Haryana

StateCommission

A/1108/2015

STAR HEALTH AND ALLIED INSURANCE CO.LTD. - Complainant(s)

Versus

DEV DUTT PARASHAR - Opp.Party(s)

NITESH SINGHI

17 May 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA

 

  First Appeal No.1108   of 2015

Date of Institution:21.12.2015

  Date  of  Decision:17.05.2017

 

Star Health and Allied Insurance Company through its Manager/Authorized officer, Branch office unit NO.13, Ground Floor, Tribhuvan Complex, Ishwar Nagar, Mathura Road, New Delhi.

…..Appellant

Versus

 

1.      Dev Dutt Parashar S/o Sh.Pyarelal R/o Behind Green Wood School, New Colony Extension, Palwal, Tehsil and District Palwal.

2.      Jagdish Sharma Sales Executive, Star Health, R/o village Mandkol,Tehsil and District Palwal.

3.      Tek Chand S/oSh.Kukam Chand, Agent, Star Health R/o Village Firozpur, Tehsil and District Palwal.

…..Respondents

 

CORAM:             Mr.R.K.Bishnoi, Judicial  Member

                              Mrs. Urvashi Agnihotri, Member

                   

Present:-    Mr.Nitesh Singhi, Advocate for the appellant.

                   Mr.Ravi Kant, Advocate for respondent No.1.

                   None for respondent Nos.2 and 3.

 

                                                 ORDER

R.K.BISHNOI, JUDICIAL MEMBER:

           

As per complainant he obtained medi claim policy of Reliance General Insurance subsisting for the years 2007-2013. As per assurance of opposite party (O.P.) Nos.2 and 3 he obtained Star Health and Allied insurance policy from O.P.No.1 on the basis of previous policy which was renewed and was followed from 30.08.2014 to 29.08.2015.  He received treatment from QRG  Central Hospital and Research Centre, Faridabad from 18.11.2014 to 20.11.2014 and spent Rs.40,625/-. He submitted claim with O.P.No.1, but, the same was not allowed. So they be directed to pay Rs.40,625/- besides other compensation as mentioned in the complaint.

2.      O.P. Nos.1 and 2 were proceeded against ex parte and O.P.No.3 was given up by complainant.

3.      On the basis of evidence of complainant only the complaint was allowed by learned District Consumer Disputes Redressal Forum, Palwal (In short “District Forum”) vide impugned order dated 09.11.2015 and directed as under:-

“i        to make the payment to the complainant to the tune of Rs.40,625/- which he has spent from his own pocket even after having Medi-claim policy with interest @ 9% per annum from the date of his admission to hospital i.e. 18.11.2014 to till date.

ii        to pay compensation for harassment, mental agony, pain, suffering and inconvenience caused to the complainant to the tune of Rs.10,000/-.

                   iii       to pay litigation expenses to the tune of Rs.5100/-.”

4.      Feeling aggrieved therefrom O.Ps. have filed this appeal.

5.      Arguments heard. File perused.

6.      It is alleged by appellant that proper service was not effected upon them. As per orders dated 30.04.2015 and 26.08.2015 it is clear that they were proceeded against ex parte on the basis of presumption because notice alleged to be issued to effect service upon them was not received back within one month.  There is no cogent evidence on the file showing that the notice was ever served upon it. 

7.      It is alleged in para No.7 of grounds of appeal that complainant was operated upon in the year 2005 for appendicitis and in the year 2011 cholesctectomy.  It is also alleged that present problem was due to inflamed incisional scar with stitch gamuloma and complainant concealed this fact while obtaining insurance policy. These facts can only be established if appellant is afforded an opportunity to lead evidence.  It is golden principle of law that proper opportunity of hearing be afforded to a party to defend itself.

8.      In view of above discussion, ex parte proceedings dated 30.04.2015 initiated against appellant-O.P.No.1  and impugned order dated 09.11.2015 are set aside subject to payment of Rs.5000/- as of costs to the complainant.

9.      The matter is remitted back to the District Forum, Palwal to decide the complaint on merits after affording an opportunity to O.Ps. to file reply and lead evidence.

10.    Parties are directed to appear before the District Forum, Palwal on 31.07.2017 for further proceedings. 

11.    The statutory amount of Rs.25000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules.

 

May 17th, 2017          Urvashi Agnihotri                             R.K.Bishnoi,                                                             Member                                              Judicial Member                                                       Addl. Bench                                       Addl.Bench               

S.K.