Ms.Rachna Arora, Member

1.       The complainant  has brought the instant complaint under section 12 & 13 of the Consumer Protection Act, 1986 on the allegations that the complainant has purchased/ obtained one mediclaim health insurance policy bearing No. 30379448021501, customer ID No.2000066317 of Opposite Parties on 10.12.2015 under the product name ‘Health Companion” for two adults i.e. for complainant and his wife namely Manpreet Kaur for the period of one year from 10.12.2015 to 9.12.2016 for sum insured of Rs.3 lacs. It is important to mention that only cover note or schedule of the insurance was supplied to the complainant, but the Opposite Parties never supplied any terms and conditions of the impugned insurance to the complainant much less the alleged terms and conditions ever formed part of contract between the parties. During the validity period of the said policy, the complainant suffered from enteric Fever UTI and got admitted in SJS Child Care Centre, Neeli Building, Sultanwind Road, Tej nagar Chowk, Amritsar on 29.1.2016 and remained admitted therein for about 6 days and discharged on 3.2.2016 and in this respect, necessary intimation was given by the complainant to the Opposite Parties. The complainant was discharged on 3.2.2016 and he continued on certain medicines. The complainant spent amount of Rs.31,038/- on his medical treatment and even in respect thereof the original bills, cash memos and other documents were submitted to the Opposite Parties for payment of claim under the impugned insurance which was in force at the relevant time. The complainant requested  the Opposite Parties so many times to pay the claim amount and even besides oral requests the complainant also served legal notice upon the Opposite Parties, but to no affect. As such, there is a gross negligence, carelessness, deficiency in service on the part of the Opposite Parties.    Vide instant complaint, the complainant has sought the following reliefs.

a)       Opposite Parties may please be directed to pay the claim amount of Rs.31,038/- alongwith interest @ 12% per annum and compensation of Rs.25,000/- on account of mental agony and harassment besides costs of litigation. 

Hence, this complaint.

2.       Upon notice, opposite parties served  on 28.12.2016, but despite granting sufficient time of 45 days, Opposite Parties has not filed the written version, as such, Opposite Parties have forfeited their right to file the written version. As a matter of fact, the Opposite Parties were bound to file written version within 30 days from the date of receipt of notice. But however, the period beyond 30 days from the date of service could be extendable upto 45 days only if the Opposite Parties filed application for the purpose, but that not being the case, the Opposite Parties are debarred from filing the written version vide order dated 16.2.2017 of this Forum.

3.       In his bid  to prove the case, complainant tendered into evidence  affidavit Ex.CW1/A in support of the allegations made in the complaint, affidavit of Harpreet Singh Ex.CW2/A, affidavit of Harjinder Singh Ex.CW3/A, copy of legal notice Ex.C1, postal receipt Ex.C2, copies of letters Ex.C3 and Ex.C4, copy of medical record Ex.C5 to Ex.C19, copy of driving licence Ex.C20, copy of aadhar card Ex.C21 and closed his evidence.

4.       On the other hand, to rebut the evidence of the complainant, the Opposite Parties tendered into evidence the affidavit of Sh.Sheetal patwa Ex.OP1,2/1 alongwith copies of documents Ex.OP1/2/2 to Ex.OP1.2/8 and closed the evidence on behalf of the Opposite Parties.

5.       We have heard the ld.counsel for the parties and have carefully gone through the evidence on record.

6.       The complainant has submitted his affidavit Ex.CW1/A in which he has reiterated the facts as detailed in the complaint and contended that the complainant has purchased/ obtained one mediclaim health insurance policy bearing No. 30379448021501, customer ID No.2000066317 of ops on 10.12.2015 under the product name ‘Health Companion” for two adults i.e. for complainant and his wife namely Manpreet Kaur for the period of one year from 10.12.2015 to 9.12.2016 for sum insured of Rs.3 lacs. It is important to mention that only cover note or schedule of the insurance was supplied to the complainant, but the Opposite Parties never supplied any terms and conditions of the impugned insurance to the complainant much less the alleged terms and conditions ever formed part of contract between the parties. During the validity period of the said policy, the complainant suffered from enteric Fever UTI and got admitted in SJS Child Care Centre, Neeli Building, Sultanwind Road, Tej nagar Chowk, Amritsar on 29.1.2016 and remained admitted therein for about 6 days and discharged on 3.2.2016 and in this respect, necessary intimation was given by the complainant to the Opposite Parties. The complainant was discharged on 3.2.2016 and he continued on certain medicines. The complainant spent amount of Rs.31,038/- on his medical treatment and even in respect thereof the original bills, cash memos and other documents were submitted to the Opposite Parties for payment of claim under the impugned insurance which was in force at the relevant time. The complainant requested  the Opposite Parties so many times to pay the claim amount and even besides oral requests the complainant also served legal notice upon the Opposite Parties, but to no affect.

7.       On the other hand, though Opposite Party appeared through advocate, but did not file the written version to contest the claim of the complainant beside availing sufficient time  of 45 days. Opposite Parties has not filed the written version, as such, Opposite Parties have forfeited their right to file the written version. As a matter of fact, the Opposite Parties were bound to file written version within 30 days from the date of receipt of notice. But however, the period beyond 30 days from the date of service could be extendable upto 45 days only if the Opposite Parties filed application for the purpose, but that is not being the case, the Opposite Parties are debarred from filing the written version vide order dated 16.2.2017 of this Forum.  In this way, the evidence produced by the Opposite Parties to rebut the evidence of the complainant, can not be given any affect in the absence of written version from the Opposite Parties. In other words, the evidence  produced by the complainant has gone unrebutted on record. In this way, the Opposite Parties have impliedly admitted the correctness of the allegations made in the complaint. It also shows that Opposite Parties  have no defence to dislodge the complaint. 

8.       Consequently, the instant complaint succeeds  and the Opposite Parties are directed to make the payment of claim amount of Rs.31,038/- to the complainant within 30 days from the date of receipt of copy of this order, failing which complainant shall be entitled to  interest @ 6% per annum on the awarded amount from the date of filing the complaint till its realization.  Opposite Parties  are also directed to pay Rs.2000/- to the complainant on account of compensation for causing mental tension and harassment besides Rs.1000/- as litigation expenses. The complaint stands allowed accordingly. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.

Announced in Open Forum.