BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.119 of 2015
Date of Instt. 24.3.2015
Date of Decision : 07.06.2016
Milan Kapoor aged about 29 years son of Raman Kapoor, R/o Raja Garden, Kapurthala Road, Jalandhar City-144001, at present 70, Vasant Avenue, Urban Estate, Phase-II, Jalandhar.
..........Complainant Versus
1.Dedicated Healthcare Services TPA(India), Pvt Ltd., Cambata Building (Erox Cinema Bldg), 2nd Floor, East Wing 42, Maharshi Karve Road, Churchgate, Mumbai-400020, Maharashtra.
2.National Insurance Company, through its Branch Manager, GT Road, Jalandhar.
3.Amit Gupta M/s Live Better Investments, SC-o1 and 2/323/6A, Central Town, Jalandhar.
4.Karveat Travel Services Pvt Ltd., 26 Madhu Industrial Estate, PB Marg, Mumbai-400013.
.........Opposite parties
Complaint Under Section 12 of the Consumer Protection Act.
Before: Sh.Bhupinder Singh (President)
Sh.Parminder Sharma (Member)
Present: Sh.Bipan Modi Adv., counsel for complainant.
Mrs.Shashi Kataria Adv., counsel for OP No2.
Opposite parties No.1 & 3 exparte.
Service of OP No.4 dispensed with.
Order
Bhupinder Singh (President)
1. The complainant has filed the present complaint under section 12 of the Consumer Protection Act against the opposite parties (herein called as OP) on the averments that complainant purchased policy bearing No.251100/46/12/8500001901/121520 dated 15.4.2014 from OP No.2 through OP No.3. Complainant submitted that his father became ill and was admitted in Kidney Hospital & Lifeline Medical Institutions, Jalandhar on 15.4.2014 wherein his father was medically treated and was discharged on 19.4.2014. Complainant spent Rs.42,000/- approximately on medical treatment of his father. The complainant lodged claim with the OP for reimbursement of the aforesaid amount under the policy. OP No.1 demanded certain details of claim which was supplied by the complainant to the OP but OP did not settle the claim of the complainant. On such averments, the complainant has prayed for directing the OPs to pay the claim amount of Rs.42000/- alongwith interest. He has also claimed compensation and litigation expenses.
2. Upon notice, OP No.2 appeared through counsel and filed written reply pleading that complainant obtained mediclaim policy bearing No.251100/46/12/85000001901/121520 for himself, his wife, his son and his parents. Complainant lodged claim No.DHSI4Z056402 for medical treatment of his father, Raman Kapoor. The OP demanded certain documents from the complainant but the complainant did not supply the same. On 3.5.2014 a deficiency letter was sent by OP No.2 to the complainant mentioning the specific documents required by the OP but the complainant did not bothered to send the same. Again reminder dated 18.6.2014 was sent to the complainant. Again complainant turned a deaf ear. However, after various oral requests, complainant sent certain documents but again did not sent a cancelled cheque with detail of account number and IFSC code to send the claim amount to the complainant in his account. Again deficiency letter through email dated 8.8.2014 was sent to the complainant and ultimately when he did not send the cancelled cheque, a closure letter was sent to the complainant dated 14.8.2014 and only then the complainant approached the OP and submitted the cancelled cheque. OP settled the claim of the complainant to the tune of Rs.27,192/- as per terms and conditions of the policy because the policy pertaining to his father was cover 50% of the amount insured. The amount insured in the policy was Rs.2 Lacs and sum insured for the father of the complainant namely Raman Kapoor was 50% i.e. Rs.1 Lac and accordingly deduction were made from the claim of the complainant and this amount of Rs.27,192/- was transferred in the account of the complainant vide NEFT UTR No.AXISP15169001988. OP submitted that OP has settled the claim of the complainant as per terns and conditions of the policy.
3. Notice of this complaint was given to the OPs No.1 & 3 but nobody has turned-up despite service and as such they were proceeded against exparte.
4. In support of his complaint, learned counsel for the complainant has tendered into evidence affidavit Ex.CW1/A alongwith copies of documents Ex.C1 to Ex.C32 and closed evidence.
5. On the other hand, learned counsel for the OP No.2 has tendered affidavit Ex.OPA alongwith copies of documents Ex.OP1 to Ex.OP12 and closed evidence.
6. We have heard the Ld. counsel for the parties, minutely gone through the record and have appreciated the evidence produced on record by both the parties with the valuable assistance of Ld. counsels for the parties.
7. From the record i.e. pleadings of the parties and the evidence produced on record by both the parties, it is clear that complainant purchased policy bearing No.251100/46/12/8500001901/ 121520 Ex.C25 dated 15.4.2014 from OP No.2 through OP No.3. Complainant submitted that his father became ill and was admitted in Kidney Hospital & Lifeline Medical Institutions, Jalandhar on 15.4.2014 wherein his father was medically treated and was discharged on 19.4.2014 as per discharge summary Ex.C2. Complainant spent Rs.42,000/- approximately on medical treatment of his father as per bills Ex.C3, Ex.C9 to Ex.C23. The complainant lodged claim with the OP for reimbursement of the aforesaid amount under the policy. OP No.1 demanded certain details of claim which was supplied by the complainant to the OP but OP did not settle the claim of the complainant. Learned counsel for the complainant submitted that all this amounts to deficiency in service on the part of the OPs qua the complainant.
8. Whereas the case of the OP No.2 is that complainant obtained mediclaim policy bearing No.251100/46/12/85000001901/ 121520 for himself, his wife, his son and his parents. Complainant lodged claim No.DHSI4Z056402 for medical treatment of his father Raman Kapoor. The OP demanded certain documents from the complainant but the complainant did not supply the same. On 3.5.2014 a deficiency letter Ex.OP1 was sent by OP No.2 to the complainant mentioning the specific documents required by the OP but the complainant did not bothered to sent the same. Again reminder dated 18.6.2014 Ex.OP2 was sent to the complainant. Again complainant turned a deaf ear. However, after various oral request, complainant sent certain documents but again did not send cancelled cheque with detail of account number and IFSC code to send the claim amount to the complainant in his account. Again deficiency letter through email dated 8.8.2014 Ex.OP3 was sent to the complainant and ultimately when he did not send the cancelled cheque, a closure letter was sent to the complainant dated 14.8.2014 Ex.OP4 and only then the complainant approached the OP and submitted the cancelled cheque. OP settled the claim of the complainant to the tune of Rs.27,192/- as per terms and conditions of the policy because the policy pertaining to his father was cover 50% of the amount insured. The amount insured in the policy was Rs.2 Lacs and sum insured for the father of the complainant namely Raman Kapoor was 50% i.e. Rs.1 Lac and accordingly deductions were made from the claim of the complainant as per Ex.OP8 and Ex.OP9 both dated 8.12.2015 which was duly sent to the complainant and this amount of Rs.27,192/- was transferred in the account of the complainant vide NEFT UTR No.AXISP15169001988. Learned counsel for the OP No.2 submitted that OP has settled the claim of the complainant as per terns and conditions of the policy. So, there is no deficiency of service on the part of the OP No.2 qua the complainant.
10. From the entire above discussion, we have come to the conclusion that complainant obtained policy bearing No.251100/46/ 12/8500001901/121520 Ex.C25/Ex.OP11 for himself, his wife, his son and his parents. Father of the complainant namely Raman Kapoor became ill and he was admitted in Kidney Hospital & Lifeline Medical Institutions, Jalandhar from 15.4.2014 to 19.4.2014 as per discharge summary Ex.C2. Complainant spent about Rs.42,000/-. The complainant lodged claim No.DHSI4Z056402 for the medical treatment of his father Raman Kapoor with the OP No.2. The OP demanded certain documents/clarification from the complainant vide letter dated 30.5.2014 Ex.OP1 but complainant did not sen those details/documents. OP issued remainder dated 18.6.2014 Ex.OP2. Thereafter, deficiency letter dated 8.8.2014 Ex.OP3 and thereafter closure letter dated 14.8.2014 Ex.OP4 and thereafter complainant approached the OP and then submitted cancelled cheque and the OP as per terms and conditions of the policy, settled the claim of the complainant to the tune of Rs.27,192/-. OP made deductions in the claim of the complainant as per terms and conditions of the policy which were fully defined/explained in letter dated 8.12.2015 Ex.OP8 and letter dated 8.12.2015 Ex.OP9 as the parents claim payable under the policy was upto 50% of the sum insured i.e. Rs.1 Lac, sum insured applicable to Raman Kapoor, father of the complainant. Complainant could not point out any defect or deficiency in the deductions made by the OP while settling the claim of the complainant vide these letters both dated 8.12.2015 Ex.OP8 and Ex.OP9 and this amount has been transferred by OP in the account of the complainant vide NEFT UTR No.AXISP15169001988. All this shows that the OP has settled the claim of insured Raman Kapoor, father of the complainant as per terms and conditions of the policy.
11. Resultantly, we do not find any deficiency of service on the part of the OPs qua the complainant. Hence, complaint is without merit and same is hereby dismissed with no order as to cost. Copies of the order be sent to the parties free of costs under rules. File be consigned to the record room.
Dated Parminder Sharma Bhupinder Singh
07.06.2016 Member President
