Delhi

New Delhi

CC/403/2010

Madhu Rani Gautam - Complainant(s)

Versus

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

23 Mar 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/403/10                                                                                                                                                                                Dated:

In the matter of:

Smt. Madhu Rani Gautam,

W/o Sh. H.S Gautam,

R/o I-2/56, Sector-16, Rohini, Delhi-85

 

……..COMPLAINANT

       

VERSUS

1. The Oriental Insurance Co. Ltd.,

        CBO-16, New Delhi

        Jeevan Vihar Building, 3^rd FL, Sansad Marg,

        New Delhi-110001

 

2. M/s. Genins India Ltd.,

        (M/s. Genins India TPA Ltd.)

        Through its Manager,

        D-60, Sector-2, Noida – 201303

 

                         ………. OPPOSITE PARTY

 

ORDER

President:  C.K Chaturvedi

        The grievance of deficiency against OP is in respect of denial of medical expenses incurred by complainant for her daughter under a medi claim policy issued by OP, which covered her family, and three children w.e.f 16.07.08 to 15.07.09.

        It is alleged that her daughter Hanish was admitted in St. Stephen Hospital on 14.04.09, on 17.04.09 and they has to spend Rs.7,955/- as her treatment, and all original documents were submitted to OP vide CW1/B2, CW1/C. The OP repudiated the claim only on the ground that the claim was submitted later and not within 7 days of discharge as per terms 5-5 of the policy.

We have considered the reply of OP, which is reiteration of denial due to late submission. There is no other dispute. In our considered view, the OP has just taken shelter of a technical nature of objection to deny the claim, without any substance. Such a rule cannot be absolute and provides for waiver, and is also unreasonable, as per a patient after discharge, is normally not fit to take up such matter immediately, and in any case since its TPA is in picture, OP has all means to settled the claim forthwith.

        We hold denial of claim mala fide, arbitrary and just to harass the complainant, who is advocate and has missed Court hearing to pursue this small claim and had to litigate with OP.

        We take a serious view of this functioning and direct OP to pay the bills of Rs.7,955/- with 12% interest from date of submission of claim and we award punitive damages of Rs.35,000/- to complainant inclusive of litigation expenses for wrongful denial against policy laid down by IRDA, which has condemned restriction for technical reasons.   

The order shall be complied 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 23.03.2015.

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

(S.R. CHAUDHARY)                 (Ritu Garodia)

MEMBER                                  MEMBER