Haryana

Kurukshetra

36/2016

Surjeet Singh - Complainant(s)

Versus

HDFC - Opp.Party(s)

D.S.Kirmach

02 Jan 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KURUKSHETRA.

                                

                                         Complaint no.36/16.

                                         Date of instt. 4.2.16.

                                       Date of Decision: 2.1.18.

 

Surjeet Singh son of Bant Raj, resident of village Jyotisar, Josar Nadar Wala Dera, Tehsil Thanesar, District Kurukshetra.                                                                                                                                                                                                                                                                                                                                      ……….Complainant.      

                        Vs.

 

1. HDFC Life Health Assure Plan Health Claim Plot No.577, Udyog Vihar Phase V, Gurgaon through its Manager/Authorized Signatory.
2. HDFC Standard Life Insurance Company Limited, SCO No.66, 2^nd Floor, Sector-17, Near IBP Petrol Pump, Kurukshetra, through its authorized signatory.

……Opposite parties.

 

Complaint under section 12 of Consumer Protection Act.                   

 

 

Before            Sh. G.C. Garg, President.

                     Dr. Jawahar Lal Gupta, Member

                     Smt. Viraj Pahil, Member

 

Present :            Sh. D.S. Kirmach, Adv. for complainant.

                         Sh. Gaurav Gupta, Adv. for OP No.2.

                        OP No.1 ex parte.

                            

ORDER

 

                   This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Surjeet Singh against HDFC Life Health Assure Plan and another, the opposite parties.

2.             It is stated in the complaint that complainant had taken a health insurance policy bearing No.90104079 for a sum of Rs.5,00,000/- and before issuing the above said policy, the OP No.2 also assured the complainant that in future any kind of mis-happening regarding the health of complainant and in that case Ops are liable to pay all the medical expenses. On 2.9.2015 the complainant was admitted in Shri Balaji Aarpgyam Hospital, Kurukshetra due to some heart problems and got his treatment from 2.9.2015 to 4.9.2015 and spent a sum of Rs.1,60,000/- on his treatment. After getting the treatment, the complainant submitted all the documents bill relating to treatment to the Ops and completed all the formalities but now the Ops are lingering the matter on one pretext or the other. The complainant has also got served a legal notice through his counsel but to no effect. Thus, it amounts to deficiency in service on the part of Ops and as such, the present complaint has been moved by the complainant with the prayer to direct the Ops to pay Rs.1,60,000/- as medical claim amount, to pay Rs.50,000/- as compensation for mental agony and physical harassment, Rs.5500/- as litigation charges and Rs.1100/- as misc. expenses.

3.             Upon notice, opposite party No.2 appeared and contested the complaint by filing reply taking preliminary objections that the complainant has suppressed the original facts with the motive to get compensation by way of misleading this Forum; that after receiving the claim intimation from the complainant, the answering OP requested the complainant to provide the requisite information and documents for verifying the genuineness of claim and processing the claim. Answering OP sent letters dated 18.9.2015, 29.9.15 and 10.10.2015 but the complainant has not provided the complete information and documents and finally the answering OP sent letter dated 19.10.2015 to the complainant for providing the history of diabetes and hypertension with exact duration since when certified by the treating doctor but till date no revert has been received and claim of the complainant was closed as no claim for non submission of necessary documents. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of answering Op and as such, the complaint of the complainant is liable to be dismissed. On merits, the contents of the complaint were denied to be wrong. Preliminary objections were reiterated. Prayer for dismissal of the complaint was made.

4.             OP No.1 has failed to come present despite service and as such, he was proceeded ex parte vide order dated 14.10.2016.

5.             Both the parties have led their respective evidence.

6.             We have heard learned counsel for the parties and have gone through the record carefully.

7.             The complainant has proved on file the document Ex.C3 which shows that the amount of Rs.1,60,000/- was spent by the complainant for his treatment. As per Ex.C6 the complainant was suffering from severe chest pain. In these circumstances, we are of the view that the complainant is entitled to the amount of Rs.1,60,000/- from the Ops.

8.             In view of our above said discussion, the complaint of the complainant is allowed partly and the Ops are directed to make payment of Rs.1,60,000/- to the complainant. The order be complied within a period of 60 days failing which penal action under Section 27 of the Consumer Protection Act, 1986 shall be initiated against Ops and in that case the complainant is entitled to simple interest @ 6% per annum on the above said amount of Rs.1,60,000/-from the date of order till its final payment. File be consigned to record after due compliance. File be consigned to record after due compliance.

                 Copy of this order, be communicated to the parties.

Announced

2.1.2018.          

                                                  (G.C.Garg)

                                                   President,

                                        District Consumer Disputes                                                                     Redressal Forum, Kurukshetra.

 

 

                                                   

(Dr. Jawahar Lal Gupta)        (Viraj Pahil)                 

    Member                             Member