STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH.

First Appeal No.172 of 2024 Date of institution : 08.04.2024 Reserved on : 01.08.2025 Date of Decision : 22.08.2025

1. Star Health and Allied Insurance Company Limited, 3^rd Floor, Nirmal Complex, EH-198, Civil Lines, G.T.Road, Jalandhar- 146001 through its Branch Manager having having its office at 2^nd Floor, Daily Tej Building 8-B, Bahadur Shah Zafar Marg, New Delhi-110002 through its Authorized Person.

2. Star Health and Allied Insurance Company Limited, Regd. Office-

1, New Tank Street, Valluvar, Kottam High Road, Nungambakkam, Chennai-600034 through its Managing Director having its office at 2^nd Floor, Daily Tej Building 8-B, Bahadur Shah Zafar Marg, New Delhi-110002 through its Authorized Person.

….Appellants/Opposite Parties Versus

1. Karanbir Singh (aged about 35 years) S/o Sh.Santokh Singh.

2. Kiranjit Kaur (aged about 36 years) W/o Karanbir Singh.

Both residents of H.No.B-16/265, Mohalla Prem Nagar, Nawanshahr, District SAS Nagar. ….…Respondents/Complainants First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 30.01.2024 passed by the District Consumer Disputes Redressal Commission, SBS Nagar, Nawanshahr in CC No.209 of 2023.

Quorum:-

Hon’ble Mrs. Justice Daya Chaudhary, President Ms. Simarjot Kaur, Member Mr. Vishav Kant Garg, 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 appellants : Sh.Neeraj Khanna, Advocate (through VC)

For the respondent : Sh.Vikas Kumar Gupta, Advocate SIMARJOT KAUR, MEMBER :

The Appellants/Opposite Parties have filed the present Appeal to challenge the impugned order dated 30.01.2024 passed by the District Consumer Disputes Redressal Commission, SBS Nagar, Nawanshahr (in short, “the District Commission”), whereby the Complaint filed by the Complainant had been allowed

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

3. Briefly, the facts of the case as made out by the Complainant in the Complaint filed before the District Commission are that the Complainant had purchased Health Insurance Policy No.P/161125/01/2023/005105 issued by OPs No.1&2 for himself and his family. At the time when the aforesaid offer was made by the official of OPs, an assurance was given to Complainant No.1 that it was a cashless policy. It was further informed by the OPs that said Insurance Policy would cover all types of sickness and medical treatment etc. The amount spent on such medical treatment would be reimbursed. The clam amount would be disbursed within a period of one week from the date of lodging the claim. The Complainants were covered under the Health Insurance Policy w.e.f. October 2020. A premium for renewal of Insurance Policy was paid. In October 2022, the Complainant No.2 had suffered a problem of irregular cycle of menses and her body had started gaining weight. Due to said reason, the Complainant No.2 got treatment/medicine from PGI but she did not get any relief from there also. Further, she had taken treatment from Fortis Hospital, Ludhiana also but from there also she did not get any relief. Thereafter, she had taken treatment from Jammu Hospital Jalandhar where a doctor of said hospital had advised her to undergo Mini Gastric Bypass Surgery. At that time, the Complainants had requested the said hospital for cashless treatment. However, the OPs had denied on the ground that there was a mismatch between the height of the insured in the Proposal Form and in the indoor treatment record. Accordingly, the OPs had rejected the preauthorization request for cashless treatment twice. The doctor had requested OPs to reconsider the matter. Due to said reason, the Complainants had suffered mental agony/harassment. They had spent more than Rs.4,00,000/- and paid an amount o