Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 270.
Instituted on : 13.06.2018.
Decided on : 12.03.2019.
Dilbag Dangi, age 32 year, son of Sh. Satywan Dangi, C/o Jai Parkash, Resident of 1037, Vijay Nagar, District Rohtak.
………..Complainant.
Vs.
The Manager, HDFC Standard Life Insurance Company Limited, 2nd Floor, Ashoka Plaza, Delhi Road, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh. Naveen Saini, Advocate for the complainant.
Opposite party already exparte vide order dated 03.08.2018.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that on 13.05.2013, the complainant had purchased HDFC Health Plan UID-101N087V01, policy No.90002789 from the opposite party and as per the schedule, the premium was to be paid annually. The complainant opted for gold plan with single life cover and the risk commencement date as per the policy document was 17.05.2013. The complainant had paid his premium on 08.05.2014 for Rs.7686/-, but due to some family circumstances, he was not able to deposit the premium on May, 2015. That in the month of September, 2015, complainant went to the office of opposite party to know about the renewal of his policy. The complainant was informed that he can renew his policy after paying full premium with penalty amounting to Rs.8300/-. On 17.09.2015, the complainant deposited the said amount with opposite party against proper receipt. That complainant met with an accident in February, 2016 and he tried to get cashless treatment but he was shocked to know that that his policy has been lapsed. That on enquiry, it was told by the officials of the opposite party that Rs.500/- is still outstanding against penalty amount. That the opposite party did not give any information about this penalty to the complainant till January, 2016. That on 26.02.2016 complainant also got deposited the said amount and the policy was renewed. That the complainant was again asked to get his medical tests conducted. Complainant got his medical test conducted and the opposite party told that he was suffering from sugar and was asked to deposit Rs.9500/- as premium. Later on, complainant himself got his medical examination done and he came to know that the report was wrong and he was not suffering from sugar. The complainant again tried to get cashless treatment but they told that his policy has been lapsed. At last complainant operated himself and incurred Rs.86,530/- on his treatment and requested the respondent to pay this amount. The complainant submitted all necessary documents but despite several visits and repeated requests of the complainant, claim was not settled. That on 27.12.2017, complainant sent legal notice to opposite party, but opposite party even did not bother to give reply to the same. That the act of opposite party of not paying the alleged claim amount is illegal and there is deficiency in service on the part of opposite party. As such, it is prayed that opposite party may kindly be directed to reimburse the claim amount i.e. Rs.86530/- with interest and also to pay Rs.50,000/- as litigation and compensation as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite party, but despite due service of notice opposite party failed to appear before the Court. Hence, opposite party was proceeded against exparte vide order dated 03.08.2018 passed by this Forum.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C28 and has closed his evidence on dated 18.02.2019.
4. We have heard learned counsel for the complainant and have gone through material aspects of the case very carefully.
5. Perusal of the documents reveals that as per document Ex.C1, the date of commencement of policy is 17.05.2013. As per document Ex.C2 dated 08.05.2014, the policy was renewed by paying the renewal premium amount Rs.7686/-. Thereafter, again the renewal premium of Rs.8300/- was paid vide receipt Ex.C3 dated 17.09.2015. As per complaint and affidavit filed by the complainant, he met with an accident in February 2016 and filed his claim under the cashless policy but the same was denied on the ground that the policy has been lapsed. As per the receipt Ex.C7, the complainant has also paid an amount of Rs.500/- on dated 26.02.2016 towards penalty amount which was not told by the opposite party at the time of renewal of policy. On the other hand, opposite party has neither appeared nor placed on record any document to prove that the policy was in lapse condition. Complainant has also sent a letter Ex.C25 and a legal notice Ex.C26 to the opposite party but no reply was sent by the opposite party. As such it is presumed that opposite party has nothing to say in the matter and all the allegations leveled by the complainant against the opposite party stands proved. Hence the complainant is entitled for the amount of expenses incurred by him on his treatment under the policy.
6. By way of complaint, complainant has demanded a sum of Rs.86530/- and has placed on record copy of bills Ex.C6, Ex.C12 to Ex.C23. Accordingly, we hereby allow the complaint and direct the opposite party to pay Rs.86350/-(Rupees eighty six thousand three hundred fifty only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 13.06.2018 till its realization and shall also to pay a sum of Rs.3000/-(Rupees three thousand only) as compensation and litigation expenses to the complainant within one month from the date of decision.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
12.03.2019.
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Nagender Singh Kadian, President
…………………………………
Ved Pal, Member.
………………………………..
Renu Chaudhary, Member.
