Delhi

New Delhi

CC/400/2015

Inderpal Singh - Complainant(s)

Versus

Instant Health Care Pvt Ltd. - Opp.Party(s)

23 Aug 2016

ORDER

 

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI),

 ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE,

 NEW DELHI-110001

 

Case No.C.C./400/2015                                                                                   Dated:

In the matter of:

SH. INDERPAL SINGH,

S/O SH.PAYRE SINGH,

R/o A-134,GUJTRAWALA TOWN,

PART-1,

DELHI-110009.

        ……..COMPLAINANT

VERSUS

1.     INSTANT HEALTH CARE PVT. LTD.,

        THROUGH ITS DIRECTOR’S/MANAGER

        1111, ANTRIKSH BHAWAN,

        K G MARG, CONNAUGHT PLACE,

        NEW DELHI-110001

 

2.     NATIONAL INSURANCE CO. LTD.,

        DIVISIONAL NO V, 7^th FLOOR, HEMKUNT HOUSE,

        RAJENDER PLACE,

NEW DELHI-110008

 

3.      E-MEDITEK SOLUTIONS LTD.,

THROUGH ITS DIRECTOR’S/MANAGER

45,NATHUPURA ROAD, DLF PHASE-III

GURGAON-122001

                                                                       .... OPPOSITE PARTY

 

MEMBER : NIPUR CHANDNA

 

ORDER

 

The wife of the complainant (now deceased) is the policy holder of insurance policy bearing No. 260300/46/068500000195 of OP Insurance Company  for a sum insured  of Rs.3,00,000/- with cumulative bonus of Rs.15,000/-.

                The complainant is the husband/ legal heir of deceased Manjeet Kaur.

                It is alleged by the complainant that Smt. Manjeet Kaur was admitted in hospital with diagnosis of diabetes mellitus and with HIN disease in North Delhi Nursing Home on 18/2/07 and was discharged on 24/2/07, again she was admitted with the same complaint and had expired on 24/5/07.

                It is alleged by the complainant that he filed a claim with OP No.3 alongwith all the relevant documents. The OP No.3 informed the complainant that his claim has been approved but the cheque is yet to be prepared. It is further alleged by the complainant that OP No. 3 later informed him that his claim was not settled by OP No. 1 and 2.

                Being aggrieved, complainant approached the Ombudsman, Delhi. The ombudsman vide the order dt. 24/5.12 direct the Insurance Company to take early decision in the claim filed by complainant. It is further alleged by the complainant that OP No.2 vide its letter dt.19/12/14 informed the complainant that his claim is not payable and the matter is closed treated as “ No Claim”. It is also alleged by the complainant that OP No.2 had repudiated his claim on false and frivolous ground. Hence this complaint.

                Notice of the complaint was sent to the OPS through Regd. AD Post for 10/9/2015. On 10/9/2015 counsel of OP 2 filed vakalatnama and copy of complaint supplied. Despite several opportunities OP 2 failed to file its written statements and as such defence of  OP 2 was struck off on 16/2/16.

                Complainant filed his ex-parte evidence by way of affidavit wherein he has corroborated the contents of his complaint.

                Complainant has placed on record copy of the insurance policy, copy of the death certificate of his wife, copy of the letter issued by the Canara Bank, a copy of the order dt. 10/5/12 of the Insurance ombudsman, copy of the repudiation letter dt.19/12/14 is support of his case.         

We have heard ex-parte arguments advanced at the bar and have perused the record.

                Ld. Counsel of the complainant has contended that the OP Insurance Co. had closed his claim as “No Claim” on the false and frivolous ground of not receiving the premium amount under the alleged policy.

                He has drawn our attention on the Health Insurance claim sheet issued by OP No. 3 who is the TPA of OP No.2 wherein it is stated that the deceased was the policy holder of OP Insurance Co. since 2001, no where it is mentioned on the sheet that the alleged policy was stood cancelled. Infact, the OP No. 3 vide its Health Insurance Claim sheet dt. 23/11/07 had approved the hospitalization claim of the deceased upto Rs. 2,17,141/-.

                The Ld. counsel of the complainant has also brought to notice the letter dt.7/2/12 issued by the Canara Bank which clarify that the cheque issued for a sum of Rs. 6795/- was passed in clearing dt. 1/1/07  favoring Instant Health Care Pvt. Ltd.

                From the unrebutted testimony of the complainant and the documents placed on record, we are convinced that the story put forth by the complainant is true. Despite receiving the premium amount OPS failed to settle the claim of the complainant. This act of OPs amount  to deficiency in services on their part.

                We therefore hold OP 1 and 2 liable for deficiency in service jointly and severally and direct them as under:-

1. Pay to the complainant a sum of Rs. 2,17,141/- (as approved) in health sheet alongwith 10% interest from the date of filing of complaint till payment of said amount.
2. Pay to the complainant a sum of Rs.20,000/- for pain and mental agony suffered by the complainant.
3. Pay to the complainant a sum of Rs.10,000/- as a cost of litigation.

 

The order shall be complied by the OP within 30 days of the receipt of the copy of the order. If the said amount is not paid by the OP within a period of one month from the date of receipt of this order, the same shall be recovered by the complainant along with simple interest at the rate of 10% per annum from the date of this order till recovery of the said amount of Rs. 30,000/-. This final order be sent to server (www.confonet.nic.in ). A copy each of this order each be sent to both parties free of cost by post.

 

        File be consigned to record room.

 

       Pronounced in open Forum on _______________.

 

 

 

 

 

 

 

 

(S K SARVARIA)

 PRESIDENT

 

 

                                                      (H M VYAS)                                     (NIPUR CHANDNA)

                                                       MEMBER                                                  MEMBER