Haryana

Kurukshetra

CC/33/2019

Pushpa Tiwari - Complainant(s)

Versus

Bajaj Allianz - Opp.Party(s)

Nayab Singh Narwal

22 Oct 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KURUKSHETRA.

 

Consumer Complaint No.33 of 2019.

Date of Instt.:28.01.2019.

Date of Decision:22.10.2019.

 

Pushpa Tiwari w/o Shri Sandeep Kumar Saini, r/o H.No.2172/7, Housing Board Colony, Sector-7, Urban Estate, Kurukshetra. 

                                                                        …….Complainant.                                            Versus

 

1. Bajaj Allianz General Insurance Co. Ltd., 2^nd Floor Bajaj Finserv Building, Survey No.208/1B, Office Nagar Behind Weikfield IT ParkViman Nagar, Pune-411014, through its Managing Director.
2. Bajaj Allianz General Insurance Co. Ltd., Regd. Office GE Plaza, Airport Road, Yerwada, Pune-411006, through its General Manager.
3. Bajaj Allianz General Insurance Co. Ltd., CO No.226, Sector-12, Part-I, Karnal (Haryana), through its Branch Manager.

                ….…Opposite parties.

 

Complaint under Section 12 of Consumer Protection Act.

 

Before       Smt. Neelam Kashyap, President.    

                   Ms. Neelam, Member.       

                   Shri Sunil Mohan Trikha, Member.                                                   

Present:     Shri Nayab Singh Narwal, Advocate for the complainant.  

Shri Atul Mittal, Advocate for the opposite parties.

           

ORDER

 

                    This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by the complainant Pushpa Tiwari against Bajaj Allianz and another, the opposite parties.

2.             The brief facts of the complaint are that the complainant purchased a joint health policy No.OG-18-1207-8421-00000012 dated 02.9.2017 valid from 02.9.2017 to 01.9.2020 in the name of complainant, her husband and her daughter Avni Saini vide ID Nos.20-87636320, 20-87636320-A and 20-87636320-B respectively for health and wellness card. In the month of October 2018 i.e. on 21.10.2018, her husband fell ill and suffering from Dengu disease and admitted in the hospital of Dr. Atul Arora, Atul Clinic, 105/13, U.E. Kurukshetra from 21.10.2018 to 26.10.2018 and she paid a sum of Rs.17,252/- to the said doctor as medical expenses. In the month of November 2018, her daughter namely Avni Saini fell ill and admitted in the hospital of Dr. Sunder Clinic, Sector-7, U.E., Kurukshetra from 07.11.2018 to 13.11.2018 and she had paid a sum of Rs.11650/- to the said hospital. The complainant intimated to the OP No.1 regarding illness of his husband Sandeep Kumar Saini vide Intimation No.75002336 and on the direction of the OP No.1, she submitted all the treatment expenses, medicines bill of her husband to OP No.1 through courier. Thereafter, she received an email from the OP No.1 to the effect that they had not received full documents and she contacted the courier services in this regard, who told that they had sent the full packet to the OP No.1 and there is no question of misplacing the documents from them. She sent all the documents to the OP No.1 through email and also sent the medical bills and expenses of doctor of her daughter to OP No.1 through courier vide intimation No.75253514. She contacted the OP No.1 on telephone regarding payment of medical expenses, but they knowingly and intentionally repudiated her claim. By not paying her genuine medical claim, the OPs are deficient in services. Hence, this complaint.

3.             Upon notice, the opposite parties appeared and filed written statement raising preliminary objections regarding maintainability; locus-standi; cause of action and jurisdiction. It is stated that the claim of the complainant was duly processed by the OPs and he was requested vide letter dated 16.11.2017 to fullfil certain requirements i.e. “We are in receipt all scan documents, hence kindly provide all the original medical bills & medical documents related to the hospitalization for further processing of claim of complainant (viz: duly filled & signed claim form, original discharge summary mentioning details of treatment, duration of the ailment with any major illness in the past, final hospital bill with paid receipt, investigation reports done supporting to the diagnosis, medicine bills with prescription), but the complainant failed to submit any reply to the aforesaid letters, therefore, in absence of any response, the claim of the complainant was processed as No Claim vide letter dated 29.12.2018. So there is no deficiency on the part of the OPs and the present complaint may kindly be dismissed with special costs.

4.             The complainant tendered affidavit Annexure CW1/A alongwith documents Ex.C-1 to Ex.C-43 and closed the evidence. On the other hand, learned counsel for OPs tendered affidavit Ex.RW1/A alongwith documents Ex.O-1 to Ex.O-3 and closed the evidence.

5.             We have heard learned counsel for the parties and have perused the case file carefully.

6.             The learned counsel for the complainant has reiterated all the averments mentioned in the complaint. He argued that the complainant purchased a joint health policy from the OPs in the name of complainant, her husband and her daughter Avni Saini for health and wellness card. In the month of October 2018, her husband fell ill suffering from Dengu disease and admitted in the hospital and she paid a sum of Rs.17,252/- to the said doctor. In the month of November 2018, her daughter namely Avni Saini fell ill and admitted in the hospital and the complainant had paid a sum of Rs.11650/- to the said hospital. The complainant intimated to the OP No.1 in this regard and submitted all the treatment expenses, medicines bills of her husband and daughter to OP No.1 through courier, but despite that, the OPs knowingly and intentionally repudiated her claim. This act of the OPs amounts to deficiency in services.

7.             Contrary to it, the learned counsel for the OPs has reiterated all the version of the reply. He argued that the claim of the complainant was duly processed by the OPs and he was requested vide letter dated 16.11.2017 to fulfill certain requirements i.e. all the original medical bills & medical documents related to the hospitalization for further processing of claim of complainant (viz: duly filled & signed claim form, original discharge summary mentioning details of treatment, duration of the ailment with any major illness in the past, final hospital bill with paid receipt, investigation reports done supporting to the diagnosis, medicine bills with prescription), but the complainant failed to submit the same, therefore, the claim of the complainant was repudiated vide letter dated 29.12.2018. There is no deficiency on the part of the OPs.

8.             It is pertinent to mention here that during the course of arguments, the learned counsel for the OPs has made a statement to the effect that if the complainant will deposit all the original documents with the OPs, then the OPs will release the claim of the complainant within 30 days. Contrary, to it, the learned counsel for the complainant has also made a statement that the complainant has sent all the original documents regarding the medical to the company through courier and received its receipt through email.

9.             From the above, it is apparent that the OPs had not denied the claim of the complainant, rather, the OPs refused to pay the complainant to the complainant on the ground that the complainant failed to provide the original medical/treatment documents. Whereas, on the other hand, the complainant has contended that the complainant has sent all the original documents regarding the medical treatment to the company through courier and received its receipt through email. In this regard, at the time of argument, the complainant has produced original docket receipts No. Z68130725 & Z68130748 dated 21.11.2018 of DTDC Courier on the case file as Mark A & Mark B, vide which, the complainant sent the original documents to the OPs on their Pune address. Moreover, the complainant has also produced copy of that medical documents on the case file as Ex.C6 to Ex.C46 respectively. It is pertinent to mention here that the OPs failed to produce any documentary evidence to prove their contention. So, we found force in the contention of the complainant that he had already sent all the original treatment documents to the OPs through DTDC courier. In these facts and circumstances of the case, we are of the considered view that since the complainant had already sent all the original documents of medical treatment to the OPs through courier on 21.11.2018, therefore, the OPs have committed a mistake in refusing to pay the claim of the complainant on this very ground. Hence, the OPs are deficient in service. The complainant has produced medical treatment bills of Avni amounting Rs.11650/- from Ex.C15 to Ex.C21 and Sandeep Kumar amounting Rs.17,252/- from Ex.C25, Ex.C41 to Ex.C46 on the case file respectively, total amounting Rs.28,092/- (17252+11650). So the OPs are liable to pay the said amount of Rs.28,092/- to the complainant alongwith the compensation and litigation charges.

10.            In view of the aforesaid discussion, we hereby allow the present complaint and direct the OPs in the following manner:-

1. To pay the amount of Rs.28,092/- to the complainant.
2. To pay Rs.10,000/- as compensation for mental agony and        physical harassment suffered by the complainant.
3. To pay Rs.5,000/- as counsel fee.

 

                The OPs are further directed to comply with the aforesaid directions jointly and severally within the period of 45 days from the date of communication of this order, failing which, the awarded amount shall carry interest @ 9% per annum from the date of order till actual payment and the complainant will be at liberty to initiate proceedings under Section 25/27 of the Act against the OPs. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the record-room, after due compliance.

Announced in open Forum:

Dt.:22.10.2019.                                                   (Neelam Kashyap)

                                                                        President.

 

(Sunil Mohan Trikha),           (Neelam)       

Member                             Member.