STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA First Appeal No. 1150 of 2017 Date of Institution: 26.09.2017 Date of Decision: 21.03.2022 Smt. Alka Nagar wife of late Captain Bharat Bhushan Nagar, resident of House No.99, Sector 19, Faridabad (Haryana).

Appellant-Complainant Versus

1. M/s National Insurance Company Limited, C-4, II Floor (C Floor Market), Paschim Marg, Vasant Vihar, New Delhi.

2. M/s National Insurance Company Limited, having its Divisional Office at 5C ½ Neelam Chowk, Faridabad (Haryana).

3. M/s Park Mediclaim TPA Pvt. Ltd, 702, Vikrant Tower, Rajendra Place, New Delhi-110 008.

4. Insurance Ombudsman Office, Universal Insurance Building, 9/2A, Asaf Ali Road, Delhi-110 002.

Respondents-Opposite Parties CORAM: Hon‟ble Mr. Justice T.P.S. Mann, President.

Ms. Manjula, Member.

Present: Shri Nihul Partap Singh, counsel for the appellant.

Shri J.P. Nahar, counsel for the respondents.

O R D E R

T.P.S. MANN, J.

Complaint preferred by Smt. Alka Nagar under Section 12 of the Consumer Protection Act, 1986 was allowed by the District Consumer Disputes Redressal Forum, Faridabad on 04.04.2016 and opposite parties No.1 to 3 directed to pay jointly and severally insured sum of Rs.5,00,000/- alongwith interest @ 9% per annum and Rs.10,000/- as compensation towards mental tension as well as harassment besides Rs.5,500/- as litigation expenses to the complainant. Opposite party No.4-Insurance Ombudsman was however absolved as it had no role in dealing with the claim case. The appeal preferred by opposite parties No.1 and 2 was dismissed by the State Commission on 28.11.2016. This was followed by opposite party- M/s National Insurance Company filing revision petition before the Hon‟ble National Consumer Disputes Redressal Commission, New Delhi, which was allowed on 09.05.2017 and the matter remanded to the District Consumer Forum. The consequent complaint was dismissed by the District Consumer Forum vide order dated 01.09.2017, which decision is now under challenge by the complainant by way of first appeal.

2. The brief facts of the complaint were that Captain Bharat Bhushan Nagar, husband of the complainant had obtained medical insurance policy bearing no. 8500000249 for the period 20.4.2009 to 19.4.2010 from Focus, K.G. Marg, New Delhi and on its expiry took Mediclaim Hospitalization Benefit policy bearing No. 354800/18/10/8500000053 under Parivar Benefit from opposite party No.1 for a sum of Rs.5,00,000/- valid from 20.4.2010 to 19.4.2011 covering himself, his wife i.e. the complainant and their son Jayant Nagar. At the time of taking policy in 2009 and on renewal of the policy the complainant‟s husband was not aware of any disease and he answered all the queries relating to his health in the application form for insurance. He was medically examined and all the formalities were observed by both the insurance companies as well as no objection was raised either at the time of taking policy or its renewal for the period 2010 to 2011. The policy was renewed purely on the basis of health fitness report of the complainant‟s husband given by their panelled doctors. In the morning of 7.11.2010 when husband of the complainant suddenly felt some problem, he had to be admitted in Sama Nursing Home, New Delhi and discharged on 9.11.2010. Thereafter he remained admitted in Mool Chand Hospital from 9.11.2010 to 10.11.2010 and was shifted to Apollo Hospital on the same day where he died on 18.11.2010. The complainant through her family members and the hospital authorities duly intimated said fact to opposite parties No.1 & 3 as well as completed all formalities as advised by said hospital. It was specifically brought to notice that said policy was cashless in nature and the complainant was not required to pay any amount but opposite parties nos. 1 to 3 kept on assuring verbally that the bills of hospitals would be reimbursed if the same were not paid during treatment. Due to non-payment of bills by opposite parties No.1 & 3 the compla