Haryana

Karnal

EA/77/2019

Devender Kumar - Complainant(s)

Versus

HDFC ERGO General Insurance Co. Ltd - Opp.Party(s)

Amardeep Singh

09 Jan 2020

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                                      Execution no.77 of 2019

                                                                    Date of instt.:10.7.2019                    

                                                            Date of Decision 9.1.2020

 

Devender Kumar aged about 35 years son of Shri Mangat Ram, resident of Village Mundh, Tehsil Assandh, District Karnal.

 

                                                                                        …..DH

Versus

 

1.       HDFC Ergo General Insurance Co. SCO NO.237, 2^nd Floor, Sector-12, Karnal through its Branch Manager.

2.       HDFC Ergo General Insurance Co. 5^th Floor, Tower-1, Stellar I.T. Park, C-25, Sector-62, Noida, UP through its Manager.

           ………JDs/Opposite parties

          Execution application U/s 27 of Consumer Protection Act.

 

Before        Sh. Jaswant Singh…….President

Sh.Vineet Kaushik ………..Member

                   Dr. Rekha Chaudhary……Member

 

Present:    Shri Amardeep Singh, counsel for DH.

                   Shri Sanjeev Vohra, counsel for JDs. 

 

         

                    Vide this order we dispose of application under Section 25 and 27 of the Consumer Protection Act filed by the decree holder.

2.                Decree holder/complainant filed present execution petition under Section 25 and 27 of the Consumer Protection Act on the averments that he has purchased medi-claim policy No.51586075 from the JDs and that is for the entire family of complainant and covers the risk of ₹10 lacs. In a scuffle, he suffered a fired shot and due to said injury his health became very critical and shifted to Mool Chand Kidney Hospital and then to Fortis Hospital, Mohali where he remained admitted from 13.5.2015 to 1.7.2015 and he spent

                                           

₹20,98,201/- on his treatment. After discharging from hospital, he lodged claim to the JDs for reimbursement but JDs repudiated the claim vide letter dated 24.9.2015. Thereafter, DH again fell ill and remained admittedfrom18.4.2016 to 29.4.2016 and spent more than ₹2,02,976/-. As per the policy, the DH is entitled to ₹18,00,000/- but the JDs paid only ₹5,40,000/- to the DH and remaining amount has not been paid. Hence, the present petition.

3.                On notice JDs appeared and filed objections wherein it has been averred that the present execution petition is not maintainable. It is submitted that as per the order of this Forum, JDs were directed to pay reimbursement amount for the hospitalization period/year of 13.5.2015 to 9.6.2015 as per the terms of the policy. It is submitted that as per the medical documents, it was found that hospitalization of the complainant for which the cashless was denied was for period of 13.5.2015 to 1.7.2015, therefore, as per policy terms and condition a sum of ₹5,40,000/- was paid and the same is admitted by the DH in the execution petition. Hence, prayed for dismissal of the execution petition.

4.                We have heard both the parties.

5.                It is admitted that an amount of ₹5,40,000/- was paid by the JDs to the DH for the period from 13.5.2015 to 1.7.2015 and remaining amount for the period from 18.4.2015 to 29.4.2016 was not paid as the DH has not lodged claim for this period with the JDs. JDs/OPs are ready to settle the claim of the DH for the remaining period if the DH lodge the claim with the JDs. In these circumstances, the present execution petition is disposed of with the direction to the DH to lodge the claim with the JDs for the remaining treatment

                                              

within fifteen days from the date of this order and JDs are directed to settle the claim of the DH within one month from the date of this order. It is further made clear that in case the JDs fails to settle the claim of the DH, in that eventuality, DH/complainant is at liberty to file fresh complaint. Parties concerned be communicated of the order accordingly and file be consigned to the record room after due compliance.

 

Announced
Dated:9.1.2020

          President,                                            

       District Consumer Disputes

     Redressal Forum, Karnal.

 

(Vineet Kaushik)                (Dr. Rekha Chaudhary)

Member                                  Member