Haryana

Yamunanagar

CC/128/2010

Neeraj Kumar Kashyap S/o Hukam Chand - Complainant(s)

Versus

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

Manoj Khurdi

29 Feb 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                         Complaint No… 128  of 2010.

                                                                                         Date of institution: 17.02.2010.

                                                                                         Date of decision: 29.02.2016

Neeraj Kumar Kashyap aged about 35 years son of Sh. Hukam Chand, resident of Village Khurdi, Tehsil Jagadhri, District Yamuna Nagar.    

 

                                                                                                                                         …Complainant.

                                                          Versus

 

National Insurance Company Limited through Branch Manager, Branch Jagadhri Road, Yamuna Nagar.

    

                                                                                                                                        …Respondents 

 

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

 

Present:  Sh. Manoj Khurdi, Advocate, counsel for complainant.  

                Sh. V.K.Sharma, Advocate, counsel for OP.              

             

 

ORDER

 

1.                     Complainant Neeraj Kumar has filed the present complaint under section 12 of the Consumer Protection Act praying therein that respondent (hereinafter referred as OP) be directed to pay a sum of Rs. 1,00,000/- as compensation alongwith interest at the rate of 24% per annum from the date of application, till realization.  

2.                     Brief facts of the present case, as alleged by the complainant, are that  he took a personal accident insurance policy bearing cover note No. 139153 dated 22.02.2008 having policy No. 420402/42/07/8100000365 valid from 21.03.2008 to 20.03.2009 from OP. During the currency of insurance policy, complainant met with an accident on 01.06.2008 while doing his work of carpenter due to which the hands of the complainant were badly injured and due to the said injuries, the complainant, remained admitted in Goyal Hospital, Jagadhri from 1.6.2008 to 7.6.2008 where he was operated and remained under treatment as OPD patient for several months. The complainant spent a huge amount i.e. more than 50,000/- (fifty thousand) on his treatment and become permanent disabled. The said accident was reported to the office of OP and filed regular claim and completed all the legal formalities but despite completing all the legal formalities the OP are putting off the matter on one pretext or the other and refused to pay any compensation to the complainant. Hence, there is a great deficiency in service on the part of OP. Hence this complaint.

3.                     Upon notice, OP appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable, complainant not come to this Forum with clean hands, there is no deficiency in service and complainant has failed to furnish the requisite documents to the OP company inspite of various letters, reminders and telephonic requests till today and on merit it has been mentioned that OP immediately on receipt of the information of the alleged accident from the complainant requested him to supply the requisite documents as mentioned in the letter dated 9.6.2008 (Annexure R-8) but the complainant failed to supply the same. The Op again wrote a letter dated 26.6.2008 (Annexure R-3) and ultimately sent third and final reminder dated 7.8.2008 (Annexure R-4) but the complainant instead of supplying the required documents to the OP, filed the present false complaint. As the complainant failed to submit the requisite documents, hence the claim of the complainant was rightly repudiated as “No Claim”. As such, there is no deficiency in service and lastly prayed for dismissal of complaint.

4.                     To prove the case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CX and documents such as Photo copy of insurance cover note as Annexure C-1, Photo copies of medical bills Annexure C-2 to C-39 including the OPD/Prescription slips of Goyal Hospital Annexure C-23 to C-25 and Discharge slip C-32, Bed Rest Certificate as Annexure C-33 and Hospital Bill Annexure C-34 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for the OP tendered into evidence affidavit of Sh. V.K.Sethi, Assistant Manager, NIC as Annexure RX and documents such as Certified copy of Insurance policy as Annexure R-1, Photo copy of letter dated 9.6.2008 as Annexure R-2, Photo copy of letter dated 26.6.2008 as Annexure R-3, Photo copy of letter dated 7.8.2008 as Annexure R-4,Photo copy of investigation report dated 25.7.2008 of Sandeep Kumar, Surveyor & Loss Assessor as Annexure R-5 and closed the evidence on behalf of OP.   

6.                     We have heard the counsels of both the parties and have gone through the pleadings as well as documents placed on the file carefully and minutely. The counsel for the complainant reiterated the averments mentioned in the complaint and prayed for its acceptance whereas the counsel for OP reiterated the averments made in the reply and prayed for dismissal of complaint.

7.                     It is not disputed that the complainant took a personal accident policy from the OP vide cover note No. 139153 having policy No. 402407/42/07/8100000365 dated 22.2.2008 valid from 21.3.2008 to 20.3.2009( Annexure R-1). It is also not disputed that complainant met with an accident while doing his work of carpenter and remained admitted in Goyal Hospital from 1.6.2008 to 7.6.2008 which is evident from discharge slip of Goyal Hospital (Annexure C-32) and Bed Rest Certificate (Annexure C-33).  The only plea of the OP insurance company is that complainant has failed to furnish the requisite documents to the OPs insurance company inspite of various letters dated 9.6.2008 (Annexure R-2), letter dated 26.6.2008 (Annexure R-3) and final reminder dated 7.8.2008 (Annexure R-4) and telephonic requests till today. Hence, there is no deficiency in service or unfair trade practice on the part of insurance company.

8.                     On the other hand, counsel for the complainant argued at length that genuine claim of the complainant has been wrongly repudiated by the Op Insurance company and draw out attention towards contents of para No.5 of the complaint wherein it has been mentioned that complainant filed regular claim with the OP and completed all the legal formalities but despite completing all the legal formalities the Op putting off the matter on one pretext or the other and further argued that only a sum of Rs. 13540/- had been spent on the treatment of complainant including the hospital bills of Rs. 8500/- (Annexure C-35) which is duly evident from the medical bills and prescription slips/OPD slips Annexures C-2 to C-35.

9.                     We have minutely perused all the bills and prescription slips including OPD slips which seems to be genuine as all the bills are of petty amount except hospital bills of Rs. 8500/- which also seems to be genuine as the complainant remained under treatment for a period of 7 days w.e.f. 1.6.2008 to 7.6.2008 and was operated for repair of veins etc. The plea of the OP Insurance Company that complainant has not submitted the requisite documents and in this regard the OPs Insurance company wrote several letters is not tenable as it is evident from the report dated 25.7.2008 of Sandeep Kumar, Surveyor & Loss Assessor (Annexure R-5) that complainant lodged his claim with the OP Insurance Company immediately i.e. within 15 days because the Surveyor/Loss Assessor specifically mentioned in the opening para of his report that on receiving the intimation from the office of OP Insurance Company on 26.6.2008 he visited the residence of the insured on 1.7.2008 and further verified the facts from the Goyal Hospital which was found in order. Further, the Surveyor has specifically mentioned in his report that claim form given to the insured and he took photographs of the complainant. So, the OP cannot said that complainant has not lodged any claim with them. Even from the other angle also as the complaint of the complainant is pending since its filing i.e. 17.2.2010 all the photo copies of the prescription slip/OPD slip including all the bills has been filed with this complaint and photo copies of the same were supplied to the OP Insurance Company but the Op Insurance Company failed to verify from the concerned hospital or chemist shops and failed to file any adverse evidence to rebut the version of the complainant. As the OP Insurance Company has not filed any cogent evidence to rebut the version of the complainant or to prove that the bills submitted by the complainant are fake/manipulated one. Hence, we have no option except to partly accept the complaint of complainant. 

10.                   Resultantly, we partly allow the complaint of complainant and direct the OP Insurance Company to reimburse the medical claim amount of Rs. 13540/- to the complainant alongwith interest at the rate of 7% per annum from the date of filing of complaint till its realization and further to pay a sum of Rs. 1000/- as litigation expenses. Order be complied within a period of 30 days after preparation of copy of this order failing which complainant shall be entitled to invoke the jurisdiction of this Forum as per law. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 29.02.2016.

                                                                                                (ASHOK KUMAR GARG)

                                                                                                PRESIDENT

 

 

 

                                                                                                (S.C.SHARMA)

                                                                                                MEMBER