STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH.

Date of institution : 02.01.2023 Reserved on : 06.11.2025 Date of Decision : 20.11.2025

1. Oriental Insurance Company Limited, Regional Office SCO 109-

111, Sector 17-B, Chandigarh, through its Incharge of regional office Chandigarh.

2. Oriental Insurance Company Limited, Branch Office 1, 32 GT Road, opposite Narinder Cinema, Jalandhar through its Branch Manager.

Now, both through its Authorized Signatory Mrs.Gurupdesh Kaur, Manager, The Oriental Insurance Company Limited, Regional Office SCO 109-111, Sector 17 D, Chandigarh.

….Appellants/Opposite Parties Versus Vikram Vijh, son of Late Sh.V.P.Vijh, Care of V.P. Vijh and Company, near Skylark Hotel Jalandhar, Punjab.

Also at: Model Town, 691, Flat No.5, Almara, Jalandhar.

….…Respondent/Complainant First Appeal under Section 41 of the Consumer Protection Act, 2019 against the order dated 11.11.2022 passed by the District Consumer Disputes Redressal Commission, Jalandhar in CC No.544 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 appellants : Sh.Arjun Kundra, Advocate For the respondent : Sh.G.S.Brar, Advocate SIMARJOT KAUR, MEMBER :

The Appellants/Opposite Parties have filed the present Appeal to challenge the impugned order dated 11.11.2022 passed by the District Consumer Disputes Redressal Commission, Jalandhar (in short, “the District Commission”), whereby the Complaint filed by the Complainant had been partly 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 obtained Health Insurance policy No.233105/48/2015/1009. It was subsequently renewed for more than 10 years from the OP Insurance Company without any break. The Policy was valid w.e.f. 25.07.2014 to of 24.07.2015. At that time the sum insured was Rs.2 Lac. Thereafter, the policy was valid w.e.f. 25.07.2015 to of 24.07.2016, the sum insured was enhanced to Rs.4 Lac. Further, it was valid w.e.f. 25.07.2016 to 24.07.2017, 25.07.2017 to 24.07.2018 and 25.07.2018 to 24.07.2019 for the sum assured/insured of Rs.4 Lac. Ever since the sum assured was got enhanced to Rs.4 Lac, the Complainant had been paying the premium to the OP Company in accordance with the increased amount. During the currency of the policy, when the sum insured was Rs.4 lac, the Complainant was admitted in Cardionova Institute of Medical Science, Jalandhar City on 14.04.2019, as he had suffered from an episode Ventricular Tachoicardia. He had undergone angiography as a part of treatment on 19.04.2019. After the Angiography, Automatic Implantable Cardioverter-Defibrillator (AICD) device was implanted on 22.04.2019. Subsequently, he had undergone Angioplasty on 28.04.2019. During the said procedure, the Complainant had remained admitted in the aforesaid hospital as an Indoor patient. The Complainant had spent an amount of Rs.7,32,510/-. All these medical expenses included AICD device, Angiography, Angioplasty, stay in the hospital and expenses incurred on medicines. After his discharge from the hospital, the Complainant had filed the medical claim with the OP Company on 12.05.2019. Said medical claim was duly verified by the OP Company. After the verification, he was disbursed only a sum of Rs.2 lac under the Insurance Policy valid from 25.07.2018 to 24.07.2019. Whereas the Complainant was entitled to a sum of Rs.4 lac assured under the policy which was valid upto 24.07.2019. At the time of obtaining the Insurance policies, the complainant had disclosed his medical health condition as well as his