STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND DEHRADUN Date of Admission: 12.01.2024 Date of Final Hearing: 02.01.2026 Date of Pronouncement: 13.01.2026 SC/5/A/2/2024 HDFC ERGO General Insurance Company Limited

1^st Floor, HDFC House, Backbay Reclamation H.T. Parekh Marg, Churchgate, Mumbai (Opposite Party Nos. 1 to 4)

through its Dealing Office at HDFC ERGO General Insurance Company Limited Ratan Square, 20-A, 2^nd Floor, Vidhan Sabha Marg Lucknow – 226 001 (U.P.) through its Authorised Signatory (Through: Sh. Suresh Gautam, Advocate)

…… Appellant Versus

1. Sh. Mukesh Madhwal S/o Sh. Harish Chandra Madhwal R/o Sadahari Niwas, Gangotri Vihar, Lane No. 1 Kaniya, Tehsil Ramnagar, District Nainital (Uttarakhand)

At present R/o House No. B-91-A, Vishwas Park Uttam Nagar, New Delhi and working at House No. 849K, Sector – 4, Rewari (Haryana) – 123 401 (Through: Sh. B.K. Bachheti, Advocate)

2. Chairman, Insurance Regulatory and Development Authority of India Survey No. 115/1, Financial District, Nanakramguda Gachibowli, Hyderabad – 500 032 (Through: None)

…… Respondents Coram:

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

ORDER

(Per: Ms. Kumkum Rani, President):

This appeal has been directed against the impugned judgment and order dated 27.10.2023 passed by learned District Consumer Disputes Redressal Commission, Nainital (hereinafter to be referred as “The District Commission”) in consumer complaint No. 13 of 2022, styled as Sh. Mukesh Madhwal Vs. HDFC ERGO General Insurance Company Limited and others, wherein and whereby the consumer complaint was allowed and the appellant – insurance company (who was opposite party Nos. 1 to 4 before the District Commission) was directed to pay within 45 days’, the remaining claim amount of Rs. 4,46,057/- to respondent No. 1 / complainant together with interest @8% p.a. from the date of repudiation of the claim, i.e., 27.09.2021 till payment, besides to pay Rs. 25,000/- towards compensation for mental agony and Rs. 10,000/- towards litigation expenses. On account of unfair trade practice adopted and deficiency in service committed, the District Commission has also imposed penalty of Rs. 50,000/- upon the District Commission and directed it to deposit the same before the District Commission.

2. The facts giving rise to the present appeal, in brief, are, as such that the respondent No. 1 / complainant is the permanent resident of Ramnagar, District Nainital. However, in the year 2017, he was working at Rewari, Haryana and residing in Uttam Nagar, New Delhi. On 26.06.2017, the respondent No. 1 / complainant obtained a health policy, namely, Optima Restore Policy from Apollo Munich Health Insurance Company Limited (now known as HDFC ERGO General Insurance Company Limited). The said insurance policy was valid till 25.06.2018. The said insurance policy was renewed from time to time, lastly being for the period from 26.06.2021 to 25.06.2022 for total sum insured of Rs. 6,00,000/-. On 24.03.2020, due to Covid-19 Pandemic, the Government of India declared a nationwide lockdown for 21 days’. From 2017 to 2021, the complainant was working at Gurugram and when he came to Ramnagar to meet his parents, he felt some sort of discomfort on 25.04.2021, whereupon he visited Ramdutt Joshi Government Combined Hospital, Ramnagar in regard to his treatment, where after medical examination, he was referred to higher centre. The complainant was working in Microtek Forgings (A Unit of Bajaj Motors Ltd.), District Rewari, Haryana since 2017 till 18.04.2021, but thereafter, when he came to Ramnagar to meet his parents in the third week of April, 2021, he suddenly felt some sort of discomfort and consequently, visited Ramdutt Joshi Government Combined Hospital, Ramnagar. Under the directions of Government of India and internal management of the State of Uttarakhand and as a preventive measure, the concerned District Magistrate had declared certain Government Hospitals and Private Hospitals as Covid-19 hospitals for the t