State Consumer Disputes Redressal Commission
The New India Assurance Co. Ltd. vs Smt. Anandi Mehta And Another on 1 June, 2007
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND DEHRA DUN FIRST APPEAL NO. 131 / 2005 The New India Assurance Co. Ltd. ......Appellant Versus Smt. Anandi Mehta and another .....Respondents Sh. Rahul Sharma, Learned Counsel for the Appellant Sh. Ram Singh Negi, Learned Counsel for Respondent No. 1 Sh. Shekhar Chandra Nailwal, Learned Counsel for Respondent No. 2 Coram: Hon'ble Justice Irshad Hussain, President Surendra Kumar, Member Ms. Luxmi Singh, Member Dated: 01.06.2007 ORDER
(Per:
Justice Irshad Hussain, President):
This appeal is directed against the order dated 05.04.2005 passed by the District Consumer Forum, Almora in consumer complaint No. 39 / 2003, whereby the appellant - insurance company was directed to pay Rs. 1,07,839/- with interest towards expenses incurred in hospitalization treatment of late Sh. Govind Singh Mehta, who was a teacher in Inter College, Dholaghat, Almora in addition to damages of Rs. 2,000/- for mental agony and Rs. 500/- as expenses of the litigation to the complainant, the widow of the deceased.
2. We have heard the learned counsel for the parties and have considered their submissions in the light of the facts of the case and legal aspects of the matter in issue.
3. Learned counsel for the appellant - insurance company drew our attention to the terms and conditions (Paper Nos. 109 - 115) of the Special Contingency Teachers Mediclaim / Janta Personal Accident Policy, which also covered the case of the husband of the complainant. It is not a case of sustaining injury in any accident and death resulting from such injury. Therefore, under the terms and conditions of the policy, complainant was entitled to be indemnified for the expenses of hospitalization of her husband to the extent as permitted under the policy. From the terms and conditions of the said policy, it is evident that in the event of hospitalization treatment, the insured was entitled to be indemnified to the maximum expenses of Rs. 37,500/-. Even if sum of more than Rs. 1,00,000/- was spent in the treatment of the said insured, the indemnification was permissible only to the maximum extent of Rs. 37,500/- and the District Forum fell in error in allowing the claim in toto directing the insurance company to pay compensation as aforesaid. Learned counsel for the complainant failed to show us anything contrary to the said term and condition of the policy and, as such, it had been rightly argued on behalf of the appellant that policy covers only hospitalization treatment upto maximum of Rs. 37,500/-. However, it is evident that the insurance company did not allow the claim to that extent also and made deficiency in service and, therefore, compensation according to the terms and conditions of the policy need to be awarded together with reasonable interest.
4. In view of above, this appeal partly succeed and is to be allowed accordingly.
5. Appeal is partly allowed. Order dated 05.04.2005 of the District Forum is modified to the extent that the complainant shall be entitled to Rs. 37,500/- as compensation together with interest @7% p.a. w.e.f. the date of filing of the complaint i.e. 09.07.2003 till payment and Rs. 500/- towards cost as awarded by the District Forum. Cost of the appeal made easy.
(MS.
LUXMI SINGH) (SURENDRA KUMAR) (JUSTICE IRSHAD HUSSAIN)