Delhi

New Delhi

CC/115/2023

Shripal - Complainant(s)

Versus

M/S. Star Health & Allied Insurance Company Ltd. - Opp.Party(s)

12 Jul 2023

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-VI

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

I.P.ESTATE, NEW DELHI-110002.

Case No.115/2023

IN THE MATTER OF:

 

Mr. Shripal

83, Hari Vihar, Kakrola,

New Delhi-110078                                                             ....Complainant

 

VERSUS

 

Star Health and Allied Insurance Company Limited

1^st Floor, Himalaya House,

23, Kasturba Gandhi Marg,

New Delhi-110001                                                               ....Opposite Party

 

Quorum:

 

Ms. Poonam Chaudhry, President

Sh. Bariq Ahmad, Member

Sh. Shekhar Chandra, Member

 

 

                                                                                                                    Date of Institution:-28.03.2023                                                                                                                                                                           Date of Order: -      12.07.2023

 

ORDER

 

POONAM CHAUDHRY, PRESIDENT

 

 

1. The present complaint has been filed under Section 35 read with 36 of the Consumer Protection Act, 2019 (in short CP Act) read with Rule 7 of the Consumer Protection (Consumer Commission Procedure) Regulation, 2020 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. P/16129/01/005246 on 20.12.2020 from opposite party. It is further submitted that said policy was valid from 20.12.2020 to 19.12.2021 for the sum insured of Rs.5,00,000/- (Rupees Five Lakh Only).
3. It is further alleged that the complainant’s daughter Tannu Shree got admitted in the Anand Hospital for her treatment on 11.08.2021 and remained hospitalized till 16.08.2021. The said hospital generated the final bills of Rs.46,337/- (Rupees Forty Six Thousand Three Hundred Thirty Seven) which was paid by the complainant. Complainant thereafter sent all the documents to respondent but no response was received. It is alleged that complainant received a letter 10.11.2021 stating that policy has been cancelled.
4. It is further alleged the complainant having been left with no option approached this Court, hence this present complaint. It is also stated that the present case is being filled within the period of limitation. The cause of action arose to file present complaint when the claim of the complainant was rejected by opposite party.
5. It is prayed that opposite party be directed to pay a sum of Rs.46,337/- (Rupees Forty Six Thousand Three Hundred Thirty Seven) with pendentelite interest @ 18% per annum from 21.08.2021 till the actual realization. The opposite party be also directed to pay a sum of Rs.3,00,000/- (Rupees Three Lakh) as damages/compensation for mental agony, harassment and inconvenience suffered by the complainant due to deficiency in service of the opposite party. Opposite party be also directed to pay a sum of Rs.1,00,000/- (Rupees One Lakh) towards cost of litigation.  
6. Notice of the complaint was issued to OP, upon which OP entered appearance and file written statement along with application for condonation of delay. The defence of OP was stuck off vide order dated 06.06.2023. as written statement was not filed within the statutory period.
7. Complainant filed his evidence by affidavit reiterating therein the averments made in the complaint. Complainant filed the treatment record, the bills issued by Anand Hospital.
8. We have heard the AR of complainant and counsel for OP and perused the record.
9. In view of the unrebutted testimony of complainant and the documents relied upon by complainant, we are of the view that complainant has succeeded in proving that OP was guilty of deficiency of services. The onus to prove reasons for repudiation was on OP. OP failed to show that repudiation was justified and was in terms of the terms and conditions of the policy. We accordingly hold OP/Star Health and Allied Insurance Company Limited guilty of deficiency of services and direct OP to pay Rs.46,337 /- (Rupees Forty Six Thousand Three Hundred Thirty Seven) 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.25,000/ (Rupees Twenty Five 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/provided 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)