CONSUMER DISPUTES REDRESSAL COMMISSION-VII
DISTRICT: SOUTH-WEST
GOVERNMENT OF NCT OF DELHI
FIRST FLOOR, PANDIT DEEP CHAND SHARMA SAHKAR BHAWAN
SECTOR-20, DWARKA, NEW DELHI-110077
CASE NO.CC/293/21
Date of Institution:- 13.09.2021
Order Reserved on:- 04.03.2024
Date of Decision:- 13.03.2024
IN THE MATTER OF:
Ms. Menka
B-16, J.J. Colony, Sec-15,
Bharat Vihar, Kakrola,
New Delhi - 110078
.….. Complainant
VERSUS
ICICI Lombard General Insurance Co. Ltd.
414, ICICI Lombard House, Veer Savarkar Marg,
Near Siddhi Vinayak Temple Mine Gate,
Prabhadevi, Mumbai – 400025
At Also
ICICI Lombard GIC,
ICICI Lombard Health Care,
ICICI Bank Tower,
Plot NO.12, Financial Disteict, Nanakram Guda,
Gachobowli, Hyderabad-500032
Parth Hospital
House No.25, Vikas Nagar, Ranholla Road,
Near MLA office, Uttam Nagar,
New Delhi - 110059
.…..Opposite Party
ORDER
Suresh Kumar Gupta, President
- The complainant has filed the complaint under section 12 of Consumer Protection Act, 2019 (hereinafter referred to as Act) with the allegations that on 04.06.2019 she has taken online health policy no.4128I/IH/17257440/00/000 for a sum insured of Rs.3 lakh from OP-1 which was valid from 04.06.2019-03.06.2020. On 16.09.2019, she was admitted to Parth Hospital, New Delhi and remained hospitalized till 18.09.2019. A bill of Rs.23992/- was raised and paid by her. She lodged the claim with OP-1 which was rejected on 21.10.2019 being fraudulent claim. A legal notice dated 01.04.2021 was given to OP-1 to pass the claim but in vain. Hence, this complaint.
- OP-2 was duly served. OP-2 did not put the appearance despite due service as a result proceeded ex-parte on 14.10.2022.
- OP-1 did not file the reply as a result defence was closed vide order dated 10.02.2023.
- The complainant was directed to lead the evidence.
- The complainant has filed her own affidavit in evidence wherein she stated that on 04.06.2019 she has taken online health policy no. 4128I/IH/17257440/00/000 for a sum insured of Rs.3 lakh from OP-1 which was valid from 04.06.2019-03.06.2020. On 16.09.2019, she was admitted to Parth Hospital, New Delhi and remained hospitalized till 18.09.2019. A bill of Rs.23,992/- was raised and paid by her.
- We have heard AR of the complainant and perused the entire material on record.
- The complainant has filed her own affidavit in evidence in support of the allegations as set out in the complaint. The affidavit shows that she has taken the policy from OP-1. On 16.09.2019, she was admitted to Parth Hospital and remained hospitalized till 18.09.2019 which is clear from discharge summary dated 18.09.2019. She has paid the bill of Rs.23992/-. These are the entire facts in the affidavit.
- She has nowhere stated in the affidavit that she has lodged a claim with the OP-1 which was rejected under clause 12 of the Terms and Conditions of the Policy on the grounds of fraudulent claim/false statement/declaration.
- The material part of the complaint is missing in the evidence led by the complainant. The case is decided on the basis of evidence led by the parties. The evidence regarding rejection of claim by OP-1 is missing from the evidence so it cannot be said that there is deficiency of service on the part of OP-1.
- In view of the above stated discussion, we do not find any merit in the complaint of the complainant and accordingly the complaint of the complainant is dismissed without any order as to the cost.
- A copy of this order is to be sent to all the parties as per rule.
- File be consigned to record room.
- Announced in the open court on 13.03.2024.
