Punjab

Ludhiana

CC/15/397

Harinder kaur - Complainant(s)

Versus

National Ins.Co.ltd - Opp.Party(s)

P.s.Gumber Adv.

27 Apr 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

 

Consumer Complaint No. 397 of 25.06.2015

Date of Decision            :   27.04.2016

Harinder Kaur aged about 46 years wife of Gurminder Singh, 29, Atam Nagar, Dugri Road, Ludhiana. 

….. Complainant

                                                         Versus

1.The National Insurance Company India Limited, Corporate Regional Office: Royal Insurance Building, 2^nd Floor, 14 Jamshedji Tata Road, Church Gate, Mumbai-400020.

2.The National Insurance Company India Limited, Head Office: 3, Middleton Street Prafulla Chandra Sen Sarani, Kolkatta, West Bengal-700071.

3.National Insurance Company Limited, Ist Floor, G.T.Road, Near Atam Park, Ludhiana, through its Manager.

…Opposite parties

 

                             (Complaint U/s 12 of the Consumer Protection Act, 1986)

 

QUORUM:

SH.G.K.DHIR, PRESIDENT

MS.BABITA, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant                      :        Sh.P.S.Gumber, Advocate      

For OPs                         :        Ex-parte

 

PER G.K.DHIR, PRESIDENT

 

1.                Complaint under Section 12 of Consumer Protection Act, 1986(hereinafter in short referred to as ‘Act’) filed by complainant Smt. Harinder Kaur against Ops by alleging that she availed mediclaim policy under the name of Healthfirst Floater Policy bearing No.251100/46/12/8500001901 of OP1 by paying premium of Rs.12,537/- for the period from 28.2.2013 to 27.2.2014. This policy was a cashless policy. Complainant claims to have remained admitted in DMC, Hospital on 10.1.2014 for treatment of ailment of Thrombophelibitis and was discharged after treatment on 11.1.2014 against admission No.78999. Bill No.79441 for Rs.48,074/- was issued by the hospital authorities. As insurance policy was in vogue, so complainant lodged claim by filling claim form of Dedicated Healthcare Services TPA(India) Pvt. Ltd. That claim was not settled. Rather, complainant  was disclosed  time and again that medical record from DMC, Ludhiana is not verified. Period of more than one year has elapsed, but claim not passed and nor repudiated. Request letter was sent to DMC, Hospital, Ludhiana and thereafter, another letter sent through registered post on 19.11.2014, but no reply was received. By pleading deficiency in service on the part of OPs, prayer made for directing Ops to pay the claim amount of Rs.48,074/- with interest @24% p.a. Compensation of Rs.2 lac for harassment and litigation expenses of Rs.22,000/- more claimed. Complainant even claims to have sent legal notice dated 24.2.2015, but Ops failed to do the needful.

2.                Earlier, Sh.Pardeep Kumar Arora, Advocate appeared for OPs by filing memo of appearance on 21.8.2015, but later on, he did not file the vakalatnama and written statement, despite granting 6 opportunities. None turned up for OPs on 5.1.2016, despite calling the case more than four times till 3:10 P.M, and one adjournment was granted for 19.1.2016 for awaiting presence of OPs or their counsel. However, on the adjourned date of 19.1.2016, none appeared for OPs, despite wait and as such, OPs were proceeded against ex-parte.

3.                Complainant in her ex-parte evidence tendered her affidavit Ex.CA along with documents Ex.C1 to Ex.C25 and thereafter, her counsel closed the evidence.

4.                Written arguments not submitted but only oral arguments of counsel for complainant heard. Records gone through carefully.

5.                The insurance policy in question produced on record by the complainant as Ex.C1. Perusal of same reveals that the complainant was covered under this policy during the period from 28.2.2013 to 27.2.2014. Complainant claims to have remained admitted in DMC & Hospital, Ludhiana for treatment of Thrombophlebitis during period from 10.1.2014 to 11.1.2014. Record of admission or of prescription slips or of purchase of medicines in that respect has been produced on record as Ex.C3 to Ex.C13. Claim form Ex.C5 was submitted by the complainant along with cancelled cheque Ex.C6, despite that claim is neither repudiated nor accepted, even though complainant continued to have correspondence through email with OPs as revealed by email correspondence Ex.C14 to Ex.C16. Complainant is certainly a consumer. Action of OPs in not settling or repudiating the claim amounts to deficiency in service, particularly when the same has not been settled despite writing letter Ex.C17 to DMC & Hospital, Ludhiana through postal receipt Ex.C18 and sending legal notice Ex.C22 through postal receipts Ex.C23 to Ex.C25. Insurance company cannot keep the matter pending for more than 6 months, but the same has happened in this case and as such, in view of this deficiency in service on the part of OPs, complainant has to file this complaint resulting in lot of mental harassment. Keeping in view of these facts, compensation of Rs.5000/- for mental harassment and litigation expenses of Rs.3000/- need to be allowed with directions to OPs to settle the claim of complainant within 3 months from the date of receipt of copy of order positively.

6.                Therefore, as a sequel of the above discussion, complaint allowed ex-parte with the directions to OPs to settle the claim of complainant within 3 months from the date of receipt of copy of the order positively. Compensation for mental harassment of Rs.5000/- and litigation expenses of Rs.3000/- more allowed in favour of complainant and against OPs. Liability of OPs to pay compensation and litigation expenses will be joint and several. These payments be made within 30 days from the date of receipt of copy of order. Copies of order be supplied to the parties free of costs as per rules. 

7.                File be indexed and consigned to record room.

 

                   (Babita)                                         (G.K. Dhir)

          Member                                          President

Announced in Open Forum

Dated:27.04.2016

Gurpreet Sharma.