Delhi

North East

CC/2/2023

Kushal Garg - Complainant(s)

Versus

National Insurance Co. Ltd. - Opp.Party(s)

16 Jan 2023

ORDER

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GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No.02/23

 

In the matter of:

 

	Sh. Kushal Garg S/o Sh. Satish Kumar Garg R/o X-3/2, Yamuna Vihar, Delhi-110053	Complainant
	Versus
	National Insurance Official Address, New Delhi, Kashmere Gate Branch, 1566/3, Church Raod, Kashmere Gate, New Delhi-11006, India	Opposite Party

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

 

ORDER

      Anil Kumar Bamba, Member

The Complainant has filed the present complaint under Section 35 of the Consumer protection Act, 2019.

1. The case of the Complainant that he is the holder of Health Insurance with the Opposite Party having Policy No. 360401502210000735 since 2022. The Complainant submitted that on 04.08.22 his wife named Divya Garg started feeling ill and the Complainant had admitted his wife in Panchsheel Hospital, Yamuna Vihar, Delhi-110053. While the admission of his wife in the said hospital, he had deposited Rs. 10,000/-. Dr. named Deepti Gupta treated his wife and all tests were conducted as per her recommendation. The wife of the Complainant was admitted for two days in the said hospital and it incurred a bill of Rs. 21,236/-. The Complainant visited the Opposite Party for releasing the claim or bill of the hospital but they have told him to wait and after some hours they told the Complainant to pay the bill in cash. The Complainant had paid his bill in cash and the Complainant also had hospital receipt. The Complainant called Opposite Party many times and submitted all his papers regarding the claim but the Opposite Party did not release his claim. Hence, this shows deficiency on the part of Opposite Party. The Complainant has prayed for Rs. 21,236/- i.e. the bill amount and             Rs. 50,000 on account of mental harassment.
2. We have heard the Complainant on the point of admission and we have also perused the file.  As per the documents submitted by the Complainant, he had purchased Health Insurance Policy from the Opposite Party on 04.08.22 which was valid up to 03.08.23. The Complainant wife admitted to the Hospital on 04.08.22 i.e. the date of commencement of the said policy. As per repudiation letter of the Opposite Party, first 30 days waiting period ( Exclusion 03(a) ) expenses related to the treatment of any illness within 30 days from the policy commencement shall be excluded except claim arising due to an accident. Since, in this case Complainant did not produce any material along with his complaint regarding his case is not covered under waiting period of 30 days, therefore,  there is not a deficiency of service on the part of the Opposite Party.
3. In view of above discussion, we did not see any ground to admit the complaint. The complaint is dismissed.
4. Order announced on 16.01.23.

Copy of this order be given to the Complainant free of cost.

File be consigned to Record Room.

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma) President