(cid:1)(cid:2)(cid:3)(cid:4)(cid:2)(cid:3)(cid:5)(cid:6)(cid:7)(cid:6)(cid:8)(cid:3)(cid:9)(cid:10)(cid:11)(cid:5)(cid:12)(cid:13)(cid:8)(cid:14)(cid:3)(cid:15)(cid:16)(cid:5)(cid:4)(cid:12)(cid:6)(cid:8)(cid:5)(cid:3)(cid:14)(cid:8)(cid:15)(cid:14)(cid:8)(cid:5)(cid:5)(cid:7)(cid:17)(cid:3)

(cid:9)(cid:10)(cid:13)(cid:13)(cid:16)(cid:5)(cid:5)(cid:16)(cid:10)(cid:11)(cid:18)(cid:3)(cid:5)(cid:1)(cid:16)(cid:13)(cid:17)(cid:7)(cid:2)(cid:1)

(cid:1) (cid:1) (cid:1) (cid:1)(cid:1)First Appeal No.: 293/2023 Date of Presentation: 08.12.2023 Order reserved on: 02.12.2025 Date of Decision: 10.12.2025 ………………………………………………………………………

Care Health Insurance Limited (Formerly known as Religare health Insurance Company Limited), Office at 5^th Floor, 19, Chawla House, Nehru Place, New Delh i through its Manager (Legal) Vipul Tech Square, Tower C, Sector 46, Golf Course Road, Gurgaon, Haryana-122009.

..…..Appellant/Opposite Party.

Versus

1. Asha Devi W/O late Sh. Anil Kumar, 2. Ajay Kumar S/O late Sh. Anil Kumar;

3. Ayushi Thakur D/O late Sh. Anil Kumar;

All residents of Village Brangal, Post Office and Sub-Tehsil Bhalei, District Chamba, H.P.

..….Respondents/Complainants.

………………………………………………………………………

Coram Hon’ble Mr. Justice Inder Singh Mehta, President Hon’ble Ms. Yogita Dutta, Member.

Whether approved for reporting?, (cid:2)(cid:3)(cid:4)(cid:5)(cid:3)(cid:4)(cid:6)(cid:1)(cid:7)(cid:4)(cid:8)(cid:9)(cid:6)(cid:5)(cid:4)(cid:6)(cid:10)(cid:1)(cid:9)(cid:11)(cid:1)(cid:5)(cid:3)(cid:4)(cid:1)(cid:12)(cid:9)(cid:13)(cid:14)(cid:12)(cid:1)(cid:8)(cid:14)(cid:8)(cid:4)(cid:6)(cid:10)(cid:1)(cid:15)(cid:14)(cid:16)(cid:1)(cid:17)(cid:4)(cid:1)(cid:14)(cid:12)(cid:12)(cid:9)(cid:18)(cid:4)(cid:19)(cid:1)(cid:5)(cid:9)(cid:1)(cid:10)(cid:4)(cid:4)(cid:1)(cid:5)(cid:3)(cid:4)(cid:1)(cid:9)(cid:6)(cid:19)(cid:4)(cid:6)(cid:20)(cid:1) Yes.

For the Appellant: Mr. Jagdish Thakur, Advocate.

For the Respondents: Mr. Mohar Singh, Advocate vice Mr. Nimish Gupta, Advocate.

………………………………………………………………………

Justice Inder Singh Mehta, President.

O R D E R:

Instant appeal is arising out of the order dated 20.09.2023 passed by learned District Commission, Chamba, H.P. in consumer complaint No.36/2022, titled Asha Devi & Ors. Vs. Religare Health Insurance Company Ltd., whereby, the complaint filed by the complainants was allowed and the opposite party was directed to pay a sum of Rs.10,00,000/- to the complainant alongwith interest @ 9% per annum from the date of complaint till its realization. The opposite party was further directed to pay compensation to the complainants to the tune of Rs.10,000/- besides litigation cost of Rs.10,000/-. Brief facts of Case

2. Brief facts of the case are that late Sh. Anil Kumar purchased a health policy No.10692630 from the opposite party/insurance company for a sum of Rs.10,00,000/- which was effective w.e.f. 02.06.2016 to 01.06.2019 and premium was Rs.5,887/-. On 06.02.2019, when Sh. Anil Kumar was coming back to his house in his vehicle, the vehicle met with an accident and Sh. Anil Kumar died in the said accident. Since life assured late Sh. Anil Kumar died during the subsistence of the policy, the opposite party is liable to pay the insured amount of Rs.10,00,000/-, but the opposite party/insurance company rejected the claim of the complainants vide letter dated 05.10.2019 on false and flimsy grounds. By alleging deficiency in the service on the part of opposite party, the complainants have filed the present complaint.

3. The opposite party/insurance company filed reply and stated that deceased life assured Shri Anil Kumar died due to rash and negligent driving causing intentional self-inflicted injury. As per RFSL report, 222.76 mg% Ethyl Alcohol was detected in blood of deceased Sh. Anil Kumar. So claim of complainants was rightly repudiated on the ground that insured Sh. Anil Kumar died due to rash & negligent driving under the influence of Alcohol. As such, there is no deficiency in service on the part of the opposite party. Hence, the oppos