ILAYARAJA M v. CARE HEALTH INSURANCE LTD THROUGH ITS AUTHORIZED SIGNATORY

3

care of Dr.N.Rajesh, MD, DNB, DM (Gastroenterology). Investigations revealed a highly elevated Lipase level of 767 U/L (normal range: 23-300 U/L), confirming pancreatitis. After treatment and stabilization, she was discharged on 29.11.2024. The medical expenses incurred at Sri Gokulam Specialty Hospital amounted to Rs.17,999/-, bringing the total medical expenses incurred to Rs.41,011/-. It was stated that the complainant applied for cashless treatment at Sugam Hospital, Rasipuram, as it was a network hospital of the Opposite Party. However, the Opposite Parties denied the cashless facility without proper justification, thereby compelling the complainant to bear the medical expenses out of his own pocket and subsequently file a reimbursement claim. It was stated that the complainant submitted the claim forms along with all supporting documents, including discharge summaries, hospital bills, investigation reports, and a medical justification letter dated 10.12.2024 issued by the hospital. It was stated that on 23^rdDecember 2024, the Opposite Party rejected both claims stating that the "PATIENT COULD HAVE BEEN TREATED ON OPD BASIS" and citing "PERMANENT EXCLUSION - VITALS AND LAB REPORT NORMAL." This rejection was stated to be completely wrong and unjustified, as the lab reports were not normal. The CRP level was 71.85 mg/L (7 times above normal) and the Lipase level was 767 U/L (2.5 times above normal), both indicating serious medical conditions. It was further stated that the patient had head injury with loss of consciousness and high fever requiring hospitalization. It was stated that the hospital issued a Medical Justification Letter dated 10.12.2024 clearly stating that inpatient treatment was medically necessary and could not be managed on an OPD basis. The treating doctors confirmed that the child's condition required IV treatment, close monitoring, and hospitalization to prevent complications, and that pancreatitis and severe dehydration in a 10-year-old child constituted medical emergencies requiring inpatient care. It was stated that the Opposite Parties committed gross deficiency in service by denying the cashless facility, arbitrarily rejecting genuine claims on false grounds, ignoring medical evidence and the professional opinion of the treating doctors, and thereby causing immense financial burden and mental agony to the complainant. It was stated that the Opposite Parties indulged in unfair trade practice by collecting premiums while denying legitimate claims, misrepresenting policy coverage, and assigning false reasons to reject valid claims. It was prayed for allowing the complaint.

4

3. Written Version filed by the Opposite Parties No.1 and 2 in brief:- The case of the Opposite Parties is that all allegations and averments levelled against them were denied, save those expressly admitted. It was stated that the Opposite Parties issued a health insurance policy bearing Policy No.91326582, namely "Care Supreme," to the Complainant, along with his spouse and two Children, for the period from 19.10.2024 to 18.10.2025, for a sum insured up to Rs.5,00,000/-, subject to the terms and conditions of the policy. It was stated that upon receipt of the claim, the Opposite Party company triggered an investigation to verify the veracity of the claim, and upon such investigation, it was found that, as per the discharge summary of the treating hospital dated 28.11.2024, the insured was diagnosed and treated for acute gastritis with dehydration and/or pancreatitis; it was also stated that, as per the discharge summary, all the vital parameters of the insured were within normal range on the day of admission, and on examination, the patient was conscious and oriented, afebrile, and not dyspneic, with PR 82/min, RR 32/min, and SpO₂ 97%. It was further stated that, as per the lab reports of the insured, the TLC count was within normal limits on the day of admission, which usually does not occur in cases of infection. It was also stated that, as per the discharge summary of the treating hospital, the insured was diagnosed with dehydration, but no serum electrolyte test was conducted, which is not the general practice in any medical institution, as such a test is mandatory in cases of dehydration, thereby raising questions regarding the line of treatment administered by the treating hospital. It was stated that as per the USG whole abdomen reports, no abnormality was found, which questions the prolonged hospitalization of the insured in the treating hospital. It was stated that upon receipt of the claim, the Opposite Party Company triggered an investigation to check the veracity of the claim, and upon investigation, as per the discharge summary of the treating hospital dated 29.11.2024, the insured was diagnosed with acute viral fever/dehydration. It was stated that, as per the lab reports of the treating hospital, the TLC count of the insured was mildly deranged on the day of admission. It was further stated that the insured patient was admitted with complaints of fever, but no fever profile tests other than dengue were conducted throughout the hospitalization, which raised questions regarding the line of treatment given by the hospital. It was stated that the pathology reports of the treating hospital in respect of the insured were digitally signed, and the pathologist's stamp was not

5

present on the reports, which raised questions regarding the authenticity of the said reports. It was stated that, accordingly, with reference to the aforementioned condition, the hospitalization of the insured was neither required nor warranted. Hence, the said claim was rejected on the grounds of "PERMANENT EXCLUSION - ADMISSION PRIMARILY FOR INVESTIGATION AND EVALUATION (CODE EXCL 04) - AS PER ATTACHED MEDICAL

DOCUMENTS, VITALS AND LAB REPORTS WERE WITHIN NORMAL LIMITS AND THE

PATIENT COULD HAVE BEEN TREATED ON AN OPD BASIS." Accordingly, the claim denial letters dated 07.12.2024 and 09.12.2024 were sent to the Complainant as per Clause 4.1(b)(i) of the issued policy terms and conditions. It was stated that, as per Clause 4 (Exclusions) of the policy: 4.1 Standard Exclusions: (b) Permanent Exclusions:

Investigation & Evaluation (Code Excl 104): (a) Expenses related to any admission primarily for diagnostic and evaluation purposes only are excluded and (b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded. It was stated that the reimbursement claim of the insured was duly denied by the Opposite Party Company in accordance with the terms and conditions of the issued policy. It was prayed for dismissal of the complaint with heavy costs.

4. Submissions:

Complainant:- Proof Affidavit of Thiru.M.Ilayaraja (PW1), Exhibits A1 to A10 marked, Written argument dated 06.04.2026 and oral argument heard. Opposite Parties No.1 and 2:- Proof Affidavit of Thiru.Kural Insa (RW1), Exhibits B1 to B11 marked in which Exhibits B10 and B11 marked with objection, Written argument dated 13.04.2026 and oral argument heard.

5. Points for consideration:-

1) Whether the Complainant is a `Consumer' as provided under the Consumer Protection Act, 2019?

2) Whether the Opposite Parties No.1 and 2 committed any deficiency in service and unfair trade pratice to the Complainant?

3) Whether the Complainant is entitled to get the reliefs as claimed in the complaint?

6

4) To what other relief or reliefs the Complainant is entitled to?

6. Point No.1:- (i). On the side of the Complainant, it was argued that he had purchased a health insurance policy bearing No.91326582, valid from 19.10.2024 to 18.10.2025, with a sum insured of Rs.5,00,000/- with monthly premium of Rs.938.85/-, and a total premium of Rs.11,265.69/-, from Opposite Party No.1 through online mode for himself, his wife, and his two minor daughters. Exhibit A1 (copy of the insurance policy certificate) was relied upon to prove the said contention. It was argued that since the branch office of the 1^stOpposite Party is situated within the territorial limits of this Hon'ble Commission, the same was impleaded as the 2^ndOpposite Party. It was argued that having availed the services of the Opposite Parties No.1 and 2, the Complainant is a 'consumer' as provided under Section 2(7)(ii) of the Consumer Protection Act, 2019. (ii). On the side of the Opposite Parties No.1 and 2, it is not disputed that the Complainant is a 'consumer'. The Opposite Parties have admitted that they issued a health insurance policy bearing No.91326582, namely "Care Supreme," in favour of the Complainant covering his spouse and two children for the policy period from 19.10.2024 to 18.10.2025 with a sum insured of Rs.5,00,000/-, subject to the terms and conditions of the policy, and that the Complainant paid valid consideration for the same. Exhibit B2 (Discharge Summary) was relied upon by the Opposite Parties in support of this fact. (iii). On considering the contentions of the Complainant and Opposite Parties with the available material evidence and in the absence of any contrary version on the side of the Opposite Parties No.1 and 2, we find that the Complainant had proved with sufficient material evidence that he is a 'consumer' as provided under the Consumer Protection Act, 2019. From the above, we find that the Complainant is a 'consumer' as defined under Section 2(7)(ii) of the Consumer Protection Act, 2019. Accordingly, Point No.1 is answered.

7. Point No.2:- (i). On the side of the Complainant, it was argued that on 24.11.2024, the Complainant's minor daughter, Dharshini (aged 10 years), suddenly fell seriously ill with high fever for three days, severe vomiting, head injury with loss of consciousness for two minutes, and severe dehydration, which constituted a medical emergency requiring immediate hospitalization. The Complainant immediately rushed his daughter to Sugam Hospital, Rasipuram, a network hospital of the Opposite Parties, where she was admitted as

7

an inpatient on 24.11.2024. The doctors diagnosed her condition as acute gastritis with dehydration and suspected pancreatitis. It was argued that the critical medical findings during the hospitalization at Sugam Hospital were: (i) CRP (C-Reactive Protein) level of

71.85 mg/L, which was severely elevated (normal range below 10 mg/L), indicating significant inflammation; (ii) head injury requiring a CT brain scan; and (iii) requirement of IV fluids, antibiotics, and antiemetics. The Complainant's daughter remained admitted at Sugam Hospital from 24.11.2024 to 28.11.2024 for four days. The medical expenses incurred at Sugam Hospital amounted to Rs. 23,012/-. Exhibit A2 (Discharge summary) and Exhibit A3 (hospital bills from Sugam Hospital) were relied upon to prove the said contention. It was argued that due to persistent vomiting and elevated pancreatic enzymes, the treating doctors at Sugam Hospital referred the Complainant's daughter to Sri Gokulam Specialty Hospital, Salem, for specialized gastroenterology treatment. She was admitted at Sri Gokulam Hospital on 28.11.2024 under Dr. N. Rajesh, MD, DNB, DM (Gastroenterology). It was argued that investigations at Sri Gokulam Hospital revealed a highly elevated Lipase level of 767 U/L (normal range 23-300 U/L), confirming pancreatitis. After treatment and stabilization, the Complainant's daughter was discharged on 29.11.2024. The medical expenses at Sri Gokulam Hospital amounted to Rs.17,999/-. Exhibit A4 (discharge summary from Sri Gokulam Hospital) and Exhibit A5 (hospital bills) were relied upon to prove the said contention. It was argued that the total medical expenses incurred were Rs.41,011/- (Rs.23,012/- + Rs.17,999/-). Duly filled claim forms along with all supporting documents, including discharge summaries, bills, investigation reports, and a Medical Justification Letter dated 10.12.2024 issued by Sugam Hospital, were submitted. The claims were registered as Nos.95248359-00 (Sugam Hospital) and 95239964-00 (Sri Gokulam Hospital).It was further argued that the treating hospital issued a Medical Justification Letter dated 10.12.2024 which clearly stated that inpatient treatment was medically necessary and could not be managed on an OPD basis. The letter specifically mentioned that the Complainant's daughter's CRP level was 71.85 mg/L, indicating significant inflammation, and that she had elevated levels of lipase and amylase suggesting pancreatic involvement requiring immediate medical intervention. The letter confirmed that continued inpatient care for four days was deemed medically necessary. Exhibit A6 and Exhibit A7 (Medical Justification Letter) and Exhibit A10 (copy of Health Claim Form) were

8

relied upon to prove the said contention. It was argued that the Opposite Party's contention in its written version that "TLC counts were within normal limits" on admission is clinically irrelevant because, firstly, a normal TLC does not negate pancreatitis, viral fever with dehydration, or elevated CRP; secondly, in cases of acute pancreatitis and viral fever, leukocytosis (elevated WBC) may be absent in the early phase; and thirdly, the Opposite Party, being a lay insurance company, cannot selectively rely on one laboratory parameter while ignoring other significantly abnormal findings. It was further argued that the Hon'ble Supreme Court has held that insurance companies cannot substitute their lay opinion for the medical judgment of qualified treating doctors. It was argued that the Opposite Parties, in its proof affidavit, raised the contention that no serum electrolyte test was conducted despite dehydration. This argument is misconceived, as there is no policy condition or medical protocol mandating a serum electrolyte test as a prerequisite for diagnosing or treating dehydration. Clinical management of dehydration with intravenous fluids is a standard and universally accepted medical practice, and the treating doctor's clinical assessment governs the line of treatment, not the post-facto opinion of the Opposite Parties. It was argued that on 23.12.2024, the Opposite Party company wrongfully rejected both claims stating "PERMANENT EXCLUSION VITALS AND LAB REPORT NORMAL PATIENT COULD HAVE BEEN TREATED ON OPD BASIS." It was argued that the rejection was arbitrary, unjustified, and contrary to the medical records, as the lab reports were not normal as alleged. It was argued that the medical evidence clearly established that (a) CRP level was 71.85 mg/L, nearly 7 times above the normal range (below 10 mg/L); (b) Lipase level was 767 U/L, about 2.5 times above the normal range (23-300 U/L); and (c) these significantly elevated parameters indicated serious medical conditions necessitating inpatient treatment and could not have been managed on OPD basis. The Complainant contended that the rejection letters dated 23.12.2024 were based on false grounds and amounted to wilful misrepresentation of medical facts. Exhibit A8 and A10 were relied upon to prove the said contention. It was argued that the Opposite Party has not produced any independent medical expert opinion contradicting the treating doctor's opinion. Mere suspicion or lay reasoning by insurance adjusters cannot override the medical judgment of the qualified treating physician. It was argued that the Opposite Parties has committed gross deficiency in service by wrongfully denying the cashless facility and arbitrarily

9

rejecting a genuine claim on unsustainable grounds. It was further contended that the Opposite Parties deliberately ignored the documented medical evidence and the professional opinion of the treating doctors, thereby causing immense financial burden and mental agony to the Complainant. It was also argued that the Opposite Parties have indulged in unfair trade practice by collecting premiums while denying legitimate claims, misrepresenting policy coverage, and relying on false reasons to reject valid claims. (ii). On the side of the Opposite Parties No.1 and 2, it was argued that the 1^st Opposite Party is a specialized health insurance company, duly licensed by the Insurance Regulatory and Development Authority of India (IRDAI), and is engaged in offering various health-related insurance products, including health insurance, top-up coverage, personal accident insurance, critical illness cover, and international travel insurance, in accordance with applicable laws and regulatory guidelines. It was argued that, upon receipt of the claim, an investigation was triggered by the Opposite Parties to verify the veracity of the claim. It was argued that, as per the discharge summary dated 28.11.2024, the insured was diagnosed at the treating hospital with Acute Gastritis with dehydration and pancreatitis. Exhibit B2 (copy of discharge summary) and Exhibit B3 (Health Claim Form) were relied upon to substantiate the said contention. It was further argued that, as per the discharge summary in respect of the insured, all vital parameters were within normal limits on the day of admission. On examination, the patient was found to be oriented and conscious and was afebrile. The pulse rate was recorded at 82 beats per minute, the respiratory rate at 32 breaths per minute, and SpO₂ at 97%. It was argued that the complainant's daughter was admitted with complaints of fever; however, no fever profile tests, other than a dengue test, were conducted throughout the hospitalization, which questions the line of treatment given by the hospital. Further, the pathology reports of the treating hospital in respect of the insured were digitally signed, and the stamp of the pathologist was also not present in the reports, thereby raising questions regarding the authenticity of the said reports. Exhibit B8 (Copy of the Lab Reports) was relied upon in support of this contention. It was argued that in reference to the aforementioned condition, that based on the medical records, the hospitalization of the insured was not required or warranted. Hence, the claim was rejected on the ground of "PERMANENT EXCLUSION - ADMISSION PRIMARILY FOR

10

INVESTIGATION AND EVALUATION (CODE EXCL 04) - AS PER ATTACHED MEDICAL

DOCUMENTS, VITALS AND LAB REPORTS WERE WITHIN NORMAL LIMITS AND THE

PATIENT COULD HAVE BEEN TREATED ON AN OPD BASIS." Accordingly, the claim denial letters dated 07.12.2024 and 09.12.2024 were sent to the complainant in accordance with Clause 4.1(b)(i) of the issued policy terms and conditions. Exhibit B9 was relied upon to prove such contention. Further, it was argued that, as per the lab reports of the insured, the TLC count was within normal limits on the day of admission, which usually does not occur in cases of infection. Exhibit B4 (CT Scan of Brain Report) was relied upon to prove such contention. It was further argued that, as per the discharge summary of the treating hospital, the complainant's daughter was diagnosed with dehydration; however, no serum electrolyte test was conducted, which is not a standard practice in any medical institution. If a patient is diagnosed with dehydration, a serum electrolyte test is essential, which raises questions regarding the line of treatment given by the treating hospital. It was also argued that, as per the USG whole abdomen report, no abnormality was found, which questions the prolonged hospitalization of the insured in the treating hospital. Exhibit B5 (Copy of USG abdomen Scan Report) was relied upon to prove such contention. It was argued that, as per the USG whole abdomen report, no abnormality was found, which questions the prolonged hospitalization of the insured in the treating hospital. It was further argued that, as per the discharge summary of the treating hospital dated 29.11.2024, the complainant's daughter was diagnosed with acute viral fever and dehydration. As per the laboratory reports of the treating hospital, the TLC count of the insured was mildly deranged on the day of admission; however, diagnosis and treatment under such circumstances are excluded under the policy conditions. In support of these contentions, Exhibit B5 (Copy of USG abdomen Scan Report), Exhibit B6 (Discharge Summary), and Exhibit B10 marked with objection (Copy of Policy Conditions) were relied upon to prove the said contentions. It was argued that the reimbursement claim of the insured was duly denied by the Opposite Party in accordance with the terms and conditions of the issued policy. It was further argued that there was no deficiency in service or unfair trade practice on the part of the Opposite Parties No.1 and 2, and that all actions were taken in discharge of official duties strictly as per the policy terms and conditions.

11

(iii). On the considering the contentions advanced on both sides and the material evidence available on record, it is found that the Complainant had obtained a valid health insurance policy bearing No.91326582 from the opposite parties for the period from 19.10.2024 to 18.10.2025 with a sum insured of Rs.5,00,000/-, covering himself and his family members, as evidenced by Exhibit A1 (Insurance Policy Certificate) and Exhibit B1 (Policy Certificate issued by Opposite Party), and there is no dispute regarding the existence of the insurance policy or the relationship of consumer between the parties; the dispute pertains to the repudiation of the medical claim submitted by the Complainant for treatment of his minor daughter, wherein the Opposite Parties contend that the hospitalization was not medically necessary and that the claim was rightly rejected under the exclusion clause relating to admission primarily for investigation and evaluation, relying upon Exhibits B4, B5, B6, B8, B9 and B10 marked with objection, whereas the Complainant, on the other hand, relies upon Exhibits A2, A4, A6 and A7 including the Medical Justification Letter, wherein a close scrutiny of Exhibit A7 reveals that Sugam Hospital admitted Miss Dharshini, aged 10 years, on 24.11.2024 with a history of persistent high fever, severe vomiting, fatigue and a fall resulting in complications, that the doctors recorded a significantly elevated CRP level of 71.85 mg/L prior to admission indicating severe inflammation requiring inpatient care, and that during hospitalization elevated lipase and amylase levels were detected suggesting pancreatic involvement necessitating immediate medical intervention, and the treating doctor certified that the patient required continued inpatient treatment for four days for monitoring vital signs, administration of intravenous fluids and medications, further diagnostic investigations and prevention of complications through close observation, and opined that outpatient treatment could not have safely or effectively managed the patient's condition, thereby justifying the necessity of hospitalization and recommending reimbursement of the claim; it is further found that the contention of the Opposite Parties regarding normal TLC values and absence of abnormalities in USG abdomen cannot override the clinical assessment of the treating specialists, and in the absence of any contrary expert medical evidence, the medical opinion supported by contemporaneous records carries greater evidentiary value, and similarly objections regarding absence of serum electrolyte testing or alleged procedural irregularities are not sufficient to discredit the treatment, as the repudiation letters dated

12

07.12.2024, 09.12.2024 and 23.12.2024 (Exhibit A8) are based on selective interpretation of records without considering the totality of medical evidence, and therefore the reliance on exclusion clause (Code EXCL 04) is not sustainable, accordingly, it is held that the Opposite Parties have failed to establish that the hospitalization was unnecessary or that the claim falls within the exclusion clause, whereas the Complainant has proved that the treatment was medically justified, and hence the repudiation amounts to deficiency in service, while the plea of unfair trade practice being substantiated, and the Opposite Party's contention limiting liability to Rs.31,316/- on internal assessment cannot override the admissible claim determined on evidence and policy terms, and is therefore not acceptable. It is pertinent to note that, upon close scrutiny of Exhibit B9 (Non-Registration Claim), it is evident that the claim documents submitted by the Complainant were not registered. Moreover, the reliance placed by the Opposite Parties on the decision in Export Credit Guarantee Corporation of India Ltd. V. M/s Garg Sons International and other connected judgments is noted. There is no dispute with the settled legal position that an insurance policy is a commercial contract and its terms must be construed strictly, and that an insured cannot claim anything beyond what is covered under the policy. However, the said principles are of general application and cannot be mechanically applied to the facts of the present case without examining the medical evidence and the factual matrix involved. In the present case, the core issue is not merely one of interpretation of policy terms, but whether the hospitalization of the insured was medically necessary and whether the repudiation of the claim is justified on the basis of the medical records and expert opinions available on record. These are essentially questions of fact to be decided on appreciation of evidence, and not by applying abstract principles of contract interpretation in isolation. Similarly, the reliance placed on the decision in City Union Bank v. R. Chandramohan (2023) is also misconceived. The said decision pertains to the scope of jurisdiction of Consumer Commissions in cases involving highly complex disputed questions of fact requiring detailed evidence or allegations of fraud and criminality. The present case, however, relates to a claim for medical reimbursement supported by discharge summaries, laboratory reports, and medical justification letters, which are routinely examined and adjudicated by Consumer Commissions in exercise of their summary jurisdiction. Therefore, the said judgment is clearly distinguishable on facts and has no application to

13

the present dispute. Accordingly, the precedents relied upon by the Opposite Parties are factually distinguishable and do not advance their case in the present matter. The Opposite Parties ought not to have rejected the claim by mechanically applying the exclusion clauses without duly considering the gravity of the patient's condition. It is evident from the clinical records that the insured was not hospitalized merely for diagnostic or evaluation purposes. The presence of persistent high fever, severe vomiting, and a significantly elevated CRP level of 71.85 mg/L clearly indicates a medical emergency necessitating immediate hospitalization. The treatment protocol adopted, including administration of intravenous fluids, medications, and continuous monitoring for possible pancreatic complications, falls within the scope of active medical management. Therefore, the contention of the Opposite Parties that the admission was elective or primarily for investigation is not supported by the medical records and cannot override the clinical judgment of the treating physician, who prioritized the patient's safety and treatment needs. The contention of the Complainant is that Code EXCL 04 excludes admissions "primarily for diagnostics and evaluation purposes only" and that a plain and strict interpretation of the said clause would show that it cannot be applied to an emergency admission involving active therapeutic interventions such as intravenous antibiotics, intravenous fluids, antiemetics, and specialist gastroenterological management. It is further contended that the discharge summaries, billing records, and Medical Justification Letter clearly establish that the admissions were undertaken for active treatment and not merely for evaluation, and that the said contention is found to be established from the material available on record. Furthermore, the Complainant rightly contends that rejection of a claim without affording the insured an opportunity to properly register or process it undermines the very object and purpose of obtaining insurance coverage. In the present case, the determination of whether the child required inpatient treatment is purely a medical decision, which was made by the treating doctors based on clinical assessment. A layperson cannot be expected to disregard or substitute such expert medical opinion. When qualified medical professionals have advised hospitalization and inpatient care as the appropriate course of treatment, it would be unreasonable and impractical to assume that the child could have been safely managed on an outpatient basis. In such circumstances, it is wholly unjustified for the Opposite Parties to dispute the necessity of hospitalization. Accordingly, the contentions advanced by the

14

Opposite Parties are neither reasonable nor sustainable in law or on facts, as they have failed to substantiate their allegations or rebut the evidence adduced by the Complainant with any credible material; mere assertions, in the absence of supporting evidence, cannot be accepted. The contention of the Complainant is that, where insurance policy coverage exists, the failure of the Opposite Parties to register the claim and reimburse the hospital bills constitutes deficiency in service. The said contention is found to be correct, as the claim was mechanically denied without proper consideration. In a consumer complaint, the onus of proving deficiency in service and unfair trade practice lies upon the Complainant who alleges the same. In the present case, the Complainant has proved, by sufficient and cogent material evidence, the deficiency in service and unfair trade practice committed by Opposite Parties No.1 and 2. From the above, we find that the Complainant has proved the deficiency in service and unfair trade practice committed by Opposite Parties No.1 and 2 and consequently, this complaint is liable to be allowed. Accordingly, Point No.2 is answered.

8. Points No.3 and 4:- In Point No.2, it is decided that the Complainant has proved the deficiency of service and unfair trade practice committed by the Opposite Parties No.1 and 2 and the Complaint is liable to be allowed. In such circumstance, it would be just and reasonable that the Opposite Parties No.1 and 2 shall jointly and severally pay the Complainant a sum of Rs.41,011/- towards the eligible reimbursement of the medical expenses incurred for Complainant's daughter, pay a sum of Rs.30,000/- towards compensation for deficiency in service, pay a sum of Rs.30,000/- towards compensation for unfair trade practice, pay a sum of Rs.30,000/- towards compensation for mental agony caused to the Complainant and pay a sum of Rs.10,000/- towards cost of this complaint. Except for the above said reliefs, the Complainant is not entitled to get any other relief from this Complaint. Accordingly, Points No.3 and 4 are answered.

In the result, this Complaint is partly allowed. The Opposite Parties No.1 and 2 are directed to pay the Complainant jointly and severally: (i). a sum of Rs.41,011/- (Rupees forty one thousand and eleven only) towards the eligible reimbursement of the medical expenses incurred for Complainant's daughter, (ii). a sum of Rs.30,000/- (Rupees thirty thousand only) towards compensation for deficiency in service, (iii). a

15

sum of Rs.30,000/- (Rupees thirty thousand only) towards compensation for unfair trade practice, (iv). a sum of Rs.30,000/- (Rupees thirty thousand only) towards compensation for mental agony caused to the Complainant and (v). a sum of Rs.10,000/- (Rupees ten thousand only) towards cost of this Complaint, within two months from the date of receipt of this Order, failing which the reimbursement amount and compensation amounts stated above in (i) to (iv) shall carry interest at the rate of 9% per annum from the date of filing of this Complaint, that is, from 05.01.2026 to till realization.

Dictated by the Member to the Steno-Typist and directly typed by her and corrected by the Member and pronounced by us in the open Commission on the 27^thday of April,

2026.

Sd/- Sd/-

MEMBER PRESIDENT

Complainant side witness:-

PW1-Thiru.M.Ilayaraja Opposite Parties No.1 and 2 side witness:-

RW1-Thiru.Kural Insa

Exhibits on the side of the Complainant:-

16

Exhibits on the side of the Opposite Parties No.1 and 2:-

Sd/- Sd/-

MEMBER PRESIDENT