Advocate P. Narayan for the complainant

Advocate Sanjit Shenoy for the Opponent

Per Hon’ble Shri. Mohan Patankar, Member

                                     JUDGMENT

                                Dated 5^th July, 2014

        The present complaint is made against the New India Assurance Co. Ltd. for deficiency in service u/s 12 of the Consumer Protection Act, 1986. Brief facts are as follows-

[1]            Complainant has purchased ‘Doctors Indemnity Insurance Policy’ from the Opponent; for the period from 19/10/1995 to 18/10/1996. There was a complaint before the Hon’ble National Consumer Disputes Redressal Commission against the complainant; for awarding claim of Rs.1,50,00,000/-. Complainant along with there other doctors were under charge. The matter was finally disposed of by the Hon’ble National Consumer Disputes Redressal Commission on 9/2/2005. The complainant had approached Opponent and appointed an Advocate to defend the case. Complainant has forwarded the bill incurred for the fees and expenses to the Opponent and claimed half of the bill amounting Rs.1,60,000/-. Complainant had sent notice to the Opponent on 29/1/2004. Opponent by reply denied the claims. It is contended by the complainant that the purpose of taking indemnity policy from the Opponent is not thus served. It had put the complainant into financial losses and mental harassment. Opponent by denying the claim of expenses, rendered deficiency in services. Therefore, the present complaint is filed.

[2]            Opponent in his reply has stated that, the complainant caused breach to the terms of conditions of the policy; as a result denied the claims. Opponent has contended that the appointment of particular Advocate to defend the complainant was not preapproved by the Opponent. Complainant has also failed to inform any details regarding developments of the case and details of proceedings of the case to the Opponent. These facts were communicated to the complainant initially by letter on 25/1/1996. Complainant failed to communicate with Opponent until 21/12/2001 i.e. after lapse of six years. This was also held non compliance of terms and conditions of the indemnity policy. On these grounds the claims of complainant were repudiated.

[3]            After considering the pleadings of both parties, scrutinizing the documentary evidence and hearing the argument, following points arise for the determination of this Forum. The points, findings and reasons thereon are as follows-

Reasons-

As to the Point Nos. 1 to 3-

[4]            Complainant took the policy for medical indemnification from the Opponent. It is evident that the complainant was then abided by the terms and conditions of the policy. Condition No.8.1 states that every information, pertaining to any claim against the insurer to be forwarded to the company immediately.  This information includes every claim, process, documents. The complainant has informed about the complaint filed against him before the Hon’ble National Consumer Disputes Redressal Commission by letter dated 2/1/1996. In reply to this Opponent again brought attention of the complainant to the conditions of policy by letter dated 25/1/1996. In this letter Opponent requested the complainant to inform material progress of case periodically and copy of defences taken by all doctors i.e Opponents in this case. It is the fact that complainant has not proved that this condition was complied by him. Complainant after six years submitted his claim of Rs.1,60,000/- before the Opponent. There was no communication from the complainant as informed by the Opponent. Thus, complainant has failed to prove deficiency in service on the part of Opponent. This Forum, therefore, is of the opinion that the Opponent has not caused deficiency in service, and hence, cannot be held liable for the same.

                In the light of the above discussion, this Forum answers points accordingly and pass following order-

                                   :- ORDER :-

1. Complaint is dismissed.
2. No order as to costs and compensation.
3. Both parties are directed to collect the sets which are provided for the Hon’ble Members within one month from the date of order. Else those will be destroyed.

        Copy of order be supplied to both the parties free of cost.

Place – Pune

Date – 05/07/2014