Punjab

Sangrur

CC/457/2018

Bhupinder Singh Mann - Complainant(s)

Versus

Andhra Bank - Opp.Party(s)

Sh.Sumir Fatta

12 Sep 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

                                                                        Complaint No.457

 Instituted on:   05.11.2018

                                                                        Decided on:     12.09.2022

 

Bhupinder Singh Mann, resident of House No.71, Shivam Colony, Sangrur.                                                      

                                                         …. Complainant.     

                                                 Versus

1.             Andhra Bank, Branch Sangrur through its Branch Manager.

2.             United India Insurance Company Ltd. Banacassurance Division, DO IV, 7^th Floor, United India Towers, Basheerbagh, Hyderabad through its M.D.

3.             Good Health TPA Services Limited, Plot No.49, Nagarjuna Hills, Punjagutta, Hyderabad through its Managing Director.

             ….Opposite parties. 

For the complainant    : Shri Sumir Fatta, Adv.              

For the OP No.1         : None.

For the OP No.2         : Shri Bhushan Garg, Adv.

For the OP NO.3        : Exparte.

 

 

QUORUM                                       

JOT NARANJAN SINGH GILL     : PRESIDENT

SARITA GARG                               : MEMBER

 

 

ORDER

JOT NARANJAN SINGH GILL, PRESIDENT

1.             The complainant has filed this complaint alleging  that he obtained a CC limit from OP number 1 and  at that time OP number 1 told the complainant to obtain the medical insurance policy of OP number 2 and as such the complainant obtained for him and his family  Arogyadaan policy bearing number 0504002814P101905064 from OP number 2 for the period from 14.7.2014 to 8.6.2015 for Rs.1,00,000/- by paying the requisite premium of Rs.1628/-.  The grievance of complainant is that his wife underwent Laporoscopic Assisted Vaginal Hysterectomy with Bilaterat Salpingoophorectomy on 31.10.2015 at CMC Ludhiana and remained admitted there from 31.10.2015 to 7.11.2015 and thereafter the complainant submitted all the bills and treatment record to OP number 3 on 15.11.2015 but the OPs failed to release the claim amount.  The complainant even got served a legal notice upon the OPs on 9.1.2018 but OP number 3 repudiated the claim of the complainant.  The complainant even served another legal notice upon the OPs on 23.3.2018 and demanded back the original bills, but of no avail.  The complainant is a govt. employee and he could have availed the service of reimbursement by the Punjab Govt. but due to non returning of original bills by the Ops he could not avail that service also due to which he suffered loss.  Thus, alleging deficiency in service on the part of the OPs the complainant has prayed that the OPs be directed to pay to the complainant claim amount of Rs.1,07,414/- alongwith interest @ 9% per annum and further claimed compensation and litigation expenses.

2.             Upon notice, OP number 1 appeared and filed reply taking legal objection that the complainant has no cause of action to file the present complaint. On merits, it is admitted that the complainant availed a CC limit, but the fact that the complainant obtained the medical insurance policy at the instance of OP number 1 has been denied.

 3.            In reply filed by OP number 2, legal objections are taken up on the grounds that wife of complainant, namely, Baljinder Kaur has pre-existing disease prior to the inception of the policy in question,  that there is no deficiency in service on the part of the OP, that the complainant has not come to the Commission with clean hands.  On merits, it is admitted that the complainant took the policy in question. It is admitted that the complainant submitted the medical bills and treatment record to the OP number 3 but the claim is not payable as per terms and conditions of the policy and exclusion clause number 6.1 and as such the claim was repudiated vide letter dated 4.4.2016. It has been denied that the complainant ever demanded the original bills and the OPs never refused to return the same. Any deficiency in service on the part of OP number 2 has been denied.

4.             Record shows that OP number 3 was proceeded against exparte.

5.             The parties produced their respective evidence and closed thereafter.

6.             We have heard the arguments advanced by the learned counsel for the parties.

7.             At the outset, a bare perusal of the file reveals that the claim of the complainant was repudiated vide letter dated 4.4.2016, a copy of which on record is Ex.OP2/4 on the ground that Smt. Baljinder Kaur underwent treatment for Heavy mensutural bleeding. Policy inception dated 14.7.2014 and date of admission 30.10.2015. As per submitted documents of discharge summary complaints since 3 years it is pre existing condition and admitted for hysterectomy and as per clause 6.1 claim is not payable.

8.             Record shows that the present complaint was filed on 5.11.2018 after the period of more than two years of repudiation of the claim as the claim was repudiated on 4.4.2016.  The complainant was entitled to file the present complaint within two years upto 4.4.2018, whereas the complaint was filed on 5.11.2018 after about seven months late.  There is no explanation from the side of the complainant that why the complaint was filed so late and it seems that the complaint is barred by limitation of time by about seven months.  No application for condonation of delay at the time of filing of the complaint has been filed by the complainant. Section 24-A of the Consumer Protection Act, 1986 provides for a limitation period of two years from the date on which the cause of action has arisen for filing a complaint before the District Commission with further provision that a complaint may be entertained after the limitation period if the complainant satisfies that he had sufficient cause for not filing the complaint within such period. This clause also provides that no such complaint shall be entertained unless the District Commission, records its reasons for condoning such delay. As such, we find that this complaint is hopelessly barred by time and is not maintainable in the circumstances of the case.     

9.             In view of our above discussion, the complaint is dismissed, leaving the parties to bear their own costs.

10.            The complaint could not be decided within the statutory time period due to heavy pendency of cases.

11.            Copy of this order be supplied to the parties free of cost. File be consigned to the records after its due compliance. 

                                Pronounced.

 

                                September 12, 2022.