Delhi

New Delhi

CC/211/2013

Jasbir Singh - Complainant(s)

Versus

M/S. Oriental Insurance Company Pvt.Ltd. - Opp.Party(s)

06 Jun 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/211/13                                Dated:

In the matter of:

Sh. Jasbir Singh,

S/o of Late. Sh. Jaspal Singh,

R/o BF-58, BF Block, Janakpuri,

New Delhi-110058

……..COMPLAINANT

       

VERSUS

 

The Divisional Manager,

Oriental Insurance Co. Ltd.,

88, Janpath Ground Floor, New Delhi-110001

                                         ……..OPPOSITE PARTY

 

ORDER

Member: S.R Chaudhary

 

The Complainant’s deceased father Sh. Jaspal Singh, had taken a mediclaim policy 272900/48/2012/8096 covering period as per cover note 16.09.10 to 15.09.2014 as per Exh.25. The complainant was admitted in hospital on 21.07.12 for preliminary treatment and he was discharged on 29.07.12 as per treatment slip attached. The policy is already in force since 2006 to till 2014 as per policy documents attached with complaint in continuation without any break. As per bill attached Rs.45,190/- & Medanta hospitalization till for Rs.2,41,372/-. Later on OP has raised an objection on bill but it was at later stage rectified & claim submitted but OP remained silent. Ultimately a legal notice was served to OP on 17.09.12 and complaint was filed for justice.

OP in his reply filed taking the plea of “pre-existing” diseases taking poly of where as policy is already enforced since 2006 till claim arises where concept of pre-existing disease as per IRDA guidelines does not permit OP to repudiate the same which is sole deficiency and arbitrarily approach of OP to repudiate the claim without applying legal application of mind which is mount to be breach of contract deliberately.

Thus, OP is directed to pay claim amount of Rs.2,86,562/- along with 9% interest per annum from date of claim till realization. We also award compensation of Rs.75,000/-  for harassment and litigation expenses.

 The order shall be complied within 30 days of the receipt of the copy of the order; otherwise action can be taken against OP 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 06.06.2015.

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

(S.R. CHAUDHARY)                 (Ritu Garodia)

MEMBER                                  MEMBER