Haryana

Karnal

48/2013

Raminder Alias Ravinder S/o Chatter - Complainant(s)

Versus

Bajaj Allianz Insurance Company Limited - Opp.Party(s)

R.K. Sharma

29 Mar 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                              Complaint No.48 of 2013

                                                             Date of instt.28.01.2013

                                                               Date of decision 29.3.2017

 

Raminder alias Ravinder son of Shri Chatter, resident of village Bajida Roran, Post office Manjura, District Karnal.

 

                                                                               ……..Complainant.

                                      Vs.

1. Bajaj Allianz General Insurance Company Ltd. 167/18, Hazari Building, Public Apex Marketing, 1^st floor, Ambala Cantt, through its Area Manager/Branch Office.

2. Branch Manager, Bajaj Allianz Life Insurance Company Limited, SCO no.226, Sector-12, Urban Estate, Karnal.

 

                                                                   ………… Opposite Parties.

 

                     Complaint u/s 12  of the Consumer Protection Act.

 

Before                   Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-      Shri R.K.Sharma Advocate for complainant.

                    Shri  Rohit Gupta Advocate for opposite party no.1.

                    Shri N.K.Zak Advocate for opposite party no.2.

                    

                    

 ORDER:

 

                   This complaint has been filed by the complainant u/s 12 of the Consumer protection Act, 1986, on the averments that he got insurance policy under “Group Personal Accident Insurance Policy”, issued to Golden Multi Service Club Limited with the opposite party no.2 at Karnal and in this regard, a sum of Rs.1641/- was deposited on 26.6.2008. Certificate bearing no.012754832/ 9080183157 covering the period from 15.7.2008 to 14.7.2013 was issued. In the month of December, 2011, he received injury in his right eye, due to which he became disabled in sight, he cannot see anything from his right eye. He got treatment from many Doctors including Expert of Eye and spent huge amount on his treatment. As per terms and conditions of the policy, under column no.8, it has been specifically mentioned that in case of loss of one eye or one foot or one hand, 50% of sum insured amount of Rs.3,00,000/-, as mentioned in the policy certificate, would be payable. He visited the office of the opposite parties and requested to give 50% compensation of the insured amount to him as per the terms and conditions of the policy, but the matter was postponed on one pretext or the other. Ultimately, he got served a legal notice dated 14.9.2012 upon the opposite parties, but the same also did not yield any result. Such acts and conduct on the part of the opposite parties amounted to unfair trade practice and deficiency in service, due to which he suffered mental pain, agony and harassment apart from financial loss.

2.                Notice of the complaint was given to the opposite parties. Opposite party no.1 filed written statement controverting the claim of the complainant. Objections have been raised that the complainant has no locus standi and cause of action to file the complaint; that complicated questions of law and facts are involved, which cannot be decided by this Forum under summary jurisdiction; that the complaint is not maintainable in the present form; that there was no privity of contract between the complainant and the opposite party no.1 to consider him as consumer; that the complaint is bad for mis-joinder and non-joinder of parties, as Golden Multi Services Club Limited has not been impleaded as necessary party and that the complainant is estopped from filing the complaint by his own acts and conduct.

                   On merits, it has been denied that the complainant received injury on right eye in the year 2011 and that he has become disabled in sight and cannot see from the right eye due to the alleged injury. It has been submitted that the complainant neither submitted any document, hospital treatment record and discharge summary before opposite parties to process claim as per terms and conditions of the policy. No claim has been lodged with the opposite party no.1. The policy covers only loss of eye, whereas complainant had suffered 30% disability. The other allegations made in the complaint have been denied.

3.                Opposite party no.2 filed separate written statement disputing the claim of the complainant. Objections have been raised that there was no privity of contract between the complainant and opposite party no.2; that the complainant has concealed the true and material facts from this forum; that the complainant has no locus standi and cause of action to file the complaint; that the complaint is not maintainable in the present form; that the complaint is bad for mis-joinder and non-joinder of necessary parties; that the complainant does not fall under the definition of consumer; that this forum has got no jurisdiction to entertain and try the complaint and that the complaint is false, frivolous and vexatious.

                   On merits, it has been averred that opposite party no.2 i.e. Bajaj Allianz Life Insurance Co. Ltd. has not issued any policy under the name “Group Personal Accident Insurance Policy”. No proposal for insurance was ever received by the opposite party no.2 from the complainant, therefore, the question of issuing of the alleged policy could not arise. The other allegations made in the complaint have also not been admitted.

4.                In evidence of the complainant, his affidavit Ex.CW1/A and documents Ex.P1 to Ex.P8 have been tendered.

5.                On the other hand, in evidence of the opposite parties, affidavit of Navjeet Singh Assistant Manager-Legal Ex.OP1/A has only been tendered.

6.                We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the complainant and learned counsel for the opposite parties.

7.                The opposite party no.1 has raised no dispute regarding issuance of the policy certificate in favour of the complainant. The only dispute raised by opposite party no.1 is that the complainant neither lodged claim with opposite party no.1 nor submitted documents/hospital treatment receipts nor discharge summary for processing the claim as per terms and conditions of the policy.

8.                It is worth pointing out that the complainant in the complaint has not specifically pleaded that the claim was lodged by him with the opposite party no.1 and the requisite documents were submitted. In para no.4 of the complaint it has only been pleaded that he visited the office of opposite party at Karnal and requested to give 50% compensation of the insured amount to him as per terms and conditions of  the policy, but they postponed the matter on one pretext or the other. He has not alleged that any claim in writing was lodged by him with the opposite party. Mere sending registered legal notice to the opposite party could not give any rise to cause of action because until unless the claim was filed with opposite party no.1, there could be no question of processing and settling his claim. Under such circumstances, we have not hesitation in concluding that the complainant has failed to prove that any claim was lodged by him with the opposite party no.1. Thus, the complaint is premature.

9.                In view of the above discussion, it is ordered that the complainant would submit the required documents with the opposite party no.1 within 15 days and thereafter, the opposite party no.1 would decide his claim within further period of 30 days. Original documents produced by the complainant be returned to him on producing certified/photo copy of the same on the record so that he may submit the same alongwith claim to the opposite party.  This order shall be complied accordingly. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:29.03.2017

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member