CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

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

Present: Ms. Binny Sethi, counsel for the Appellant.

Mr. Shripal, counsel for the Respondent

PER: HON’BLE JUSTICE SANGITA DHINGRA SEHGAL, PRESIDENT

JUDGMENT

1. The facts of the case as per 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. OG-22-1101-8441-00000599 dated 14.07.2021 from opposite party. It is further stated that said policy was valid from 14.07.2021 to 14.07.2022 for the sum insured of Rs.3,00,000/- (Rupees Three Lakh Only).

3. It is further alleged that the complainant got admitted in the Mahavir Multispecialty Hospital on 01.04.2022 and remained hospitalized till 05.04.2022. The said hospital generated the final bills of Rs.41,530/- (Rupees Forty One Thousand Five Hundred Thirty) which was paid by complainant.

4. The complainant claimed the aforesaid bill amount from the opposite party, but the same was rejected vide repudiation letter dated 21.07.2022 with the reasons stated as under:

Verification of claim documents reveal aforesaid claimant was hospitalized for investigation and treatment of Macrocytic anemia and is claiming for expenses incurred of INR. 41,530/- (Rupees Forty One Thousand Five Hundred Thirty). We have received a certificate from concern pathologist Dr. K.D. Gandhi (MD Pathology) stating that, submitted pathology reports of the insured using her name are fake. Also as per received documents we have noticed certain discrepancies which are as follow:

1. ICP seems to be written in a single stretch.

2. Lab serial no of the said patients is 5 and another patients shivam singh (5075060), Anita (210042221P) has the same lab serial no how come 3 different patients has same lab serial no. (false and fabricated case).

5. It is also alleged that the present case is being filed within the period of limitation, the cause of action arose when the claim of the complainant was rejected by opposite party on 24.08.2022.

6. It is prayed that OP be directed to pay a sum of Rs.41,530/- (Rupees Forty One Thousand Five Hundred Thirty) to the complainant with pendentelite and future interest @ 18% p.a. since 21.07.2022 till its realization. Cost of litigation be also awarded.

7. Notice of the complaint was issued to OP, OP was served on 07.12.2022. However as written statement was not filed within the statutory period, in view of Section 38(3)(a) of the Consumer Protection Act, 2019 the same was not taken on record and the defence of OP was stuck off vide order dated 14.02.2023.

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 days or such extended period not exceeding 15 days as may be granted by the District Forum'. The intention of the legislature seems to be very clear that the opposite party would get the time of 30 days, and in addition another 15 days at the discretion under the Act"

9. Complainant filed her evidence by affidavit reiterating therein the averments made in the complaint. Complainant relied upon policy, the treatment record and the bills issued by Mahavir Multispecialty Hospital, the repudiation letter.”

2. The District Commission after taking into consideration the material available on record passed the order dated 08.01.2024, whereby it held as under:

“10. We have heard the AR of complainant and coun