Ld. counsel for the complainant has contended that the complainant was insured with the opposite parties and policy is valid from 22.12.2019 to 21.12.2020 and during the period of policy, the complainant suffered with chest pain and had conducted some tests and later on the complainant went to Joshi Hospital, Jalandhar, where he was diagnosed with TYPE II DM, CAD Unstable Angina disease on 26.1.2022 and he underwent surgery on 27.1.2022 and remained admitted in the hospital and discharged from hospital on 3.2.2022 and the complainant has incurred the total expenditure of Rs. 2,25,000/- on his treatment and complainant paid the same to hospital. Intimation with regard to treatment and expenditure incurred were given by the complainant to the insurance company but the opposite party has not given the insurance claim to the complainant so far.

On the other hands, Ld. counsel for the opposite party contended that the complaint filed by the complainant is premature in nature and deserves to be dismissed at the outset as the complainant has failed to provide the necessary documents for processing the claim even after various query letters. The claim has been rejected as the complainant has not provided the documents mentioned in query letters. The opposite parties have also placed on record letters Ex. OP1,2/6 to Ex. OP1,2/9 and in the said letters the opposite parties were demanding the documents. 

During the arguments, Ld. counsels for the parties contended that the present case is pre mature and necessary direction be given in the matter. 

Heard.

Perusal of file shows that claim has not been decided so far and repudiation letter has neither placed by complainant nor by opposite parties and it is established on record that claim has not yet been decided due to non-submission of claim and documents, however, according to complainant he had given intimation and submitted the claim form alongwith requisite documents. End of justice shall meet if directions in the present case are given to the parties to dispose of the matter in question to full fill the early disposal under the Consumer Protection Act.

          The claim has not been decided so far and is still pending due to non providing of documents. In case Balu Waman Kadam vs. ICICI Lombard General Insurance Co. IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant.        While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it. 

          In view of our above discussion as well as keeping in view the ratio of above said judgments, we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainant, after the complainant submit all the requisite documents.

          In view of the above discussion, the present complaint is disposed of with the direction to the complainant to submit documents as per letter dated 14.6.2022 Ex. OP1,2/9 to the opposite parties No. 1, 2-Insurance Company  for deciding the claim within a period of 30 days from the date of receipt of copy of order and on approaching the complainant for supplying the requisite documents, the opposite parties No. 1, 2 will issue proper receipt acknowledging the same. The opposite parties Nos. 1 and 2 shall decide the claim of the complainant within a further period of two months therefrom and in case of failure on the part of the opposite parties No. 1 and 2 the claim case of the complainant deemed to have been accepted.  Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.

Announced in Open Commission.

21.8.2024