ADDITIONAL BENCH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH Date of Institution : 30.01.2023 Date of Reserve : 05.04.2024 Date of Decision : 25.04.2024

1. Star Health and Allied Insurance Company Limited, Regd. And Corporate Office at Sri Balaji Complex, 15, Whites Road, Chennai-600014 through its Head of Department/Authorized Signatory.

2. Star Health & Allied Insurance Company Ltd., Branch Office at

2^nd Floor, Khajuria Complex, Opp. Hotel Venice, Dhangu Road, Pathankot through its Branch Manager.

….Appellants/Opposite parties Versus Shreshta Devi wife of Vijay Kumar, resident of House No.663, Ward No.19, Gali No.4, Rulia Ram Colony, Gurdaspur.

…..Respondent/complainant First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 26.10.2022 of the District Consumer Disputes Redressal Commission, Gurdaspur.

Quorum:-

Mr.Harinderpal Singh Mahal, Presiding Judicial Member Mrs. Kiran Sibal, Member Present:-

For the appellants : Sh.Ravinder Arora, Advocate For the respondent : Ex-parte HARINDERPAL SINGH MAHAL, PRESIDING JUDICIAL MEMBER This appeal has been preferred by the appellants/opposite parties- Star Health & Anr. against the order dated 26.10.2022 passed by the District Consumer Disputes Redressal Commission, Gurdaspur (in short ‘District Commission’) whereby the complaint filed by the respondent/complainant under Section 35 of the Consumer Protection Act, (in short ‘the Act’) was decided and passed the following order:

“10. Finally, in the matter pertaining to the present complaint and in the light of the all above, we find and address the intentional ‘repudiation’ by the OP insurers as ‘deficiency in service’ and ‘unfair practices’ at play and thus ORDER the OP insurers to pay the insurance-claim of Rs.1,28,300/-, in full, to the herein complainant, in terms of the related policy with interest @6% PA from the date of complaint till actually paid, in full, besides to pay her Rs.15,000/- in lump sum as cost and compensation within 45 days of receipt of the certified copy of these orders otherwise the aggregated amount shall attract an additional interest @3% PA from the date of the orders till actually paid.”

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

2. In nutshell, the complainant obtained a Health Insurance Policy from the opposite parties i.e. Senior Citizens Red Carpet Health Insurance Policy-MED-PRD-070 bearing Policy No.P/211212/01/2021/003231 from 22.01.2021 to 21.01.2022 for the sum assured of Rs.10,00,000/- by paying the premium of Rs.26,550/-. On 23.12.2021, the complainant suffered HIP problem and she got admitted in Amandeep Hospital, Amritsar on 23.12.2021, where she got the treatment and spent a huge amount on her treatment. The opposite parties provided cashless facility but the said service did not work in the hospital and was compelled to pay the amount in cash. The complainant then raised health insurance claim of Rs.1,28,300/- from the opposite parties but they illegally repudiate the claim of the complainant, vide letter dated 27.12.2021 on the pretext that she has been suffering from NONHODGKINS YMPHOMA. It is submitted that the complainant was previously affected with Cancer problem but she took best treatment and her disease was remove in September, 2010 and no symptoms of cancer disease was found in complainant and got the Fully Cured Report. This act and conduct of the opposite parties for denying the genuine claim compelled the complainant to approach the District Commission seeking following reliefs:

i) to pay the claim amount of Rs.1,28,300/-;

ii) to pay Rs.1,00,000/- as compensation for mental and physical harassment; and iii) to pay Rs.20,000/- as litigation expenses.

3. Upon notice, opposite parties appeared and filed their written reply taking preliminary objections that the complainant has no cause of action. The parties are bound with terms and conditions of the p