IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION Date of Institution: 11.03.2024 Date of Hearing: 16.10.2025 Date of Decision: 15.12.2025 FIRST APPEAL NO.-175/2024 IN THE MATTER OF STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED THROUGH ITS SENIOR MANAGER, ST

1 FLOOR, HIMALAYA HOUSE, 23, KASTURBA GANDHI MARG, CONNAUGHT PLACE NEW DELHI - 110001 (Through: Mr. Abhishek Nanda, Advocate)

...APPELLANT VERSUS MAHENDER B 10, J.J. COLONY, SEC – 15, BHARAT VIHAR, KAKROLA, NEW DELHI - 110078 (Mr. Shripal, AR for Respondent)

…RESPONDENT CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE MS. BIMLA KUMARI, MEMBER (FEMALE)

Present: Ms. Riya Kumari and Mr. Abhishek Nanda, Counsel for the appellant (Enrl. No. D/6908/21, Mobile:

201828601, Email: abhisheknanda lawyer@yahoo.co.in)

Mr. Shripal, Counsel for the respondent (Enrl. No. D/11332/24, Mobile: 9213147616, Email : vevsshv@gmail.com)

PER: HON’BLE JUSTICE SANGITA DHINGRA SEHGAL, PRESIDENT JUDGMENT

1. The facts of the case as per the District Commission record are as under:

“1. The present complaint has been filed under Section 35 read with 36 of the Consumer Protection Act, 2019 (in short CP Act) read with Rule 7 of the Consumer Protection (Consumer Commission Procedure) Regulation, 2020 against Opposite Party (in short OP) alleging deficiency of services.

2. Briefly stated the facts of the case are that the complainant had taken a on line health insurance policy bearing no. P/160000/01/2019/004550 from opposite party. The said policy was valid from 02.03.2019 to 01.03.2020 for the sum insured of Rs.3,00,000/- (Rupees Three Lakh Only).

3. Complainant got admitted in the Parth Hospital for his treatment on 21.09.2019 and remained hospitalized till date 25.09.2019. The said hospital generated the final bills of Rs.36,916/- (Rupees Thirty Six Thousand Nine Hundred Sixteen)

which was paid by complainant.

4. It is also alleged that there after complainant claimed the aforesaid bill amount from the opposite party, but OP rejected the claim on dated 05.11.2019 with the reasons stated as under:-

Our medical team has perused your representation and has noted the contents therein. The team which reexamined the claim records has observed that as per the submitted investigation reports are within normal limits. Our medical team is of the opinion that the hospitalization was not warranted.

5. It is alleged complaint has been filed within the period of limitation. It is prayed that:

1. OP be directed to pay a sum of Rs.36,916/- (Rupees Thirty Six Thousand Nine Hundred Sixteen) on account of the medical expenses incurred on the treatment of the complainant/insured with pendentelite interest @ 18% p.a. from 05.11.2019 till the realization.

2. OP be also directed to pay a sum of Rs.2,00,000/- (Rupees Two Lakh) to the complainant as compensation for the loss, pain and injury suffered by the complainant on account of mental agony.

harassment due to deficiency in service of the opposite party.

3. The opposite party be also directed to pay a sum of Rs.1,00,000/-

(Rupees One Lakh) towards cost of litigation expenses.

6. Notice of the complaint was issued to OP, OP was served on 04.08.2023, however as written statement was not filed within the statutory period, the defence of OP was stuck off vide order dated

17.11.2023

7. Section 38(3)(a) of the Consumer Protection Act, 2019 which relates to the period of limitation to file written statement provides as under:-

"(a) refer a copy of such complaint to be opposite party directing him to give him version of the case within a period of thirty days or such extended period not exceeding fifteen days as may be granted by the District Commission.

8. In this regard the Hon'ble Supreme Court has held in the case titled New India Assurance Company Ltd. Vs. Hilli Multipurpose Cold storage Pvt. Ltd. reported in 2020 (5) SCC 757 as under:

"Sub Section (2)(a) of Section 13 of the Consumer Protection Act provides for the opposite party to give his response within a period of 30 day