Delhi District Court
Rajesh Kumar vs . Star Health And Allied Insurance on 28 August, 2023
IN THE COURT OF MS. CHITRANSHI ARORA , CIVIL JUDGE-03,
SOUTH-WEST DISTRICT, DWARKA COURTS, NEW DELHI.
CS SCJ 312/2020
RAJESH KUMAR VS. STAR HEALTH AND ALLIED INSURANCE
COMPANY LTD. & ANR.
In the matter of :-
Rajesh Kumar
S/o Sh. Kailash Chand,
R/o A-463, Jwala Puri,
Sunder Vihar,
New Delhi-110087 .................Plaintiff
Vs.
1. Star Health and Allied Insurance Company Ltd.,
Through its Managing Director,
Branch Office at :
G-8, first Floor,
Hauz Khas Market,
New Delhi-110016
Branch Office at:
C-8, 3rd Floor, Community Centre,
Janakpuri, Near New Krishna Park,
Near West Janakpuri Metro Station,
New Delhi-110058
2. ICICI Bank Ltd.
Through its Manager
Branch Office:
Shop No.3, Najafgarh Road, Nagloi,
Branch Code-2354
New Delhi-110043 ..........Defendants
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 1 of 20
SUIT FOR RECOVERY
Date of institution of the suit : 12.03.2020
Judgment reserved on : 18.08.2023
Date of judgment : 28.08.2023
JUDGMENT
1. Vide this judgment, I shall decide the present suit for recovery of Rs.1,00,000/- (Rupees One Lac only) alongwith interest, filed by the plaintiff against the defendant.
BRIEF FACTS AS PER THE PLAINT: -
2. The plaintiff had purchased the family mediclaim policy from defendant no.1 and had renewed the same from time to time since 03.09.2010. The plaintiff had renewed the same on 16.09.2019 via online mode and paid the premium of Rs.15,699/- through his account with the defendant no.2 bank bearing no.235405500201. After receipt of the premium, the defendant no.1 issued the policy bearing no.P/161200/01/2019/004746, which was valid from 16.09.2019 to 15.09.2020.
3. The plaintiff was admitted in the emergency section of Sri Balaji Action Medical Institute on 23.12.2019 and was discharged on 25.12.2019. The hospital generated the bill of Rs.62,549/-. When the plaintiff approached the defendant no.1 with his claim of the bill amount, the defendant no.1 rejected the same, due to which the plaintiff had to bear the same.
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 2 of 20
4. When the plaintiff inquired through the customer care number of defendant no.1, the customer care employee told the plaintiff that the policy had been cancelled as the defendant no.2 had charged back the premium amount. Thereafter, when the plaintiff approached the defendant no.2 inquiring the same, the bank officials did not give any satisfactory answer to him.
5. The plaintiff again approached the defendant no.1 via email dated 28.12.2019, however, the defendant no.1 did not give reply to the same. Due to this, the plaintiff had to pay the policy premimum of Rs.15,699/- to the defendant no.1 again in cash on 01.01.2020.
6. The defendants have colluded and deliberately cancelled the mediclaim policy of the plaintiff without any prior intimation. The defendant no.1 is liable to refund the amont of Rs.62,599/- spent by the plaintiff in his medical treatment and Rs.15,699/- which is the policy premium paid by the plaintiff prior to further renewal of the policy. The plaintiff has also claimed interest at the rate of 18% i.e. Rs.10,570/- and Rs.11,000/- from the defendants.
7. The plaintiff had sent a legal notice dated 14.01.2020 to the defendants through speed post which was duly served upon both the defendants. Despite service of legal notice, the defendants have neither replied nor paid the amount to the plaintiff.
8. In the background of these facts, the plaintiff has filed the suit for recovery against the defendants.
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 3 of 20 WRITTEN STATEMENT FILED BY DEFENDANT NO.1 :-
9. In the Written Statement filed by the defendant no.1, the defendant no.1 made the following preliminary objections:-
(i) The plaintiff has no locus standi to file the present suit as it is based on false and frivolous allegations;
(ii) The plaintif has no cause of action against defendant no.1;
(iii) The suit is barred by non-joinder of necessary party as the plaintiff had purchased the policy from one of the channel partners of defendant no.1 i.e. Digisecure, who has not been made party in the present case;
(iv) The plaintiff had taken Family Health Optima from the defendant's branch office at Hauz Khas Market, New Delhi and the said policy covered the plaintiff, his wife Mrs. Anita Verma and their dependant children namely Anshul Verma and Niharika Verma for sum assured of Rs.3,00,000/-. The policy no.P/161200/01/2020/ 005321 with the policy period of 16.09.2019 to 15.09.2020, was cancelled due to charge back refund raised from the customer via Digisecure. Thus, the policy was cancelled. In the meanwhile, the plaintiff was admitted in the hospital between 23.12.2019 to 25.12.2019.
(v) After his hospitalization, the plaintiff again issued the premium of Rs.15,699/- on 01.01.2020 alongwith good health declaration CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 4 of 20 stating that he has not contracted any disease during the break-in period of policy. On the basis of such declaration, the defendant no.1 issued the policy in favour of the plaintiff, with continuous coverage (3 months break)vide policy no. P/161200/01/2020/009472 with the policy period of 01.01.2020 to 31.12.2020 having sum assured of Rs.3 Lacs. Infact the plaintiff has concealed the fact of his illness and his admission in the hospital;
(vi) The plaintiff has further claimed that he has not received the refund of the cancelled policy. It was because of the channel partner Digisecure through whom the plaintiff had purchased the policy. However, after filing the present suit, the plaintiff has received the said amount vide D.D. No.462081 dated 20.07.2020.
10. In para-wise reply on merits, the defendant no.1 has denied all the averments of the plaintiff as false and frivolous, reiterated the contents of the preliminary objections and prayed that the suit be dismissed as not being maintainable.
WRITTEN STATEMENT FILED BY DEFENDANT NO.2 :-
11. In the Written Statement filed by the defendant no.2, the defendant no.2 made the following preliminary objections:-
(i) There is no prima-facie case against defendant no.2. The plaintiff has failed to state as to how the cause of action has arisen against defendant no.2;
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 5 of 20
(ii) Plaintiff has misled this court by making false submissions.
12. In para-wise reply on merits, the defendant no.2 has denied all the averments of the plaintiff as false and frivolous, reiterated the contents of the preliminary objections and stated that the defendant no.2 had received a complaint, wherein the plaintiff had stated that the transaction of Rs.15,699/- was not settled witht merchant and had asked for refund of the amount. The said complaint was registered vide service reference no.SR634066715 on 10.09.2019. On receipt of the complaint, defendant no.2 raised the charge back on the transaction made by the plaintiff on 10.09.2019. The amount of Rs.15,699/- was debited from the account of the plaintiff and the charge back was declined by the insurance company, i.e. defendant no.1 as they had provided the renewed policy, evidencing that the amount of Rs.15,699/- was settled with them. The defendant no.2 sent the SMS on the plaintiffs registered mobile number intimating about the rejection of the chargeback request by defendant no.1.
13. The defendant no.2 has further asserted that it has no role to play in the issuance of policy or rejection of claim. It had duly provided its services and the amount was deducted from the account of the plaintiff, after the transaction was complete and role back was rejected by defendant no.1 as the policy was issued when defendant no.2 contacted the defendant no.1 on the basis of complaint of the plaintiff. The defendant no.2 has followed the guidelines issued by RBI, by raising a chargeback within TAT of 50 days as per Master/ Visa guidelines, of the disputed amount of Rs.15,699/- after receipt of complaint made by plaintiff on 10.09.2019.
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 6 of 20 ISSUES:-
14. After completion of pleadings, the following issues were framed by the Ld. Predecessor of this Court vide order dated 06.04.2022:-
1. Whether the plaintiff is entitled to a decree for a sum of Rs.1,00,000/- (rupees One lakh) in his favour and against both the defendants, as prayed for? OPP
2. Whether the plaintiff is entitled to a pendente lite and further interest @ 18% interest on the said amount of Rs.1,00,000/- as prayed for?
OPP
3. Relief.
PLAINTIFF'S EVIDENCE:-
15. In plaintiff evidence, the plaintiff Sh. Rajesh Kumar, deposed as PW-
1, vide affidavit of evidence, exhibited as Ex.PW1/X, bearing his signatures at Point A and Point B, wherein he reiterated the contents of the plaint.
16. For the sake of brevity and to avoid repetition, the contents are not being reproduced. PW-1 relied upon the following documents i.e.:-
(i) Ex.PW1/1 (OSR) is Aadhaar Card,
(ii) Ex.PW1/2 (Colly.) (OSR) is the copy of medical insurance
policy no.161200/01/2019/004746 valid from 16.09.2019 to
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 7 of 20
15.09.2020 alongwith documents and receipts issued by defendant no.1 from pages 18 to 22,
(iii) Mark-A is ICICI Bank Statement from pages 24 to 26,
(iv) Ex.PW1/3 (Colly.) (OSR) are the medical bills issued by Sri Balaji Action Medical Institute from pages 27 to 36,
(v) Ex.PW1/4 (OSR) is the policy premium receipt,
(vi) Ex.PW1/5 (OSR) is the copy of renewal medical policy for the period dated 01.01.2020 to 31.12.2020,
(vii) Ex.PW1/6 (OSR) is the legal notice dated 14.01.2020,
(viii) Ex.PW1/7 is the original speed post receipt and
(ix) Ex.PW1/8 de-exhibited and marked as Mark-B is the Indian Post tracking report.
17. PW-1 was duly cross examined by the Ld. counsels for the defendants. During cross-examination, the plaintiff denied that the premium paid by him was charged back. He also asserted that he was not aware of the policy cancellation.
18. The plaintiff, then summoned a witness from ICICI Bank Sh. Babban, RO, ICICI Bank, Shop No.3, Najafgarh Road, Nangloi, ICICI Bank Ltd., Delhi deposed as PW-2. He brought the bank statement of the account holder CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 8 of 20 namely Rajasthani Jewellers bearing account no.2354405500201 for the period from 09.09.2019 to 21.01.2020 attested by Deputy Branch Manager Ms. Seema Gola, employee I.D. 191900. PW-2 was not cross-examined despite grant of opportunity.
19. The plaintiff, then summoned a witness from Sri Balaji Action Medical Institute. Sh. Ram Avtar, Medical Record Technician, Sri Balaji Action Medical Institute, deposed as PW-3. He brought the certified medical bills and the complete medical record of the plaintiff bearing patient IP No.SB19/51495, exhibited as Ex.PW3/A (Colly.) (48 pages). PW-3 was not cross-examined despite grant of opportunity.
20. Thereafter, the plaintiff evidence was closed vide separate statement of plaintiff on 27.07.2022. The matter was then put up for defendant evidence.
DEFENDANT NO.1'S EVIDENCE:-
21. In defendant no.1's evidence, Sh. P. C. Tripathi, Zonal Manager of defendant no.1 deposed as DW-1, vide affidavit of evidence, exhibited as Ex.DW1/A, bearing his signatures at Point A and Point B, wherein he reiterated the contents of the Written statement. DW-1 relied upon the following documents:-
(i) Ex.DW1/1 is the email dated 23.09.2019 and
(ii) Ex.DW1/2 is the certificate u/s.65-B, Indian Evidence Act
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 9 of 20
22. DW-1 was duly cross-examined by Ld. Counsel for plaintiff. During cross-examination, DW-1 stated that defendant no.1 had received intimation from Digisecure that the plaintiff had disputed the amount paid by him as premium with his banker and therefore, premium did not flow to it, as a result of which, his policy was cancelled. He acknowledged that defendant no.1 had sent the policy and receipt of premium paid by the plaintiff for the policy commencing from 16.09.2019 till 15.09.2020 after its renewal. He further acknowledged that defendant no.1 had not filed any document showing that intimation of cancellation of policy of the plaintiff. Further, he voluntarily stated that Digisecure had informed the defendant no.1 in the month of January, 2020 that the chargeback had been lifted by the bank and the premium shall reach the defendant no.1 and that the defendant no.1 was thinking to renew the policy from the due date of renewal, when it came to know that the plaintiff had taken another policy in the month of January. Thereafter, they refunded the amount of Rs.15,699/- paid as premium in July, 2020.
DEFENDANT NO.2'S EVIDENCE:-
23. In defendant no.2's evidence, Sh. Manish Kumar, the Authorized Representative of defendant no.2, deposed as DW-2, vide affidavit of evidence, exhibited as Ex.DW-2/A, bearing his signatures at Point A and Point B, wherein he reiterated the contents of the Written statement. DW-2 relied upon the following documents:-
(i) Ex.DW2/1 i.e. original authority letter;
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 10 of 20
(ii) Ex.DW2/2 i.e. print out of the renewed policy running into 4
pages as it is admitted document;
(iii) Ex.DW2/3 i.e. print out of the SMS log running into 4 pages as
it is accompanied with certificate u/s.65-B, Indian Evidence Act and
(iv) Ex.DW2/4 i.e. Certificate u/s.65-B, Indian Evidence Act
24. DW-2 was duly cross-examined by Ld. Counsel for plaintiff. During cross-examination, DW-2 stated that after the request of chargeback has been received from the plaintiff and the amount has already been deducted from the customer's account, the amount stays with the insurance company and in this case, no amount was received by the bank from the insurance company.
25. The matter was then listed for final arguments.
FINAL ARGUMENTS:-
26. Final arguments were advanced by the Ld. Counsels for all the parties.
27. Ld. Counsel for the plaintiff argued that the defendant no.1 had wrongly denied the claim of plaintiff since he had already paid the premium, and the defendant no.1 had already issued the renewed policy for the period from 16.09.2019 to 15.09.2020. The policy was in existence and there was no cancellation of the policy. The defendant no.1 has miserably failed to prove its assertions made in the Written Statement and the plaintiff is entitled to recover the amout claimed.
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 11 of 20
28. Per contra, Ld. Counsel for the defendant no.1 argued that the plaintiff is not entitled to recover any amount from the defendant no.1 as the policy was cancelled on intimation of chargeback received from Digisecure. The plaintiff had infact, made a false declaration of his good health to get another policy renewed on 01.01.2020.
29. Ld. Counsel for the defendant no.2 argued that there is no cause of action against defendant no.2 and defendant no.2 has discharge its duty as per the banking norms.
30. I have heard the submissions advanced by Ld. counsels for both the parties. I have also perused the entire case record meticulously.
ISSUE-WISE FINDINGS:-
Issue no. 1- Whether the plaintiff is entitled to a decree for a sum of Rs.1,00,000/- (rupees One lakh) in his favour and against both the defendants, as prayed for? OPP
31. The burden to prove this issue lies upon the plaintiff. The plaintiff has asserted that he had taken a mediclaim policy from defendant no.1 insurance company, on 03.09.2010, which he has been renewing since the begining. The plaintiff paid the premium of Rs.15,699/- on 16.09.2019, through his account no.235405500201, with defendant no.2 bank. Thereafter, he received the renewed policy for the period from 16.09.2019 to 15.09.2020. However, the defendant no.1 denied his medical claim of Rs.62,549/- for the time when he was admitted in the Sri Balaji Action Medical Institute, from 23.12.2019 to 25.12.2019, on the ground that his policy was cancelled as the CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 12 of 20 defendant no.2 bank had charged back the policy premium. The defendant no.1 had not given any prior intimation to the plaintiff and cancelled his policy unilaterally and wrongfully declined his insurance claim. Thus, the plaintiff has claimed Rs.62,549/- which has been spent by him in his medical treatment during the subsistence of his policy and Rs.15,699/-, which is the policy premium amount paid by the plaintiff to the defendant no.1.
32. The plaintiff has relied upon the copy of his medical insurance policy no. P/161200/01/2020/005231, for the period from 16.09.2019 to 15.09.2020, the invoice of the premium amount of Rs.15,699/- generated and issued by defendant no.1 dated 10.09.2019, a document dated 21.09.2019 where the defendant no.1 has certified that the plaintiff has paid Rs.15,699/- towards premium for hospitalization insurance vide policy no. P/161200 / 01/2020/005231 issued on 10.09.2019, and a letter wherein the defendant no.1 had acknowledged the issuance of policy and payment of premium by plaintiff, all exhibited as Ex. PW1/2. The plaintiff has also placed on record ICICI bank statement marked as Mark A and medical bill of Sri Balaji Action Medical Institute, exhibited as Ex.PW1/3, the policy premium receipt exhibited as Ex.PW1/4, the copy of renewed medical policy exhibited as Ex.PW1/5 and legal notice with speed post receipts exhibited as Ex.PW1/6 and Ex.PW1/7, respectively. The bank witness PW-2 also brought the bank statement of the plaintiff, exhibited as Ex.PW2/A. The witness from Sri Balaji Action Medical Institute PW-3, brought the certified medical bills and medical records of the plaintiff exhibited as Ex.PW-3/A.
33. Per contra, the defendant no.1, though has admitted that the plaintiff had taken the Family Health Optima policy from the defendant no.1, CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 13 of 20 covering him, his wife and his two children, for the sum insured of Rs.3 lacs, and that a policy bearing number P/161200/01/2020/005231, with the policy period of 16.09.2019 to 15.09.2020, was issued, has denied its liability. It has asserted that it is not liable to pay the plaintiff for his medical treatment, since the policy was cancelled due to a chargeback refund raised by the plaintiff via Digisecure. To prove its defence, the defendant no.1 has relied upon an e-mail dated 23.09.2019, sent by Digisecure wherein it had mentioned that the plaintiff has disputed the chargeback for the transaction of Rs.15,699/- that happened on 10.09.2019 and had asked the defendant no.1 to provide the supporting documents.
34. A perusal of the pleadings and evidence led by the parties, shows that the primary dispute is between the plaintiff and the defendant no.1. The only defence of the defendant no.1 is that the policy of the plaintiff no.1 for the period of 16.09.2019 to 15.09.2020, was cancelled on account of a charge back raised by the plaintiff. The plaintiff has denied the same.
35. It is interesting to note that the defendant no.1 has not produced any document, to prove that the plaintiffs policy for the period from 16.09.2019 to 15.09.2020, was infact cancelled and the intimation qua the same was given to the plaintiff. The only document relied upon by the defendant no.1, is an email it had received from Digisecure. A perusal of the email shows that Digisecure had mentioned that the plaintiff has disputed the chargeback for the transaction of Rs.15,699/- that happened on 10.09.2019 and had asked the defendant no.1 to provide the supporting documents. However, this does not show that the transaction was actually cancelled and the intimation was sent to the plaintiff. The email relied upon by the defendant no.1 shows CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 14 of 20 that there was a dispute which was raised by the plaintiff and the defendant no.1 had to provide some documents in support of the same. There is no clarity given by the defendant no.1 as to what happened after the email was received by it. Was the dispute resolved, was the transaction amount charged back, was the transaction cancelled, was the plaintiff contacted to resolve the issue? All these questions remain unanswered and the email relied upon by the defendant no.1 does not support its averments that the plaintiffs policy was cancelled.
36. What is noteworthy is that the defendant no.2, has also supported the case of the plaintiff, and asserted that though there was a dispute raised by the plaintiff with respect to the transaction of Rs.15,699/-, the same was resolved and the chargeback was declined by the defendant no.1, and the defendant no.1 had provided the copy of the renewed policy evidencing that the amount of Rs.15,699/- was settled.
37. The documents exhibited as Ex.PW1/2, shows that not only the amount of Rs.15,699/- was debited from the plaintiffs account, but the same was received and acknowledged by defendant no.1. The defendant no.1 had also issued the renewed policy no. P/161200/01/2020/005231, wherein it had clearly mentioned - "In consideration of payment of Rs.15,699/- towards renewal premium of policy number: P/161200/01/2019/00476, the policy stands renewed for a further period of 1 year as per the details given below."
38. Further, the defendant no.1 had also issued a document in the name of 'Hospitalisation benefit policy', being part of Ex.PW1/2, wherein it had CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 15 of 20 certified that the plaintiff had paid Rs.15,699/- towards premium for hospitalisation insurance bearing Policy no.P/161200/01/2020/005231 for the period 16.09.2019 to 15.09.2020 issued on 10.09.2019 and that it had received the payment vide receipt no.1203005374 on 10.09.2019. This is supported by the bank statement of the plaintiff Ex.PW2/A, which shows that an amount of Rs.15,699/- was debited from his account on 10.09.2019, in favour of defendant no.1. The witness of defendant no.2 had also brought the SMS log report exhibited as Ex.DW2/3, where the defendant no.2 had informed the plaintiff through SMS that the dispute of INR 15,699/- had been declined by the merchant.
39. Infact, DW-1, during his cross-examination, had voluntarily stated that after Digisecure informed the defendant no.1 that the chargeback was lifted by the bank, defendant no.1 was thinking to renew the policy from the due date of its renewal. This statement shows that defendant no.1 has tacitly admitted that since there was no chargeback on the policy premium, the policy should be renewed from the due date of its renewal itself, meaning thereby that there was no effective cancellation of the policy at all.
40. All the evidence read together clearly show that the defendant no.1 has failed to prove his defence as there is no document brought on record by the defendant no.1 which can show that the renewed policy no. P/161200/01/2020/005231 was infact cancelled. Further, it stands established that plaintiff had paid the amount of Rs.15,699/- on 10.09.2019, for renewal of his policy and the defendant no.1 had received the said amount, after which the defendant no.1 issued the renewed policy no. P/161200/01/2020/005231, for the period from 16.09.2019 to 15.09.2020, CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 16 of 20 and the dispute with respect to chargeback of the amount was resolved and the policy continued without any cancellation. Thus, once this is clear and established, the next obvious question is if the plaintiff is entitled to receive the claimed amount.
41. The witness from Sri Balaji Action Medical Institute PW-3, had brought the certified copies of the bills and treatment records of the plaintiff exhibited as Ex.PW3/A. Perusal of the same confirms that the plaintiff was admitted in the hospital from 23.12.2019 to 25.12.2019, against which the Sri Balaji Action Medical Institute had raised the bill of Rs. 62,549/-. The defendant no. 1 has admitted that it denied the said claim of the plaintiff. Since, it has already been proved that the policy no.P/161200/ 01/2020/005231, was valid and in existence for the period from 16.09.2019 to 15.09.2020, the inescapable conclusion is that the defendant no.1 had wrongly declined the claim of the plaintiff.
42. The Ld. Counsel for the defendant no.1 argued that the defendant no.1 has already refunded the amount of Rs.15,699/- paid as premium by the plaintiff for the renewal of policy for the period from 16.09.2019 to 15.09.2020, after the filing of this case, and hence, it cannot be held liable to make any the payment to the plaintiff. However, I do not find merit in the argument of the Ld. Counsel for the defendant, since the defendant no.1 cannot be absolved from its liability, if the policy was in existence and it has wrongly declined the plaintiffs claim, on the ground that after the filing of the suit, it has returned the premium amount to the plaintiff. If such a modus operandi is promoted and approved, it will create havoc in the insurance industry and will give unbridled autonomy to the insurance companies to CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 17 of 20 wriggle out of their duties to pay the claim of the customers, by merely refunding the premium amount at a later date.
43. The plaintiff has also claimed Rs.15,699/- paid as premium to the defendant no.1, however, the plaintiff cannot be entitled to recover the premium amount and the claim for hospital bill, both. These amounts are mutually exclusive, in the sense that, if the plaintiff is entitled to recover the amount of hospital bill from the defendant no.1, it cannot expect the defendant no.1 to refund the premium amount. However, since the plaintiff has already received the premium amount, he will be entitled to recover the claimed hospital bill after deduction of the premium amount already refunded by the defendant no.1. Accordingly, the plaintiff is entitled to recover Rs.46,850/-, which is the amount claimed by the plaintiff for his hospital bill (Rs.62,549/-) minus the amount of premium of (Rs.15,699/-) already refunded by the defendant no.1, from defendant no.1.
44. The plaintiff has also claimed interest at the rate of 18 percent per annum, till the date of filing of the suit, on account of harassment, mental pain and agony. However, this seems to be an inflated rate of interest claimed by the plaintiff. Therefore, the plaintiff is entitled to recover interest at the rate of 9 percent per annum on the hospital bill amount i.e 62,549/- from the date of discharge of the plaintiff from hospital i.e. 25.12.2019 to the date of filing the suit.
45. Accordingly, this issue is decided partly in favour of the plaintiff and against defendant no.1.
CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 18 of 20 Issue no.2- Whether the plaintiff is entitled to a pendente lite and further interest @ 18% interest on the said amount of Rs. 1,00,000/- as prayed for? OPP
46. The plaintiff has also claimed interest at the rate of 18 percent per annum from the date of filing of the suit till the date of its realization. However, this seems unreasonable and inflated. Therefore, the plaintiff is entitled to recover interest at the rate of 9 percent per annum on the hospital bill amount i.e.Rs.62,549/- from the date of filing the suit till the date of decree and interest at the rate of 6 percent per annum on the hospital bill amount i.e.Rs.62,549/- from the date of decree till the date of realisation, from the defendant no.1.
47. Accordingly, this issue is decided in favour of the plaintiff and against defendant no.1.
RELIEF:-
48. In view of the aforesaid discussion, the facts and circumstances of the case, the findings given on the above issues, documents placed on record and the evidence led, the plaintiff has partly proved his case on the balance of preponderance of probabilities. The plaintiff is entitled to recover Rs.46,850/- (Rupees Forty Six Thousand Eight Hundred Fifty Only), along with interest at the rate of 9 percent per annum on the hospital bill amount i.e. Rs.62,549/- from the date of discharge of the plaintiff from hospital i.e 25.12.2019 to the date of filing the suit, interest at the rate of 9 percent per annum on the hospital bill amount i.e.Rs.62,549/- from the date of filing the suit till the date of decree and interest at the rate of 6 percent per annum on CS SCJ 312/2020 Rajesh Kumar Vs. Star Health And Allied Insurance Company Ltd. & Anr. 19 of 20 the hospital bill amount i.e.Rs.62,549/- from the date of decree till the date of realisation, from the defendant no.1.
49. Cost of the suit is awarded to the plaintiff, to be paid by defendant no.1.
50. Decree sheet be prepared accordingly.
51. File be consigned to record room after due compliance.
Digitally signed by CHITRANSHI CHITRANSHI ARORA
ARORA Date:
2023.08.28
16:39:24 +0530
Pronounced in the open court (Chitranshi Arora)
Today on 28.08.2023 CJ-03, South-West,
Dwarka Court, ND
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