District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 128/2022
Date of Institution:07.03.2022.
Date of Order:.07.07.2023.
Shri Mohan S/o Shri Sonhpal R/o village Sagarpur, Faridabad.
…….Complainant……..
Versus
Aditya Birla Health Insurance Co. Ltd. Address:- Regd. Office 9th floor, tower 1, One Indiabulls Centre, Jupiter Mills Compound, 841, Senapati Bajat Marg, Elphinstone Road, Mumbai – 400 013.
…Opposite party
BEFORE: Amit Arora……………..President
Indira Bhadana………….Member.
PRESENT: Sh. Shubham Bhardwaj, counsel for the complainant.
Ms. Levanshi Mangla, counsel for opposite party.(Defence struck off vide order dated 13.12.2022)
ORDER:
The facts in brief of the complaint are that the complainant had purchased a health insurance policy vide policy No. 13-20-0103633-00 from the opposite party. The complainant had the premium amount upto date to the above noted opposite party insurance company. Before or at the time of purchase of above noted policy the insured person i.e. complainant, was in healthy sate of condition without any disease or ailments, if any, already disclosed the above noted opposite party company. The complainant S/o Shri Sohnpal, insured vide policy No. 13-20-0103633.00 was admitted from dt. 2.7.2021 to 6.7.2021 in Sun Shine Hospital Hospital, Sector-64, Faridabad. As per course and diagnosis in hospital insured i.e. complainant was admitted with C/o fever vomiting, pain, difficulty in passing urine from last 4 days, headache & bodyache having high grade fever 103 degree farnehite. The total amount spent by complainant on payment of bills of the hospital was Rs.47371/- from his own pocket. The total bill amount of Sun Shine Hospital, sEctor-64, Faridabad, where complainant was admitted from 2.7.2021 to 6.7.2021 was of Rs.47371/- only as per details of the bills. The complainant as per terms and conditions of insurance policy had covered above noted diseases in its health insurance cover and despite that, even after several request by the complainant, opposite party did not pay the insured amount to the complainant. The complainant sent legal notice to the opposite party but all in vain. The aforesaid act of opposite party amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite party to:
a) pay Rs.47371/- alongwith interest 18% on the above noted claim amount shall be made in favour of complainant and against opposite party.
b) pay Rs. 21,000/- as compensation for causing mental agony and harassment .
c) Any other relief which the court deems fit.
2. The case was fixed for filing reply on behalf of opposite party. Reply on behalf of opposite party not filed. Learned counsel for opposite party appeared in person before the court and stated that “I have no objection if the defence struck off on behalf of opposite party/Aditya Birla”. Heard. In view of the statement of the counsel for the opposite party, defence on behalf of opposite party was hereby struck off vide order dated 13.12.2022.
3. The parties led evidence in support of their respective versions.
4. We have heard learned counsel for the complainant and have gone through the record on the file.
5. In this case the complaint was filed by the complainant against opposite party–Aditya Birla Health Insurance Co. ltd. with the prayer to: a) pay Rs.47371/- alongwith interest 18% t on the above noted claim amount shall be made in favour of complainant and against opposite party. b) pay Rs. 21,000/- as compensation for causing mental agony and harassment . c) Any other relief which the court deems fit.
To establish his case the complainant has led in his evidence, Ex.CW1/A – affidavit of Mohan, Ex.CW/B 1 to 38 page (colly) Claim Form- Part A,, Claim form – Part B, insurance policy,, Adhaar card,, cash memos/estimate, Final Bill, Discharge summary,, Detail of medicine break up, tests, Ex.CW/C/1 to 4 page (colly) letter dated 6.2.2023regarding required documents.
6. There is nothing on record to disbelieve and discredit the aforesaid evidence of complainant. Learned counsel for opposite party appeared in person before the court and stated that “I have no objection if the defence struck off on behalf of opposite party/Aditya Birla”. Heard. In view of the statement of the counsel for the opposite party, defence on behalf of opposite party was hereby struck off vide order dated 13.12.2022.
7. After going through the evidence led by the complainant as well as the statement of Counsel for opposite party, the Commission is of the opinion that the complaint is allowed.
8. Opposite party is directed to :
a) pay Rs.47,371/- to the complainant alongwith interest @ 6% p.a. from the date of filing of complaint till its realization.
b) pay Rs.2200/- as compensation for causing mental agony and harassment.
c) pay Rs.2200/- as litigation expenses.
Compliance of this order be made within 30 days from the date of receipt of copy of this order. Copy of this order be sent to the parties concerned free of costs. File be consigned to the record room.
Announced on: 07.07.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
