Delhi

East Delhi

CC/215/2014

MALA ARORA - Complainant(s)

Versus

BAJAJ ALLIANCE - Opp.Party(s)

29 May 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. NO.  215/14

 

Mrs. Mala Arora

W/o Shri Ritesh Arora

1/6215, Street No. 4

Rohtas Nagar, Shahdara

Delhi – 110 032                                                               ….Complainant

 

Vs.

 

1. M/s. Bajaj Allianz Insurance Co. Ltd.

E-502-503, 5^th Floor

Parmesh Tower 1^st

13 Community Centre, Karkardooma

East Delhi, Delhi

 

2. M/s. Bajaj Allianz Insurance Co. Ltd.

Head Office: Plot No. 271, Phase – 2

Industrial Area, Panchkula

Chandigarh – 131 015                                                      ….Opponents

 

 

Date of Institution: 01.05.2014

Judgment Reserved on: 29.05.2017

Judgment Passed on: 30.05.2017

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari  (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By : Sh. Sukhdev Singh (President)

 

 

JUDGEMENT

            This complaint has been filed by Ms. Mala Arora against                  M/s. Bajaj Allianz Insurance Co. Ltd. under Section 12 of the Consumer Protection Act, 1986 alleging deficiency in service.

2.         The facts in brief are that the complainant purchased an insurance policy named Bajaj Allianz Family CareFirst vide policy no. 0108274114 dated 17.09.2008, valid from 10.09.2008 to 10.09.2011 for the sum assured of       Rs. 3,00,000/-.  Complainant’s daughter Ms. Mahima Arora suffered from pain in the abdomen which was diagnosed as cyst in the abdomen for which surgery was advised by  Dr. Raj Bokaria as per diagnostic and other investigations.  It is stated that daughter of the complainant was admitted in Shri Mool Chand Hospital on 11.09.2013 vide inpatient no. 13/6916 where the operation for removal of cyst from abdomen was performed.  She was discharged from the hospital on 13.09.2013. 

            Out of total bill amount of Rs. 70,342/- for indoor treatment,              M/s. Bajaj Allianz Ins. Co. paid under medical cover only Rs. 53,739/- and the balance of Rs. 16,603/- was paid by the complainant.  The complainant spent Rs. 19,719/- on preadmission medical and diagnostic expenses and            Rs. 3,080/- on post hospitalization charges on medical advice.  The complainant spent total amount of Rs. 93,141/- on the treatment of her daughter out of which the insurance company paid only Rs. 53,783/- and was liable to pay the short payment of Rs. 39,358/-.  Hence, the complaint prayed for direction to OP to pay balance payment of Rs. 39,358/-; compensation for deficiency in service and interest on the balance amount.

3.         OPs were served with the notice of the complaint, but no reply was filed on their behalf, finally they were proceeded ex-parte.

4.         In support of its case, the complainant has examined herself on affidavit.   She has also narrated the facts, which have been stated in the complaint.  She has also got exhibited documents such as policy no. 0108274114 dated 17.09.2008, valid from 10.09.2008 to 10.09.2011 (Ex.CW1/1), impatient ticket (Ex.CW1/2 colly.), copies of details of expenses (Ex.CW1/3 colly.) and bills/cash memos of all the expenditure (Ex.CW1/4 colly.). 

5.           We have heard Ld. Counsel for the complainant and have perused the material placed on record.  From the documents placed on record, it is the case of the complainant herself that the insurance company have paid an amount of Rs. 53,783/-, out of a total amount of Rs. 93,141/- making a short payment of Rs. 39,358/- for which she has made the present complaint.  However, she has not placed any document on record as to why the insurance company have not paid the amount of Rs. 39,358/-.  When there is no document on record for non-payment of Rs. 39,358/-, the question of any deficiency on the part of insurance company does not arise.  When there is no deficiency on the part of insurance company, the complaint of the complainant seems to be without any cause, which deserves its dismissal and the same is dismissed without any cost.   

            Copy of the order be supplied to the parties as per rules.

            File be consigned to Record Room.

 

 

(DR. P.N. TIWARI)                                              (HARPREET KAUR CHARYA)

Member                                                                                Member 

 

           

            (SUKHDEV SINGH)

                                                      President