STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND DEHRADUN Date of Admission: 25.11.2020 Date of Final Hearing: 31.10.2025 Date of Pronouncement: 12.11.2025 SC/5/A/143/2020

1. Bajaj Allianz General Insurance Company Limited through its Branch Manager at International Trade Tower, 2^nd Floor, 1, Old Survey Road Above Bank of Baroda, Near Crossroad Mall Dehradun – 248001, Uttarakhand

2. Bajaj Allianz General Insurance Company Limited through its Director, Bajaj Finserv

3^rd Floor, Survey No. 208/1-B, Viman Nagar Pune – 411014

3. Bajaj Allianz General Insurance Company Limited through its Director, 2^nd Floor, Bajaj Finserv Building Survey No. 208/B-1, Behind Weikfield IT Park Off Nagar Road, Viman Nagar, Pune – 411014 (Through: Sh. Deepak Ahluwalia, Advocate)

…… Appellants Versus Sh. Manoj Singh S/o Sh. Amarnath Singh R/o Akashdeep Colony Enclave, Phase-2 Roorkee, Tehsil Roorkee District Haridwar, Uttarakhand (Through: Sh. Shree Gopal Narsan, Advocate)

…… Respondent Coram:

Ms. Kumkum Rani, President Mr. B.S. Manral, Member

ORDER

(Per: Ms. Kumkum Rani, President):

This appeal under Section 41 of the Consumer Protection Act, 2019 has been directed against the impugned judgment and order dated 29.09.2020 passed by learned District Consumer Disputes Redressal Commission, Haridwar (hereinafter to be referred as “The District Commission”) in consumer complaint No. 190 of 2019, styled as Sh. Manoj Singh Vs. Bajaj Allianz General Insurance Company Limited and others, wherein and whereby the consumer complaint was allowed and the appellants / opposite parties were directed to pay compensation of Rs. 1,77,705/- to the respondent / complainant together with interest @6% p.a. from the date of filing of the consumer complaint, i.e., 02.07.2019 till payment and Rs. 5,000/- towards costs. 2. The facts giving rise to the present appeal set out in the consumer complaint are that believing upon the version of agent of the appellants / opposite parties (insurance company), the respondent / complainant had purchased / obtained a mediclaim insurance policy from the insurance company for himself, his wife and child for insured sum of Rs. 5,00,000/-, upon online payment of premium of Rs. 1,023/- by way of deduction from his account on 22.10.2017. The aforesaid amount is used to be deducted from the complainant’s account every month and remitted / credited to the account of the insurance company. On 26.01.2019, the complainant felt chest discomfort, whereupon he was admitted in Matrachhaya Hospital, Roorkee, where Dr. Ajay Singh Panwar got certain tests done and the complainant came to know about the diagnosis four days’ ago, as was mentioned by the aforesaid doctor in the prescription dated 26.01.2019 and the doctor advised him for coronary angiography. Thereafter, on 01.02.2019, the complainant visited Max Super Speciality Hospital, Dehradun in regard to his treatment, where after examination by Dr. Punish Sadana and other doctors, he was got admitted in the hospital. In regard to the disease of the complainant, Dr. Punish Sadana informed the insurance company on 01.02.2019 by submitting cashless request form, wherein the diagnosis was mentioned as “unstable angina”. Upon admission in the hospital, the complainant was checked-up by Dr. Punish Sadana and on the basis of cashless policy, the treatment of the complainant was started. Inspite of obtaining cashless policy by the complainant, the insurance company refused to pay the expenses incurred in complainant’s treatment, to the insurance company, whereas the disease “angina” suffered by the complainant does not falls under exclusion clause No. C2 of the insurance policy. After arranging the funds from his known and friends, the complainant honoured the medical bill of Rs. 1,77,705/- raised by the hospital and got himself discharged on 06.02.2019. Thereafter, the complainant submitted claim form with the insurance company along with requisite documents, but the claim was not settled by the insurance comp