Haryana

Karnal

CC/120/2021

Suresh Kumar - Complainant(s)

Versus

New India Assurance Company Limited - Opp.Party(s)

Bhagwan Dass

22 Aug 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 120 of 2021

                                                        Date of instt.25.02.2021

                                                        Date of Decision:22.08.2023

 

Suresh Kumar son of Shri Prithvi Singh resident of house no.711, Prem Nagar, Karnal. Aadhar no.6134 8308 4567.

 

                                               …….Complainant.

                                              Versus

 

1. New India Assurance Company Ltd. (Health Department) SCO no.36-37, Sector-17A, Post Box no.49, near Jagat Cinema, Chandigarh through its Regional Manager.

 

2. Raksha Health Insurance TPA, SCO-39, First floor, Sector-26, above Barbigue Nationa, Chandigarh-160019.

 

                                                                ……Opposite parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

              Dr. Rekha Chaudhary…..Member

          

 Argued by: Shri Bhagwan Dass, counsel for complainant.

Shri Suderhan Patlan, counsel for the OP no.1.

OP no.2 exparte(vide order dated 17.03.2022).

 

                     (Dr. Rekha Chaudhary, member)

ORDER:

  

                  The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant has purchased a Health Policy no.35360634182800000051 from the OP no.1. The said policy was continuously renewed since more than 10 years. Complainant submitted his claim for his wife Pupsha Kumar in the year 2018 amounting to Rs.17,301/- and this claim of complainant was approved by the OP no.1 of Rs.16,751/-. Thereafter, this claim of the complainant was to be released in the bank account of the complainant i.e. Oriental Bank of Commerce, Sadar Bazar, Karnal in the year 2018 but this amount has not been released to the complainant till today. The complainant came to know through the correspondence made by Shri Harish Mehta Mirco Office Incharge, New India Assurance Company Ltd. E-75, Hospital Area, Kisan Basti Chowk, Nilokheri, District Karnal, that this amount has been sent in the name of Rajan Kumar in SBI account by mistake made by OP no.2. This mistake has been brought to the knowledge of OPs after about two months of the due claim and therefore, the correspondence was made on 10.10.2019, 12.11.2019 through email. Mr. Harish Mehta Incharge has regularly and continuously requested OPs to rectify the mistake and the amount may be released in favour of the complainant but nothing has been heard so far, inspite of the latest correspondence made on 24.07.2020. The OPs were under obligation to release the health claim of complainant amounting to Rs.16,751/-, when it was approved, now complainant is entitled to claim interest @ 24% per annum on his claim since 2018. Then complainant sent a legal notice dated 11.09.2020 to the OPs but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; locus standi; cause of action; jurisdiction and concealment of true and material facts. On merits, it is pleaded that OP no.1 has approved the claim amount of Rs.16751/- and transferred in the account of the OP no.2 and it was the duty of the OP no.2 to transfer the same in the account of the complainant. The mistake, if any, in wrong transferring the amount is on the part of the OP no.2 and not on the part of the OP no.1.There is no deficiency in service and unfair trade practice on the part of the OP no.1. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OP no.2 did not appear and opted to be proceeded against exparte, vide order dated 17.03.2022 of the Commission.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of cheque dated 22.06.2022 amounting to Rs.16,751/- Ex.C1, copy of emails dated 21.08.2019, 22.11.2019 and 24.07.2020 Ex.C2 to Ex.C5 and closed the evidence on 13.09.2022 by suffering separate statement.

5.             On the other hand, OP no.1 led no evidence after availing several opportunities including last one opportunity. Thus, the evidence of the OP no.1 was closed, vide order dated 25.07.2023 of the Commission.

6.             We have heard the learned counsel for the parties and have gone through the record available on the file carefully.

7.             During the pendency of the complaint, on 23.07.2022, complainant received a cheque dated 22.06.2022 amounting to Rs.16,751/- as approved claim amount from the OPs under protest. Now he has requested for interest @ 24% per annum on his claim since 2018 alongwith compensation for harassment, mental pain and agony and towards the litigation expenses.

8.             OP no.1 has produced a letter dated 06.07.2022 by which OP no.2 apologized to OP no.1 for the mistake that the cheque amount of Suresh Kumar i.e. complainant’s amount was wrongly credited in bank account of Rajan Kumar. Now the insured has returned the amount of Rs.16751/- and made a cheque in favour of Suresh Kumar.

9.             On perusal of said letter, it is clear that mistake was on the part of the OP no.2 and for the said act of the OP, complainant cannot suffered for his claim amount. When the said fact came to the knowledge of OP no.2, it was the duty of OP No. 2 to immediately transfer the claim amount to the account of the complainant, but the OP did not do. The claim of the complainant has been approved in the year 2018 and same has not been transferred in the account of complainant. Rather, same was transferred in the account of another person named as Rajan. Complainant was harassed by the OP no.2 for more than period of four years for such petty amount and dragged the complainant in unwanted litigation.

10.           To rebut the evidence produced by the complainant, OP no.2 did not appear and opted to be proceeded against exparte. Thus the evidence produced by the complainant goes unchallenged and unrebutted and there is no reason to disbelieve the same. Thus, the act of the OPs amounts to deficiency in service and unfair trade practice. Hence, in view of the above, it would be justified, if the interest on the claim amount, compensation for harassment, mental pain and litigation expenses be awarded to the complainant.

11.           Thus, as a sequel to abovesaid discussion, we partly allow the present complaint and direct the OP no.2 to pay interest @ 9% per annum on the claim amount i.e. Rs.16,751/- from the date of approval of the claim till its payment i.e.23.07.2022. We further direct the OP no.2 to pay Rs.10,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.5500/- for the litigation expenses. This order shall be complied within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:22.08.2023     

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                 Member