STATE CONSUMER DISPUTES REDRESSAL COMMISSION PUNJAB, DAKSHIN MARG, SECTOR -37 A, CHANDIGARH Date of Institution : 24.03.2022 Reserved on : 12.10.2022 Date of Decision : 02.11.2022 Future Generali India Insurance Company Limited, Head Office-Unit No.801 & 802, Tower C, 247 Embassy Park, LBS Marg, Vikhroli (West), Mumbai-400083, Maharashtra.

Also at 63, 3^rd Floor, SCO No.5 and 6, PUDA Complex, Jalandhar-

144001 ……..Appellant/Opposite Party Versus Chander Bhatia S/o Vasudev Bhatia, R/o Ward No.4, Balachaur, Tehsil Balachaur, Nawanshahar, Shaheed Bhagat Singh Nagar, Punjab-144514.

…..Respondent/Complainant First Appeal under Section 41 of Consumer Protection Act, 2019 against orders dated 24.12.2021 passed by the District Consumer Disputes Redressal Commission, Shaheed Bhagat Singh Nagar.

Quorum:-

Hon’ble Mrs. Justice Daya Chaudhary, President Mrs. Urvashi Agnihotri, Member Present:-

For the appellant : Sh. Arjun Kundra, Advocate For the respondent : Sh. Kapil Khanna, 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 JUSTICE DAYA CHAUDHARY, PRESIDENT:-

The appellant/opposite party i.e. Future Generali India Insurance Company Limited has filed the present appeal under Section 41 of the Consumer Protection Act, 2019 as amended upto date (in short the ‘Act’) being aggrieved by the impugned order dated 24.12.2021 passed in Consumer Complaint No.36 of 2021 by the District Consumer Disputes Redressal Commission, Shaheed Bhagat Singh Nagar (hereinafter referred as the “District Commission”) whereby the complaint filed by respondent-complainant had partly been allowed by directing OPs to pay a claim amounting to Rs.4,24,270/- to the complainant alongwith interest @6% per annum from the date of filing the complaint till its realization and also issuing direction to pay a compensation of Rs.5000/- for mental harassment and also Rs.5000/- to be deposited in the Legal Aid Account of the District Commission. The compliance of the order was to be made within a period of 45 days from the date of receipt of copy of the order.

2. There was a delay of 42 days in filing the appeal. M.A. No.420 of 2022 was filed for condonation of delay which was supported by an affidavit. Said delay was condoned vide order dated

28.03.2022 and M.A. was disposed of.

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

4. Briefly, the facts of the case which are necessary for disposal of the present appeal are that the respondent/complainant filed a complaint before the District Commission stating therein that he was holder of Insurance Policy issued in his name as well as his wife Ritika Rani and daughter Gurnoor. The complainant, his wife and daughter were stated to be regular customers of the OPs from the year 2017 till July 2020. The complainant suffered from Pancreatitis with Peripancreati Collections and he got medical treatment from Dayanand Medical College & Hospital, Ludhiana (in short ‘DMC’) and remained admitted in the said Hospital from 26.07.2019 to 06.09.2019. He spent an amount of Rs.4,24,270/- towards his treatment. The complainant approached OP-Insurance Company by submitting medical bills with the request to pay the amount incurred by him but on one pretext or the other, the matter was put off and ultimately it was declined vide letter dated 09.01.2020. The following prayer was made in the complaint:-

“OP be directed to make payment of Rs.4,24,270/- on the basis of the insurance policy “Health Total – Family Floater” pertaining to medical expenses incurred by the complainant on his treatment alongwith interest and compensation.”

5. Notice was issued in the complaint to the OP who appeared through counsel and filed reply wherein certain preliminary objections were raised about the maintainability of the complaint and opposed the averment