Arun Kumar K Teli vs ORIENTAL INSURANCE CO. LTD.

THIS revision petition has been filed by the petitioner against the order dated 09 -10 -2013 passed by State Consumer Disputes Redressal Commission, Gujarat (in short, ''the State Commission '') in Appeal No. 3543 & 3544/2012 - Dr. Arun Kumar K. Teli Vs. Oriental Insurance Co. Ltd., by which Appeal No. 3543/2012 was dismissed but Appeal No. 3544/2012 was allowed and order of District Forum allowing complaint was set aside against which this revision petition has been filed.

BRIEF facts of the case are that complainant/petitioner obtained medi -claim policy from respondent/opposite party for a period one year from 30 -04 -2010 to 29 -04 -2011 and obtained another medi -claim policy from 30 -04 -2011 to 29 -04 -2012 for Rs. 3 lakhs. Complainant ''s wife, who was covered under the policy was admitted in hospital on 06 -07 -2011 and was discharged on 18 -08 -2011 and expenditure of Rs.1,27,254/ - was incurred. As claim was not paid, alleging deficiency on the part of opposite party, complainant filed complaint. Opposite party resisted complaint and prayed for dismissal of complaint. Learned District Forum after hearing both the parties allowed complaint. Appeal filed by the opposite party was allowed by learned State Commission vide impugned order, against which this revision petition has been filed. Heard learned counsel for the parties finally at admission stage and perused record.

LEARNED counsel for the petitioner submitted that learned State Commission committed error in observing that there was only one policy and claim of Rs. 3 lakh had already been exhausted in first policy, hence nothing was payable whereascomplainant obtained separate polices for different two years, hence revision petition be allowed and impugned order be set aside. Learned counsel for the respondent submitted that order passed by learned State Commission is in accordance with law, hence revision petition be dismissed.

PERUSAL of record reveals that complaint obtained policy no. 172201/48/2011/256 for a period of one year from 30.04.2010 to 29.04.2011 and another policy no. 172201/48/2012/209 for the period from 30.04.2011 to 29.04.2012 for the same amount of Rs. 3 lakh along with coverage of his wife. Learned State Commission wrongly observed that as complainant ''s claim had already been considered in another complaint no. 240/2011 and full sum insured has been exhausted, he is not entitled to any amount in complaint no. 285/2011. This observation is contrary to record because complainant filed two separate complaints for reimbursement of medical expenses incurred in two different policies in two different years. Learned counsel for the Respondent has not denied insurance policy for 30 -04 -2011 to 29 -04 -2012 and in such circumstances, complainant was entitled to reimbursement of medical expenses and learned District Forum rightly allowed complaint but learned State Commission committed error in allowing appeal and dismissing complaint. In such circumstances, order is liable to be set aside. Consequently, revision petition filed by the petitioner is allowed and impugned order dated 09 -10 -2013 passed by learned State Commission in appeal no. 3544/2012 is set aside and order of District Forum allowing complaint is upheld with no order as to costs.