BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.217 of 2015

Date of Instt. 21.05.2015

Date of Decision :04.11.2015

1. Sugreev Sharma son of P.N.Sharma;

2. Urmila Sharma wife of Sugreev Sharma;

Both residents of H.No.10, New Raj Nagar, Near Shiv Mandir, Basti Bawa Khel, Jalandhar.

..........Complainants Versus

United India Insurance Company Limited, DO-II, Syal House, Lajpat Nagar, Jalandhar through its Branch Manager.

.........Opposite party.

Complaint Under the Consumer Protection Act.

Before: S. Jaspal Singh Bhatia (President)

Ms. Jyotsna Thatai (Member)

Sh.Parminder Sharma (Member)

Present: Sh.Atul Malhotra Adv., counsel for complainants.

Sh.RS Arora Adv., counsel for opposite party.

Order

J.S.Bhatia (President)

1. The complainants have filed the present complaint under the Consumer Protection Act, against the opposite party on the averments that complainants being member of a registered co-operative society namely The Shri Krishna Co-Op., N/A Thrift & Credit Society Ltd., H.No.5, Gali No.10, Ajit Nagar, Near Kishanpura Chowk, Jalandhar got issued insurance policy from opposite party after making payment of due premium at the office of the said society at Jalandhar. Complainant No.1 is the main member and complainant No.2 is wife of complainant no.1. After the receipt of the due premium and after receiving all of the documents and completing formalities, complainants were issued cards by opposite party which were valid for the year 2014-15. During the pendency of the said insurance policy, complainant No.2 on 3.7.2014 felt severe pain in lower abdomen and contacted Shakuntla Devi Vig Hospital, Kapurthala Road, Jalandhar and was admitted from 4.7.2014 to 9.7.2014. Complainant No.2 got treatment in said hospital and had to spend about Rs.24694/- on the treatment, medicines etc. Complainant No.2 was discharged on 9.7.2014. At the time of admission, complainants had tried to contact opposite parties for cashless insurance by opposite parties but could not be contacted due to the reason that the toll free number was giving busy tone every time. Further complainants have also shown the said card to the doctors at Shakuntla Devi Vig Hospital, Kapurthala Road, Jalandhar but since complainant No.2 was suffering from acute pain as such the doctor at said hospital had to start treatment without waiting for the representative of the opposite party. Thereafter complainants were able to contact Ramandeep Singh, representative of opposite party who visited the doctor Rakesh Vig and discussed the entire case. Thereafter complainants approached opposite party for the claim of expenses incurred for Rs.24694/-. Complainants supplied all of the documents and information to opposite parties as and when demanded by opposite parties alongwith the claim form. Further complainants supplied and delivered all of the original medical and expenditure bills to opposite party alongwith raised a claim for Rs.24694/-. Even after the receipt of all of the documents and information from complainants, the opposite party kept sleeping over the issue of payment of the claim of the complainants and have failed to either settle or make the payment of the claim till present date. On such like averments, the complainants have prayed for directing the opposite party insurance company to pay compensation of Rs.90,000/- and further Rs.5000/- as litigation expenses.

2. Upon notice, opposite party insurance company appeared and filed a written reply pleading that the complainant has said “opposite parties” 19 times in his present ill-advised complaint replacing the original, instead of just deleting the opposite party No.2 under the order of the Forum, files the new one under the same number of institution now titled Sugreev Sharma Vs. United India Insurance Company Limited. The mess for him has arisen out of the fact that he had originally filed complaint No.217 of 2015 (and which so was recorded in the entire record, including the register of the “complaints filed” maintained by the office) tilted Sugreev Sharma Vs. Bhai Ghanhya Sehat Sewa Scheme. After that the complainant moved application to add two more as opposite parties to OP No.1 Bhai Ghanhya Sehat Sewa Scheme but this Forum did not agree for the TPA the proposed opposite party No.2 to be added, and directed the complainant to bring in addition only the United India Insurance, in addition to Bhai Ghanhya the opposite party no.1. What the complainant has done, he has now brought the complaint titled Sugreev Sharma Vs. United India Insurance Company. It is submitted that it is the newly titled complaint which is coming out of the shrewd mind of the complainant in contempt of the order of the Forum, therefore, be dismissed with exemplary costs. The complainant has tried to act smart in omitting Bhai Ghanhya Sehat Sewa Scheme without receiving the order from the Forum for the deletion of the OP no.1. The order was only for the deletion of the OP No.2. It further pleaded that the opposite party has neither accepted nor repudiated the claim of the complainant. It is also informed, though not confirmed, that claim was on way to finalization but is held up on account of the filing of the present complaint. It denied other material averments of the complainant.

3. In support of their complaint, learned counsel for the complainants has tendered into evidence affidavit Ex.CA alongwith copies of documents Ex.C1 to Ex.C18 and closed evidence.

4. On the other hand, learned counsel for the opposite party has tendered affidavit Ex.OA and closed evidence.

5. We have carefully gone through the record and also heard the learned counsels for the parties.

6. Without going into other aspects of the dispute, the present complaint can be disposed off by directing opposite party to decide the claim of the complainants within stipulated period. The opposite party insurance company has pleaded that it has neither accepted nor repudiated the claim of the complainants. In para 6 of the complaint, the complainants have pleaded that the opposite party kept sleeping over the issue of payment of the claim of complainants and have failed to either settle or make the payment of the claim till present date. So admittedly the claim of the complainants has not been decided by opposite party insurance company so far. So, we feel that opposite party insurance company should be given an opportunity to decide the claim of the complainants one way or another.

7. Consequently, the present complaint is partly accepted and the complainants are directed to furnish any further document to the opposite party insurance company within 15 days from the date of receipt of copy of this order and after the expiry of said period of 15 days opposite party insurance company shall positively decide the claim of the complainant one way or another within two months on the basis of documents already submitted by the complainants and further on the basis of documents produced by them during the trial of the present complaint and further on the basis of documents, if any which the complainants may further submit to the opposite party within the said period of 15 days. In case of failure of opposite party insurance company to decide the claim of the complainants within above said period of two months, the claim filed by the complainant shall be deemed to have been accepted by it. In the circumstances of the case, there shall be no order as to cost or compensation. Copies of the order be sent to the parties free of costs under rules. File be consigned to the record room.

Dated Parminder Sharma Jyotsna Thatai Jaspal Singh Bhatia

04.11.2015 Member Member President