Delhi

New Delhi

CC/226/2022

Mr. Ashwani Singh Azad - Complainant(s)

Versus

ICICI Lombard General Insurance Company Ltd. - Opp.Party(s)

16 May 2023

ORDER

 

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-VI

(NEW DELHI), ‘M’ BLOCK, 1STFLOOR, VIKAS BHAWAN,

I.P.ESTATE, NEW DELHI-110002.

Case No.226 /2022       

IN THE MATTER OF:

 

 

Mr. Ashwani Singh Azad

WZ-153/A, 1^st Floor, Mandir Wali Gali,

Opposite Dev Property Shadipur Village,

Patel Nagar, New Delhi-110008                                            ....Complainant

 

                                      VERSUS

 

      ICICI Lombard General Insurance Company Limited

      Fourt Parsavnath Capital Tower

      Bhai Veer Singh Marg,

      New Delhi-110001                                                    ....Opposite Party

 

Quorum:

Ms. Poonam Chaudhry, President

Sh. Bariq Ahmad, Member

Sh. Shekhar Chandra, Member

                                                                                                                   Date of Institution:-09.09.2022                                                                                                                                                                        Date of Order   : -    16.05.2023

ORDER

 

POONAM CHAUDHRY, PRESIDENT

 

 

 

1. The present complaint has been filed under Section 12 and 35 of the Consumer Protection Act, 1986 (in short CP Act) against Opposite Party (in short OP) alleging deficiency of services.
2. Briefly stated the facts of the case are that the complainant had taken       a online health insurance policy bearing no. 4128i/HSHA/219785438/00/000 on 15.04.2021 from opposite party. The said policy was valid from 15.04.2021 to 14.04.2022 for the sum insured of Rs.3,00,000/- (Rupees Three Lakh).
3. It is also alleged that the complainant got admitted in the J.K. Hospital for treatment on 26.07.2021 and remained hospitalized till 30.07.2021. The said hospital generated the final bills of Rs.50,442/- (Rupees Fifty Thousand Four Hundred Forty Two) which was paid by complainant.
4. The complainant claimed the aforesaid bill amount from the opposite party, but the same was rejected by the opposite party vide letter dated 29.09.2021 stating that policy status is cancelled, hence rejected. The after complainant sent a letter on dated 18.10.2021 to the insurance company/OP  but no response was received. The complainant being left with no option has approached this Commission. Hence the present complaint.
5. It is alleged the present case has been filed within the period of limitation. It is further alleged that the cause of action to file present case arose when the claim of the complainant rejected by opposite party on 29.09.2021. It is also alleged that residence of the complainant is situated at “Kakrola” New Delhi, hence, this Court has jurisdiction to entertain the present complaint.
6. It is prayed that OP be directed to pay a sum of Rs.50,442/- (Rupees Fifty Thousand Four Hundred Forty Two) to complainant with pendent elite and future interest @ 18% p.a. from the date of repudiation of claim 29.09.2021 till realization. It is also prayed that OP be directed to verify and produce the medical treatment record and bills of complainant’s treatment from 26.07.2021 to 30.07.2021.  and OP be also directed to pay cost of litigation.
7. Notice of the complaint was issued to OP, OP was duly served on 28.09.2022. However as none appeared for OP despite service as such the defence of OP was stuck off vide order dated 01.12.2022. 
8. Complainant filed his  evidence by affidavit reiterating therein the averments of the complaint. Complainant filed copy of policy, the treatment record, the bills issued by J.K. Hospital, The repudiation letter.
9. We have heard the AR of complainant and perused the record.

 

10. In view of the unrebutted testimony of complainant, we are of the view that complainant has succeeded in proving that OP was guilty of deficiency of services in repudiating the claim of complainant. We accordingly hold OP/ICICI Lombard General Insurance Company Limited guilty of deficiency of services and direct OP to pay Rs.50.442/- (Rupees Fifty Thousand Four Hundred Forty Two) to the complainant with interest @ 9% per annum from date of filing of claim within four weeks of date of receipt of order, failing which OP will be liable to pay interest @ 12% per annum till realization. We also direct OP to pay compensation of Rs.50,000/ (Rupees Fifty Thousand only) for mental agony and harassment and Rs.10,000/- (Rupees Ten Thousand only) as cost of litigation to the complainant.

A copy of this order be sent to all the parties free of cost. The order be uploaded on the website of this Commission.

File be consigned to record room along with a copy of the order.

 

Poonam Chaudhry

(President)

 Bariq Ahmad                                                                                                                                       Shekhar Chandra

  (Member)                                                                                                                                               (Member)