Delhi District Court
Peeyush Goel vs United India Insurance Co,. Ltd on 8 December, 2025
IN THE COURT OF CIVIL JUDGE-07, (CENTRAL),
TIS HAZARI COURTS, DELHI
CS SCJ No. : 1374/22
CNR No. : DLCT03-002687-2022
DATE OF DECISION : 08.12.2025
PRESIDING OFFICER: Mr. SAHIL GUPTA
SH. PEEYUSH GOEL
S/O SHRI SURESH GOEL
R/O. H.N.61, 313/63F, ANAND NAGAR,
INDER LOK, DELHI-1100035.
.........Plaintiff
Versus
1. United India Insurance Company Limited
Through Its. CEO/MD/Director/Head
M-13 3RD FLOOR, PUNJ HOUSE, ANNEXXE,
CONNAUGHT PLACE, NEW DELHI-110001
Email Id [email protected]
2. MD India Health Insurance TPA private Limited
Through it CEO/MD/Director/ Head
Head Office, S.N. 46/1E-SpaceA2 Building, 3rd floor,
Pune Nagar, Vadgaonsheri, Pune, 411014, Maharashtra
3. Maharaja Agarsain Hospital
Through it CEO/MD/Director/ Head
Punjabi Bagh, DELHI
.........Defendants
DATE OF INSTT: 21.05.2022
DATE RESERVED FOR JUDGMENT: 13.11.2025
CS SCJ No. : 1374/22 Page no. 1 / 10
PEEYUSH GOEL vs. United India Insurance Company Limited & Ors.
Argued by:
(a) Ms. Sarita Aggarwal, counsel for plaintiff.
(b) Mr. Tribindh Kumar, counsel for defendant no.1.
(c) Defendant no. 2 ex-parte vide order dt. 22.03.23.
(d) Mr. Narain Dutt Sharma, counsel for defendant no.3.
SUIT FOR REVOERY OF RS. 2,72,884/- WITH PENDENTE
LITE AND FUTURE INTEREST @ 18% P.A.
JUDGMENT:
1. The present suit has been filed by plaintiff with the averments that:
"That the plaintiff has taken family Medicare cashless policy from defendant no.1 which is valid from 17.05.21 to 16.05.22 and his wife, namely Swati Gupta was also insured. That the defendant no.1 is the insurance company from whom the plaintiff had purchased the policy and defendant no.2 is TPA of the said policy. That the defendant no.3 is the hospital in which the wife of the plaintiff was treated. That the wife of the plaintiff delivered a baby on 02.02.2022 in Maharaja Agarsen Hospital and was discharged from the hospital on 04.02.2022. That after the discharge, the wife of the plaintiff felt numbness in upper part of her body on 05.02.2022, and she was brought for the treatment to Maharaja Agarsen hospital and was admitted under gynecology department on 05.02.2022. That the wife of the plaintiff was diagnosed with acute Ischemic Stroke-right frontal lobe was shifted to neurology department. That at the time of admission in the hospital, the plaintiff filed all the necessary forms and documents related to policy for cashless treatment and defendant initially sanctioned ₹65,670/- but to the utter surprise and shocked to the plaintiff, the claim of his wife was denied vide letter dated 09.02.2022 issued by defendant no.2 on the grounds that maternity was not covered under the policy. That the plaintiff was forced to pay ₹1,52,884/- (including Rs. 65,670/-) CS SCJ No. : 1374/22 Page no. 2 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. as hospital expenses from his own pocket to defendant no.3. That the plaintiff sent a legal notice dated 01.03.2022 to the defendant no.1 and 2 calling upon the defendants to reimburse the amount paid, but despite the service of the notice, the defendants did not pay any amount. Hence the present suit."
2. WS was filed by defendant no.1 and the defendant submitted that the policy purchased by the plaintiff excludes the expenses incurred against hospitalization arising out of maternity as the plaintiff did not opt for maternity and newborn baby coverage. That the hospitalization and complications were directly connected with the pregnancy of the wife of the plaintiff as the discharge summary issued by the hospital mentions that the wife of the plaintiff was diagnosed with 'Pre-eclampsia D6 Lower Segment Cesarean Section' characterised by high blood pressure.
3. Defendant no.2 was duly served with summons on 18.11.22 but despite the service of summons, none appeared o behalf of defendant no.2. Vide order dated 22.03.23, right of the defendant no.2 to file written statement was closed and for nonappearance the defendant no.2 was proceeded ex parte.
4. WS was filed by defendant no.3 and the defendant submitted that the defendant no.3 is only a pro forma party and no relief has been claimed against defendant no.3.
5. In the replication filed by the plaintiff, the contentions of CS SCJ No. : 1374/22 Page no. 3 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. the written statement filed by defendant no.1 & 3 have been denied and the averments made in the plaint have been reiterated and reaffirmed.
6. Hence, pertinent question to be decided in the present case is :
A. Whether the plaintiff is entitled to a decree of ₹2,72,884/- against the defendants along with pendentelite and future interest @ 18% per annum as prayed for? OPP B. Relief
7. Sh. Peeyush Goel, the plaintiff, examined himself as PW-1. He tendered his evidence by way of affidavit which is Ex.PW-1/A wherein he reiterated the averments made in the present plaint. The same are not reproduced here for the sake of brevity. The plaintiff relied on the following documents in his support.
(a) Ex. PW-1/1 (OSR) - Aadhar Card.
(b) Ex.PW-1/2 - Family Medicare Policy bearing Policy
No. 0401002821P101293418.
(c) Mark A - Copy of MRI report/Medical report dt.
05.02.22.
(d) Mark B - Mediclaim declined by the defendant no.2
(letter dt. 09.02.22)
(e) Mark C - Medical Bill of Rs. 1,52,884/-.
(f) Ex. PW-1/6 - Advance Payment dt. 05.02.22 & final
receipt of Rs. 1,12,884/- dt. 09.02.22.
(g) Ex. PW-1/7 - Payment slip dt. 02.03.22.
CS SCJ No. : 1374/22 Page no. 4 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors.
(h) Ex. PW-1/8 - Receipts dt. 05.02.22 and bill dt.
08.02.22.
(i) Ex. PW-1/10 - Legal notice dt. 01.03.22.
(j) Ex. PW-1/11 - Registered AD post dt. 05.03.22.
(k) Ex. PW-1/12 - Copy of tracking report.
(l) Ex. PW-1/13 - Return Envelope.
8. PW-1 was examined on chief on 11.09.24 and was cross examined by defendant no. 1 & 3 on 07.11.24 and 23.11.24 and was discharged on the same day.
9. Ms. Swati Gupta, Wife of the plaintiff, examined herself as PW-2. She tendered her evidence by way of affidavit which is Ex.PW-2/A wherein she reiterated the averments made in the present plaint. The same are not reproduced here for the sake of brevity. The plaintiff relied on the following documents in his support:
(a) Ex. PW-2/1 - De-exhibited.
(b) Ex.PW-2/2 - De-ehibited as Mark A (Opinion of the doctor).
10. PW-2 was examined in chief and was cross examined by defendant no. 1 & 3 on 18.01.25 and was discharged on the same day.
11. PW-3 namely K.D. Sharma, Record Clerk, Maharaja Agarsen Hospital, Punjabi Bagh, Delhi was examined in chief on 05.03.25. The witness brought the record MRI of the patient Mrs. Swati Gupta dt. 05.02.22. MARK A, final CS SCJ No. : 1374/22 Page no. 5 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. payment bill dt. 09.02.22 Ex.PW3/2 and discharge summary of patient Ex.PW3/3. He was cross examined and discharged on 05.03.25.
12. PW-4 namely Dr. Sadhna Gupta, Sr. Consultant in Gynaecology Department, Maharaja Agarsen Hospital, Punjabi Bagh, Delhi was examined in chief on 06.05.25. She was cross examined and discharged on 06.05.25.
13. Subsequently, the matter was put for DE.
14. The defendant no.1 & 3 did not lead any DE and accordingly, DE was closed on 06.08.25.
15. I have heard the arguments and perused the record.
Issue no. 1 - Whether the plaintiff is entitled to a decree of ₹2,72,884/- against the defendants along with pendentelite and future interest @ 18% per annum as prayed for? OPP
16. The onus to prove the issue was on the plaintiff. The case of the plaintiff is that the wife of the plaintiff delivered a baby on 02.02.2022 in Maharaja Agarsen Hospital and was discharged from the hospital on 04.02.2022 and after the discharge, the wife of the plaintiff felt numbness in upper part of her body on 05.02.2022, and she was brought for the treatment to Maharaja Agarsen hospital and was admitted under gynaecology department on 05.02.2022 after which she was diagnosed with acute Ischemic Stroke-
CS SCJ No. : 1374/22 Page no. 6 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. right frontal lobe and was shifted to neurology department. Subsequently, the claim of his wife was denied vide letter dated 09.02.2022 issued by defendant no.2 on the grounds that maternity was not covered under the policy. The only defence taken by the defendant no.1 is that the hospitalization and complications were directly connected with the pregnancy of the wife and the policy purchased by the plaintiff excludes the expenses incurred against hospitalization arising out of maternity as the plaintiff did not opt for maternity and newborn baby coverage.
17. PW1, during the cross examination, admitted that the expenses arising out of maternity were not covered in the policy and further admitted that his wife was suffering from diabetes at the time of the pregnancy. The witness further deposed that the child was delivered through C- section on 02.02.22 and his wife was discharged on 04.02.22. The witness admitted that he had not filed the medical documents and discharge summary relating to the delivery and deposed that he was not aware whether his wife was discharged against the medical advice of the doctors on 04.02.22. Lastly, the witness denied the suggestion that the issue in the brain/ subsequent complications arose due to the maternity.
18. PW2, during the cross-examination admitted that during her treatment relating to pregnancy, she was also treated for diabetes. The witness further deposed that she was discharged on suggestion of the doctors and not against the CS SCJ No. : 1374/22 Page no. 7 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. advice of the doctors.
19. PW4, namely Dr. Sadhana Gupta, working as a senior consultant in gynecology department in the Maharaja Agrasen Hospital, Punjabi Bagh was examined, and during her cross-examination, the witness deposed that the patient i.e. PW-2 was suffering from high BP and diabetes and the baby was delivered through C-section. The witness further deposed that the patient was discharged in good condition and was subsequently referred to the neurology department when she was again admitted on 05.02.22.
20. Now the question before the court is whether the subsequent admission of the wife of the plaintiff was due to the complications arising out of the pregnancy for which the wife of the plaintiff was admitted on 02.02.22 and discharged on 04.02.22. The plaintiff has relied upon the medical bill dated 09.02.22 amounting to ₹1,52,884/- generated by the hospital after the discharge of the wife of the plaintiff from the hospital for the treatment of acute Ischemic Stroke-right frontal lobe under the neurology department. The plaintiff has also relied upon the document Ex. PW-1/6 dated 05.02.22, which is the advance payment of ₹40,000/- made to the hospital at the time of the admission on 05.02.22 by the plaintiff and the final bill dated 09.02.22 for the balance amount of ₹1,12,884/-. The plaintiff deposed that initially the defendant no.1 had sanctioned the claim of ₹65,670/-, but at the time of discharge denied the claim vide letter dated CS SCJ No. : 1374/22 Page no. 8 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. 09.02.22 (Mark B). The only defence taken by the defendant no.1 is that the patient i.e. the wife of the plaintiff was discharged against the medical advice and the same is mentioned in the discharge summary dated 04.02.22 and for this reason, the same has not been filed before the court. The plaintiff, upon the directions of the court, had filed the discharge summary dated 04.02.22, where in the condition of the patient at the time of the discharge is mentioned as stable, and there is no mention of LAMA (leave against medical advice) in the discharge summary dated 04.02.22.
21. The averments made by the plaintiff stands duly proved by way of documents filed with the suit. Hence, plaintiff has duly discharged its burden of proof under Section 101 of the Indian Evidence Act, 1872. It was for the defendants to prove that the wife of the plaintiff was discharged against the medical advice of the doctors and that the complications for which the patient was subsequently admitted, arose due to the complications in pregnancy, however defendants has failed to do so. Since no evidence was led by the defendants, there is nothing on record which casts any doubt on the case of plaintiff. The case of plaintiff has just gone unchallenged, uncontroverted and unrebutted. Accordingly, plaintiff has successfully proved its case on the scale of balance of probabilities.
22. Plaintiff has also claimed interest 18% per annum on the decretal amount and the cost of legal fees. However, CS SCJ No. : 1374/22 Page no. 9 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors. considering the prevailing market conditions, it is not considered equitable to grant this high rate of interest. Accordingly, simple interest @ 9% per annum is considered reasonable and equitable.
Issue no.2 - Relief.
23. In view of above discussion, the suit of the plaintiff is hereby decreed as under:
a) A decree for the recovery of Rs.1,52,884/- is passed in favour of plaintiff and against the defendants, along with simple interest @9% from the date of filing of the present suit till the realisation of the decretal amount.
b) Costs of the suit also awarded in favour of the plaintiff and against the defendants.
24. Decree sheet be prepared accordingly.
25. File be consigned to record room after due compliance.
Digitally
signed by
SAHIL
SAHIL GUPTA
GUPTA Date:
2025.12.08
16:35:06
+0530
Announced in the open Court SAHIL GUPTA
Dated : 08.12.2025 Civil Judge -07 (Central)
Tis Hazari Court, Delhi
Note: This judgment contains 10 (Ten) pages and each page has been checked and signed by me. Digitally signed by SAHIL SAHIL GUPTA Date:
GUPTA 2025.12.08 16:35:14 +0530 SAHIL GUPTA Civil Judge -07 (Central) Tis Hazari Court, Delhi Dated : 08.12.2025 CS SCJ No. : 1374/22 Page no. 10 / 10 PEEYUSH GOEL vs. United India Insurance Company Limited & Ors.