ADDITIONAL BENCH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.

Date of Institution : 15.05.2023 Reserved on : 05.12.2025 Date of Decision : 10.12.2025 National Insurance Company Limited, Jalandhar, Division-II, Panesar Complex, 20, G.T.Road, Jalandhar, Punjab-144001, Now represented through the duly authorized signatory of Regional office at SCO No.332-334, Sector 34-A, Chandigarh.

.….Appellant/Opposite Party Versus

1. Sandeep Kumar S/o Late Sh. Hans Raj Arora, R/o House No.38/1, Krishna Nagar, Near Adarsh Nagar, Jalandhar.

2. Sunil Kumar Arora S/o Late Sh. Hans Raj Arora, R/o House No.30/5, New Ashok Nagar, Basti Sheikh Road, Jalandhar.

…..Respondents No1 & 2/Complainants

3. Paramount Health Services and Insurance (TPA) Private Ltd., Ludhiana, Third Floor, SCO-138, Feroze Gandhi Market, Ludhiana, Punjab-144001.

4. J.H.Cardiac Unit, Om Heart Care under Joshi Hospital, Kapurthala Chowk, Jalandhar, through its Principal Officer/Doctor-Incharge.

….Respondents No.3 & 4/OPs No.2 & 3 First Appeal under Section 41 of the Consumer Protection Act, 2019 against order dated 17.02.2023 passed by District Consumer Disputes Redressal Commission, Jalandhar in CC/276/2019 Quorum:-

Mr. H.P.S. Mahal, Presiding Judicial Member Mrs. Kiran Sibal, Member Argued by:-

For the appellant : Sh. Nitin Gupta, Advocate For respondents No.1&2 : Sh. A.S. Tagra, Advocate For respondents No.3&4 : Ex-parte ……………………………………………………………………….

KIRAN SIBAL, MEMBER The instant appeal has been filed by the appellant/opposite party against the order dated 17.02.2023 passed by District Consumer Disputes Redressal Commission, Jalandhar, (in short “District Commission”), whereby the complaint of the complainant under the Consumer Protection Act, (in short ‘C.P. Act’) against opposite parties (in short “OPs”) was allowed while granting the following reliefs:-

“9. In view of the above detailed discussion, it is clear that Rs.75,000/- has already been received by the complainant from the OPs No.1 & 2 by way of cashless facility. It has been alleged that he submitted bill of Rs.2,00,000/-, whereas this fact has been denied by the OP. No document has been proved to show that the claim was submitted for reimbursement. In such circumstances, the complainant is directed to submit the bills to the OPs for remaining payment made by him for his treatment within 10 days and then the OPs No.1 & 2 are further directed to settle the claim within 15 days from the date of submitting the bills. The OPs No.1 to 3 are directed to pay a compensation of Rs.10,000/- for causing mental tension and harassment to the complainant and Rs.5000/- as litigation expenses. The entire compliance be made within

45 days from the date of receipt of the copy of order…….”

2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Commission.

3. The briefs facts for disposal of this appeal are that the father of the complainants; namely, Sh. Hans Raj Arora, (now deceased) had got himself insured with OP No.1 under medical insurance policy bearing No.404300501810000079 valid from 15.07.2018 to 14.07.2019 after making payment of Rs.12,274/- as insurance premium. Since the father of the complainants had been renewing the said policy from time to time, he was entitled for Rs.37,500/- as bonus amount besides the sum assured of Rs.1,75,000/-. In the week of December, 2018 the insured faced difficulty in breathing and was diagnosed heart problem for which immediate heart surgery was advised by the doctors. He informed the insurance company and got admitted in J.H. Cardiac Unit/OP No.3-hospital for his treatment. The said hospital raised bill to the tune of Rs.2,17,285/- as cost of the treatment given by it to the insured. However, OPs No.1 & 2 had paid a sum of Rs.75,000/- only to the said hospital and the remaining amount i.e. Rs.1,05,000/- after discount of Rs.37,285/-, was to be paid to the said hospital by the insured from h