Delhi

New Delhi

CC/174/2022

Rajni - Complainant(s)

Versus

M/S. ICICI Lombard General Insurance Company Ltd. - Opp.Party(s)

16 May 2023

ORDER

 

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-VI

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

I.P.ESTATE, NEW DELHI-110002.

Case No.174 /2022       

IN THE MATTER OF:

 

 

Mrs. Rajni

RZ-65, Nand Vihar, Kakrola,

New Delhi-110078                                                       ....Complainant

 

                                      VERSUS

 

      ICICI Lombard General Insurance Company Limited

      Fourth Parsavnath Capital Tower

      Bhai Veer Singh Marg,

      New Delhi-110001                                                    ....Opposite Party

 

Quorum:

 

Ms. Poonam Chaudhry, President

Sh. Bariq Ahmad, Member

Sh. Shekhar Chandra, Member

                                                                                                                   Date of Institution:-22.07.2022                                                                                                                                                                            Date of Order   : -    16.05.2023

 

ORDER

 

POONAM CHAUDHRY, PRESIDENT

 

 

1. The present complaint has been filed under Section 12 of the Consumer Protection Act (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 online health insurance policy bearing no. 4128i/iH/167638617/00/000 dated 25.12.2019 from the opposite party. It is further alleged that the said policy was valid from 25.12.2019 to 24.12.2020 for the sum insured of Rs.5,00,000/- (Rupees Five Lakh).
3. It is further stated that the complainant got admitted in the Parth Hospital, New Delhi for treatment on 14.10.2019 and remained hospitalized till 19.10.2019. The said hospital generated the final bill of Rs.42,980/- (Rupees Forty Two Thousand Nine Hundred Eighty) which was paid by the complainant. The complainant sent all claim papers by Speed Post ED423366076in on 21.10.2019 to OP but no response was received.
4. There after complainant sent a legal notice dated 08.04.2021 to the insurance company but no response  was received. It is further alleged that the complainant has been left with no option but to approach this Court/Commission. Hence the present complaint.
5. It is also alleged that the present case is being filed within the period of limitation. The cause of action arose to file present case arose on 23.10.2019. It is further stated that the residence of the complainant is situation at “Kakrola” New Delhi as such this Court has jurisdiction to entertain the present complaint.
6. It is prayed that OP be directed to pay a sum of Rs.42,980/- (Rupees Forty Two Thousand Nine Hundred Eighty)  to complainant with pendent elite and future interest @ 18% p.a. since 21.10.2019 till realization. It is also prayed that OP be directed to verify and produce the medical treatment record and bills of treatment of complainant from 14.10.2019 to 19.10.2019.  OP be also directed to pay cost of litigation.
7. Vide order dated 19.04.2023. the defence of OP was stuck off, the same is as under:

AR of complainant states that written statement has been filed beyond the statutory period. It is stated that OP was served on 15.09.2022 but reply has been filed on 19.04.2023.

 

Section 38 Sub-Section 3 (a) of the Consumer Protection Act which relates to the period of limitation to file reply/written statement is as follows:

“(a) refer a copy of such complaint to be opposite party directing him to give him version of the case within a period of thirty days or such extended period not exceeding fifteen days as may be granted by the District Commission.

 

In this regard the Hon’ble Supreme Court has held in the case titled New India Assurance Company Ltd. Vs. Hilli Multipurpose Cold storage Pvt. Ltd. reported in 2020 (5 ) SCC 757 as under:

“Sub Section (2)(a) of Section 13 of the Consumer Protection Act provides for the opposite party to give his response ‘within a period of 30 days or such extended period not exceeding 15 days as may be granted by the District Forum’. The intention of the legislature seems to be very clear that the opposite party would get the time of 30 days, and in addition another 15 days at the discretion under the Act”.

Thus as the written statement has not been filed within the statutory period, the same cannot be taken on record. Defence of OP stands stuck off.

 

8. Complainant filed his evidence by affidavit, she relied upon the insurance policy, the treatment record and bills issued by Parth Hospital.
9. We have heard the AR of complainant and counsel for OP and perused the record.
10. It is to be noted that the treatment record and bills have been filed by complainant and copies thereof supplied to OP.

 

11. The claim of OP has not been repudiated by OP. The averments made in the complaint is that complainant sent all the claim documents to OP on 21.10.2019 but no response has been received. In view thereof we grant 4 (Four) weeks time to OP to process the claim and send the report to complainant. The complaint stands disposed off.

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                                                                                                                                       Shekhar Chandra

    (Member)                                                                                                                                               (Member)