1 sc/2s/A/3st/2020 Date of filingr 17.O3.2O2O Date of Disposal: 05.12,2025 BEFORE THE KARNATAKA STATE CONSUMR DISPUTES REDRESSAL COM MISSION, BENGALURU (PRINCIPAL BENCH)

DATED: Osth DAY OF DECEMBER 2025 CORAMI HON'BLE Mr, IUSTICE T.G,SHMSHANKARE GOWDA - PRESIDENT and HON,BLE MTs. DIWASHREE M - LADY MEMBER sc/29lAt3sLt

2020 BETWEEN:

1. The Oriental Insurance Co., Ltd., Oriental House, P,B.No.7037, A-25/27, Asaf Ali road, New Delhi-110112.

2. The Oriental Insurance Co., Ltd,, Ramanagara branch No.31, B.M.Road, Ijooru Shilpa complex, Ramanagara District.

Both are rep, by The Orlental Insurance Co., Ltd., Regional Office, 44/45, Leo Shopping Complex, 4th floor, Residency cross road, Bengaluru-25 Appellant/s (By Sri.Janardhan R Bhandage, Advocate)

AND:

1. Mruthyunjaya.H.S S/o late H.S.Shastri, Aged about 58 years

2. Sulochana W/o Mrutyunjaya Aged about 54 years R/at D.No.421, Revenue site, Nimishamba Badavane, Near D block, Ramakrishnanagara, Mysuru-570022. ........ Respondent/s (By Sri.K.B.Shivakumar, Advocate)

ORAL ORDER (PER: HON'BLE Mr. JUSTICE T.G. SHMSHANKARE GOWDA, PRESIDENT)

This Appeal is filed U/s.15 of Consumer Protection Act, 1986 (in short CP Act) by the Appellant challenging the order dated:23.01.2020 passed in CC/231./2018 on the file of Mysuru District Consumer Disputes Redressal Commission (in short the District Commission).

2.

The Appellants were the Opposite Pafties.1 & 2 (in short OPs) and Respondents were the Complainants.l & 2 before the District Commission. The Rank of the parties shall be referred to as per their status before the District Commission.

3. The Brief facts of the case are that;

Complainants.l & 2 are the couples have obtained mediclaim insurance policy from Ops in the year 2009 it and has been renewed regularly till 2016 for a sum assured of Rs.50,000/-. In the year 2017, it was renewed increasing sum assured to Rs.1 lakh.

3(a). The Complainant.2 admitted to Sushrutha Eye hospital, Mysuru on t6.OS.2Ol7 and again on

03.06.2017 for cataract surgery for both eyes. Left eye surgery was conducted on L6.OS.2Ot7, right eye surgery was conducted on 03.06.2017 and claim was made for Rs.22,500/- for each surgery. Same was honoured by Ops.

3(b).

Again on 21.09.2017, the Comptainant.2 was admitted to Bhanavi hospital, Mysuru and made claim of Rs.57,396/-. But Ops have reimbursed only Rs.5,000/_

and disallowed the remaining claim of Rs.52,396/_

holding sum assured for the year 2O!7 is only Rs.50,000/-.

3(c).

On 05.05.2018, the Comptainant.2 again admitted to Bhanavi hospital, Mysuru and she made claim of Rs.48,000/- for which Ops have discounted the bill and reimbursed only Rs.19,732/- and repudiated remaining amount of Rs.28,268/-. Hence pleading deficiency in service in respect of both repudiation, Complainant presented the complaint before the District Commission.

4.

OPs have filed the version admitting the issuance of mediclaim policy from the year 2009 to 2016 for a sum assured of Rs.50,000/- and for the year 2OL7 and 2018 the sum assured was Rs.1 lakh. After such renewal with increased sum assured, to settle claim up to Rs.1 lakhs,48 months has to be lapsed from the date of such renewal. In view of terms and conditions of the policy, the Complainants are not entitle to claim more than Rs.50,000/- on the insurance policy which renewed with increasing sum assured of Rs.l lakh up to 2020.

Accordingly their claim was settled up to Rs.50 ,00O/- and rightly repudiated the remaining claim. There is no deficiency in service and sought for dismissal of the complaint.

5.

Before the District Commission, Complainant.l has filed his affidavit evidence and produced certain documents. On behalf of OPs, Divisional Manager has filed affidavit evidence and produced his documents.

6.

The District Commission after hearing both the pafties held that terms and conditions was not attached to the policy, therefore, the Insurance Company has to refund Rs.80,664l- (Rs.52,396/- + 28,268/-) along with interest at 10o/o p.a. and to pay compensation and lit