IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION Date of Institution : 14.12.2016 Date of Reserving the order : 17.11.2025 Date of Decision : 08.01.2026 FIRST APPEAL NO.-572/2016 IN THE MATTER OF UNITED INDIA INSURANCE CO. LTD.

DELHI REGIONAL OFFICE NO.1, KANCHANJUNGA BUILDING, 8^TH FLOOR, BARAKHAMBHA ROAD, NEW DELHI-110001 …APPELLANT (Through: Ms. Nandita Saxena, Advocate Mob:9654055026, 9555577906 &

Email: nandita2412@gmail.com)

VERSUS MR. MOHINDER PAL SINGH, C-2/57, ASHOK VIHAR, PHASE-II, DELHI-110052 ……RESPONDENT (Through: Mr. Ashish S. Kulshrestha, Advocate Mob: 9811166164 Email: associatelawgroup@gmail.com)

CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE MS. PINKI, MEMBER (JUDICIAL)

Present : None for the appellant.

Mr Lalit Kumar, counsel for the respondent.

(Mob -9871654369 PER : HON’BLE PINKI, MEMBER (JUDICIAL)

JUDGMENT

1. By this judgment, we shall dispose of the appeal filed by the Appellant against the impugned order dated 30.05.2016, passed by Consumer Disputes Redressal Forum, (District New Delhi), (hereinafter referred to as District Forum), in Complaint Case no. CC-537/2011 titled ‘Mohinder Pal Singh vs. United India Insurance Co. Ltd.’, inter-alia praying for setting aside the order passed by the District Forum.

2. While the Appellant was Opposite Party before the District Forum and the Respondent was Complainant before the District Forum.

3. The facts of the case as per the District Forum, record are as under:

“The repudiation of the insurance claim of the complainant against Cashless Medical Health Policy by the OP has led the complainant file the present complaint under section 12 of The Consumer Protection Act, 1986 (in short Act) alleging, in brief, that the complainant obtained Cashless Medical Health Policy for the sum insured of Rs.6,00,000/- and paid an amount of Rs.16,976/- as premium to the OP and the OP issued a policy cover bearing number 042400/48/08/06/00000786 for insurance period 13/7/2008 to 12/7/2009. The complainant, his wife Mrs. Manjinder Kaur and daughter Ms. Guneet Kaur were covered under the policy. After a few days complainant also received identity cards from the OP. In the month of March 2009, the wife of complainant Mrs Manjinder Kaur was not well and approached the hospital for a checkup, but was refused cashless facility at the hospital. Despite the fact that the complainant had been informed at the time of taking policy that it was a cashless policy, the complainant had to bear surgery expenses in the sum of Rs. 2,86,126/- with Max Super Specialty Hospital while on account of Cashless Medical Health Insurance Policy in question the expenses should have been borne by the OP. The complaint has prayed for direction to the OP to pay the amount of the expenses incurred in surgery in the sum of Rs. 2,86,126/- and Rs.15,000/- for post-operative treatment, making the total amount in the sum of Rs. 3,01,126/- besides Rs.1,00,000/- towards mental harassment, pain, agony suffered by complainant despite having cashless policy from the OP. The complainant has also requested for any other or further order which this District Forum may deem fit and proper.”

4. The District Forum after taking into consideration the material available on record passed the judgment dated 30.05.2016, whereby it held as follows:

“We have heard the complainant and have gone through the written arguments filed on behalf of the complainant, record of the case and relevant provisions of law. None appeared on behalf of the OP for addressing oral arguments nor any written arguments are filed on behalf of the OP. No authority is produced from either side.

The basic facts of this case are not in dispute.

Undisputedly, the complainant obtained Cashless Medical Health Policy for the sum insured in the sum of Rs.600,000/- and paid an amount of Rs. 16,976/- as premium to the OP and the OP issued a policy cover bearing No. 042400/48/08/06/00000786 for insurance period 13/7/2008 to12/7/2009. It is not disputed that the