Punjab

Ludhiana

CC/23/315

Saroj Rani - Complainant(s)

Versus

Care Health Insurance Ltd - Opp.Party(s)

M.S.Sethi

09 Sep 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No: 315 dated 28.07.2023                                                         Date of decision:09.09.2023

 

Saroj Rani w/o. Late Harpal Singh, r/o.1822/1, Janta Nagar, Ludhiana-141003. M.99888-33700.                                                                                                                                                                                      ..…Complainant

                                                Versus

1. Care Health Insurance Limited (Previously known as Religare Health Insurance Company Ltd.)  , Regd. Office at :- 5^th Floor, 19, Chawla House, Nehru Place, New Delhi-110019 through authorized signatory.
2. Care Health Insurance Limited (Previously known as Religare Health Insurance Company Ltd.), SCO-13, Shanghai Tower, Feroze Gandhi Market, LLudhiana-141001 through its authorized signatory.                                                                                              …..Opposite Parties

Complaint under section 35 of the Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH.JASWINDER SINGH, MEMBER

MS.MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. M.S. Sethi, Advocate

For OPs                          :         Sh. G.S. Kalyan, Advocate

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                           The complainant has invoked the jurisdiction of this Commission by filing the present complaint and raised a consumer dispute with regard to wrong repudiation of insurance claim qua the expenses incurred by husband of the complainant upon his treatment and thus she has sought direction against the opposite parties to settle and pay the insurance claim along with compensation and litigation expenses etc. So, by filing the present complaint, complainant has prayed that held the repudiation of claim dated 21.12.2022 as arbitrary, illegal, null and void and further to consider the claim of Rs.67,000/- of the treatment of the deceased insured Harpal Singh along with interest @12% per annum. The complainant further prayed to pay compensation of Rs.25,000/- and litigation cost of Rs.11,000/-.

2.                Notice was issued to the opposite parties and on 08.09.2023 Sh. G.S. Kalyan, Advocate filed application for preponment of the case on behalf of the opposite parties as the matter has been compromised between the parties. In response to the settlement, the counsel for the opposite parties suffered a statement that as per instructions received from the company, the company is ready to consider the claim of the complainant subject to filing of reimbursement claim with following documents i.e. original discharge summary, detailed final bills, claim form, KYC documents, copy of Aadhar card, cancelled cheque along with copy of passbook etc.

3.                The said offer has been duly accepted by Sh. M.S. Sethi, Advocate counsel for the complainant by suffering separate statement in this regard on 08.09.2023 and further, he prayed for disposal of complaint of the complainant being nominee accordingly. 

4.                In view of the aforesaid settlement arrived between the parties, the present complaint stands disposed of with the direction that the complainant will file reimbursement claim with documents i.e. original discharge summary, detailed final bills, claim form, KYC documents, copy of Aadhar card, cancelled cheque along with copy of passbook etc. within 15 days from the date of receipt of copy of this order and thereafter, the opposite parties will consider the claim of the complainant within 30 days from the date of receipt of claim and documents from the complainant, failing which the complainant shall be held entitled for interest @8% per annum on the said amount till its actual payment. Copy of the order be supplied to the parties free of costs.

5.                File be indexed and consigned to record room. 

 

(Monika Bhagat)           (Jaswinder Singh)         (Sanjeev Batra)               Member                       Member                         President   

National Lok Adalat    National Lok Adalat      Consumer Commission                                                                                     cum Chairman, National                                                                          Lok   Adalat       

Announced in Open Commission                                            Dated:09.09.2023.

Gobind Ram.