National Consumer Disputes Redressal
The New India Assurance Co. Ltd. vs Chandra Kumar Chatrath on 14 January, 2013
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NATIONAL CONSUMER DISPUTES
REDRESSAL COMMISSION
NEW DELHI
REVISION PETITION NO. 237 OF 2009
(From the order dated 23.10.2008 in Appeal No. 1472/2008
of Madhya Pradesh State
Consumer Disputes Redressal Commission)
THE NEW INDIA ASSURANCE CO. LTD.
Through its Regional Manager,
87 Mahatma Gandhi Fort,
Mumbai 400 001
(Maharashtra)
...........Petitioner(s)
Versus
1. Chandra Kumar Chatrath
R/o 130 Dusheera Maidan
Ujjain (MP)
2. Raksha T.P.A. PVT. LTD.
15/5, Escort Corporate Centre,
Faridabad
Haryana
...........Respondent(s)
BEFORE HONBLE MR. JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER HONBLE MR. SURESH CHANDRA, MEMBER For the Petitioner(s) Mr. Mohan Babu Aggarwal, Advocate For the Respondent No.1 Mr. Pankaj Kumar, Advocate Ms. Sugandha Taneja, Advocate For the Resp. No.2 Exparte PRONOUNCED ON : 14th JAN.
2013O R D E R PER SURESH CHANDRA, MEMBER Delay of eight days in filing the present revision petition is condoned.
2. We have heard Mr. Mohan Babu Aggarwal, Advocate for the petitioner and Mr. Pankaj Kumar, Advocate for the respondent no. 1. Respondent no. 2 remained exparte.
3. Briefly stated, the facts of the case are that the father of respondent no. 1 was insured with the petitioner insurance company for a sum of Rs.2 lakh under a medi-claim policy and he had undergone a treatment for which he spent Rs.1,63,109/-. Against the claim of Rs.1,63,109/- made by the respondent 1 / complainant, the petitioner insurance company paid Rs.20,000/- only on the plea that treatment in question was not a surgical treatment and for such non-surgical treatment only a total sum of Rs.20,000/- could be paid or reimbursed as hospitalisation expenses. Not satisfied with the decision taken by the insurance company in restricting the claim to Rs.20,000/-, the petitioner knocked the door of the consumer fora by filing a complaint with the District Forum. The District Forum vide its order dated 28.03.2008 held that the procedure of putting the tubes in the nose is not a surgical operation and as such it non-suited the claim of the petitioner / complainant and dismissed the complaint. Aggrieved by this order of the District Forum, the respondent no. 1 went in appeal before the Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal (State Commission for short) which vide its order dated 23.10.2008 allowed the appeal and directed the petitioner insurance company to pay the respondent no. 1 / complainant a sum of Rs.1,63,109/- minus the amount already paid, within two months from the date of the order. In spite of service of the notice by the State Commission, none appeared on behalf of the petitioner insurance company and the other opposite party, hence they were proceeded exparte by the State Commission. It is against this order of the State Commission that the petitioner / insurance company and OP No. 2 has filed the present revision petition.
4. The only issue which has arisen for our consideration in this case is as to whether the treatment undertaken by the father of the respondent no. 1 was a surgical treatment or not? It is seen from the impugned order that the State Commission has allowed the appeal and the claim of the complainant on the basis of a certificate of Dr. Mukesh Jain, MS (ENT) to the effect that the tracheostomy performed requires making a hole in the respiratory passage and, therefore, it is a surgical procedure. Since the doubt raised by the insurance company about the nature of the treatment taken by the assured had been resolved with the certificate of the Doctor, the State Commission accepted the prayer of the complainant and allowed the entire amount spent for the treatment in terms of the medi-claim policy. In this context, learned counsel for the petitioner drew our attention to the definition of surgical operation, contained in para 63 of the Annexure I, which forms part of the policy, in question. According to the counsel, the procedure in question would not amount to surgical operation as per the definition contained in the terms and conditions of the medi-claim policy. In view of this, learned counsel pleaded that the impugned order accepting the full claim was bad in law and deserves to be set aside.
5. We have considered the contentions raised by learned counsel for the petitioner. It is to be noted that in spite of notice sent by the State Commission, the petitioner insurance company chose to remain absent and hence proceeded exparte. Petitioner has not placed any material to support its claim about non-receipt of the notice from the State Commission. It is also seen that the petitioner has not placed any rebuttal in respect of the certificate issued by Dr. Mukesh Jain, who is ENT Surgeon and hence an expert, on the basis of which the State Commission has passed the impugned order. In view of these facts, no fault could be found with the impugned order.
Consequently, we dismiss this revision petition but with no order as to costs.
..Sd/-
(K.S. CHAUDHARI J.) PRESIDING MEMBER ..Sd/-
(SURESH CHANDRA) MEMBER RS/