road, Bathinda.

2. Ravinder Aggarwal since deceased now represented through its Legal Representative:-

Kewal Krishnan Aggarwal, son of Des Raj, Resident of Kothi No.4, Veer Colony, Amrik Singh Road, Bathinda.

…….Respondents No.1&2/Complainants

3. Raksha Health Insurance TPA Pvt. Ltd., First Floor, 14/3, Main Mathura Road, Faridabad-121003, through its Manager/Authorized Signatory.

………Respondent No.3/Opposite Party No.2 First Appeal under Section 41 of the Consumer Protection Act, 2019 against the Order dated 03.01.2022 passed by the District Consumer Disputes Redressal Commission Bathinda in CC No.181 of 2018.

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 : Sh. Arjun Kundra, Advocate For respondents No.1&2 : Sh. Nitish Garg, Advocate For respondent No.3 : None SIMARJOT KAUR, MEMBER This Appeal has been filed by the Appellant/Opposite Party No.1 under Section 41 of the Consumer Protection Act, 2019 (in short ‘The Act’) being aggrieved by the impugned Order dated 03.01.2022 passed by the District Consumer Disputes Redressal Commission Bathinda (in short ‘the District Commission’) whereby the Complaint of the Complainant had been partly allowed.

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 Complainants before the District Commission are that the Complainants were having Bank Account with Oriental Bank of Commerce, Bathinda. The OP No.1 had issued one Medi-claim Insurance Policy to the Complainants i.e. policy No.233200/48/2018/2859 w.e.f. 23.12.2017 to 22.12.2018 under cashless scheme through OBC, Bathinda. Raksha Health Insurance TPA Pvt. Limited was the TPA-OP No.2 under the said scheme for the account holders of Oriental Bank. A cashless card was also issued in this regard. The Complainants i.e. Kewal Krishan Aggarwal and Ravinder Aggarwal were duly insured for sum of Rs.5 lac each under the aforesaid policy. The OPs had not issued complete policy along with the terms and conditions to the Complainants till date, only the Insurance Certificate was issued. Said Insurance Policy was a continuous policy since 2013. During the subsistence of the said scheme, Complainant No.2-Ravinder Aggarwal had filed his mediclaim which was rejected by the Insurance Company. Thereafter, they had paid the claim through Court i.e. Permanent Lok Adalat. At that time, during the proceedings of the Court, the OPs had renewed the Insurance of the Complainants. Under the renewed policy, the OPs had assured the Complainants that in case of any emergency, the claim could be lodged anywhere in India with the nearest office of the OPs. The insured could be admitted in any hospital in India.

4. It was further averred in the Complaint that Complainant No.2 had suddenly started vomiting. The Complainant No.1 got her admitted in Max Hospital Bathinda on 24.03.2018 and she was discharged on 28.03.2018. The OPs had once again denied the cashless facility when Complainant No.2 was in hospital. The Complainant No.2 had again started vomiting and admitted in Max Hospital Bathinda on 12.04.2018 and discharged on 14.04.2018. In the second admission in Max Hospital, the OPs