Order by:
Smt.Priti Malhotra, President.
1. Complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 stating that the complainant has availed mediclaim insurance policy bearing no.282510044809 8404000 from Opposite Party. Under this policy, the complainant has to pay premium annually. Accordingly, the complainant has deposited Rs.8764/- for the year 2019-2020, Rs.14,536/- for the year 2020-21, Rs.14536/- for the year 2021-2022, Rs.14,536/- for the year 2022-23, Rs.1,78,888/- for the year 2023-24. Unfortunately complainant felt severe pain in kidney and got admitted in RG Urology and Laparoscopy Hospital, Ludhiana on 22.06.2023 and remained there till 23.06.2023. After discharge from the hospital, the complainant submitted all the relevant documents to requisite counter for claim, but the Opposite Party rejected the claim without any cogent reason. There was no ground for rejection of claim, as the complainant was medically examined by the competent and expert doctor and no alleged disease as mentioned by Opposite Party has been detected in the report. Due to such wrongful act of the Opposite Parties, the complainant suffered mental tension and harassment. Hence this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite Party may be directed to pay the amount of Rs.1,11,263/- alongwith interest thereon @ 24% per annum.
b) To pay an amount of Rs.1,00,000/- as compensation.
c) And any other relief which this Commission may deem fit and proper be also granted to complainant in the interest of justice and equity.
2. Upon service of notice, none appeared on behalf of Opposite Party, hence Opposite Party was proceeded against exparte.
3. In order to prove his case, complainant has placed on record his affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C9.
4. We have heard, ld. counsel for the complainant and carefully gone through the record.
5. It is proved on record that complainant availed mediclaim insurance policy bearing no.2825 1004 8404 000 for the period 03.05.2023 to 02.05.2024 covering self, his wife namely Kamaljit Kaur Dhaliwal, dependent son Gurpreet Singh Dhaliwal and he was availing the said policy continuously since the year, 2019. It is also proved on record that during the policy period in dispute complainant suffered some health problem and got admitted in RG Stone and Super Specialty Hospital, Ludhiana on 22.06.2023 and was discharged on 23.06.2023. After discharge from the hospital, the complainant lodged the claim for the reimbursement of the expenses incurred on his treatment, but Opposite Parties, vide letter dated 26.06.2023 and 12.07.2023 cancelled the policy of the complainant. The said cancellation has been challenged by the complainant, through this complaint. Now, the question for determination is that whether the cancellation of policy by the Opposite Party is genuine or not?
6. Perusal of the letter dated 26.06.2023 Ex.C7 reveals that Opposite Party cancelled the policy in question on the following ground:-
The company has received claim intimation vide Claim no.RC-HS23-13672926 with respect to the above policy and noted History of HBsAg positive in 2001 i.e. before policy inception, has not been disclosed prior/post inception of the policy.
The ground so taken by the Opposite Party for cancellation of the policy in question is not genuine. Since, it has not been proved on record that the complainant was having the history of HBsAg since, 2001. Neither the Opposite Party itself appeared nor authorized any one to appear and contest the present complaint, despite being duly served, for the reasons best known to it. So, the cancellation of the policy in question and thereby not paying the genuine claim to the complainant, the Opposite Party rendered deficient services.
7. Also to corroborate his assertion, the complainant has placed on record his duly sworn affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C9. The aforesaid evidence produced by the complainant has gone unrebutted and unchallenged through any cogent and convincing evidence on record as the Opposite party did not opt to appear and contest the proceedings. In this way, the Opposite party has impliedly admitted the correctness of the allegations made in the complaint.
8. Now come to the quantum of amount to be awarded to the complainant. Vide instant complaint, complainant claimed the amount of Rs.1,11,263/-. However, perusal of the record reveals that complainant has placed on record bills amounting to Rs.1,10,462/-. Hence, we allow the same.
9. In view of the discussion above, we partly allow the complaint of the complainant and direct Opposite Party to pay Rs.1,10,462/-(Rupees One Lakh Ten Thousand Four Hundred Sixty Two only) to the complainant. Opposite Party is also directed to pay compository costs of Rs.10,000/-(Rupees Ten Thousand only) as compensation and litigation expenses to the complainant. The pending application(s), if any also stands disposed of. The compliance of this order be made by the Opposite Party within 30 days from the date of receipt of copy of this order, failing which, the Opposite Party is further burdened with additional cost of Rs.10,000/-(Rupees Ten Thousand only) to be paid to the complainant for non compliance of the order. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced on Open Commission
