DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION SAS NAGAR (MOHALI)

Consumer Complaint No.400 of 2017

                                                Date of institution:  07.06.2017                                                      Date of decision   :  09.12.2021

Inderjit Singh Chhabra R/o House No. 1162, Phase-9, Sector 63, Mohali.

….Complainant

Versus

National Insurance Company Ltd, SCF No.40-41, Ph-5, Mohali (Punjab) through its Manager.

                                                      ……..Opposite Party

Complaint under Consumer Protection Act.

Quorum:   Shri Sanjiv Dutt Sharma, President.

                Ms. Gagandeep Gosal,  Member

Present:    Complainant along with counsel Sh. Sudhir Kumar Pandey.

              Sh.Sanjeev K Arora, cl for the OP.

Order dictated by :-  Shri Sanjiv Dutt Sharma, President.

Order

               The present complaint is filed under the Consumer Protection Act, by the complainants (hereinafter referred to as ‘the CC’ for short) against the Opposite Party (hereinafter referred as ‘the OP’ for short), on the ground that the CC has subscribed the policy of the OP by paying the premium to the tune of R.32,154/-. The policy was insured for an amount of Rs 4 lacs each for the CC and his wife. The policy bears no. 404700/48/14/8500000345. Admittedly the policy of the  daughter and son of the CC  was for Rs. 2,00,000/-. The daughter of the CC was admitted in PGIMER, Sector 12, Chandigarh on 24.08.2015. There was no dispute regarding ailment of the daughter of the CC.  On 05.04.2016, the CC has filed claim of Rs. 2,19,264/- with the OP. The OP has rejected the claim of the CC pertaining to the treatment of the daughter  of the CC who was suffering from the cancer

              Thus, alleging deficiency in service  on the part of the OP, the CC has sought the following reliefs:

1. OP be directed to reimburse the medical claim of Rs. 2,19,264/- along with interest @ 18% from the date of filing of medcial claim

2.To pay  Rs. 5,00,000/- for mental agony and harassment and Rs. 50,000/- as litigation expenses.

2.         In reply, the OP has averred that the OP is ready to settle the claim by paying an amount of Rs.1,47,500/- as per terms and condition of the medi claim insurance policy. Further the OP has prayed for the dismissal of the complaint.

3.             The CC has tendered in evidence his affidavit Ex CW1/ and documents Ex C-1 to Ex C-3. On the other hand, the OP has tendered in evidence affidavit  of Sh. Sanjeev Khurana, Deputy Manager ex OP1/1.

4.     We have heard Ld.counsel for the parties  and have gone through the record minutely.

5.     There is no counter claim or evidence submitted by the CC on the point that the amount of Rs.1,47,500/- is on the lesser side and is not sufficient. The OP has already agreed to pay an amount of Rs.1,47,500/- as per terms and conditions of the policy but the same has not been paid to the CC till date.   

6.      In view of the written version and affidavit  of Sh. Sanjeev Khurana, Deputy Manager filed by the OP, the present complaint is  partly allowed. The OP is directed to pay an amount of Rs. 1,47,500/- along with interest @ 9 % P.A. from the date of filing of the present complaint till its realization. The OP is further burdened  to pay a consolidated amount of compensation to the tune of Rs. 20,000/-.   Free certified copies of this order be sent to the parties.   File be indexed and consigned to record room.

Announced

December,09, 2021

                                                                (Sanjiv Dutt Sharma)

                                                                President

                                                       I agree.

(Ms. Gagandeep Gosal)

Member