STATE CONSUMER DISPUTES REDRESSAL COMMISSION PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.

Date of Institution : 10.11.2022 Date of Reserve : 06.03.2025 Date of Decision : 25.03.2025 Harkanwal Singh aged about 51 years son of Gurbaksh Singh, Resident of Bathinda-Muktsar Road, Village Lohara, Tehsil Gidderbaha, District Mansa. ……..Appellant/Complainant Versus

1. Star Health & Allied Insurance Co. Ltd., Area Office:- 2716, 1^st Floor, Gagan Complex, Backside Majestic Park Plaza Hotel, Gurdev Nagar, Pakhowal Road, Ludhiana-141001, through its Manager/Authorized Signatory.

2. Star Health & Allied Insurance Co. Ltd., SCO 133, 2^nd Floor, above Tata Motor Finance, near Hotel Sweet Milan, Goniana Road, Bathinda-151001, through its Branch Manager/Manager/Incharge.

…….....Respondents/Opposite Parties

3. Religare Health Insurance Co. Ltd., Top Floor, SCO 56-58, Sector

9 D, Chandigarh, 160017, through its Branch Manager/Authorized Signatory.

……..Proforma Respondent/Opposite Party Appeal under Section 41 of the Consumer Protection Act, 2019 to challenge the order dated 30.08.2022 passed by the District Consumer Disputes Redressal Commission, Bathinda in C.C.No.314 of

2018.

Quorum:-

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

For the appellant : Sh.Nitish Garg, Advocate For respondents No.1&2: Sh.Vishal Sharma, Advocate for Sh.Punit Jain, Advocate For respondent No.3 : Ms.Niharika Goel, Advocate for Sh.P.M.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 SIMARJOT KAUR, MEMBER :-

The Appellant/Complainant has filed the present Appeal under Section 41 of the Consumer Protection Act, 2019, (in short the ‘Act’) for setting aside the order dated 08.02.2024 of the District Consumer Disputes Redressal Commission, Bathinda whereby the Complaint filed by the Complainant had been dismissed.

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

3. Briefly, the facts of the case as made out in the Complaint before the District Commission are that the Complainant had purchased Family Health Insurance Policy No. Policy No.P/211200/01/2017/000007 which was valid w.e.f. 01.04.2016 to 31.03.2017. He had got the said Policy renewed from time to time. The last renewal was w.e.f. 01.04.2018 to 31.03.2019 vide Policy No.P/211217/01/2019/000009. The said policy was for a coverage for an amount of Rs.20,25,000/- (Rs.15,00,000/- (+) Rs.5.25.000/- (Bonus)) for the Complainant and his family. The family members covered under the said policy were Complainant himself Harkanwal Singh, his wife Veerpal Kaur and their children Jashan Jot Kaur & Gurnoor Singh. The OPs No.1&2 had assured the Complainant at the time inception of the policy that this was cashless insurance and in case of any problem total treatment in any hospital in India is free and total medical expenses upto Rs.15,00,000/- would be paid/covered.

4. It was also averred that in the year 2018, suddenly the Complainant had suffered from Kidney disease. Further it was mentioned in the Complaint that prior to this, he was never admitted in any hospital for Kidney disease. He was admitted in Fortis Hospital, Mohali on 21.04.2018 and discharged on 28.04.2018 in emergency for Kidney transplant. In this regard, the claim was duly lodged with OPs No.1&2 under UHID No.001565136 IPD No. IPFHM0031205. The Fortis Hospital, Mohali was network empanelled Hospital for OPs No.1&2 and they were duty bound to provide cashless treatment. But said Hospital in connivance with the OPs No.1&2 did not provide cashless treatment. They had raised a bill for an amount of Rs.3,74,555/- from the Complainant on account of kidney transplant of the Complainant. Under the said Insurance, Policy an amount of Rs.1,00,000/- or 10% of Sum Insured whichever is le