STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH.

Date of institution : 15.07.2025 Reserved on : 29.01.2026 Date of Decision : 11.02.2026 SBI General Insurance Company Limited through its Chairman/Managing Director/Principle Officer Branch Office at District Shopping Complex, Ranjit Avenue, Amritsar through its Branch Manager.

Now through its Authorized Signatory, Jitendra Dhabhai, Chief Manager (Legal), Zonal Office, 46, 3^rd Floor, Karol Bagh, Pusa Road, Opp. Metro Pillar No. 129, New Delhi - 110005 …Appellant/Opposite Party Versus Mr. Raghu Raj Arora S/o Sh. Vijay Kumar, R/o 2355/12, Street No. 4, Kishankot, Islamabad, Amritar.

.…Respondent/Complainant First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 26.03.2025 passed by the District Consumer Disputes Redressal Commission, Amritsar in C.C. No. 463 of 2019.

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 appellant : Sh. Krishna Kant, Advocate For the respondent : None VISHAV KANT GARG, MEMBER :

Appellant/Opposite Party i.e. SBI General Ins. Co. Ltd.

has filed the present Appeal through its Chairman to challenge the impugned order dated 26.03.2025 passed by the District Consumer Disputes Redressal Commission, Amritsar (in short, “the District Commission”), whereby the Complaint filed by the Respondent/Complainant-Raghu Raj Arora 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 Respondent/Complainant in the Complaint filed before the District Commission are that the Complainant had purchased SBI General Group Health Insurance Policy No.0000000006924313-01, which was valid for the period w.e.f. 08.08.2018 till 07.08.2019. During the subsistence of the policy and due to illness, the Complainant had remained hospitalized at The Corporate Hospital, Amritsar w.e.f. 23.11.2018 to 25.11.2018 and had incurred Rs.89,635/- on his treatment. The policy had provided the treatment on cashless basis upto the sum of Rs.1 lakh. The OP was informed about the hospitalization of the Complainant. However, the OP instead of clearing the total treatment expenses of Rs.89,635/-, had only reimbursed Rs.22,417/- to the Hospital as the remaining amount of Rs.67,218/- was made by the Complainant. As under the policy, the expenses upto the tune of Rs. 1 lakh was payable, therefore, deducting Rs.67,218/- from the treatment expenses without any basis was illegal and arbitrary action on the part of the OP. The OP alongwith the cover note had not provided the detailed terms and conditions of the policy.

4. Stating the act of the Opposite Party is not paying the complete treatment expenses, to be a case of ‘deficiency in service’ and ‘unfair trade practice’. It was prayed in the Complaint that the OP be directed to pay remaining treatment expenses of Rs.67,218/- along with interest @ 12% p.a. from the date of payment till its realization. Rs.50,000/- be awarded on account of causing mental agony and harassment suffered at the hands of the OP as well as litigation expenses. 5. Upon issuance of notice in the Complaint, the Appellant/ Opposite Party had filed its written statements by raising certain preliminary objections to the extent that the Complainant had no cause of action as the due amount as per the terms and conditions of the policy had already been paid. The amount of non-related items with regard to the medical treatment was not reimbursed. During the Hospitalization, the Complainant had opted for Room with higher facilities having rent charges i.e. Rs.4,500/- per day against the amount allowed is Rs.1,000/- per day under the policy.