STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

Bajaj Allianz Insurance Co. Ltd., SCO No.139-140, Sector 8-C, Chandigarh, through its Branch Manager.

Now at Bajaj Allianz Life Insurance Co. Ltd., SCO 215-217, 4^th Floor, Sector 34, Chandigarh.     

(through Sh.Rajinder Singh Kalsi, Zonal Legal Manager, Bajaj Allianz Life Insurance Co. Ltd., SCO-215-217, Sector 34, Chandigarh)                                         

…….Appellant

V E R S U S

1.     Ajay Saini, age 29 years, son of Sh. Biswanath Saini, resident of House No.2208FF, Sector 37-C, Chandigarh.

2.     Sh. Parveen Kumar Sharma (Agent), H.No.3279, Sector 23-D, Chandigarh.

              ....Respondents

Appeal under Section 15 of the Consumer Protection Act, 1986.

BEFORE:    JUSTICE SHAM SUNDER, PRESIDENT.

                   MRS. NEENA SANDHU, MEMBER.

                   SH.JAGROOP SINGH MAHAL, MEMBER.

Argued by:  Sh.Varun Chawla, Advocate for the appellant.

                Sh.N.S.Jagdeva, Advocate for respondent no.1

                Respondent No.2, already exparte.

PER  JUSTICE SHAM SUNDER, PRESIDENT

1.                This appeal is directed against the order dated 22.07.2011, rendered by the District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (hereinafter to be called as the District Forum only), vide which, it accepted the complaint, and directed the Opposite Parties, jointly and severally, as under:-

“i)     To pay Rs.32,205/- (being 95% of Rs.33,900/-

ii)     to the complainant to indemnify him for the       expenditure incurred on the treatment of his        wife as per terms of the policy.

iii)    to pay Rs.10,000/- to the complainant as   compensation  for causing mental agony and harassment.

                iv)     to pay Rs.7,000/- to the complainant as costs                             of litigation.

    This order be complied with by the OPs within 30 days from the date of receipt of its certified copy, failing which OPs shall be liable to pay Rs.42,205/- i.e. [Rs.32,205 + Rs.10,000) along with interest @18% per annum from the date of filing the present complaint i.e.27.05.2010 till actual payment besides payment Rs.7,000/- as costs of litigation”.

2.                The facts, in brief, are that, the complainant took a Health Insurance Policy known as “Bajaj Allianz Family Care First” from Opposite Party No.1, on 15.11.2008, valid for the period from 15.11.2008 to 15.11.2011. The said policy, covered the risk of ailment of the complainant, as well as his wife. In the month of February 2010, his wife suffered a sudden severe abdomen pain. She was taken to Dr. Mangla Hospital, Sector 19, Chandigarh, where various tests were conducted on her. Ultimately, she was operated upon, for endometriosis and fibroids uterus. After discharge of the wife of the complainant, from the hospital, the complainant, lodged a claim for reimbursement of the expenditure, incurred on her treatment with Opposite Party No.1, and submitted all the relevant papers. The said claim was duly received by Opposite Party No.1 on 13.2.2010. It was stated that according to the terms and conditions of the policy, Opposite Party No.1, was to reimburse the complainant, to the extent of 95%, of the expenditure incurred by him, on the treatment of his wife. It was further stated that the terms and conditions of the policy, including the exclusion Clause(s), were never read over, or explained to the complainant, by the Opposite Parties. It was further stated that ultimately, the claim of the complainant, was repudiated by Opposite Party No.1. It was further stated that the repudiation of such claim, illegally, amounted to deficiency, in rendering service, on the part of the Opposite Parties.  When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), for directing the Opposite Parties for refund of Rs.33,900/-, alongwith interest @18% p.a.; compensation in the sum of Rs.50,000/- on account of mental agony and physical harassment; and litigation costs, to the tune of Rs.11,000/-, was filed.

3.                On notice, the Counsel for Opposite Party No.1, put in appearance, whereas, none appeared on behalf of Opposite Party No.2, despite service, and he was accordingly, proceeded against exparte, vide order dated 08.7.2010.

4.                During the pendency of the complaint, an application for correction of the name and  address of Opposite Party No.1, was filed by the complainant. The application of the complainant, was allowed and the amended title of Opposite Party No.1, as Bajaj Allianz Life Ins. Co. Ltd., 1^st Floor, SCO No.139-140, Sector 8C, Chandigarh, was filed. However, this correction was not incorporated, in the head note of the complaint, by the concerned Official.

5.                Thereafter, a fresh notice, was sent to the substituted Opposite Party No. 1 i.e. Bajaj Allianz Life Insurance Company Limited, Ist Floor, SCO No.139-140, Sector 8C, Chandigarh, and a report of refusal, was received. Accordingly, the substituted Opposite Party No.1, was proceeded against exparte, vide order dated 09.05.2011.

6.                The complainant led evidence, in support of his case.

7.                After hearing the Counsel for the complainant, and, on going through the evidence, and record of the case, the District Forum, accepted the complaint, in the manner, referred to, in the opening para of the instant order. 

8.                Feeling aggrieved, the instant appeal, has been filed by the appellant/substituted Opposite Party No.1

9.                We have heard the Counsel for the appellant, as well as respondent no.1, and have gone through the evidence and record of the case, carefully. 

10.             The Counsel for the appellant, submitted that no doubt, the name of the appellant, as Opposite Party No.1., was substituted, in place of the original Opposite Party No.1, yet the address of the substituted Opposite Party No.1, given by the complainant was not correct, and, as such, no due service of the said Party, was effected, nor any authorized representative, on its behalf, therefore, could enter appearance. He further submitted that, under these circumstances, the substituted Opposite Party No.1, was condemned unheard. He further submitted that, under these circumstances, the appeal be accepted and the case be remanded back to the District Forum, for fresh decision.

11.             On the other hand, the Counsel for respondent no.1/complainant, submitted, that the address of the substituted Opposite Party No.1, given in the amended title, was correct. He further submitted that the authorized representative, on behalf of Opposite Party No.1, refused to accept service and, thus, there was no alternative, with the District Forum, than to proceed against it exparte. He further submitted, that an opportunity, was given to the substituted Opposite Party No.1, to enter appearance, and file written reply, and, if it did not avail of the same, then it could not be said, to be condemned unheard. He further submitted that the order of the District Forum, being legal and valid, deserves to be upheld.

12.             After giving our thoughtful consideration, to the rival contentions, advanced by the Counsel for the appellant, as well as respondent no.1 and the evidence, on record, we are of the considered opinion, that the appeal is liable to be accepted and the complaint deserves to be remanded back, to the District Forum, for fresh decision, for the reasons to be recorded hereinafter. There is, no dispute, about the factum, that originally, the complainant, filed the complaint against Bajaj Allianz General Insurance Co. Ltd. SCO No.(left blank), Sector 8C, Chandigarh, through its Branch Manager, but during the pendency of the complaint, on the basis of an application, moved by the complainant, Bajaj Allianz Life Ins. Co. Ltd., Ist Floor, SCO No.139-140, Sector 8C, Chandigarh, was substituted, in place of the original Opposite Party No.1. According to the Counsel for the appellant, the address of the appellant was 2^nd Floor,  SCO No.139-140, Sector 8C, Chandigarh, at the relevant time, whereas, the complainant gave its wrong address. There is, no reason, to disbelieve the contention of the Counsel for the appellant, as nothing has been produced, on record, by respondent no.1/complainant, to the effect, that the office of the substituted Opposite Party No.1/appellant, was 1st Floor, SCO 139-140, Sector 8C, Chandigarh. Under these circumstances, it could be safely held, that the substituted Opposite Party No.1(now appellant), was not duly served, at the correct address, nor the question of refusal, by its authorized agent, of the notice, sent by the District Forum, ever arose. It may be stated here, that, in the proceedings, before the Consumer Foras, the principles of natural justice, are required to be resorted to, meaning thereby, that all the parties to the dispute(s), are required to be given an opportunity of furnishing their version, by way of written reply, and lead evidence, by way of affidavit(s) It is also a settled principle of law, that the Consumer Foras are meant to advance the cause of justice, than to thwart the same. The Consumer Foras, are not required to enter into hypertechnicalities, so as to deny substantial justice to the parties. When hypertechnicalities and substantial justice, are pitted against each other, then the latter will prevail, over the former. In the instant case, from the record, it is proved that substituted Opposite Party No.1/appellant, was condemned unheard. On this ground, the order of the District Forum, deserves to be set aside, and the District Forum, is required to decide the complaint afresh, on merits.

13.             No other point, was urged, by the Counsel for the appellant, as well as respondent no.1.

14.             For the reasons recorded above, the appeal is accepted, with no order as to costs, and the impugned order of the District Forum, is set aside. The complaint is remanded back to the District Forum, with a direction, to afford an opportunity to Opposite Party No.1/appellant, to file its written version, and evidence, by way of affidavit(s) and then decide the same, afresh, after affording the Parties/Counsel, an opportunity of being heard.

15.             The parties are directed to appear before the District Forum, on 10.02.2012 at 10.30.a.m.

16.             The District Forum, record be sent back, immediately, alongwith a copy of this order.    

17.             Certified copies of this order be sent to the parties, free of charge.

18.             The required file be consigned to Record Room, after completion

Pronounced.

January 24, 2012

Sd/-

[JUSTICE SHAM SUNDER]

PRESIDENT

Sd/-

[NEENA SANDHU]

MEMBER

Sd/-

[JAGROOP SINGH MAHAL]

MEMBER

Rg.