Punjab

Moga

CC/17/37

Surinder Kumar - Complainant(s)

Versus

HDFC Standard Life Insurance Co. Ltd. - Opp.Party(s)

Sh. Munish Majithia

13 Jun 2017

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 37 of 2017

                                                                                      Instituted on: 06.04.2017

                                                                                      Decided on: 14.06.2017

 

Surinder Kumar, aged about 62 years s/o Ram Chand r/o Gilla Da Agwar, near Deepak Medical Store, Indergarh Tehsil Dharamkot, District Moga.

                                                                                ……… Complainant

 

Versus

1.       HDFC SL, 1^st Floor, Plot no.990, Ward no.5, G.T. Road, Opposite State Bank of Patiala, Moga, through its Manager.

 

2.       HDFC Bank Ltd. Sandoz House, 2^nd Floor, Shiv Sagar Estate, Dr. Annie Besant Road, Worli- Mumbai, through its Managing Director/Manager/Principal.

 

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President

                   Smt. Bhupinder Kaur, Member

 

Present:       Sh. Munish Majithia, Advocate Cl. for complainant.

                   Opposite parties ex-parte.

 

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the "Act") against HDFC SL, 1^st Floor, Plot no.990, Ward no.5, G.T. Road, Opposite State Bank of Patiala, Moga, through its Manager and others (hereinafter referred to as the opposite parties) directing them to pay a sum of Rs.5,00,000/- with regard to policy no.90058676. Further opposite parties may be directed to pay Rs.50,000/- as compensation on account of mental tension, harassment and agony to complainant and to grant any other relief which this Forum deems fit and proper be granted.

  2.              Briefly stated the facts of the case are that the complainant has purchased a HDFC life policy no.90058676 for a sum of Rs.5,00,000/-. Under this policy complainant and his wife Kamlesh Kumar were insured against any prepost hospitalization benefit and other benefit. The complainant and his wife had undergone for medical test which was conducted in Mittal Hospital, Moga at the instance of their company. In these tests, the concerned official of their company told that complainant's wife is over weight and have no other diseases and demanded some charges due to over weight and complainant had paid the same through cheque. On 31.10.2016, complainant's wife namely Kamlesh Kumar admitted in Dayanand Medical College and Hospital, due to some infection problem, where complainant spent worth Rs.4,60,716/-. Besides this complainant has also incurred more than Rs.50,000/- on account of conveyance charges and diet money. The complainant requested the opposite parties orally as well as in writing for making the payment of hospital and other charges. But company had rejected the claim on the ground that it is pre-existing disease. Before purchase of the policy, the complainant and his wife were medically examined, through officials of opposite parties. The refusal of the claim is unjust, illegal, void at law. There was no reason or ground for rejection of claim of the complainant. Legal notice was also served upon the opposite parties, but to no effect. The opposite parties were asked many a times to admit the rightful claim, but they refused to do so. Due to the acts of the opposite parties, the complainant has suffered mental tension, harassment and agony. Hence this complaint.

3.                Notice issued for the service of opposite party no.1 duly served. But none had appeared on behalf of opposite party no.1. As such, opposite party no. 1 was proceeded against ex-parte. On the other hand, registered cover issued for the service of opposite party no.2 not received back either served or un-served. As such, after expiry of waiting period of 30 days, opposite party no.2 was proceeded against ex-parte.

4.                In ex-parte evidence, the complainant tendered in evidence his duly sworn affidavit Ex.C-1 and copies of documents Ex. C-2 to Ex.C-277 and closed the evidence. 

5.                We have heard the learned counsel for the complainant and have very carefully gone through record placed on file.

6.                Complainant argued that the complainant has purchased a HDFC life policy no.90058676 for a sum of Rs.5,00,000/-. Under this policy complainant and his wife Kamlesh Kumar were insured against any prepost hospitalization benefit and other benefit. The complainant and his wife had undergone for medical test which was conducted in Mittal Hospital, Moga at the instance of their company. In these tests, the concerned official of opposite parties told that complainant's wife is over weight and have no other diseases and demanded some charges due to over weight. On 31.10.2016, complainant's wife namely Kamlesh Kumar admitted in Dayanand Medical College and Hospital, due to some infection problem, where complainant spent worth Rs.4,60,716/-. Besides this complainant has also incurred more than Rs.50,000/- on account of conveyance charges and diet money. Thereafter, the complainant lodged his medical claim with opposite parties for the amount spent by him on treatment. But they failed to make the payment of claim amount. On the other hand, despite due service, opposite parties did not opt to appear and contest the present complaint, as such evidence of complainant goes un-rebutted. The opposite parties thereby impliedly admitted the case of the complainant.

7.                From the appreciation of the evidence on record, it becomes evident that the information regarding the admission and treatment of wife of the complainant was given by hospital to opposite parties, but they rejected the claim of the complaint on false grounds and had not paid anything out of expenses of treatment. From the perusal of file, it reveals that at the time of admission of wife of the complainant in hospital, the hospital intimated the opposite parties regarding it and requested for pre-authorization for cashless treatment, which was rejected by the opposite parties on certain grounds, copy of e-mail regarding the same sent by opposite parties to the hospital is Ex.C-277, vide this e-mail the opposite parties only rejected the case for cashless treatment of wife of the complainant before final diagnose and not rejected the claim of the complainant on merits. The complainant has not lodged the claim for reimbursement of the expenses borne by him for the treatment alongwith all required medical reports and bills with opposite parties to get the claim under the policy. The complainant failed to prove that he ever lodged any claim with opposite parties for the reimbursement of his medical expenses after discharge from the hospital alongwith medical reports and bills and opposite parties have rejected his claim on merits. In these circumstances, we are of the considered opinion that the present complaint is pre-mature, as the complainant has not lodged his claim with opposite parties alongwith necessary documents and bills.

8.                In view of the above discussion, the present complaint is hereby dismissed as premature. However, complainant is at liberty to lodge the claim with the opposite parties by submitting all the required documents within 15 days from the date of receipt of a copy of this order and opposite parties are hereby directed to process and settle the claim of the complainant within 45 days from the date of lodging of the claim. However, complainant is at liberty to file fresh complaint on same cause of action, if he does not feel satisfied qua the decision of opposite parties regarding his claim. Copy of the order be sent to the parties free of costs. File be consigned to the record room.

Announced in Open Forum.

Dated: 14.06.2017

 

                                                   (Bhupinder Kaur)                           (Ajit Aggarwal)

                                                               Member                                      President