Haryana

Sonipat

CC/50/2015

VINOD KUMAR S/O ROOP RAM - Complainant(s)

Versus

1. BIRLA SUN LIFE INSURANCE CO. LTD.,2. BIRLA SUN LIFE INSURANCE CO. LTD. - Opp.Party(s)

RAKESH SINGH SAROHA

17 Nov 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

SONEPAT.

 

                             Complaint No.50 of 2015

                             Instituted on:20.02.2015

                             Date of order:17.11.2015

 

Vinod Kumar son of Roop Ram, r/o village Kharkhoda, tehsil Kharkhoda, distt Sonepat.

                                      ...Complainant.

                      Versus

 

1.Birla Sun Life Insurance Company, one Indiabulls Centre, Tower 1, 15^th and 16^th floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone road, Mumbai, through its Divn. Manager.

2.Birla Sun Life Insurance Company Main Market, 1^st floor of HDFC Bank, Sector 14, Sonepat through its Branch Manager.

 

                                      ...Respondents.

 

COMPLAINT UNDER SECTION 12 OF

THE CONSUMER PROTECTION ACT,1986

 

Argued by: Sh. RS Saroha Adv. for complainant.

           Ms. Konica Taneja Adv. for respondents.

         

BEFORE-  NAGENDER SINGH, PRESIDENT.

        SMT.PRABHA WATI, MEMBER.

        D.V.RATHI, MEMBER.

 

O R D E R

 

         Complainant has filed the present complaint against the respondents alleging therein that he got himself insured under mediclaim cashless policy from the respondents. Unfortunately the complainant become ill and got treatment from Shri Balaji Action Medical Instt. New Delhi and has spent Rs.1,79,840/- on his treatment.  But the respondents instead of making the said payment, have sent a cheque of Rs.1200/- to the complainant and that amounts to a grave deficiency in service on the part of the respondents. So, he has come to this Forum and has filed the present complaint.

2.       In reply, the respondents have submitted that the complainant had submitted an application for insurance on his own name for BSLI Dream Endowment plan for sum assured of Rs.4,03,680/- and AD/D rider and hospital care rider for sum assured of Rs.1,50,000/-  and the policy was delivered to the life assured on 28.10.2010. At the time of filling the above said proposal form, the complainant has opted to pay the premium for first year.  The respondents have not committed any unfair trade practice. The complainant himself has violated the terms and conditions of the policy and has filed the false complaint.  There is no deficiency in

service on the part of the respondents and thus, prayed for the dismissal of the present complaint since it has no merit.

3.       We have heard the ld. Counsel for both the parties at length and we have also gone through the entire relevant material available on the case file carefully & minutely.

4.       Ld. Counsel for the complainant has submitted that the respondents wrongly, illegally and only to cause unnecessary harassment to the complainant has sent a cheque of Rs.1200/- only, whereas he has incurred Rs.1,79,840/- on his treatment and that amounts to a grave deficiency in service on the part of the respondents.

         On the other hand, ld. Counsel for the respondents has submitted that the complainant had submitted an application for insurance on his own name for BSLI Dream Endowment plan for sum assured of Rs.4,03,680/- and AD/D rider and hospital care rider for sum assured of Rs.1,50,000/-  and the policy was delivered to the life assured on 28.10.2010. At the time of filling the above said proposal form, the complainant has opted to pay the premium for first year.  The respondents have not committed any unfair trade practice. The complainant himself has violated the terms and conditions of the policy and has filed the false complaint.  There is no deficiency in service on the part of the respondents.

         In the present case, the respondent in their evidence has tendered the affidavit of Aakriti Manocha and has submitted the common application form of the complainant alongwith copy of Dream Endownment Plan.  The respondent has not placed on record any investigation or assessment vide which, they came to the conclusion that the complainant’s entitlement is only of Rs.1200/-.  There is nothing on record which may go to prove the criteria vide which the respondent sent a cheque for a very meager amount of Rs.1200/- to the complainant against the insured sum of Rs.1,50,000/-. In our view, the complainant has taken the treatment during the validity of the insurance policy and rider sum assured was Rs.1,50,000/-.  The respondent has wrongly sent a cheque of Rs.1200/- to the complainant.  So, definitely the complainant is entitled to get the claim amount of Rs.1,50,000/- from the respondent. However, if the complainant has got encashed the said cheque of Rs.1200/-, then the respondent are at liberty to deduct the amount of Rs.1200/- from the amount of Rs.1,50,000/-.

         Accordingly, we hereby direct the respondent to make the payment of Rs.1,50,000/- or Rs.1,48,800/-(if cheque of Rs.1200/- got encashed by the complainant) to the complainant within a period of 45 days from the date of passing of this order, failing which, the above said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its realization.

         With these observations, findings and directions, the present complaint stands allowed.

         Certified copy of this order be provided to both the parties free of cost.

File be consigned to the record-room.

 

 

(Prabha Wati Member) (DV Rathi Member)     (Nagender Singh-President)

DCDRF, Sonepat.      DCDRF Sonepat         DCDRF, Sonepat.

 

Announced 17.11.2015