Delhi

StateCommission

A/107/2015

MAX BUPA HEALTH INSURANCE CO. LTD. - Complainant(s)

Versus

AMIT KUMAR JAIN - Opp.Party(s)

03 May 2017

ORDER

IN THE STATE COMMISSION: DELHI

(Constituted under section 9 of the Consumer Protection Act, 1986)

 

Date of Decision: 03.05.2017

 

First Appeal No. 107/2015

(Arising out of order dated 24.11.2014 passed by the Consumer Disputes Redressal Forum, Kashmere Gate, Delhi in Complaint Case No. 117/2014)

 

        In the Matter of:

 

                Max Bupa HIC Ltd.

          B1/1-2, Mohan Cooperatives,

          Industrial Estate, Mathura Road,

          New Delhi-110044

 

……Appellant     Versus     Sri Amit Kumar Jain, S/o Sri Rishi Prakash Jain, R/o DU 150, II Floor, Pitam Pura, Delhi                                                       …….Respondent

CORAM

Justice Veena Birbal, President

Salma Noor, Member

1.   Whether reporters of local newspaper be allowed to see the   judgment? 

2.   To be referred to the reporter or not?

 

Justice Veena Birbal, President

1.             This is an appeal u/s 15 of the Consumer Protection (in short ‘the Act’) wherein challenge is made to ex-parte order dated 24.11.2014 passed by the Consumer Disputes Redressal Forum, Kashmere Gate, Delhi in Complaint Case No. 117/2014 whereby the aforesaid complaint case has been allowed and appellant/OP has been directed as under:

                “i. To pay a sum of Rs. 1,31,432/- (One Lac Thirty One Four Hundred and Thirty Two only) towards refund of amount paid at Jaipur Golden Hospital alongwith 10% p.a. interest from the date of payment till realization.

                ii. To pay a sum of Rs. 20,000/- towards compensation for pain and agony costs incurred towards expenses in this case.”

2.             A complaint u/s 12 of the Act was filed before the Ld. District Forum by the respondent herein i.e. complainant before the Ld. District Forum stating therein that respondent/complainant had purchased a Medi Claim Policy bearing No. 00140062201200 for a sum of Rs. 5 Lakhs  + 15 Lakhs and total sum assured was Rs. 25 Lakh. The policy was having validity from 24.11.2012 to 23.11.2013. The respondent/complainant paid Rs. 16,640/- as a premium. It was alleged that the wife of the respondent/complainant had fallen sick and was admitted in Jaipur Golden Hospital, Rohini on 31.05.2013 wherein her condition started deterioration as a result of which she was shifted to Fortis Hospital, Shalimar Bagh. At Jaipur Golden Hospital the respondent/complainant had made a payment of Rs. 1,31,432/- in cash on 07.06.2013. It was alleged that in Fortis Hospital a bill of Rs. 34,050/- was paid by the appellant/OP. However, bill of Jaipur Golden Hospital was not paid by the appellant/OP. Feeling aggrieved, the respondent/complainant had filed a complaint before the Ld. District Forum seeking reimbursement of a sum of Rs. 1,31,432/- along with interest and compensation.

3.             Perusal of impugned order shows that the appellant/OP was proceeded ex-parte before the Ld. District Forum on 21.10.2014. After considering ex-parte evidence by way of affidavit of the respondent/complainant, the Ld. District Forum had allowed the complaint and directed the appellant/OP to pay the amount as has been stated above.

4.             Aggrieved with the aforesaid ex-parte final order of the Ld. District Forum, the present appeal is filed.

5.             Ld. Counsel for the appellant/OP has submitted that before the Ld. District Forum, the appellant/OP had appointed a counsel for conducting the case. However, the said counsel did not appear on the date fixed as a result of which the appellant/OP was proceeded ex-parte. It is stated that appellant/OP had come to know of the ex-parte final order only when certified copy of the same was received from the Ld. District Forum on 13.01.2015. It is contended that the appellant/OP was under the impression that the case was being followed diligently by its counsel. However, the appellant/OP was taken aback when impugned order was received. It is submitted that appellant/OP be not allowed to suffer for the lapse on the part of its counsel. In support of his contention Ld. counsel has relied upon the judgement of ‘Rafiq and Anr. Vs. Munshilal and Anr. (1981) 2SCC788 which is also referred in Lalit Mohan Puri Vs. Pure Drinks (New Delhi) Ltd., New Delhi AIR1995Delhi 172, where it is clearly mentioned that the party should not suffer that loss for the negligence of the counsel. It is also submitted that even on merits, the appellant has good case. It is contended that the claim of the respondent/complainant was relating to the maternity benefits and as per terms and conditions of the policy, the respondent/complainant was not entitled for the said benefits for a period of 24 months from the date of issue of policy.

6.             Counsel for the respondent/complainant has initially opposed the present appeal. However, after some arguments, counsel for the respondent/complainant states that he has no objection if impugned order is set aside, subject to payment of costs and appellant/OP be given chance to contest the case on merits.

7.             From the above discussion it is apparent that appellant/OP has not been heard in the matter. No doubt delay is being caused in the matter. In the interest of justice, we are of the view that for effective disposal of the case on merits, it is appropriate that the defence of the appellant/OP should come on record. For the delay caused, respondent/complainant can be compensated with costs.

8.             Accordingly, in view of no objection given by the respondent/complainant as well as in the interest of justice, we accept this appeal and set aside the impugned order, subject to payment of costs of Rs. 10,000/- to respondent/complainant.

9.             The parties shall appear before the Ld. District Forum on 30.05.2017. On the said date, appellant/OP shall pay cost of Rs. 10,000/- to respondent/complainant and shall also file its written statement. Thereafter, the Ld. District Forum shall proceed further in the matter in accordance with law.

                It is clarified that nothing stated herein above shall have any bearing on the merits of the case.

                A copy of the order be sent to the parties free of cost. The same also sent to Ld. District Forum for necessary information.

                File be consigned to record room.  

                                

(Justice Veena Birbal)

President

 

 

(Salma Noor)

Member