Haryana

Ambala

CC/373/2021

Manisha Mittal - Complainant(s)

Versus

New India Assurance Co Ltd. - Opp.Party(s)

Sourabh Ahuja

24 Sep 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	373 of 2021
Date of Institution	:	07.12.2021
Date of decision	:	24.09.2024

Manisha Mittal W/o Sunil Mittal R/o H.No.10564/6 old post office Road Ambala city.

          ……. Complainant

Versus

New India Assurance Co. Ltd. Through its manager, Civil Lines Arya Chowk Above OBC Bank, Ambala District Ambala.

                                                                                   ….….  Opposite party

Before:        Smt. Neena Sandhu, President.

                    Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:      Shri Bhupesh Bharara, Advocate, legal aid counsel for the  complainant.

                   Shri Jitender Sharma, Advocate, counsel for the OP.

Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘OP’) praying for issuance of following directions to it:-

1. To pay the claim amount of Rs.1,35,000/- alongwith interest @18% per annum, from the date of receipt of part payment of Rs.80,000/-.
2. To pay Rs.1,00,000/- as compensation for the mental agony and physical harassment suffered by the complainant.  
3. To pay cost of litigation to the tune of Rs.55000/-
4. Grant any other relief which the Hon’ble Commission may deems fit.

 

2.             Brief facts of the case are that the complainant is the policy holder of policy number 35350242190100000393 namely personal accident insurance of the OP and she got it renewed from time to time by paying the premium of Rs.2018/-. The above policy is valid from 14.11.2019 to 13.11.2020. Unfortunately on 09.11.2020 the complainant met with an accident as she slipped and fell. She was admitted to J.P. Surgical Hospital on 09.11.2020 and diagnosed fracture of proximal humerous and shaft humerous of left side. She was got operated for the same and discharged from the hospital on 15.11.2020. After discharge, she continuously went for treatment till 31.05.2021 and was advised to take rest of twenty seven weeks. She lodged claim with the OP for an amount of Rs.135000/- incurred on her treatment but the OP approved only an amount of Rs.80000/-,  vide letter dated 23.09.2021. Number of requests made by the complainant to make payment of full claim amount to the OP, did not yield any result. Hence, the present complaint.
3.           Upon notice, the OP appeared and filed written version wherein it raised preliminary objections to the effect that this complaint is not maintainable; the complaint is ex-facie misconceived, vexatious, untenable and devoid of any merit; cause of action, the complainant has not come with the clean hands and has suppressed the material facts; the complainant is not a consumer etc. On merits, it has been stated that after lodging of the claim by the complainant, the OP appointed surveyor Shri R.K. Kakkar who reported that the complainant was doing tuitions work upto 8th class and he obtained opinion of Dr. S.K. Dhawan, Ambala Cantt after going through the medical record of the complainant gave his opinion that in such cases the rest of 16 weeks is appropriate. As per the opinion of Dr. S.K. Dhawan the rest of 4 months is appropriate. The complainant has filed a false claim of Rs.135000/- whereas the complainant was entitled for Rs.80000/-. OP vide letter dated 23.9.2021 sought consent of the complainant to approve Rs.80000/- and the complainant on 24.9.2021 gave her consent to receive the amount of Rs.80000/- and the same has already been paid to her. Rest of the averments of the complainant were denied by the OP and prayed for dismissal of the present complaint with costs.
4.           Learned counsel for the complainant tendered documents as Annexure C-1 to C-8 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OP tendered affidavit of Ms Mona Bagga, Senior Divisional Manager of the OP-New India Assurance Co. Ltd., Ambala Cantt. and  affidavit of Sh.R.P. Kakkar, Investigator, B.A. A.I.I.I General Insurance Claims, resident of 11 Shiv Partap Nagar, Near Dyal Bagh Gurudwara, Ambala Cantt. as Annexure RW1/A and RW2/A respectively alongwith documents as Annexure R-1 to R-3 and closed the evidence on behalf of OP.
5.           We have heard the learned counsel for the parties and have carefully gone through the case file and also gone through the written arguments filed by the learned counsel for the OP.
6.           Learned counsel for the complainant submitted that by not making payment of the entire claim amount of Rs.1,35,000/- qua the treatment taken by the complainant during subsistence of the policy in question, the OP is deficient in providing service, negligent and indulged into unfair trade practice. 
7.           On the contrary, the learned counsel for the OP submitted that the claim of complainant was entertained and settled for Rs.80,000/- as per the consent dated 24.09.2021 given by the complainant and also as per terms and conditions of the policy in question. 
8.           The issue for determination in this case is whether the complainant is entitled to any amount over and above Rs.80,000/- or not. It may be stated here that though in the complaint, the complainant has claimed that she had incurred the amount of Rs.135000/- on her treatment, yet, not even single evidence in this regard, qua medical bills/record has been placed on record by the OP. The plea of the OP is that Sh. R.P. Kakkar, Investigator in his affidavit, Annexure RW2/A has clearly stated that false claim to the tune of Rs.1,35,000/- has been filed by the complainant and on the other hand, she is entitled to get Rs.80,000/- only. Consent letter dated 23.09.2021, Annexure R-3, for approval of Rs.80,000/-, was duly received by the complainant and she put her signatures on it and accordingly, an amount of Rs.80,000/-, was paid to her.  It is significant to mention here that once the OP has specifically raised such a plea, the complainant was under obligation to disprove the said plea of the OP but she miserably failed to do so. In this view of the matter, we do not find any merits in the complaint filed by the complainant consequently, we dismiss the same. The parties are left to bear their own costs. Certified copies of the order be sent to the parties concerned as per rules.  File be annexed and consigned to the record room.

  Announced:- 24.09.2024

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President