Details	DD	MM	YY
Date of Judgment	29	04	2022
Date of filing	16	05	2019
Duration	13	11	02

IN THE CONSUMER DISPUTES REDRESSAL COMMISSION GUJARAT STATE, AHMEDABAD APPEAL NO. 432 of 2019 Court No. 1 The National Insurance Co. Ltd., Through it’s Authorized Signatory, Regional office, II Flor, Dr IT Patel trust building, Tilak Road, Vadodara. …Appellant Vs

1. Mukesh Shah (Trusty- President)

Helpline Grahak Mandal Shop no. 63, Second floor, Hirachand Mension Besides OBC Bank, Nr. Kothi noi pol, Ravpura Vadodara.

2 (1) Parulben A. Tambodi w/o of Ashokbhai G. Tambodi

2 (2) Sanket A. Tambodi 2 (3) Twinkle A. Tambodi Near Vrajdham Mandir, Manjalpur, Vadodara. …Respondents APPERANCE : Mr. R. P. Trivedi, ld. Advocate for the appellant.

Mr. Samir Doshi, ld. advocate for the respondents.

Coram : Hon’ble Mr. Justice V. P. Patel, President Mr. I.D. Patel, Judicial Member Ms. A.C. Raval, Member Order: (By Ms. A.C. Raval, Member)

1. Appellant has filed this appeal under section 15 of the Consumer Protection Act 1986, being aggrieved and dissatisfied with the judgment and order dated 15.04.2019 Passed by the Consumer Disputes Redressal Commission, Vadodara (for short Learned District Commission) in Consumer case no. 01/2016.

2. Heard learned advocate Mr. R. P. Trivedi, for the appellant and learned Advocate Mr. Samir Doshi for the respondents. Perused the record of the case and judgment and order passed by the ld. District commission.

2.1 The appellant here in is the original opponent and respondents is complainant no.1 and no. 2. (Herein after the appellants and respondents will be referred as per their original status)

Facts of the case of the complaint :

3. Complainant No. 1 Helpline Consumer Board which is a board registered under Bombay Public Trust Act 190 and Gujarat Society Registered Act 120. They are engaged in the activity of giving justice to the consumers. They are the representative of complainant No. 2. Complainant No. 2 has been taking Medi-claim policy since 2006 which policy is renewed from time to time. Thus there is a consumer insurance relationship between the complainant and opponent. The last policy of the complainant was of Rs. 3,00,000/- for the period from 24.02.2015 to 27.02.2015. And the complainant underwent treatment for vomiting, weakness, weight loss etc. from Dr. Vipul Bhavsar on 28.06.2015 and the cost was Rs. 5,993/-. Thereafter, he was admitted to Dr. Kishan N. Jani’s hospital on 29.06.2015 and was treated as an indoor patient till 07.07.2015. The total cost of these two treatments is Rs. 1,33,955/-. The insurance company stated that the diseases is result of due consumption of alcohol. So the insurance company had repudiated the claim as per policy condition no. 4.8. Being aggrieved by the repudiation of claim, complainant filed Consumer Compliant No.

01/2016 before the District Commission Vadodara.

Order under challenge :

4. The District Commission has partly allowed the complaint and opponent were directed to pay Rs. 1,39,955/- with 8% interest within two months from the date of complaint. It is further order that opponent shall pay Rs. 1,000/- as mental torture and Rs. 2,000/- as cost of proceeding to the complainant.

Argument of the Appellant :

5. Learned advocate for the appellant has argued that the judgment and order is patently illegal, contrary to the documentary evidence on record, policy conditions and coverage granted. Order is against the settle principles of laws, dehorns the provisions of the Act and hence liable to be quashed and set aside. That the Learned District Commission had erred in considering the terms & condition of the policy. Ld. Forum has not considered the Medical case Papers, Discharge summary of treating hospital and policy terms and conditions, which has resulted in gross injustice to the appellant and evidence produced in support thereof, therefore also it is liable to be quashed and set aside. It is pertinent to note that the trial under Consumer Forum is of summary trial. So th

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