DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION SAS NAGAR (MOHALI)
Consumer Complaint No.382 of 2019
Date of institution: 15.03.2019 Date of decision : 01.11.2021
Rajinder Singh son of Late Shri Natha Singh, resident of village Ibhrahimpur, Tehsil Dera Bassi, District SAS Nagar (Mohali), Punjab.
…….Complainant
Versus
1. M/s. Cholamandalam Ms. General Insurance Company, SCO No.2463-64, 1st Floor, Sector 22-C, Chandigarh through its Claim Head Mr. Pawan Preet Dhawan.
2. M/s. Cholamandalam Ms. General Insurance Company Ltd., New No.319, Old No.154, Shaw Wallace Building, 2nd Floor, Thambu Chetty Street, Parry’s Corner, Chennai-600001.
……..Opposite Parties
Complaint under Consumer Protection Act.
Quorum: Shri Sanjiv Dutt Sharma, President.
Ms. Gagandeep Gosal, Member
Present: Complainant in person.
Shri Arsh vice Shri Simrandeep Singh, cl. for OPs.
Order dictated by :- Shri Sanjiv Dutt Sharma, President.
Order
The present order of ours will dispose of a complaint under Consumer Protection Act, filed by the complainant (hereinafter referred as ‘CC’ for short) against the Opposite Parties (hereinafter referred as ‘OPs’ for short), on the ground that the CC had subscribed an insurance policy titled as “Family Floater/Arogya” on 02.08.2018 from the OPs, vide policy No.2842/00157601/0002/000/0 which was valid upto 01.08.2019. It is further averred that under the policy, the CC and his wife namely Gurmeet Kaur were medically insured till its validity. Premium to the tune of Rs.7,866/- inclusive of GST was duly paid vide receipt dated 02.08.2018. It is averred that the wife of the CC was admitted in Indus International Hospital, Chandigarh Ambala Road, Dera Bassi due to her ailment/kidney problem on 07.11.2018. She was under the treatment of Dr. Navjit Singh Sidhu and was discharged on 12.11.2018. Hospital authorities had prepared an invoice of Rs.98,582/- for the entire treatment and demanded the same from the CC. OPs on approach, advised the CC to make payment to the hospital authorities and submit the bills and assured that the amount will automatically be transferred in the account of the CC. On assurance from the OPs, the CC did the same. It is further averred that the OPs till date have failed to make any payment. Even legal notice was sent on 12.02.2019 through Advocate to the OPs, but of no use.
Thus, alleging deficiency in service on the part of the OPs, the CC has sought the payment of Rs.1,00,000/- spent on the treatment of his wife and Rs.5,000/- as litigation expenses and another Rs.20,000/- on account of mental and physical harassment. Complaint of the CC is duly signed and verified. Further the same is also supported by an affidavit of the CC.
2. In reply the OPs have raised a number of preliminary objections mainly on the ground that the complaint is pre mature since the CC has not provided the documents as asked by the OPs. Further the OPs have termed the complaint of the CC as misconceived, baseless etc. Even it is averred that there is no cause of action to the CC to file the present complaint. On merits, the averments of the complaint are simply denied. However, in Para No.4, it is mentioned that the OPs asked for documents from the CC to confirm the previous history of any disease suffered by Ms. Gurmeet Kaur wife of the CC and some other documents which were not provided by the CC. Thus, by denying the contents of the complaint, the OPs have prayed for dismissal of the complaint.
3. The CC in support of his complaint submitted his affidavit Ex.CW-1/1 and documents Ex.C-1 to Ex.C-3. On the other hand the OPs have submitted affidavit of Pradeep Pathak, their Dy. Manager alongwith documents Ex.OP-1 to Ex.OP-3.
4. We have heard the complainant and the proxy counsel on behalf of the OPs and have perused the record.
5. Admittedly the CC had subscribed an insurance policy titled as “Family Floater/Arogya” on 02.08.2018 from the OPs vide policy No.2842/00157601/0002/000/0 which was valid upto 01.08.2019. It is also admitted fact that premium to the tune of Rs.7,866/- inclusive of GST was duly paid vide receipt dated 02.08.2018. It is also admitted fact that wife of the CC was admitted in Indus International Hospital, Chandigarh Ambala Road, Dera Bassi due to her ailment/kidney problem on 07.11.2018 and was under the treatment of Dr. Navjit Singh Sidhu and was discharged on 12.11.2018. It is also not denied by the OPs that the hospital authorities had raised the bill to the tune of Rs.98,582/- for the treatment of Ms. Gurmeet Kaur wife of the CC. It is also proved on the file that the CC approached the OPs time and again for payment of above said amount, but till date no amount was paid to the CC. However, the requests of the CC fell on deaf ears and the CC alleged harassment and physical torture from the hands of the OPs. The OPs have termed the claim of the CC as premature and have raised objections that the required documents from the CC to prove the previous and past hospital papers including reports relating to diabetes, mellitus, kidney, disease, hypertension etc. have not been supplied by the CC. However, nothing is uttered in the reply of the OPs that whether they have considered the claim of the CC or not. We feel, that the objections raised by the OPs are based on surmises and conjectures. The act of the OPs appears to be intentional and willful to deprive the CC from his genuine claim. We feel, that the OPs had the option to appoint a surveyor who could visit the hospital from where the wife of the CC took treatment. Generally it is seen that as and when such policies are floated in the market, these kind of OPs attract the customers and at the time of subscribing of policy make big promises and even claim that they can immediately pay the medical claim and people like the CC then get attracted on such type of flimsy assurances and subscribe such policies. The point in controversy before us is whether the OPs have a valid, strong and cogent reason to withhold the claim amount of the CC. We feel, that in view of the above discussion, the OPs have no proper reason to withhold the genuine claim of the CC which he had spent for the treatment of his wife. Nothing is submitted by the OPs that any inquiry was conducted by them to know that the wife of the CC was suffering from any prior ailment etc. We feel, that it was incumbent upon the OPs to conduct such inquiry or to collect record at their own and not to demand vague and absurd documents from the CC by withholding the claim amount which he had spent for the treatment of his wife. It further shows the malafide act and conduct of the OPs in withholding the claim of the OPs which is definitely a malpractice and deficiency in service on the part of the OPs. The arguments addressed by proxy counsel on behalf of the OPs do not augur well for him and we do not find any logic in the arguments. Moreover, the complainant is a senior citizen and it appears that he is being unnecessarily harassed by the officials of the OPs without any cogent and valid reasons.
6. Accordingly, the complaint is allowed. It is ordered that the OPs should pay to the CC an amount to the tune of Rs.98,582/-(Rs. Ninety Eight Thousand Five Hundred Eighty Two only) alongwith interest @ 9% per annum from the date of filing of the claim by the CC till actual payment. OPs are further burdened to pay consolidated amount of Rs.15,000/- (Rs. Fifteen Thousand only) to the CC for causing mental as well as physical harassment. Compliance of this order be made within 60 days from the date of this order. Free certified copies of this order be sent to the parties. File be indexed and consigned to record room.
Announced
November 01, 2021
(Sanjiv Dutt Sharma)
President
I agree.
(Ms. Gagandeep Gosal)
Member
