Rajeev Kumar Sharma v. M/s Future General Total Insurance Solutions

1

RBT/CC/303/2022

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

ROPAR, CAMP COURT AT MOHALI

Rajeev Kumar Sharma S/o Late BarbansLal, C/o ShreenathTradelinks, Plot No.31, JLPL, Industrial Area, Sector 82, SAS Nagar (Mohali), Punjab, R/o House No. 1 1 78- C, Ranjit Nagar, Sector 1 1, Kharar, District SAS Nagar (Mohali). Punjab. ..……..Complainant.

Versus

1. M/s. Future General Total Insurance Solutions, (M/s. Future General India Insurance Co. Ltd.) Through its Manager, SCO No. 4-5, 2ND Floor, Sector 8-C, Chandigarh.

2. M/s Landmark Insurance Brokers Pvt. (Code-60061507)) Through its Manager, SCO No. 60-62, Sector 17-C, Chandigarh.

……..Opposite Party.

Consumer Complaint under Section 35 of the

ConsumerProtection Act 2019 as amended upto date.

QUORUM:-

Sh. Kuljit Pal Singh : President Smt. Ranvir Kaur : Member Sh. Ramesh Kumar Gupta : Member

PRESENT:

For the complainant : Mr. Varun Sharma Adv. For the OP1 : None. Proceeded Ex-Parte vide order Dated 15.09.2022

For the OP2 : Sh. Krishan Kant Adv.

RAMESH KUMAR GUPTA MEMBER:

1. The present complaint has been received from District Consumer Disputes Redressal Commission, SAS Nagar, Mohali, bythe order of the Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh, vide orderDated 21.07.2025 for its disposal.

2. Brief facts of the Case are that the complainant filed the present complaint under the provisions of the Consumer Protection Act alleging deficiency in service and unfair trade practice on the part of the opposite parties in repudiating his medical insurance claim. It is the case of the complainant that he had obtained a health insurance policy namely Future Health Suraksha - Family Floater Insurance

2

RBT/CC/303/2022

Policy bearing No. FHR-37-21-7382473-00-000 Ex-C1, from OP No.1 i.e. Future Generali India Insurance Company Limited through OP No.2 i.e. M/s Landmark Insurance Brokers Pvt. Ltd. for the period from 30.06.2021 to 29.06.2022 after payment of premium amount of Rs.19,404/-. Under the said policy, the complainant, his wife and his son Agam Vashisht were covered as insured members. It is averred that during the subsistence of the policy, the complainant's son Agam Vashisht suffered from dengue fever and was admitted in Kaushal Multi-Speciality Hospital, Kharar on 01.10.2021 Ex-C3, and remained hospitalized till 09.10.2021. The complainant incurred medical expenses amounting to Rs.90,079/- Ex-C3 (Page-120), towards his son's treatment and submitted the reimbursement claim along with relevant medical documents, bills and treatment records to OP No.1. It is further alleged that despite submission of all requisite documents, OP No.1 failed to settle the claim and ultimately repudiated the same vide repudiation letter dated 24.01.2022 Ex- C5, on the ground of alleged discrepancies noticed during verification of the medical records, including differences in timings recorded in certain documents and requirement of certain clarifications from the hospital/laboratory authorities. The complainant alleged that such repudiation was unjustified and amounted to deficiency in service, causing him financial loss, mental agony and harassment. The complainant further stated that he approached the opposite parties repeatedly and also served a legal notice dated 07.03.2022, but no satisfactory response was received. Hence, alleging deficiency in service and unfair trade practice on the part of the Opposite Parties, the complainant prayed for following directions to the Opposite Parties as under:-

i. To pay/reimburse the amount of Rs.90,079/- paid by the Complainant along with the interest (a) 18% p.a.;

ii. To pay a sum of Rs.1.00.000/- on account of harassment, mental agony;

iii. To pay an amount of Rs.30,000/- for litigation cost.

Hence, this complaint.

3. A perusal of the record reveals that notice of the complaint was duly issued to Opposite Party No.1 for filing its written version. However, OP No.1 failed to file its written version within the statutory period prescribed under the Consumer Protection Act, 2019. Consequently, vide order dated 15.09.2022, OP No.1 was proceeded against ex parte.

Thereafter, on 03.01.2023, Sh. Lovedeep Sarin, Advocate, appeared on behalf of OP No.1 and filed his memo of appearance along with a written statement.

3

RBT/CC/303/2022

However, by that time the statutory period for filing the written version had already expired and OP No.1 had already been proceeded against ex parte. The matter thereafter proceeded to the stage of complainant's evidence. Subsequently, vide order dated 05.12.2023, this Commission passed the following order:-

"No evidence of OP No. l is present. From the perusal of the file, it transpires, that numerous opportunities have been granted OP No.l to lead the evidence but till date evidence not tendered.. No case is made out for further adjoining the case for evidence of OP No.l . Put up for 08.02.2024 tor arguments. However, in the interest of justice, before advancing the arguments. OP No. 1 will be at liberty to place on record the documents, if any."

4. Upon notice, OP No. 2 appeared and filed its reply contesting the allegations levelled by the complainant and raising preliminary objections regarding the maintainability of the present complaint against it. OP No. 2 denied all the allegations except those specifically admitted and submitted that no cause of action or dispute exists against it. It was further pleaded that the complainant has concealed the true role and responsibility of OP No. 2 as an insurance broker. OP No. 2 explained that it is a company engaged in insurance broking activities and acts only as a facilitator, conduit and intermediary between the customer and the principal insurance company. It was submitted that, as per the requirements of the customer, OP No. 2 merely assists in forwarding insurance proposals, applications, quotations and related documents to the concerned insurance company. The premium amount for the insurance policy is directly paid by the customer to the insurance company and OP No. 2 neither receives the premium nor charges the customer for its broking services. It was further stated that after receiving the proposal and documents, the insurance company independently conducts its underwriting process and issues the policy directly in favour of the insured. Therefore, there is no privity of contract between the complainant and OP No. 2, as the contractual relationship exists only between the complainant and the insurer, i.e. OP No. 1.

It was further submitted that OP No. 2 has no authority to underwrite the risk, issue an insurance policy, decide or settle insurance claims. The responsibility regarding issuance of policy, interpretation of policy terms and settlement or repudiation of claims lies solely with the insurance company. In the present case, OP No.2 pleaded that it only acted as a facilitator between the complainant and

4

RBT/CC/303/2022

OP No.1 and its role came to an end after forwarding the necessary documents and issuance of the insurance policy by OP No. 1.

On merits, OP No. 2 denied having issued the insurance policy or having received any premium from the complainant and submitted that all such matters relate to OP No. 1 insurance company. It was denied that the complainant ever approached OP No. 2 for settlement of the claim, as claim settlement was exclusively within the domain of OP No. 1. The allegations regarding deficiency in service, fraud, unfair trade practice, mala fide intention and harassment were specifically denied. OP No. 2 further pleaded that the complainant failed to establish that he is a consumer of OP No. 2, as no consideration was paid by him towards the services of the insurance broker. It was accordingly prayed that the complaint be dismissed qua OP No. 2, as no liability or deficiency in service can be attributed to the answering opposite party.

5. The learned counsel for the complainant has tendered into evidence affidavit of the complainant Ex.CW1/1 along with documents Ex.C1 to Ex.C9 and closed the evidence.

6. In rebuttal evidence, learned counsel for OP No.2 tendered the affidavit of Sh. P. Janardhan. Executive Vice President (Compliance & Legal) and Authorized Signatory of M/s Landmark Insurance Brokers Pvt. Ltd., Suite No.303, 3rd Floor. SCO 60- 62. Sector-17C. Chandigarh as Ex.OP2/1closed the evidence.

7. The learned counsel for the OP No2 has stated that "my written statement already filed with affidavit and documents may be treated as my written arguments". Complainant has also filed written arguments on 02.07.2026, whereas none appeared on behalf of OP No.1.

8. Accordingly, after hearing OP2 as well as complainant and on the basis of the pleadings, documents and evidence available on record, the matter was taken up for decision.

9. The first question that arises for consideration before this Commission is whether the written version filed by OP No.1 on 03.01.2023, after expiry of the statutory period prescribed under the Consumer Protection Act, 2019 and after having been proceeded against ex parte vide order dated 15.09.2022, can legally be taken on record and considered in accordance with law, while adjudicating the present complaint.

10. The issue as to whether a written version filed after expiry of the statutory period and subsequent to an order proceeding the Opposite Party ex parte can be taken on record is no longer res integra. The legal position stands authoritatively

5

RBT/CC/303/2022

settled by the Hon'ble Supreme Court of India andthe Hon'ble National Consumer Disputes Redressal Commission in the following judgments:

a. The Hon'ble Supreme Court of India, in Kaushik Narsinhbhai Patel and Ors. Vs M/s S.J.R. Prime Corporation Private Limited and Ors. (2024), held that in the absence of any specific provision dealing with the non-filing of a written statement or the forfeiture of the right to file one, the general legal position dictates that the Opposite Party (OP) must be barred from indirectly bringing in pleadings to introduce its case or evidence through the backdoor. While the OP is rightly permitted to participate in the consumer proceedings, its participation is strictly limited. The respondent can only be permitted to argue legal questions arising out of established authorities and provisions of law, or issues regarding lapse, laches, and the consequential admissibility of the evidence led by the complainant.

b. The Hon'ble Supreme Court of India in New India Assurance Company

Limited Vs Hilli Multipurpose Cold Store Private Limited, (2020) 5 SCC 757, the law is squarely settled by the Hon'ble Constitution Bench wherein paragraph 41 concludes as under:

'41. To conclude, we hold that our answer to the first question is that the District Forum has no power to extend the time for filing the response to the complaint beyond the period of 15 days in addition to 30 days as is envisaged under Section 13 of the Consumer Protection Act; and the answer to the second question is that the commencing point of limitation of 30 days under Section 13 of the Consumer Protection Act would be from the date of receipt of the notice accompanied with the complaint by the opposite party, and not mere receipt of the notice of the complaint.'"

"Although the aforementioned ruling was passed under Section 13(2)(a) of the Consumer Protection Act, 1986, the underlying legal principle applies with equal force to the parimateria provisions of Section 38 of the Consumer Protection Act, 2019."

c. The Hon'ble Supreme Court of India in M/s Daddy's Builders Private Limited &Anr. Vs. Manisha Bhargava &Anr., (2021) 3 SCC 669- The law on this point stands further fortified-wherein it was categorically held that the

"Consumer Commissions have no jurisdiction or power to accept a written statement/written version beyond the maximum statutory period of 45 days. Any delay exceeding the cumulative 45-day window is fatal and cannot be condoned under the guise of discretionary or inherent powers."

11. In view of the law laid down by the Hon'ble Supreme Court in the judgments referred to hereinabove, it is now well settled that this Commission has no jurisdiction to take on record a written version filed beyond the statutory period

6

RBT/CC/303/2022

of 30 days, extendable by a further period of 15 days, prescribed under the Consumer Protection Act, 2019. The said period is mandatory and not merely directory. Consequently, once the statutory period stood exhausted and OP No.1 had already been proceeded against ex parte, the written version subsequently filed by OP No.1 on 03.01.2023 could not legally be taken on record or considered for adjudication of the present complaint. Accordingly, the written version filed by OP No.1 beyond the prescribed statutory period is rejected and shall not form part of the pleadings or be read in evidence while deciding the present complaint. However, this order shall not preclude OP No.1 from addressing such submissions, if otherwise permissible in law, on the basis of the material already available on record.

12. As per record Opposite Party no.1 was duly served with the notice of the present complaint and was granted adequate and reasonable opportunity to appear, contest the proceedings, and file its written version as contemplated under the provisions of the Consumer Protection Act, 2019. However, despite due service and repeated opportunities, the Opposite Party neither appeared before this Commission nor filed any written version within the prescribed statutory period. Consequently, after following due procedure and recording the absence of the Opposite Party, it was proceeded against ex parte vide separate orderDated

15.09.2022.

It is a settled principle of law that the rules of natural justice do not require a Commission to provide endless opportunities to a party who, despite having knowledge of the proceedings, chooses not to participate. The principle of audi alteram partem stands duly satisfied when notice is served, and a reasonable opportunity of hearing is afforded. A party that voluntarily abstains from the proceedings cannot subsequently claim prejudice arising out of its own omission or inaction.

It is further pertinent to observe that the proceedings being ex parte does not dispense with the obligation of this Commission to independently assess the merits of the complaint. An ex parte order cannot be passed mechanically merely on account of the non-appearance of the Opposite Party. Therefore, this Commission has carefully examined the pleadings, affidavit evidence, and documents placed on record by the Complainant.

Since the Opposite Party remained absent throughout the proceedings and failed to file any written version, evidence, documents, or any rebuttal to controvert the allegations made in the complaint, the evidence led by the Complainant has

7

RBT/CC/303/2022

remained unrebutted and unchallenged. Upon independent scrutiny of the material available on record, the Commission finds the same sufficient for adjudication of the present complaint on the merits. Accordingly, the complaint is being decided based on pleadings and evidence available on record.

13. It is evident from the pleadings and material available on record that the grievance of the complainant primarily arises out of the repudiation, dated 24.01.2022 Ex-C5, of the reimbursement claim by OP No.1 i.e. the Insurance Company. The complainant had obtained the insurance policy from OP No.1 after payment of the requisite premium amount and, during the currency of the policy, submitted a reimbursement claim in respect of the hospitalization and treatment of his son Agam Vashisht. The said claim was processed and subsequently repudiated by OP No.1 vide repudiation letter dated 24.01.2022. Thus, the cause of action, if any, arose against OP No.1 on account of rejection of the insurance claim.

So far as OP No.2 i.e. M/s Landmark Insurance Brokers Pvt. Ltd. is concerned, its role was confined only to that of an insurance broker/facilitator between the complainant and OP No.1 Insurance Company. OP No.2 neither issued the insurance policy, nor received the premium amount, nor undertook the insurance risk. It also had no authority or role in underwriting the policy, assessment of the claim, taking decision regarding admissibility of the claim, or repudiation thereof. The responsibility for issuance of the policy and settlement or repudiation of the insurance claim lies exclusively with the insurer, subject to the terms and conditions of the policy.

The complainant has failed to place on record any material evidence to establish any deficiency in service, unfair trade practice, negligence or any wrongful act attributable to OP No.2. Merely because OP No.2 facilitated the procurement of the insurance policy cannot make it liable for acts and decisions independently taken by OP No.1 Insurance Company. The contractual relationship relating to insurance coverage and claim settlement existed between the complainant and OP No.1 alone.

It is a settled principle of law that a party can be held liable only for acts or omissions falling within its domain and responsibility. Since OP No.2 had no role either in repudiation of the claim or in determining the entitlement of the complainant under the policy, no liability can be fastened upon OP No.2 for the alleged deficiency in service committed, if any, by OP No.1.

8

RBT/CC/303/2022

14. Before proceeding with the merit of the case We, refer to Ex-C5 (Claim Repudiation Letter) of whichoperative part is reproduced as under:-

We win not pay your claim. Following discrepancies are not justified. Then Google timeline of Insured has been collected and as per Google timeline, patient visit once in hospital then come back to home. As per IPD entry patient was admitted on 01-10-21 around 12:36 PM but as per vitals chart, patient vitals noted from 12 PM. written statement from pathologist Dr Sandhu (not lab technician), that they have seen this patient & all reports issued for this patient are issued by them along with date & time of issue. 3) Need self-attested copy of registration certificate of Dr Sandhu i with date, Time , Name dseal and Signature. Need clarification from Dr Sandhu for Providing Digital signature on lab reports.- Not provided. Discrepancies has been found in the TPR chart received and same which is collected by our investigator - Timings are different in both charts, please clarify - (Need clarification from hospital authority and

insured)-Not provided."

Hence we regret to inform you that the claim is inadmissible and thus repudiated."

15. OP No.1 Insurance Company repudiated the reimbursement claim of the complainant on the ground that certain discrepancies were noticed during the claim verification/investigation process. As per the repudiation letter, OP No.1 stated that the Google timeline of the insured patient was examined, wherein it was observed that the patient visited the hospital and thereafter returned to his residence, which created doubt regarding the actual hospitalization. It was further observed that although the IPD record reflected admission of the patient on 01.10.2021 at about 12:36 PM, the vital chart showed recording of vitals from 12:00 PM, thereby indicating an alleged inconsistency in the medical records.

It was further mentioned by OP No.1 that a written statement from Dr. J.S. Sandhu, Pathologist, was sought regarding the issuance of laboratory reports and confirmation that the patient was examined by him and that the reports were issued under his authority with proper date and time. OP No.1 also required a self-attested copy of the registration certificate of Dr. Sandhu containing his name, seal, signature and date, along with clarification regarding the digital signature appearing on the laboratory reports. However, according to OP No.1, the requisite clarification/documents were not provided. OP No.1 further alleged discrepancies in the TPR (Temperature, Pulse and Respiration) charts received from the hospital and those collected during investigation, particularly regarding differences in timings recorded in both charts. The Insurance Company stated that clarification from the hospital

9

RBT/CC/303/2022

authority and the insured was required regarding such discrepancies, but no satisfactory clarification was provided. On these grounds, OP No.1 declined the claim of the complainant, stating that the discrepancies found in the submitted documents were

not satisfactorily explained.

16. It is also necessary to observe that the very purpose of health insurance is to provide financial security and timely assistance to the insured person at the time of medical exigency. In order to maintain the faith and confidence of the common man in the insurance sector, the insurance companies are expected to act fairly, ethically and responsibly while processing genuine claims of the insured persons.

In the present case, the repudiation of the claim by OP No.1 is primarily based upon certain alleged discrepancies noticed in the medical records, including differences in timings and certain verification aspects. However, such discrepancies, by themselves, cannot be treated as conclusive proof of a false or fraudulent claim. It is a matter of common understanding that medical records are prepared by hospital staff, doctors and other healthcare professionals, and the insured person has no direct control over the manner, timing or technical recording of such entries. A patient approaching a hospital in a medical emergency places reliance upon the treating doctors and hospital authorities and cannot be expected to supervise each and every administrative or technical entry made in the treatment

records.

The insurance company, being a party seeking to deny the contractual benefit, is required to establish through cogent and reliable evidence that the claim is fraudulent, fabricated or otherwise not payable under the terms of the policy. Mere suspicion, conjectures or minor inconsistencies in medical documentation cannot be made the sole basis for rejection of a genuine claim. In the present matter, OP No.1 has failed to produce any substantive evidence, including the testimony of the investigator or any other independent evidence, to establish that the hospitalization was fraudulent or that the medical documents relied upon by the complainant were fabricated.

The attempt to rely upon minor discrepancies in the treatment record, without establishing any actual fraud or manipulation, cannot defeat the legitimate claim of the insured. Such an approach would defeat the very object and purpose of

10

RBT/CC/303/2022

medical insurance, which is intended to provide protection and assurance to policyholders during times of medical necessity.

17. For proper adjudication of the matter We, refer to the following citations as under:-

i. The legal position regarding rejection of genuine insurance claims on hyper-technical grounds stands settled by the Hon'ble Supreme Court in

Om Prakash Vs. Reliance General Insurance &Anr., (2017) 9 SCC 724, wherein the Hon'ble Apex Court held that the provisions of the Consumer Protection Act are intended to protect the interests of consumers and that insurers are required to adopt a fair and consumer-oriented approach while considering claims. It was observed that a genuine claim cannot be defeated by taking shelter under technicalities or procedural irregularities when the insured has substantially complied with the requirements and the occurrence of the insured event is otherwise established.

ii. It is also relevant to refer to the principle laid down by the Hon'ble Supreme Court in Mahakali Sujatha v. The Branch Manager, Future Generali India Life Insurance Company Limited & Another, Civil Appeal No. 3821 of 2024 decided on 10.04.2024 (2024 INSC 296), wherein it was held that when an insurer alleges suppression of material facts, fraud or misrepresentation, the burden to establish such allegation lies upon the insurer and the same cannot be discharged merely on the basis of assumptions, investigation observations or unsubstantiated assertions. The insurer is required to place on record cogent and reliable evidence to prove

the alleged misconduct of the insured.

18. From the record, it is evident that the complainant had obtained a health insurance policy from OP No.1 i.e. the Insurance Company, after payment of the requisite premium amount. During the currency of the policy, the complainant's son namely Agam Vashisht was hospitalized for treatment of dengue fever and the complainant incurred expenses towards his treatment. The complainant submitted a reimbursement claim along with relevant medical documents including discharge summary, treatment records and bills to OP No.1 amounting to Rs. 90,079/-Ex-C3 (Page-120),.However, the claim was repudiated by OP No.1 vide repudiation letter dated 24.01.2022.

11

RBT/CC/303/2022

It is relevant to mention that OP No.1, against whom the complainant has primarily raised the grievance, was duly served but failed to appear before this Commission and was accordingly proceeded against ex parte. Despite having knowledge of the proceedings, OP No.1 neither filed any written version nor led any evidence in rebuttal to controvert the allegations of the complainant or to substantiate the grounds mentioned in the repudiation letter. Consequently, the evidence produced by the complainant remained unrebutted and unchallenged. However, with regard to OP No.2 i.e. M/s Landmark Insurance Brokers Pvt. Ltd., it is observed that the role of OP No.2 was confined only to acting as an insurance broker/facilitator between the complainant and OP No.1. OP No.2 neither issued the insurance policy, nor received the premium amount, nor undertook the insurance risk. Further, OP No.2 had no authority to assess, approve, reject or repudiate the insurance claim. The decision regarding settlement or repudiation of the claim was solely within the domain of OP No.1 Insurance Company. The complainant has failed to establish any independent act of deficiency, negligence or unfair trade practice attributable to OP No.2. Therefore, in view of the un-rebutted evidence available on record and failure of OP No.1 to justify the repudiation of the claim, this Commission is of the considered view that repudiation of the claim by OP No.1 was not justified and amounts to deficiency in service. However, the complaint against OP No.2 M/s Landmark Insurance Brokers Pvt. Ltd. is liable to be dismissed, as no deficiency in service or liability is proved against OP No.2.

19. After considering the entire material available on record, this Commission is of the considered view that the very object and spirit of a health insurance policy is to provide financial protection and security to the insured at the time of medical necessity. The officials dealing with insurance claims are expected to examine genuine claims in a fair, reasonable and consumer-oriented manner and should not reject legitimate claims on mere technicalities or on the basis of minor procedural discrepancies.

In the present case, the factum of issuance and validity of the insurance policy, hospitalization of the insured patient, treatment undertaken and submission of the reimbursement claim have not been disputed by OP No.1. The complainant has placed on record the discharge summary, treatment records, prescriptions, medical bills and other relevant documents establishing the hospitalization and medical expenses incurred. Once the complainant furnished the available claim

12

RBT/CC/303/2022

documents, the responsibility of further verification, if required, was upon the Insurance Company and the insured could not be made to suffer on account of any alleged discrepancy between the hospital records or non-availability of further clarification from the hospital authorities.

OP No.1 has repudiated the claim primarily on the basis of alleged discrepancies in the medical records, differences in timings of certain entries, observations regarding Google timeline and alleged pending clarifications. However, OP No.1 has failed to produce any cogent and convincing evidence to establish that the hospitalization was fictitious, the treatment was unnecessary, the medical records were fabricated, or that the complainant had indulged in any fraud, misrepresentation or suppression of material facts. No affidavit of the investigator, expert medical opinion, forensic examination report, statement of treating doctors or any independent evidence has been brought on record to substantiate the allegations of fraud or manipulation.

It is well settled that while an insurer is entitled to rely upon the terms and conditions of the policy, the burden of proving the applicability of any exclusion or defence lies upon the insurer. Mere suspicion, internal investigation observations or minor inconsistencies in medical documentation cannot be treated as conclusive proof of fraud. Medical records are prepared by doctors and hospital staff and an insured patient has no control over administrative entries, timings of recording of vitals or technical aspects of documentation. Such routine discrepancies cannot, by themselves, defeat a genuine claim unless supported by substantive evidence establishing fabrication or manipulation. Further, the alleged investigation material relied upon by OP No.1 has neither been properly proved by leading evidence nor supported by the testimony of any investigator or independent witness. A repudiation based only on unverified allegations and internal observations cannot displace the documentary evidence produced by the complainant regarding hospitalization and treatment. The Insurance Company cannot avoid its contractual obligation merely by raising doubts or relying upon unsubstantiated allegations.

Therefore, in the absence of any reliable evidence showing fraud, misrepresentation, suppression of material facts or violation of any policy condition, this Commission finds that OP No.1 was not justified in repudiating the reimbursement claim. The rejection of the claim on the basis of minor documentary discrepancies and unproved allegations amounts to an arbitrary

13

RBT/CC/303/2022

denial of legitimate insurance benefit and constitutes deficiency in service on the part of OP No.1.

20. Accordingly, as an upshot of our above discussion and findings recorded hereinabove, the present complaint is Partly allowed against opposite party No.1 i.e. the Insurance Company and is dismissed against Opposite Party No.2 i.e. M/s Landmark Insurance Brokers Pvt. Ltd.as the complainant has failed to establish any deficiency in service or unfair trade practice on the part of OP No.2.

21. Consequently, OP No.1, being liable for the deficiency in service established on record, is directed as under:

i. To pay to the complainant a sum of Rs.90,079/- (Rupees Ninety Thousand Seventy-Nine only), being the amount incurred towards the hospitalization expenses for the treatment of his son, Agam Vashisht, as reflected in Ex.C-5 (Page No.120), along with interest @ 9% per annum from the date of repudiation of the claim, i.e. 24.01.2022, within 30 days from the date of receipt of the certified copy of this order, failing which this amount shall carry interest @ 12% per annum till its actual realization.

ii. To pay a sum of Rs.10,000/- (Rupees Ten Thousand only) to the complainant as compensation towards mental agony, harassment and inconvenience suffered by him due to unjustified repudiation of the insurance claim.

iii. To pay a sum of Rs. 11,000/- (Rupees Eleven Thousand only) towards litigation expenses.

iv. The Opposite Party shall comply with this order within a period of 45 days from the date of receipt of the certified copy of this order. In case of failure to make the payment within the stipulated period, the aforesaid amount shall carry further interest @ 12% per annum from the date of expiry of the said period of 45 days till realization. The complainant shall be at liberty to initiate appropriate execution proceedings in accordance with law in case of non-compliance of the present order.

v. The complaint stands disposed of accordingly. The parties shall bear their own costs except as directed above.

vi. Copy of the order be supplied by the District Consumer Disputes Redressal Commission, Mohali, as per rules. File be sent back to the District Consumer

14

RBT/CC/303/2022

Commission, Mohali, for consigning the same, to the Record Room, after due compliance.

Pronounced: 02.07.2026 (Ramesh Kumar Gupta) (Ranvir Kaur) (Kuljit Pal Singh) Member Member President

gurmanpreet singh

jr. scale stenographer

15

RBT/CC/303/2022

CC No.303 of 2022 Rajeev Kumar Sharma Vs M/s Future

PRESENT:

For the complainant : Mr. Varun Sharma Adv. For the OP1 : None. Proceeded Ex-Parte vide order Dated 15.09.2022

For the OP2 : Sh. Krishan Kant Adv. Vide our separate detailed order of even date, the complaint is partly allowed. Copy of the order be supplied by the District Consumer Disputes Redressal Commission, Mohali, as per rules. File be sent back to the District Consumer Commission, Mohali, for consigning the same, to the Record Room, after due compliance.

(Ramesh Kumar Gupta) (Ranvir Kaur) (Kuljit Pal Singh) Member Member President

02.07.2026