Haryana

Yamunanagar

CC/990/2010

Rajesh Kumar S/o. Kesho Ram - Complainant(s)

Versus

Divisional Manager Oriental Insurance Co.Ltd. - Opp.Party(s)

Subash Sharma

30 Jul 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                           Complaint No. 990 of 2010.

                                                                                           Date of institution: 19.10.2010.

                                                                                           Date of decision: 30.7.2015

Rajesh Kumar son of Shri Kesho Ram, resident of village Ajijpur, District Yamuna Nagar.  

                                                                                                                  …Complainant.

                                                      Versus

 

1. Divisional Manager, Oriental Insurance Company Limited 20 FIE Patparganj, Industrial Area, New Delhi.                                       
2. The Oriental Insurance Co. Ltd. Regd. & Head Office A/25/27 Asaf Ali Road, New Delhi.                                                     
3. Branch manager, The Oriental Insurance Company Ltd. Branch at Opp. Madhu Hotel, Yamuna Nagar.                                                                                                                           

                                                                                                                  …Opposite parties. 

 

Before:             SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                        SH. S.C.SHARMA………………………….MEMBER.

 

Present:    Sh. Subhash Sharma, Advocate, counsel for complainant.  

                Smt. Aruna Sharma, Advocate, counsel for OPs.     

             

ORDER

 

1.                     Complainant Sh. Rajesh Kumar has filed the present complaint under section 12 of the Consumer Protection Act. 1986, praying that respondents ( hereinafter referred as OPs) be directed to sanction and release the claim amount of Rs. 50,000/- on account of medical expenses alongwith compensation of Rs. 40,000/- for mental and physical agony and Rs. 5500/- as litigation expenses.

2.                     Brief facts of the complaint, as alleged by the complainant, are that complainant was insured under insurance policy bearing No. 271700/48/2009/1713 valid from 2.1.2009 to 1.1.2010 under Nagrik Suraksh policy covering the risk of Rs. 2,00,000/- on account of personal accident and Rs. 50,000/- on account of hospitalization issued by the OP No.1. It has been further alleged that complainant had met with an accident on 27.10.2009 and received multiple fractures regarding this an FIR bearing No. 225 dated 30.10.2009 under section 279/337/338 IPC was registered in police station Bilaspur, District Yamuna Nagar against the driver of Haryana Roadways bearing Bus No. HR-58-9036. It has been further stated that respondent company i.e. OP No.1 was informed and claim was lodged vide claim No. 48/2010/444 under the abovesaid policy. On intimation, opposite parties deputed Sh. M.L.Ahuja, Investigator to investigate the matter. It has been further stated that the complainant visited the office of OPs so many times and requested to sanction and release the compensation but all in vain. When the claim of the complainant was not settled by the OPs then a legal notice dated 10.3.2010 was issued to the OP No.1. Lastly, it has been stated that the complainant was astonished to receive the letter dated 3.12.2009 vide which the opposite party repudiated the claim of the complainant as “ No Claim” As the claim of the complainant has not been paid by the OPs, hence, there is a great deficiency in service on the part of OPs, so, they be directed to pay the claim amount of Rs. 50,000/- alongwith compensation of Rs. 40,000/- and Rs. 5500/- as litigation expenses.

3.                     Upon notice, OPs appeared and filed their written statement by taking some preliminary objections such as complaint not maintainable, has not come to this Forum with clean hands, no negligence or deficiency in service and on merit it has been mentioned that an intimation was received by the OP No.3 and on this Sh. M.L.Ahuja, Investigator was appointed to investigate the matter. Sh. M.L.Ahuja asked the complainant to handover the original bills but he neither show the original bills of the hospital and chemist nor handed over to the investigator. Rather, complainant Rajesh Kumar told the abovesaid Investigator that he had to file the claim case against the Haryana Roadways before the Motor Accident Claim Tribunal (MACT) and will get the claim. Therefore, he cannot give the original bills or record of treatment/ expenses. It has been further stated that a letter dated 16.11.2009 and reminder dated 3.12.2009 were issued to the complainant Rajesh Kumar for submitting the original bills, x-ray reports and medical treatment record etc. but the complainant totally failed to submit the required documents. As the complainant failed to submit the original bills, treatment charts and x-ray reports, his claim could not be settled by the OPs. So, there is no deficiency in service on the part of OPs and prayed for dismissal of complaint.  

4.                     To prove his case, counsel for complainant tendered into evidence affidavit of complainant as Annexure CX and documents such as Copy of Legal Notice as Annexure C-1, Photo copy of Postal receipt as Annexure C-2, Photo copy of acknowledgement as Annexure C-3, Photo copy of insurance certificate as Annexure C-4 and Photo copy of FIR No.225 dated 30.10.2009 as Annexure C-5 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for the OPs tendered into evidence affidavit of Sh. R.S.Kalra, Divisional Manager, Oriental Insurance Company Ltd. Yamuna Nagar as Annexure RX and Affidavit of M.L.Ahuja, Investigator  as Annexure RY and documents such as Photo copy of Insurance certificate as Annexure R-1, Photo copy of Surveyor Report of M.L.Ahuja as Annexure R-2, Photo copy of letters dated 3.12.2009 & 16.11.2009 as Annexure R-3 & R-4 Photo copy of Letter dated 3.12.2009 as Annexure R-5 and closed the evidence on behalf of OPs.

6.                     We have heard the counsels of both the parties and have gone through the pleadings as well as documents placed on the file carefully and minutely. The counsel for the complainant reiterated the averments mentioned in the complaint and prayed for its acceptance whereas the counsel for OPs reiterated the averments made in the reply and prayed for dismissal of complaint.

7.                     Learned counsel for the complainant argued that complainant had met with an accident on 27.10.2009 and received multiple fractures. Learned counsel for the complainant further argued that a claim was also lodged with the OPs which was registered vide claim No. 48/2010/444 under the policy bearing No. 271700/48/2009/1713 i.e. Nagrik Suraksha Policy in question. It has been further stated that complainant visited branch office of the OPs to know the fate of his claim but the OPs made one or the other excuse and till date complainant has not been given any clue about the fate of his claim. A legal registered notice was also sent on 10.3.2010 which has not been replied by the OPs.  In this way, the act and conduct of the OPs clearly established that the OPs are negligent and also deficient in service on their part.

8.                     On the other hand, counsel for the OPs argued that on intimation Sh. M.L. Ahuja, Investigator was appointed to investigate the matter. However, complainant denied to handover the original bills and treatment chart and other records regarding the medical expenses etc. to the investigator as the complainant has not handed over the original bills and medical treatment, hence the OPs could not process his claim. It has been further stated that complainant had disclosed before the investigator that he would file case against Haryana Roadways in MACT Court as the complainant has received injuries due to the rash and negligent driving of driver of the Haryana Roadways Bus bearing No. Hr-58-9036 while driving his motorcycle. Therefore, he did not give the original bills and treatment record to  the investigator. Learned counsel for the OPs further argued that complainant was asked to submit the original bills and other medical record vide letter dated 16.11.2009 and further letter dated 3.12.2009 but despite these letters complainant till date has not submitted any original bills or treatment record. Hence, there is no negligence or deficiency in service on the part of OPs and prayed for dismissal of complaint.

9.                     The only plea of the counsel for the complainant is that all the original bills and treatment record has been submitted to the OPs and his genuine claim has been withheld by the OPs which is not tenable because the complainant failed to disclose date of admission and exact amount spent on his treatment in his complaint, even the complainant has totally failed to disclose the name of the hospital in which he remained admitted for taking treatment and also the period for which he remained there. The complainant also failed to file any documentary evidence vide which he handed over the original bills and treatment record to the OPs or to the investigator. To prove his contention complainant filed his affidavit Annexure CX and copy of legal notice dated 10.3.2010, postal receipt and AD as Annexure C-2 and C-3 and insurance policy bearing No. 271700/48/2009/1714 as Annexure C-4 and copy of FIR bearing No. 225 dated 30.10.2009 as Annexure C-5 only. Except these documents, the complainant has not filed any other document. It is also pertinent to mention here that complainant has tendered only insurance policy bearing No. 271700/48/2009/1714 amounting to Rs. 3,00,000/- as Annexure C-4 whereas he is claiming the medical expenses under the policy bearing No. 271700/48/2009/1713 but this policy has not been filed before this Forum by the complainant. During the course of arguments counsel for the complainant admitted that a claim case is also pending before the Hon’ble Motor Accident Claim Tribunal at Yamuna Nagar regarding the compensation of the complainant.

                        In the circumstances mentioned above and after going through the facts noted above, that the complainant has miserably failed to submit the original bills and treatment record to the OPs and even the photo copies of the same has not been placed on record before this Forum, we are of the considered view that complainant is not entitled to get any relief. Hence, the complaint of the complainant is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court.30.7.2015.

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

 

                                                                                     

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.