Delhi

New Delhi

CC/1321/2009

Kishori Lal - Complainant(s)

Versus

M/S. Bajaj Allianz General Insurance Company Ltd. - Opp.Party(s)

11 Mar 2019

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.1321/2009                                                                                                                                       Dated:

In the matter of:

Mr. Kishori Lal,

R/o F 36, Gali No.5,

West Chander Nagar, Delhi-110051.

                 ……..COMPLAINANT

VERSUS

Bajaj Alliance Insurance Co. Ltd.

C-31/32, 1^st Floor,

Connaught Place,

      New Delhi-01.

Opposite Party.

 

ARUN KUMAR ARYA, PRESIDENT

                

ORDER

       

The complainant has filed the present complaint against the OP under section 12 of Consumer Protection Act, 1986.  The gist of the complaint is that on 7.10.2007, the complainant purchased a mediclaim  policy bearing No.0066762250 for a sum insured Rs.60,000/- from OP and paid a premium of Rs.500/-.  It is stated that only a computerized policy was given without  any terms and condition to the complainant.

2.     In the month of November 2007, the complainant met with an accident and he was admitted in the Ganesh ortho trauma medical.   The complainant lodged the claim with OP for reimbursement of claim of  Rs.65,363/- incurred by him for his treatment.  The complainant has sent all the original bills/copies and discharge certificate for processing the claim. Since, no response was received from the office of OP,  the complainant personally visited the OP’s office and made a request for settling  the claim. The officer of OP assured him that within a short period the claim would be processed but till date nothing has been done by the OP.  Complainant, therefore, approached this Forum for redressal of his grievance.

3.     Complaint has been contested by OP.  In its written statement,  OP stated  that the complainant had opted for a New Family Gain product of OP which is not a mediclaim policy as claimed by the complainant.    As per policy terms and conditions in this policy, hospital cash benefit rider has been designed to pay towards reimbursement of hospital stay i.e. room rent charges only as a result of injury, sickness or diseased and does not cover medical expenses incurred during the stay.  It is stated that a claim for hospital cash benefit has been made by the complainant before the OP, pursuant to which the claim was settled for an amount of Rs.240/- which was paid to the complainant on 15.4.2008 vide POD:632472223.  It is further stated that as per the terms and conditions of the policy, if the customer was not satisfied with the policy, the customer had an option to return the policy within 15 days  from the receipt of policy.  But complainant did not do the same, it clearly shows that the customer was satisfied with the policy, further, further prayed for dismissal of complaint.

4.     Both the parties have filed their evidences  by way of affidavit,

5.     We have heard argument advance at the Bar and have perused the record.

6.     Perusal of the file shows that Bajaj Allianz New Family Gain Policy was issued to the complainant, which is not the  mediclaim policy.  The policy covered the rider i.e. hospital cash.  The OP Insurance Co. as per policy terms and conditions of  hospital i.e. cash benefit rider which  has been designed to pay towards reimbursement of hospital stay  settled the claim of the complainant  for an amount of Rs.240/- which was paid to the complainant on 15.4.2008 vide POD:632472223.   

7.     In view of the above discussion and after going though the policy documents, we are of the considered opinion that the policy in question is not a medicalim one, hence, the claim was rightly settled by the OP Co.  It is alleged by the complainant that he had not received a sum of Rs.240/-.  We therefore, direct OP to pay to the complainant a sum of Rs.240/- with this observation, the present complaint is disposed off.  File be consigned to Record Room.

 A copy each of this order each be sent to both parties free of cost by post. This final order be sent to server (www.confonet.nic.in ). File be consigned to Record Room.

Announced in open Forum on 11/03/2019. 

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

 

(NIPUR CHANDNA)                                                  (H M VYAS)

       MEMBER                                                                MEMBER