Delhi

New Delhi

CC/134/2010

Madan Lal - Complainant(s)

Versus

M/S. Iffco-Tokio General Insurance Company Ltd. - Opp.Party(s)

14 Jul 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI), ‘M’ BLOCK, 1^STFLOOR,

VIKAS BHAWAN, I.P.ESTATE,

NEW DELHI-110002.

 

Case No.CC/134/10              Dated:

In the matter of:

 

SHRI MADAN LAL

R/O 100, POCKET, C-9,

SECTOR-8, ROHINI,

NEW DELHI-110085

 

 

                   ……..COMPLAINANT

         

VERSUS

1.IFFCO-TOKIO GENERAL INSURANCE COMPANY LTD.

601-604, ANSAL IMPERIAL TOWER,

C-BLOCK COMMUNITY CENTRE,

NARIANA VIHAR,

NEW DELHI-1100028

 

2. IFFCO-TOKIO GENERAL INSURANCE COMPANY LTD.

4^th FLOOR, 416-421,

NARAIN MANZIL,

23, BARAKHAMBA ROAD,

CONNAUGHT PLACE,

NEW DELHI-01

 

3.PARAMOUNT HEALTH SERVICES PVT. LTD. F-90/12, NEAR E.S.I. HOSPITAL,

OKHLA IND. AREA,

PHASE-1, NEW DELHI

 

………. OPPOSITE PARTIES

 

 

 

ORDER  [ ORAL]

 

Date of Arguments :14.07.2015

President: C K CHATURVEDI

Present: Main Counsel for complainant is not present and counsel for OP.

Arguments  heard.

The short fact of the case are that complainant has purchased medi claim Policy No.52077516 from OP-1 and complainant was admitted in Max Hospital Pitam Pura on 8.3.09 for the treatment of Urinary Bladder stone + Right UVJ Stone and discharged on 8.3.09.

Complainant submitted his claim through agent to Insurance Company and took the receiving of documents vide Annexure ‘C’.  The complainant received a query letter from TPA; OP-2 on 8.6.09 and the complainant submitted the documents again through his agent and again agent submitted the connected documents and claim paper to the OP-2 (Annexure-D).  After some time complainant made a query from OP-2 and he was told hat the claim was closed because the documents were not supplied and he has not replied the query of TPA and therefore the complaint filed.  OP in its reply reiterated the same reply of non cooperation by the complainant.  We have heard the OP and perused all relevant documents.  The record shows the complete claim form and other documents were submitted by the complainant to the Insurance Company and after that same query was required to be answered to the Hospital through TPA.   This is a serious deficiency on the part of OP. They are contesting the case for last 7 years in the Court instead of settling it, for this frivolous and flimsy behavior and imperfection of service by repudiating the claim.  OP is directed to settle the claim within 90 days after collecting all documents filed on record and contacting hospital, TPA etc.  OP is also directed to pay Rs.15,000/- as compensation for harassment, and mental trauma caused in not settling the claim inclusive of  litigation expenses.

The order shall be complied with within 30 days of the receipt of the copy of the order; otherwise action can be taken under Section 25 / 27 of the Consumer Protection Act.

File be consigned to record room.

Copy of the order be sent to the parties free of cost.

 

        Pronounced in open Court on 14.07.2015.

 

        File  consigned to record Room.

 

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

 

 (RITU GARODIA)

MEMBER