Delhi

New Delhi

CC/275/2022

Sanjay Kumar - Complainant(s)

Versus

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

02 Jun 2023

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-VI

(NEW DELHI), ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN,

I.P.ESTATE, NEW DELHI-110002.

Case No.CC-275/2022

IN THE MATTER OF:

Mr. Sanjay Kumar

House No. 285, Near Shiv Mandir,

Kakrola, New Delhi-110078                                                             ...Complainant

Versus

 

Bajaj Allianz General Insurance Company Limited

12^th Floor, Dr. Gopal Dass Bhawan,

28, Barakhamba Road,

Connaught Place, New Delhi-110001.                                ...Opposite Party

 

Quorum:

 

Ms. Poonam Chaudhry, President

Sh. Bariq Ahmad, Member

                                                  Date of Institution:31.10.2022

                                  Date of Order              :02.06.2023

 

ORDER

 

POONAM CHAUDHRY, PRESIDENT

 

1. The present complaint has been filed under Section 12 and 35 of the Consumer Protection Act, 1986 (in short CP Act) against Opposite Party (in short OP) alleging deficiency of services.
2. Briefly stated the facts of the case are that the complainant had taken a on line health insurance policy bearing no. OG-23-1101-8441-00000195 on 11.05.2022 from opposite party. The said policy was valid from 11.05.2022 to 10.05.2023 for the sum insured of Rs.5,00,000/- (Rupees Five Lakh).
3. It is further stated that the complainant’s Son Rahul got admitted in the Mahavir Multispecialty Hospital for treatment on 18.06.2022 and remained hospitalized till 22.06.2022. The said hospital generated the final bill of Rs.41,694/- (Rupees Forty One Thousand Six Hundred Ninety Four) which was paid by complainant. Complainant claimed the aforesaid bill amount from the opposite party, vide Claim No. OC-23-1002-8441-00005579 but the opposite party rejected the claim vide letter dated 06.12.2022.
4. It is further alleged that complainant thereafter sent a letter by speed post with all required documents and treating doctor’s letter and Pathologist certificate to the OP but no response was received form the insurance company.
5. The complainant thus having been left with no option approached this Court, hence present complaint. It is alleged that the present case is being filed within the period of limitation. The cause of action to file present case arose when the claim of the complainant was rejected by opposite party vide letter dated 06.12.2022. It is also stated the residence of the complainant is situated at “Kakrola” New Delhi, hence, this Court has jurisdiction to entertain the present complaint.
6. It is prayed that OP be directed to pay a sum of Rs.41,694/- (Rupees Forty One Thousand Six Hundred Ninety Four) to the complainant with pendentelite and future interest @ 18% p.a. from the date of repudiation of claim till realization. It is also prayed that OP also be directed to verify and produce the medical treatment record and bills of treatment of complainant’s son from 18.06.2022 to 22.06.2022. It was prayed that cost of litigation be also awarded.
7. Notice of the complaint was issued to OP, upon which OP entered appearance. However as written statement was not filed by OP within the statutory period, in view thereof, the defence of OP was stuck off vide order 22.05.2023.
8. We have heard the AR of complainant and counsel for OP and perused the record.
9. Complainant filed his evidence by affidavit. Complainant has relied upon the insurance policy, the treatment record and bills issued by Mahavir Multispecialty Hospital. Complainant has filed a copy of registration certificate of the said hospital, a copy of certificate issued by Pathologist of the hospital K.D. Gandhi and copy of certificate of treating Doctor P. Kalra. It is to be noted complainant’s son was hospitalized during the tenure of coverage of the insurance policy.
10. In view of the unrebutted testimony of complainant and the documents relied, we are of the view that complainant has succeeded in proving that OP was  guilty of deficiency of services in repudiating the claim of complainant’s son. We accordingly hold OP/Bajaj Allianz General Insurance Company guilty of deficiency of services and direct OP to pay Rs.41,694/- (Rupees Forty One Thousand Six Hundred Ninety Four) to the complainant with interest @ 9% per annum from date of filing of claim, within four weeks of date of receipt of order, failing which OP will be liable to pay interest @ 12% per annum till realization. We also direct OP to pay compensation of Rs.50,000/ (Rupees Fifty Thousand only) for mental agony and harassment  and Rs.10,000/- (Rupees Ten Thousand only) as cost of litigation to the complainant.

A copy of this order be sent to all the parties free of cost. The order be uploaded on the website of this Commission.

File be consigned to record room along with a copy of the order.

 

Poonam Chaudhry

(President)

 

 

Bariq Ahmad

(Member)