DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

BATHINDA

C.C. No. 102 of 06-04-2018

Decided on : 21-11-2019

Sukhmanjit Singh aged about 42 years S/o Sh. Bhupinder Singh, R/o near ITI Mansa Road, Bathinda, Tehsil & District Bathinda.

…...Complainant

Versus

1. Indusind Bank Ltd., Near Bus Stand, Opp. HDFC Bank Ltd., GT Road, Branch Bathinda, through its Branch Manager

2. Cholamandalam MS General Insurance Co. Ltd., Branch Bathinda, near Sethi petrol Pump, GT Road, Bathinda, through its Branch Manager

.......Opposite parties

Complaint under Section 12 of the Consumer Protection Act, 1986.

Quorum :

Sh. M.P.Singh Pahwa, President

Smt. Manisha Member

Present :

For the complainant : Sh. A S Sekhon, Advocate.

For the opposite parties : Sh. K K Vinocha, Advocate, for OP No. 1.

OP No. 2 exparte.

O R D E R

M. P. Singh Pahwa, President

1. Sukhmanjit Singh, complainant (here-in-after referred to as 'complainant') has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (here-in-after referred to as 'Act') against Indusind Bank Ltd., and another (here-in-after referred to as opposite parties').

2. Briefly stated the case of the complainant is that he availed loan from opposite No. 1 vide A/c No. PJB00275E (loan account).

3. It is pleaded that opposite party No.1 allured the complainant to purchase "Group Health Master policy Family Medicare Policy” of opposite party No. 2 for his better future. The complainant purchased the policy in the month of July, 2017 and paid premium of Rs. 5645/-. The certificate of insurance was issued by opposite party No.2 bearing 2842/00136055/0009/000/00 for a floater sum of Rs.2,00,000/- for the period from 29-7-2017 to 28-7-2018 and Health Master Policy No, 2842/00136055/000/00. The complainant fell ill on 7-9-2017 and was admitted with 'Bansal Hospital & Cancer Centre (Super Speciality Hospital) Bhatti Road, Bathinda on 7-9-2013 vide CR No. 4814 and discharged on 19-9-2017. The complainant again remained admitted in the said Hospital for the period 25-9-2017 to 27-9-2017 and then for the period from 11-10-2017 to 13-10-2017. On discharge, bills were paid. The claim was lodged for reimbursement of Rs. 1,97,245/- with the opposite parties . The claim has been rejected illegally and fraudulently vide letter dated 21-11-2017 on the ground that “The present ailment is diagnosed/diagnosable within first thirty days of inception of the policy and the claim is inadmissible as per General Exclusions C-II.

4. It is alleged that repudiation of claim is illegal and void.

5. It is pleaded that the policy was for the period from 29-7-2017 to 28-7-2018. The complainant admitted in hospital first time on 7-9-2017 i.e. After 40 days of the commencement of policy and not within 30 days as allged by the Insurance Company.

6. It is further pleaded that due to this act and conduct of the opposite parties, the complainant suffered mental harassment and stress. For these sufferings, he has claimed compensation to the tune of Rs. 1,00,000/- in addition to reimbursement of claim amounting to Rs. 1,97,245/- and cost of litigation. Hence, this complaint.

7. Upon notice, none appeared on behalf of opposite party No. 2. As such, exparte proceedings were taken against opposite party No. 2.

8. The opposite party No. 1 appeared through counsel and contested the complaint by filing written reply. In written reply, the opposite party No. 1 raised legal objections that the complainant has got no locus-standi and cause of action to file the complaint. That the complainant has not come to this Forum with clean hands. He has suppressed true facts from this Forum. That the complaint is bad for mis-joinder of parties and lastly that the rights and obligations regarding loan in question between the parties are duly incorporated in Loan Agreement.

9. On merits, it is admitted that complainant availed loan from it but all other averments of the complainant are denied mainly due to the reason that same pertains to opposite party No. 2. In the end, the opposite party No. 1 prayed for dismissal of complaint.

10. In support of his complaint, the complainant has tendered into evidence his affidavit dated 20-7-2018 (Ex. C-1), photocopy of certificate of Insurance (Ex. C-2), photocopy of repudiation letter (Ex. C-3), photocopy of medical record including bills (Ex. C-4 to Ex. C-37) and closed the evidence.

11. In order to rebut this evidence, the opposite party No. 1 has tendered in to evidence affidavit dated 15-5-2018 of Robind Arora (ex. OP-1/1), photocopy of loan agreement (Ex. OP-1/2), photocopy of account statement (Ex. OP-1/3) and closed the evidence.

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

13. The learned counsel for the complainant has submitted that complainant has availed Insurance policy from opposite party No. 2. Copy of policy is Ex. C-2. The opposite party No. 2 has illegally repudiated the claim vide letter dated 21-11-2017 (Ex. C-3) on the ground that present ailment is diagnosed/diagnosable with first thirty days of inception of the policy. Hence, claim is not inadmissible. The opposite party No. 2 has not come forward to contest the claim. The opposite party No. 2 has also not produced Insurance policy to support this contention. Moreover, the policy was effective from 29-7-2017 and the treatment is from 7-9-2017 which is more than 30 days after inception of the policy. As such, repudiation is not sustainable. The complainant is entitled to the relief as prayed for.

14. The learned counsel for opposite party No. 1 has reiterated his stand as taken in written version, the repetition of which is not considered necessary for the sake of brevity.

15. We have carefully gone through the record and have considered the rival contentions.

16. The complainant has claimed that he has availed Insurance policy of opposite party No. 2. The certificate of Insurance is placed on record as Ex. C-2. It is also the case of the complainant that he took treatment of different dates from 7-9-2017 onwards by spending Rs. 1,97,245/-. The complainant has produced bills to prove expenses. The opposite party No. 2 has repudiated the claim vide letter dated 27-11-2017 (Ex. C-3) on the ground that “Present ailment is diagnosed/diagnosable with first thirty days of inception of the policy”, but the opposite party No. 2 has not come forward to contest the claim of complainant and to justify repudiation of claim. The complainant took treatment from 7-9-2017 onwards which is much after of 30 days from the inception of policy. Therefore, repudiation of claim is not sustainable. It amounts to deficiency in service on the part of opposite party No. 2.

17. Now the question is regarding the amount for which complainant can be held entitled. The complainant has claimed an amount of Rs. 1,97,245/-. There are certainly some limitations for different claims. The complainant has not brought on record policy containing all the terms and conditions. The complainants can claim only as per terms and conditions/limitation prescribed in the policy.

18. For the reasons recorded above, this complaint is partly accepted with cost of Rs. 10,000/- against opposite parties No. 2. It stands dismissed qua opposite party 1. The opposite parties No. 2 is directed to pay claim in question to complainant as per limitations prescribed under the policy terms and conditions.

19. The opposite party No. 2 will also furnish the details of the payment made to the complainant.

20. The compliance of this order be made by the opposite party No. 2 within 45 days from the date of receipt of copy of this order.

21. The complaint could not be decided within the statutory period due to heavy pendency of cases.

22. Copy of order be sent to the parties concerned free of cost and file be consigned to the record.

    Announced :

    21-11-2019

    (M.P.Singh Pahwa )

    President

     

    (Manisha )

    Member