##PAGE1##

FA-35/2018 D.O.D:24.12.2025

NATIONAL INSURANCE CO. LTD. VS SMT. MAMTA AGGARWAL & ORS

IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL

COMMISSION

Date of Institution : 23.01.2018

Date of Reserving the order : 26.11.2025

Date of Decision : 24.12.2025

FIRST APPEAL NO.-35/2018

IN THE MATTER OF

NATIONAL INSURANCE CO. LTD.

2-E/9, JHANDEWALAN EXTENSION,

NEW DELHI

…APPELLANT

(Through: Mr S.K. Pandey, Advocate

Mob: 9811287225)

VERSUS

1. MS. MAMTA AGGARWAL

W/O LATE MR. RAJESH AGGARWAL

2. MS. SHUBHANGI AGGARWAL

D/O LATE MR. RAJESH AGGARWAL

3. MS. MUSKAT AGGARWAL

D/O LATE MR. RAJESH AGGARWAL

4. MS. KRISHHNA AGGARWAL

D/O LATE MR. RAJESH AGGARWAL

ALL RESIDENTS OF

D-95, 2ND FLOOR, MEHENDRU ENCLAVE

DELHI-110053

……RESPONDENT

(Through: Mr. Ram. N. Sharma, Advocate

Mob.9810260183)

CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE MS. PINKI, MEMBER (JUDICIAL)

Present : Mr. S K Pandey counsel for the appellant

(M: 9811287225 & Email:skpandey5082@gmail.com)

Mr Trivedi Prafulla counsel for the respondent

(M: 9911066152 & Email-adv.tprafulla@gmail.com)

DISMISSED PAGE 1 OF 9

FA-35/2018 D.O.D:24.12.2025

NATIONAL INSURANCE CO. LTD. VS SMT. MAMTA AGGARWAL & ORS

PER : HON’BLE PINKI, MEMBER (JUDICIAL)

JUDGMENT

1. By this judgment, we shall dispose of the appeal filed by the

Appellant against the impugned order dated 29.11.2017, passed by

Consumer Disputes Redressal Commission, (District North) Room

No.2, Old Civil Supply Building, Tis Hazari, Delhi (hereinafter

referred to as District Commission), in Complaint Case no. CC-

155/2015 titled as Smt. Mamta Aggarwal & Ors Vs National

Insurance Co. Ltd.

2. While the Appellant was Opposite Party before the District

Commission and the Respondents were Complainants before the

District Commission.

3. The delay in filing the appeal was condoned by the then Member

(Judicial) vide order 12.04.2019, subject to payment of costs of

Rs.2,000/-. The said cost was paid to the respondent on

31.10.2019.

4. The facts of the case as per the District Commission, record are as

under:

“The complainant had taken mediclaim policy from

the O.P. company so many years i.e. from 2005 which is

being renewed without any break till 2014-2015 when

the same was renewed through APAC Insurance

Broking Services (I) Pvt. Ltd. who is agent of O.P. and

issued a policy which covers the complainant, his wife,

dependent three children for a sum insured of

Rs.5,00,000/- for himself, Rs.3,50,000/- for his wife,

Rs.2,00,000/- for both daughters Rs.1,75,000/-. It is

alleged that the policy was last renewed from

29.06.2014 to 28.06.2015 vide policy

No.360202/48/14/8500000670. It is further alleged

that the O.P. neither explained anything about the

coverage nor gave any terms and conditions alongwith

the policy except one page document. It is further alleged

DISMISSED PAGE 2 OF 9

FA-35/2018 D.O.D:24.12.2025

NATIONAL INSURANCE CO. LTD. VS SMT. MAMTA AGGARWAL & ORS

that the complainant was feeling uneasiness, pain

abdomen, urine output, fever with loose motion when he

was taken to Apex Hospital Pvt. Ltd. on 03.01.2015

when various tests were performed on him by the

hospital and complainant was diagnosed as K/C,

ALD/CLD/PHT/ARF/AC GASTORENTERITIS/SHCOK. It

is alleged that the complainant was admitted by

hospital and complainant remained in the hospital w.e.f.

03.01.2015 to 05.01.2015 as per the discharge

summary of the hospital. It is further alleged that the

complainant also spent a sum of Rs.59,255/-. It is

alleged that the intimation about the admission of

complainant was lodged immediately by the

complainant with the O.P. through hospital and the O.P.

was requested to register the claim and to authorize the

hospital for the claim expenses of the complainant. It is

further alleged that the TPA of O.P. refused the cashless

facility under some exclusion clause of policy whereas

no such clause was suppled to complainant with the

policy. It is alleged that thereafter as desired by TPA of

O.P all the necessary papers, viz. claim form duly

completed, admission and discharge summary and

medical bills of hospital in