BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KAITHAL.

                                                     Complaint Case No.24 of 2019.

                                                     Date of institution: 28.01.2019.

                                                     Date of decision:30.12.2019.

Mehar Singh son of Bishan Singh, resident of Village Tyontha, Tehsil Pundri, District Kaithal.

                                                                        …Complainant.

                        Versus

1. Axis bank Limited, Branch Village Tyontha, Tehsil Pundri, District Kaithal through its Branch Manager.
2. Apollo Munich Health Insurance Company Ltd., Ist Floor, Office-101 Cardinal Gracious Road, Opp. P. & g Plaza Chakala, Andheri East, Mumbai, Maharashtra-400099 through its Manager.
3. Apollo Munich Health Insurance Company Ltd., Central Processing Centre, 2^nd & 3^rd Floor, LABS Centre, Plot No.404-05 Udyog Vihar, Phase-III, Gurgaon (Gurugram) through its Manager.

….Respondents.

Before:      Sh. D.N.Arora, President.

                Sh. Rajbir Singh, Member.

                Smt. Suman Rana, Member.

Present:     Sh. Anil Kumar, Advocate for the complainant.   

                Sh. Sudeep Malik, Advocate for the OP.No.1.

                Ops No.2 & 3 exparte.

ORDER

D.N.ARORA, PRESIDENT

                The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the complainant got purchased a Mediclaim Policy from the Ops No.2 & 3 through the Op No.1 for the sum of Rs.3,00,000/- valid for the perioid 23.05.2017 to 22.05.2018 and the premium amount of Rs.13,996.65 paise was deducted from his account in the branch of Op No.1.  It is alleged that on 10.07.2017, there was problem in the stomach of complainant and he remained admitted in Shri Ram Chand Memorial Hospital Advance Neuro & Trauma Centre, Karnal on 10.07.2017 where it was diagnosed that the liver of complainant is defected and he remained admitted till 18.07.2017.  Thereafter, the complainant again felt some problem and he remained admitted in the said hospital from 22.07.2017 to 26.07.2017.  It is further alleged that the complainant was not feeling well and again visited for treatment at Hyderabadi General Hospital, Panipat on 31.07.2017 where he remained admitted till 05.08.2017.  It is further alleged that the complainant got lodged the claim with the Ops No.2 & 3 and submitted the bills of Rs.70,749/- but the claim of complainant was repudiated by the Ops No.2 & 3 vide letter dt. 09.11.2017.  The said repudiation of claim is wrong and illegal.  So, it is a clear cut case of deficiency in service on the part of Ops and prayed for acceptance of complaint.  Hence, this complaint.     

2.            Upon notice, the OP No.1 appeared before this Forum, whereas Ops No.2 & 3 did not appear and opted to proceed against exparte vide order dt. 15.03.2019.  Op No.1 contested the complaint by filing reply raising preliminary objections that the medical insurance was not done by the answering Op bank and the same was taken by the complainant from the Ops No.2 & 3, hence, the liability for payment of any amount lies on the shoulders of Ops No.2 & 3 only.  There is no deficiency in service on the part of Op.  On merits, the objections raised in the preliminary objections are reiterated and so, prayed for dismissal of complaint.

3.             The complainant tendered into evidence affidavit Ex.CW1/A and documents Annexure-C1 to Annexure-C36 and thereafter, closed the evidence.

4.           On the other hand, the Op No.1 tendered into evidence affidavit Ex.RW1/A and thereafter, closed the evidence.

5.             We have heard the learned Counsel for both the parties and perused the record carefully.  During the course of arguments, statement of ld. Counsel for the complainant recorded separately to the effect that the documents which have been demanded by the Ops No.2 & 3 vide Annexure-C2, he will submit the same within 15 days and he has no receipt of Rs.5450/- and the direction may be given to the Ops for passing the claim.  We have perused the document Annexure-C2 and following documents were demanded by the Ops No.2 & 3 from the complainant:

“1. Need Investigation report to support the Liver abscess (Sonography report and Histopath of the liver abscess).

2.   Need Indoor case paper of all the 2 admission.

3.   Discharge summary 10 July to 18 July is not submitted.

4.   Payment receipt 5450/-” 

        So, in view of statement of ld. Counsel for the complainant as-well-as-facts and circumstances of the case, the ends of justice will be met if we direct the complainant to submit the required documents by the Ops No.2 & 3 as per Annexure-C2 except the document of payment receipt of Rs.5450/- as ld. Counsel for the complainant made statement that he has no receipt of Rs.5450/- with the Op No.2 & 3 within 15 days from the date of preparation of copy of this order and thereafter, the Ops No.2 & 3 will decide the claim of complainant within 30 days.  Thus, we disposed off the present complaint accordingly as per direction mentioned above.  However, it is made clear that if the complainant is not satisfied with the decision of claim decided by the Ops No.2 & 3, then the complainant is at liberty to file the fresh complaint, if so desired as per law.  No order as to costs.  A copy of this order be sent to both the parties free of costs.  File be consigned to the record room after due compliance.

Announced in open court:

Dt.:30.12.2019.  

                                                                        (D.N.Arora)

                                                                        President.

(Suman Rana),           (Rajbir Singh)         

Member                             Member.