Chandigarh

DF-I

CC/31/2019

Hardev Singh - Complainant(s)

Versus

BUNDL Technologies Pvt. Ltd. cum Swiggy - Opp.Party(s)

Naveen Sheokand

05 Dec 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

 

                    

Consumer Complaint No.	:	CC/31/2019
Date of Institution	:	21/01/2019
Date of Decision	:	05/12/2019

 

Hardev Singh son of Gurbachan Singh r/o H.No.2641, Sector 37-C, Panchkula.

… Complainant

V E R S U S

1. BUNDL Technologies Pvt. Ltd. cum Swiggy, SCO 154-55, 4^th Floor, Deepak Tower, Sector 17-C, Chandigarh through its Managing Director/Authorised Signatory.
2. IFFCO-TOKIO 2B & C, Madhya Marg, Sector 28A, Chandigarh 160002.

… Opposite Parties

CORAM	:	SHRI RATTAN SINGH THAKUR	PRESIDENT
		SHRI SURESH KUMAR SARDANA	MEMBER

                                               

ARGUED BY	:	Sh. Naveen Sheokand, Counsel for complainant
	:	OP-1 ex-parte
	:	Sh. Rajneesh Malhotra, Counsel for OP-2

Per Rattan Singh Thakur, President

1.      The long and short of the allegations are, complainant joined as delivery boy with OP-1 on 14.12.2017. OP-1 provided insurance cover from the date of his joining and was valid till 13.8.2019 whereby whole of his family was covered. The policy was valid till 13.8.2019.  It is the case, complainant was admitted in PGI, Chandigarh on 24.8.2018 due to burn injury (plastic surgery) and discharged on 6.9.2018.  He was again admitted in the PGI, Chandigarh on 14.9.2018 due to burn injury plastic surgery and discharged on 22.9.2018. The complainant paid total bills of Rs.31,105/- of PGI, Chandigarh out of his own pocket. The complainant thereafter filed claim with the OP, but the same was not processed and released. The complainant also served a legal notice dated 11.12.2018, but, to no avail. Hence, the present consumer complaint for directing the OPs to pay amount of claim, compensation of Rs.1,00,000/- alongwith litigation expenses of Rs.35,000/-. 
2.     OP-1 did not appear despite due service, therefore, vide order dated 20.3.2019, it was proceeded ex-parte.
3.     OP-2/insurer contested the consumer complaint and claimed documents were not submitted, therefore, the claim was not allowed and the District Forum at Chandigarh has no jurisdiction. However, it is admitted, the master policy was issued to OP-1 and was subject to terms and conditions which was valid from 14.8.2019 to 13.8.2019. Their case is, complainant supplied the claim form and one sheet of estimate of medicines are Annexure R-2. The claim under medical policies was to be processed by TPA.  As discharge summary, claim intimation and investigation reports were not supplied, therefore, the claim is premature. On these lines, the cause is sought to be defended.
4.     Rejoinder was filed and averments made in the consumer complaint were reiterated.
5.     Parties led evidence by way of affidavits and documents.
6.     We have heard the learned counsel for the parties and gone through the record of the case. After perusal of record, our findings are as under:-
7.     Per pleadings of the complainant, coverage of the complainant in the policy is not in dispute before us. The only grouse of OP-2 is the requisite documents were not supplied. The complainant has produced on record Annexure C-1 i.e. the card; Annexure C-2 admission card as indoor patient issued by PGI Chandigarh from 24.8.2018 to 14.9.2018 and date of discharge 6.9.2018. Annexure C-3 is the essentiality certificate which pertains to the period of treatment from 24.8.2018 to 6.9.2018 whereby name of medicines and the amount has also been detailed totaling Rs.21,717/-. Though OP-2 has taken the stand in its written reply that certain documents viz. original discharge summary, claim intimation details and original investigation reports were not supplied by the complainant, but, no documentary proof in the shape of some communication has been placed on record.  If the claim submitted by the complainant was not accompanied by the requisite documents, OP-2 (being insurer) was required to seek the same through some writing. Otherwise also, copies of most of the documents in support of his claim were annexed by the complainant alongwith the present consumer complaint. In the light of those documents and to prove its bonafide, OP-2 could have easily processed and reimbursed the claim of the complainant during the pendency of the instant consumer complaint, but, it failed to do so.  Therefore, OP-2 is proved to be deficient in rendering service.
8.     In view of the above discussion, the present consumer complaint succeeds and the same is accordingly partly allowed. OP-2 is directed as under :-

1. to process and reimburse the admissible claim of the complainant alongwith interest @9% per annum w.e.f. 21.11.2018 (one month after submission of claim) till realization.
2. to pay an amount of Rs.15,000/- to the complainants as compensation for causing mental agony and harassment to him;
3. to pay Rs.10,000/- to the complainant as costs of litigation.

9.     This order be complied with by OP-2 within thirty days from the date of receipt of its certified copy, failing which, it shall make the payment of the amounts mentioned at Sr.No.(i) & (ii) above, with interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.
10.     Since no deficiency in service or unfair trade practice has been alleged or proved against OP-1, the consumer complaint qua it stands dismissed with no order as to costs. 
11.     The certified copies of this order be sent to the parties free of charge. The file be consigned.

	Sd/-	Sd/-
05/12/2019	[Suresh Kumar Sardana]	[Rattan Singh Thakur]
hg	Member	President