STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH.

Date of institution : 29.12.2021 Reserved On : 12.08.2022 Date of decision : 06.09.2022 The New India Assurance Company Ltd., Divisional Office No.5, G.T. Road, Miller Ganj, near Manju Cinema, Ludhiana, through its Senior Divisional Manager, now through its duly Constituted Attorney Sh.

Amrit Pal Singh, Manager.

….Appellant/Opposite Party No.1 Versus

1. Gurmala Devi w/o Sh. Suresh Gupta, R/o Flat No.305, Basera Heights, South City, Ludhiana.

….Respondent/Complainant

2. Raksha TPA Pvt. Ltd., SCO 181, Sector 7-C, Chandigarh.

….Respondent/Opposite Party No.2 First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 02.11.2021 passed by the District Consumer Disputes Redressal Commission, Ludhiana.

Quorum:-

Hon’ble Mrs. Justice Daya Chaudhary, President Mrs. Urvashi Agnihotri, 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. Paul S. Saini, Advocate For respondent No.1 : Sh. Chandan Deep Singh, Advocate For respondent No.2 : None.

JUSTICE DAYA CHAUDHARY, PRESIDENT Appellant/opposite party No.1 i.e. The New India Assurance Company Limited has approached this Commission by way of filing the present appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 02.11.2021 passed by the District Consumer Disputes Redressal Commission, Ludhiana (in short, “the District Commission”) in CC No.567 of 2013, whereby the complaint filed by the respondent/complainant namely Gurmala Devi was allowed by directing the opposite parties to consider and pay four claims i.e. ₹1,12,857/- (₹24,523/-, ₹30,053/-, ₹26,838/- and ₹31,443/-) to respondent No.1/complainant stating to be in accordance with the terms and conditions of the policy along with interest at the rate of 6.5% per annum from the date of filing of the complaint till its payment. The opposite parties were also directed to pay compensation of ₹5,000/- to the complainant. The compliance of the order was to be made within a period of 40 days from the date of receipt of copy of the order.

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

3. Briefly, the facts of the case as made out by the respondent/complainant before the District Commission are that he purchased a ‘Hospitalization & Domiciliary Hospital Benefit Policy’ from the appellant/opposite party No.1 for the first time on 12.05.2008. Said policy was renewed by the opposite party No.1 on payment of premium. Thereafter, again the policy was renewed from 09.06.2010 to 08.06.2011 after examination of the complainant by the doctors of opposite party No.1 as per medical report dated 02.06.2010. The policy was further renewed from 09.06.2011 to 08.06.2012. It has further been mentioned in the complaint that the complainant lodged/submitted her claim of treatment expenses of ₹24,523/- incurred while remained admitted in the CMC Hospital, Ludhiana from 14.01.2011 to 15.01.2011 on account of treatment of bilateral watering of eyes. The complainant was operated on 14.01.2011 for Right Endoscopic Dacrocystorhinastomy under G.A.

4. The claim lodged by the complainant was not settled by the opposite parties within the reasonable period in-spite of recommendation by the opposite party No.1 to reconsider. However, vide letter dated 16.09.2011 the opposite party No.2 called upon the complainant to provide the certificate of the continuation of the policy without any delay. The claim was again lodged for reimbursement of medical expenses in respect of her treatment from 14.04.2011 to 16.04.2011 for a sum of ₹30,053/- in CMC & Hospital, Ludhiana but still the opposite parties did not settle/pay the claim. It was further mentioned in the complaint that the complainant further lodg