DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi-110016.

Case No.21/2011

Mrs. Vijaya Singh

B-1/1050, Vasant Kunj

New  Delhi-110070                                                     ……Complainant

                                                  Versus                      

1.       National Insurance Company Ltd.

          Palika Bhawan,

          Sector-13,  R. K. Puram,

          New Delhi-110066.

2.       Alankit Healthcare Ltd.

          Alankit House,

          2E/21, Jhandewalan Ext.

          New Delhi-110055.                                     ……Opposite Parties

                                                          Date of Institution          : 18.01.11                                                            Date of Order        : 02.01.16   

Coram:

Sh. N.K. Goel, President

Ms. Naina Bakshi, Member

O R D E R

Briefly stated, the case of the Complainant is that the husband of the Complainant Mr. Ajay Kumar Singh had taken a ‘Parivar Mediclaim Policy No.360900/48/08/8500001441 issued by OP No.1 covering the period from 03.11.2008 to 02.11.2009 for himself and his family members. She went for a medical check-up in October, 2009 and in the investigation it was found that she was having malignant cells and a Colposcopy test was done on 10.11.2009. Since the malignancy was there, a surgery was suggested.  The surgery was done on 21.11.2009.  However, she found that the policy had already lapsed on 02.11.2009. Her husband immediately on 11.11.2009 approached the OPs and requested them to renew the policy.  They were informed by the OPs that since there had been a gap of more than three days, therefore, the policy could not be renewed.  They were forced to take a fresh policy bearing No.360900/48/09/8500001529 by paying the premium of Rs.7508/- covering the period from 18.11.2009 to 17.11.2010. In the first week of December, 2009, she approached the OPs with her claim (Rs. 45188/- cost towards treatment and Rs. 3,000/- towards travelling expenses) but the same was rejected orally by the OPs and there has been no response in writing till date. As per the terms of medical insurance policy issued by the OPs they are bound to reimburse all medical expenses incurred by her connected with her surgery and medical treatment.  She sent a legal notice dated 13.03.2010 by registered post which was duly served upon the OPs but to no response. Hence, pleading deficiency in service on the part of OPs, the Complainant has prayed as under:-

1. Direct the OPs to reimburse the Complainant all medical expenses of Rs.48,188/- borne by the Complainant for surgery and medical treatment.
2.  Direct the OPs to pay a sum of Rs.1 lakh to the Complainant towards mental agony and physical strain caused to the Complainant.
3. Direct the OPs to pay a sum of Rs.10,000/- as cost of the proceedings.

OP No.1 in the written statement has stated that the Complainant never raised a claim with the insurance company and, hence, there could not be any deficiency in service.  The policy issued to the husband of the Complainant was subject to certain terms and conditions and the same were binding on both the contracting parties. As stated by the Complainant herself,  the Parivar Mediclaim policy being No.360900/48/08/8500001441 had lapsed on 02.11.2009 and the same was subject to certain terms and conditions. The insurance company is only responsible for providing services to its insured for and during the period of insurance cover only and not thereafter.  As such there was no deficiency in service on the part of insurance company and accordingly the Complainant is not entitled  for any compensation. OP No.1 has prayed for dismissal of the complaint with heavy cost.

OP No.2 was proceeded exparte vide order dated 14.11.2011.

OP No.3 has been given up by the Complainant on 25.05.2011.

 Complainant has filed rejoinder to the written statement of OP No.1 and has reiterated the averments made in the complaint.   According to her, her claim was rejected by the OP orally.

Complainant has filed her own affidavit in evidence.  On the other hand, affidavit of Sh. H.K. Soni, Deputy Manager has been filed on behalf of OP-1.

Written arguments have been filed on behalf of the parties.  We have heard the arguments on behalf of the parties and have also gone through the record very carefully.

 Undisputably, the Complainant had not filed the claim with the OP No.1 in writing. The complainant ought to have filed her claim with the OP-1 in writing.  Rejection of the claim by the OPs orally does not prove that the OPs had committed any deficiency in service.  No reason has been explained as to why the complainant did not lodge her claim in writing. Hence, the Complainant has failed to prove any deficiency in service on the part of OP No.1.  Therefore, we dismiss the complaint with no order as to costs.

Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations.  Thereafter file be consigned to record room.

Announced on  02.01.16.

(NAINA BAKSHI)                                                             (N.K. GOEL)                                                                                                  MEMBER                                                                        PRESIDENT

Case No. 21/11

02.01.16

Present –   None

        Vide our separate order of even date pronounced, the complaint is dismissed.    Let the file be consigned to record room.

(NAINA BAKSHI)                                                  (N.K. GOEL)                                                                                                         MEMBER                                                               PRESIDENT