Chandigarh

DF-I

CC/771/2017

Premi Devi - Complainant(s)

Versus

Allahabad Bank - Opp.Party(s)

Devinder Kumar

26 Feb 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

                                                     =======

 

                                     

Consumer Complaint No.	:	CC/771/2017
Date of Institution	:	03/11/2017
Date of Decision	:	26/02/2019

 

Premi Devi w/o Sh. Rikhi Ram, R/o H.No.1327, Chaman Colony, Dhanas, Chandigarh.

…..Complainant

 

V E R S U S

 

1.      Allahabad Bank, Sector 8, Madhya Marg, Chandigarh, through its Branch Manager.

 

2.      Heritage Health TPA Pvt. Limited, Nicco House, 5^th Floor, 2 Hare Street, Kolkata – 700 001, through its Managing Director.

 

3.      United India Insurance Company, IBA Cell, Ground Floor, Vulcan Insurance Building, 77, Veer Nariman Road, Mumbai – 400 020.

…… Opposite Parties

QUORUM:	RATTANSINGH THAKUR	PRESIDENT
	MRS.SURJEET KAUR	MEMBER
	DR.S.K.SARDANA	MEMBER

                                                                       

ARGUED BY	:	Sh. Devinder Kumar, Adv., Counsel for Complainant.
	:	Ms. Jasleen Kaur, Counsel for Opposite Party No.1.
	:	Opposite Parties No.2 & 3 ex-parte.

 

PER Surjeet Kaur, Member

1.         Adumbrated in brief, the facts necessary for the disposal of the instant Consumer Complaint are that the Complainant along with her husband who was a retiree of Allahabad Bank (Opposite Party No.1) became member of Medical Insurance Scheme introduced by Allahabad Bank for its existing/ retired personnel and accordingly, paid the requisite premium of Rs.14,950/- to Heritage Health TPA Pvt. Ltd. (Opposite Party No.2), whereafter they were issued their respective health cards (Annexure C-5 & C-6). On account of acute constipation problem, the Complainant visited the Fortis Hospital on 22.08.2017, where after complying with all the pre-requisites, as desired by Opposite Party No.2, the Complainant got herself admitted on 05.09.2017. On the discharge of the Complainant on 06.09.2017, the Fortis Hospital raised a bill of Rs.41,981/-. However, instead of paying its share of Rs.39,701/- out of the total bill raised to the Fortis Hospital, Opposite Party No.2 repudiate the claim on flimsy grounds on 06.09.2017 (Annexure C-14). Later on, the Fortis Hospital raised a bill of Rs.53,031/- of the same treatment, which the son of the Complainant paid vide receipt Annexure C-16. Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of the Opposite Parties, the complainant has filed the instant Consumer Complaint.
2.         Notice of the complaint was sent to Opposite Parties seeking their version of the case. However, nobody appeared on behalf of Opposite Parties No.2 & 3 despite service, therefore, they were proceeded ex-parte.
3.         Opposite Party No.1 contested the Complaint and filed its reply, inter alia, admitting the basic facts of the case. It has been pleaded that the Bank has no role regarding grievance arising out of the Policy in question. Any grievance/ dispute regrading lodging of claims/less payment/ non-payment or late payment or claims under the Policy etc. were of the TPA and/or the Insurance Company. Pleading that there is no deficiency in service or unfair trade practice on its part, Opposite Party No.1 has prayed for dismissal of the complaint.
4.         The complainant has filed a replication, wherein she has reiterated all the averments, contained in the complaint, and repudiated those, contained in the written version of Opposite Party No.1.
5.         The parties led evidence in support of their contentions.
6.         We have gone through the entire record and heard the arguments addressed by the Ld. Counsel for the Complainant and Ld. Counsel for Opposite Party No.1 (Opposite Parties No.2 & 3 being ex-parte).
7.         Significantly, the Opposite Parties No.2 & 3 did not appear to contest the claim of the Complainant and preferred to proceed against ex-parte. This act of the Opposite Parties No.2 & 3 draws an adverse inference against them. The non-appearance of the Opposite Parties No.2 & 3 shows that they have nothing to say in their defence against the allegations made by the Complainant. Therefore, the assertions of the complainant go unrebutted and uncontroverted.
8.         In the present circumstances, it is established beyond all reasonable doubts that the complaint of the Complainant is genuine as she has been made to run from pillar to post for no fault on her part. The harassment suffered by the Complainant is also writ large. The Opposite Parties No.2 & 3 have certainly and definitely indulged into unfair trade practice as they ought to have initiate steps to redress the grievance of the Complainant promptly, which they failed to do. At any rate, the Opposite Parties No.2 & 3 even did not bother to redress the grievance of the Complainant, despite having approached for the same by the Complainant time & again. It is important to note that due to the irresponsible attitude of the Opposite Parties No.2 & 3, the Complainant has certainly suffered a lot. We feel that it was the duty of the Opposite Parties No.2 & 3 to pay the genuine claim of the Complainant, promptly, but they have miserably failed to do and rather propelled this unwarranted, uncalled for litigation upon the Complainant. Therefore, the act of the Opposite Parties in not paying the genuine claim of the Complainant despite charging the requisite premium, proves deficiency in service on their part, which certainly has caused immense, mental and physical harassment to the complainant.
9.        There is no dispute about the fact that the medical claims arising out of the Policy in question are to be paid by the TPA/Insurance Company and the Opposite Party No.1 Bank has no role to play therein. Hence, the present Complaint fails qua Opposite Party No.1.
10.         For the reasons recorded above, the present complaint of the Complainant deserves to succeed against the Opposite Parties No.2 & 3, and the same is partly allowed qua them. The Opposite Parties No.2 & 3, jointly & severally, are directed:-

[a]     To pay Rs.53,031/- along with interest @ 9% p.a. from 06.09.2017, till its realization, to the Complainant;

 [b]    To pay Rs.20,000/- as compensation to the complainant for the deficiency in service, unfair trade practice and harassment caused to her.

[c]     To also pay a sum of Rs.10,000/- to the complainant as litigation expenses. 

                The complaint against Opposite Party No.1 fails and is accordingly dismissed with no order as to costs. 

11.         The above said order shall be complied within 30 days of its receipt by the Opposite Parties No.2 & 3; thereafter, they shall be liable for an interest @12% per annum on the amount mentioned in sub-para [a] above from 06.09.2017, till it is paid. The compensation amount as per sub-para [b] above, shall carry interest @12% per annum from the date of institution of this complaint, till it is paid, apart from compliance of the directions as in sub-para [c].
12.         The certified copies of this order be sent to the parties free of charge. The file be consigned.

	Sd/-	Sd/-	Sd/-
26/02/2019	[Dr.S.K.Sardana]	[Surjeet Kaur]	[Rattan Singh Thakur]
	Member	Member	President