D.R.TAMTA, MEMBER
The complainant has filed the present complaint against O.P under section 12 of Consumer Protection Act, 1986. The facts as alleged in the complaint are that complainant had taken a Nagrik Surkasha Mediclaim policy bearing No.2006/10624 for the period 10.08.2005 to 09.08.2009 against payment of Rs.337/-. On 18.12.2006 the complainant received accidental injury near Rani Ganj in District Unnao, U.P from where he was shifted to Surya Hospital, Safipur_I, Rama Devi Choraha, Kanpur, where he remained up to 03.01.2007. Complainant had spent Rs.48,795/- on hospitalization, treatment, medicine, fixtures and surgery etc. It is alleged that all the documents along with the medical bills has been filed by the complainant within time. Complainant filed claim with O.P for reimbursement of the amount which was repudiated by the O.P vide its letter dated 24.08.2007. It is alleged that repudiation of claim by O.P was illegal and unjustified. It is alleged that the complainant has made various requests and reminders to the O.P for reimbursement of the claim of complainant but all in vain. On these facts complainant prays that O.P be directed to pay a sum of Rs. 48,795/-, apart from cost and compensation as claimed.
2. O.P appeared and filed written statement. In its written statement OP has not disputed that the complainant had taken a mediclaim policy and also filed a claim on account of expenses on the treatment. However, its case is that the complainant was admitted in the hospital on 18.12.2006 and was discharged on 03.01.2007 but the complainant submitted the papers only on 17.05.2007 for reimbursement. It is alleged that the complainant informed the police station on 10.04.2007 while no FIR has been provided and to support the said intimation to the police. On 15.07.2007 the complainant intimated the Branch Office of the O.P about the alleged accident. Hence, the said claim was closed due to delay in intimation to the O.P as per the policy conditions. It is alleged that the claim of the complainant is not admissible under the terms and conditions of the policy. Dismissal of the complaint has been prayed for.
3. Complainant has filed his affidavit affirming the facts alleged in the complaint. He has also proved documents exhibited as Ex. CW-1/1 to CW-1/11. On the other hand Shri R.K. Nagpal, Divisional Manager has filed affidavit in evidence on behalf of O.P testifying all the facts as stated in the written statement. Parties have also filed their respective written submissions.
4. We have carefully gone through the records of the case and have heard Ld. Counsels of the parties.
5. From the perusal of record, we find that there is no dispute that complainant had taken a Mediclaim policy in question. There is also no dispute that the complainant was hospitalized from 18.12.2006 to 03.01.2007 and subject spent of Rs. Rs.48,795/-. The case of the O.P is that there was considerable delay as intimation was given by the complainant on 17.05.2007 were the incident had taken place on 18.12.2006.
6. We have perused the record that the complainant has placed on record repudiation letter of the O.P as exhibited Ex.CW-1/9 which is dated 24.08.2007. In the intimation itself it has been mentioned that the incident took place on 18.12.2006. According to the O.P there is a delay of intimation of 5 months whereas the intimation was required to be given within 7(seven) days of indicence.
7. Question arises whether inordinate delay is a ground for repudiation of the claim? In this respect in Devender Singh Vs. National Insurance Company Ltd. III CPJ (2003) CPJ 77 (NC), Hon’ble National Commission has held that when the insured reported the theft of vehicle to the insurer after a gap of almost a month, repudiation of claim by the insurer was justified. In Prahlad & Anr. Vs. Oriental Insurance Company Ltd. IV (2012) CPJ 770 (NC), Hon’ble National Commission has held that the Insurance Company was informed about the accident nearly about 2 months from the date of the incident, therefore repudiation of the claim is valid. In another case reported as New India Assurance Co. Ltd. Vs. Trilok Chand Jane, First Appeal No.321/2005 decided by Hon’ble National Commission on 9/12/2009 it has been held that informing the insurer about theft of the vehicle after 9 days was fatal to the investigation, therefore repudiation of claim was justified. In the present case complainant informed the insurer about the theft after 5 months which certainly is inordinate delay, therefore it cannot be said that repudiation of claim by O.P was unjustified.
8. In view of these authorities, we hold that since there was inordinate delay in informing the insurer about incident, therefore, repudiation cannot be said to be unjustified nor it can be said that there was any deficiency on the part of OP. Complaint is accordingly dismissed.
Copy of the order be sent to the parties by Registered post and the file be consigned to record room.
Announced this 25th day of April, 2015.
(BABU LAL) (D.R. TAMTA) (SHAHINA)
President Member Member
