Complainant Devid Masih vide the present complaint filed U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short The Act) for issuance of the necessary directions to the opposite party to pay Rs.70,000/- together with equal amount as compensation and Rs.50,000/- as special damages and Rs.10,000/- as legal charges from the opposite party alongwith interest @ 18% p.a. from the date of accident ill payment and costs of Rs.10,000/- to him, in the interest of justice.

2.          The case of the complainant in brief is that he got a policy from the opposite party vide policy No.361201/42/13/82000000024 for the period from 22.4.2013 to 21.4.2014 for covering risk of life and injury for a sum of Rs.4,00,000/-. Unfortunately, he met with an accident when he was going to perform his duty as guard at ATM of OBC at Dhariwal District Gurdaspur on his motorcycle on 20.6.2013 in the evening. He intimated the opposite party vide registered letter No.EP 2297663771N dated 26.6.2013 about the accident and as well through email message. After the accident, he was admitted in Mission Hospital, Dhariwal and as he suffered injury to his jaw and as well to his right shoulder and the treatment of his jaw was not available in the said hospital and he was taken to Dental Medical Hospital Amritsar where the treatment of his jaw was carried out by the doctors. Front portion of his teeth were fractured and operation was performed on him and as a result of entire treatment had to spent about Rs.70,000/-. He has next pleaded that as per the policy he is entitled to be compensated for the expenses incurred by him for the treatment of the injury suffered by him. A legal notice dated 15 April 2014 was also issued to the opposite party to compensate him but of no use. Thus, there is deficiency in service on the part of the opposite parties. Hence this complaint.

3.         Upon notice, the opposite party insurer appeared through its counsel and filed its written version taking the preliminary objections that the complainant has no cause of action to file the present complaint; the complainant has no locus standi to file the present complaint and the claim has not been decided and has been made no claim. The complainant failed to provide the relevant documents which are very much necessary for the finalization of claim. The letters in this regard have been sent to the complainant many times, but the complainant failed to provide the relevant documents. The letter dated 22.8.2014 has been sent to the complainant in which the list of documents has been given, but the complainant has not provided the relevant documents as demanded. The letter dated 8.10.2014 has again been sent in this regard, in which the same documents again demanded, but no document has been provided. After that the final reminder dated 18.11.2014 has again been sent to the complainant in which again the documents has been demanded but in spite of final reminder no document has been provided. By the letter dated 18.11.2014 the final reminder has been given in which the request has been made to submit the relevant documents within 7 days. In spite of that letter no document has been sent due to which the claim has been made as “NO Claim” So the complaint is premature as the claim has never been decided on merits. On merits, it was submitted that it was wrong and specifically denied that complainant met with an accident when he was going to perform his duty as Guard at ATM of OBC, Branch Dhariwal District Gurdaspur on his motorcycle on 20.6.2013 in the evening. The story made by the complainant was wrong. It was also denied that the claim has been duly intimated on 26.6.2013. The complainant may be put to strict proof regarding the timely intimation to the concerned office. As already stated the claim has already been made “No Claim” due to non-providing of the relevant documents, which are required for the finalization of claim. The complainant failed to provide the relevant documents inspite of the letters dated 22.8.2014, 8.10.2014 and 18.11.2014. So, it was the complainant who was at fault and failed to fulfill his part of obligation. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.           Complainant tendered into evidence his own affidavit Ex.CW-I/A along with the other documents exhibited as Ex.CW1 to Ex CW21 and closed the evidence.

5.         On the other hand, Sh.Subash Chander  A.O. of opposite party tendered into evidence his own affidavit Ex.OP1, alongwith the other documents Ex.OP2 to Ex.OP10 and closed the evidence.

6.      We have examined all the documents/evidence produced on record and have also duly considered and perused the arguments duly put forth by the learned counsels for both the sides, while adjudicating the present complaint. We find that the OP insurers have admittedly not decided the impugned medical-insurance road-side accident-claim on merits but have simply deferred/ set-aside the same as ‘no-claim’ on account of the non-submission of the demanded documents by the complainant who has also somehow failed to produce any ‘evidence’ on record of having submitted the requisite documents to the OP insurers as demanded by them. Presently, we find that the complainant has produced on the records of the complaint proceedings all the documents requisite to decide and settle the insurance claim and the OP insurers have also been duly supplied with copies of the same and as such the claim can be expeditiously settled, now.

7.       In the light of the all above, we are of the considered opinion that the present complaint shall be best disposed of by directing the OP insurers to decide and settle the pending claim in question in terms of the related Policy expeditiously but certainly within 30 days of the receipt of the copy of these orders. The OP insurers shall be at liberty to procure certified copy of any document desired for settling the claim as available on the complaint file in accordance with the applicable rules etc and the complainant shall also provide them the necessary assistance in his own interest.   

8.       Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

                                                                            (Naveen Puri)

                                                                                     President   

Announced:                                                              (Jagdeep Kaur)

December, 24 2015                                                         Member

*MK*