DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 348/2022

 

Shri Mannan Miah,

S/O- Late Adu Miah,

Madhya Charipara,  

P.S. Amtali, P.O. A.D. Nagar,

Agartala, Tripura West.            ..............Complainant.

 

-VERSUS-

 

1. Cholamandalam MS General Insurance Company Ltd.,

Registered Office : 2nd Floor, Dare House, 2, N.S.C. Bose Road,

Chennai- 600001.

(Represented by its 

Branch Manager, Agartala, West Tripura). 

 

2. Branch In-charge,

Cholamandalam General Insurance Co. Ltd., 

1st Floor, Above 'W' Showroom, Near Raymonds,

Mantribari Road, RMS Chowmuhani, 

Agartala, Tripura. ................Opposite Parties.

 

 

    __________PRESENT__________

 

 SRI GOUTAM DEBNATH

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

DR (SMT) BINDU PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA, AGARTALA.

 

SRI SAMIR GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA. 

 

 

C O U N S E L

 

For the Complainant : Sri Sankar Lodh,

  Sri Kishalay Roy,

  Smt. Susmita Banik, 

  Learned Advocates. 

 

For the Opposite Parties : Sri Rajib Saha,

   Learned Advocates.

 

 

 

ORDER  DELIVERED  ON:   15/02/2023.

 

F I N A L    O R D E R

Mannan Miah has lodged this complaint against Cholamandalam MS General Insurance Company Ltd. U/S 35 of the Consumer Protection Act, 2019 alleging inter alia that he purchased one Corona Raksha Insurance policy. The condition of the policy was that in case the insured is diagnosed Covid-19 during the period from 13.09.2020 to 24.06.2021 and required continuous hospitalization for a period of 72 hours, he will be entitled to a lump sum amount of Rs.1.5 lakhs. 

The complainant insured was diagnosed  Covid-19 positive and he was hospitalized for more than 72 hours. 

On 17th June, 2021 the complainant through Email submitted his claim with the O.P. with all medical documents claiming Rs.1.5 lakhs but the O.P. Insurance company did not entertain the claim of the complainant. Hence, the complainant lodged a complaint with the Insurance Ombudsman, Guwahati. The Ombudsman vide order dated 08.03.2022 directed the Insurance Company to pay Rs.50,000/- as the Insurance Company desire to settle the claim for a sum of Rs.50,000/-. Being dissatisfied the complainant has filed this case on the ground of deficiency in service and claiming the full amount of Rs.1.5 lakhs. 

The claimant has annexed 11 documents including the Policy of Insurance, Order of the Ombudsman and Acknowledgment of payment of cheque for Rs.50,000/- as per the order of the Ombudsman. 

2. The O.P. Insurance Company denied and disputed the claim of the complainant mainly on the ground that the dispute raised by the complainant has already been finally settled by the Ombudsman and accordingly the O.P. Insurance Company has paid the sum of Rs.50,000/- to the complainant. 

The complainant submitted evidence on affidavit. 

3. During the course of argument Learned Counsel of the complainant argued that out of the total sum of Rs.1.5 lakhs, he has been paid only Rs.50,000/-, as such he is entitled to the further sum of Rs.1 lakh as per the terms of the Policy of Insurance. 

Per contra, Learned Counsel of the O.P. Insurance Company argued that the complainant vide acknowledgment dated 12.04.2022 received a cheque for Rs.50,000/- as full and final satisfaction of the claim as per award of the Insurance Ombudsman. Hence, the present case is not maintainable.

4. On the basis of divergent argument the following point emerged for discussion and decision:-

  (I) Whether after decision of the Ombudsmen and receiving the sum of Rs.50,000/- as full and final satisfaction, this Commission can further adjudicate the claim of the complainant?

 

5. DECISION AND REASONS FOR DECISION:-

Admitted position of the complaint is that the complainant received a sum of Rs.50,000/- as per order of the Ombudsmen as ''Full and final Satisfaction'' of his claim. Now, the only point for adjudication is whether in accordance with Section 100 of Consumer Protection Act, 2019 the complainant can further lodge a complaint before this Commission. Section 100 of the Act declares that the provisions of this Act shall be in addition to and not in derogation of the provision of any other law for the time being in force. Be that as it may, the meaning of Section 100 is that even if other Act provides for remedy to a litigant under different Forums, but litigant is not barred from approaching the Consumer Commission to seek his remedy under this Act. The principle of res-judicata and estoppel are applicable because the complainant has already received his relief against the Policy of Insurance as full and final satisfaction of his claim. However, we are not oblivious that the niceties of civil procedure code is not to be applied in Consumer Courts. Had his claim been dismissed or the complainant had denied to accept the award, the matter could have been otherwise although Ombudsman is appointed under the Insurance Ombudsman Rule, 2017.

6. In the result, it is decided that since the grievance of the complainant has already been addressed by a competent Forum to which the complainant had consented, the present complaint is not maintainable.

  The case stands disposed off. 

Supply a copy of this Final Order free of cost to the complainant and the Opposite parties.

Announced.

 

 

 

SRI  GOUTAM DEBNATH

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

DR (SMT)  BINDU  PAL

MEMBER, 

DISTRICT CONSUMER DISPUTES 

REDRESSAL COMMISSION, 

WEST TRIPURA,AGARTALA

 

 

SRI SAMIR  GUPTA

MEMBER,

 DISTRICT CONSUMER DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,AGARTALA.