Chandigarh

DF-I

CC/30/2019

Vikas Kumar - Complainant(s)

Versus

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

Naveen Sheokand

04 Dec 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

 

                    

Consumer Complaint No.	:	CC/30/2019
Date of Institution	:	21/01/2019
Date of Decision	:	04/12/2019

 

Vikas Kumar son of Milkhi Ram r/o House No.741, Sector 19, 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. Paramount Health Service and Insurance TPA Pvt. Ltd., Plot No.A-442, Road No.28, M.I.D.C. Industrial Area, Wagale Industrial Estate, Ram Nagar, Vittal-Rukhmani Mandir, Thane-400604, through its Authorsied Signatory.
3. The New India Assurance Co. Ltd., SCO 36-37, 4^th Parking, Sector 17-A, Chandigarh 160017 through its Authorised Signatory.

… Opposite Parties

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

                                               

ARGUED BY	:	Sh. Naveen Sheokand, Counsel for complainant
	:	OPs 1 & 2 ex-parte
	:	Sh. Vinod Chaudhri, Counsel for OP-3

 

Per Rattan Singh Thakur, President

1.      The long and short of the allegations are, complainant is working with OP-1 since 14.12.2017 as a delivery boy. OPs had issued a mediclaim policy under group scheme of OP in which the health coverage was also provided to the family of the complainant. To this effect, employee ID was also provided which was valid upto 13.8.2018. Complainant’s case is, his wife Mrs. Priyanka was admitted in Advance Mother and Child Care Centre on 8.2.2018 and discharged on 9.2.2018. She gave birth to a baby boy in the hospital. Baby of the complainant was admitted in Advance Mother and Care Centre and shifted in NICU care under monitoring and phototherapy on 12.2.2018 and discharged on 14.2.2018. Total bill of Rs.37,500/- was raised and paid to the Mother & Child Care Centre. However, despite two claims having been lodged, not a single penny has been paid. 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.     OPs 1 & 2 did not appear despite due service, therefore, vide order dated 20.3.2019, they were proceeded ex-parte.
3.     OP-3/insurer contested the consumer complaint and filed its written reply. Its case is, discharge summary reflects the date of admission was 12.2.2018 which was prior to the date of joining i.e. 13.4.2018 and the claim was denied. It was further denied there was any deficiency in service on the part of the insurer as the claim was repudiated per terms and conditions of the policy. On these lines, the cause is sought to be defended.
4.     Rejoinder was filed and averments made in the consumer complaint were reiterated. However, it was claimed Rs.31,000/- was reimbursed to the complainant after filing of the instant consumer complaint.
5.     Parties led evidence by way of affidavits and documents.
6.     We have heard the learned counsel for the contesting parties and gone through the record of the case. After perusal of record, our findings are as under:-
7.     Per pleadings of the complainant, he had joined the service of OP-1 on 14.12.2017 and there was a medi-claim policy coverage to the complainant and his family members while as per reply, claim was repudiated as the date of admission and discharge pertains from 8.2.2018 to 9.2.2018 which was prior to the date of his joining in the company.  However, the company i.e. OP-1 has not refuted the allegations of the complainant that he had not joined as such on 14.12.2017. Even there is a card issued by OP-3 which shows, insurance was valid upto 13.8.2018.  No document was produced to show bills pertained prior to the date of his joining as such i.e. delivery boy with OP-1.  Issuance of policy is not in dispute before us.
8.     Not only this even in the replication filed by the complainant, it was claimed during the pendency of the consumer complaint Rs.31,000/- was disbursed by OP-3 to him. This fact was not disputed. Now we shall confine the appreciation on the point of correct amount which was to be refunded by OP-3.
9.     The complainant has produced on record Annexure C-4 which is a bill issued by Advance Mother and Child Care, Zirakpur in the name of his wife and the total amount charged was Rs.27,500/- and there is another bill of Rs.10,000/- issued by Advance Mother and Child Care. Thus, the total amount of the bill comes out to Rs.37,500/- while the amount paid as per replication is Rs.31,000/- only. Therefore, Rs.6,500/- was paid less. No reason was assigned how the remaining part of the claim was repudiated. These facts and evidence constitutes deficiency in service on the part of OPs 2 & 3.
10.     In view of the above discussion, the present consumer complaint succeeds and the same is accordingly partly allowed. OPs 2 & 3 are directed as under :-

1. to pay balance amount of Rs.6,500/- to the complainant alongwith interest @9% per annum from the date of repudiation till realization.
2. to pay an amount of Rs.10,000/- to the complainant as compensation for causing mental agony and harassment to him;
3. to pay Rs.5,000/- to the complainant as costs of litigation.

11.     This order be complied with by OPs 2 & 3 within thirty days from the date of receipt of its certified copy, failing which, they 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.
12.     Since no deficiency in service or unfair trade practice has been alleged or proved against OP-1, therefore, the consumer complaint qua it stands dismissed with no order as to costs. 
13.     The certified copies of this order be sent to the parties free of charge. The file be consigned.

	Sd/-	Sd/-
04/12/2019	[Suresh Kumar Sardana]	[Rattan Singh Thakur]
hg	Member	President