Haryana

StateCommission

CC/61/2015

IQBAL SINGH MAAN - Complainant(s)

Versus

BAJAJ ALLIANZ GEN. INSURANCE CO. - Opp.Party(s)

SAHIL ABHI

06 Feb 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

Complaint No     :     61 of 2015

Date of Institution:   11.05.2015

Date of Decision :    06.02.2017

 

Iqbal Singh Maan, Resident of D-277, Sarvodaya Enclave, New Delhi-110017.

                                      Complainant

Versus

1.      Bajaj Allianz General Insurance Company Limited, GE Plaza, Airport Road, Yervada, Pune-411006.

          having Branch Office at 3^rd Floor, JMD Regent Plaza, Mehrauli, Gurgaon Road, Gurgaon-122001, Haryana.

2.      Travel Solutions, O-133, DLF Shopping Mall, Arjun Marg, DLF Phase-1, Gurgaon-122002, Haryana.

                                      Opposite Parties

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Mr. B.M. Bedi, Judicial Member.

                                                                                                         

Argued by:          Shri Vivek Kishore, Advocate for Complainant.

Shri Rajesh Verma, Advocate for Opposite Party No.1.

None for Opposite Party No.2.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

          Iqbal Singh Maan-complainant purchased insurance policy (Exhibit C-1) from Bajaj Allianz General Insurance Company Limited (for short ‘Bajaj Allianz’)-Opposite Party No.1 through Travel Solutions-Opposite Party No.2 before he proceeded to United States of America on September 17^th, 2014. The policy commenced from September 16^th, 2014 and was valid up to October 6^th, 2014 and it covered the following benefits:

•        Medical Expenses, Evacuation and Repartriation up to $ 2,00,000/-

•        Dental Pain Relief up to $ 500

•        Personal Accident up to $25,000

•        AD & D up to $5000/- 

•       Delay of Baggage $100/-

•       Loss of Checked Baggage up to $1000/-

•       Trip Cancellation up to $1000/-     

2.                On September 18^th, 2014 the complainant fell ill. He was admitted in Sky Ridge Medical Center, Denver, Colorado where he remained under treatment upto September 22^nd, 2014. The complainant has produced medical record Exhibit C-2.  The total bill (Exhibit C-2) of complainant’s treatment was US$104876.22 besides US$ 481 and US$923 vide bills vide bill Exhibit C-3 and Exhibit C-4 respectively. The complainant filed claim with Bajaj Allianz-Opposite Party No.1 but it did not pay the amount. Hence, the complainant filed complaint before this Commission.

3.                Bajaj Allianz-Opposite Party No.1 in its written version stated that the complainant was suffering pre-existing disease because he had undergone coronary angioplasty in colorodo, in 2014, USA for unstable angina and had history of borderline diabetes of 3 years duration and obesity as per certificate dated March 2^nd, 2015 issued by Dr.Sanjay Rajdev, 7 Hills Hospital, Mumbai.  Thus, as per terms and conditions of the policy, the complainant was not entitled for the claimed amount. Besides no proof of expenditure has been produced by the complainant and prayed for dismissal of the complaint.

4.                The Opposite Party No.2 did not contest the complaint despite the fact that it appeared through counsel but neither it filed written version nor anybody appeared to contest the complaint on their behalf.

5.                In evidence complainant-Iqbal Singh Mann appeared as CW-1 and tendered documents Exhibits C-1 to C-8. The opposite parties examined Navjeet Singh as OPW-1.

6.                Counsel for the parties have been heard. File perused.

7.                While appearing as his own witness (CW-1), the complainant in his examination-in-chief has stated that neither he paid any amount in USA nor the hospital authorities demanded any amount from him.   The relevant portion of complainant’s statement (CW-1) is reproduced as under:-

“I remained admitted in the hospital for four days.  The medical record is Exhibit C-2. I was discharged on 22.09.2014. (Discharge summary at page 42).   The total bill was of 104876.22 US$ is Exhibit C-3.  The amount is mentioned at pages 109-114.  Other bills of 481 US$ (Exhibit C-4) and 923 US$ are on page 120 & 124.  I came back from USA on 10.10.2014.  I had not paid the amount in USA nor they asked me to pay.  I submitted my insurance policy to the hospital.”

8.                Even in the course of cross-examination also, the complainant stated that he had not paid any amount for his treatment abroad.  He stated that “As on date also I have not paid any amount to the hospital in USA.”

9.                The complainant was only entitled to be indemnified by Bajaj Allianz-Opposite Party No.1 for the treatment expenses incurred by him while visiting abroad. Since as per the complainant himself he has not paid any amount, therefore, Bajaj Allianz-opposite party No.1 is not liable to indemnify the complainant.

10.              In the result the complaint fails. It is dismissed. 

 

Announced: 06.02.2017

(B.M. Bedi) Judicial Member

(Nawab Singh) President

 

CL