DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi-110016.
Case No. 757/2010
Mr. Dev Raj Singh Dahiya,
9996/3, Street No. 5, Sarai Rohilla,
New Rohtak Road, New Delhi – 110005 ...Complainant
Versus
1. The Manager
New India Assurance Co. Ltd.
R-7A, Main Green Park, New Delhi.
2. The Managing Director,
M/s Raksha TPA Pvt. Ltd.
C/o Escorts Corporate Centre,
15/5, Mathura Road,
Faridabad, Haryana …Opposite Parties
Date of Institution : 30.12.2010 Date of Order : 04.06.2016
Coram:
Sh. N.K. Goel, President
Sh. S.S. Fonia, Member
O R D E R
Briefly stated the case of the Complainant is that he had taken the mediclaim policy bearing no. 311500/34/07/11/00000698 from the OP-1 valid from 27.8.2007 to 26.08.2008 by paying Rs. 7056/- towards premium (Copy attached as Annex. CW/1). In August 2007, he was diagnosed of the cancer of larynx and got admitted in Lok Nayak Hospital on 30.8.2007. He was operated for the same on 31.8.2007 and remained admitted there till 22.9.2007. After the treatment he was discharged from the hospital on 22.9.2007. The complete set of documents and medical expenses are attached as Annex. CW1/2 (Colly.). The complainant submitted the claim for expenses to the tune of Rs. 30,457/- to the OPs but the OPs for almost 2 years kept asking for the papers again and again some time on the pretext of misplacing of the same or due to some other reason. Documents in support are attached as Annex. CW/3 (Colly.). After pursuing the case he states to have received a letter dated 20.11.2008 from OP-2 whereby he was informed that his claim had been settled and an amount of Rs. 3739/- through cheque bearing no. 250812 had been dispatched to his address which had been returned back with the remark “no such person”. The complainant states that he was shocked to see this letter as the OP-2 had sent the said cheque at wrong address and secondly the amount was much less than the claim amount. The complainant had claimed Rs. 30,457/- whereas the OPs had sanctioned only Rs. 3739/-. The complainant wrote letter against this asking the OPs to justify the sanction of the said amount but the OPs till date did not reply to the same. Documents are attached as Annex. CW/4 (Colly). Feeling aggrieved and claiming deficiency in service, the complainant has invoked jurisdiction of this Forum and prayed for the following:-
A. Direct the OPs to reimburse the medical bill of Rs. 30,457/- with interest @ 18% till the making of the payment
- Direct the OPs to pay the compensation of Rs. 40,000/- to
the complainant towards mental agony, mental torture,
harassment etc.
C. Direct the OPs to pay Rs. 15,000/- to the complainant
towards the litigation and miscellaneous expenses.
OP-1 has filed written statement inter-alia stating that “answering respondent has already paid whatsoever is due as per terms and conditions of the insurance policy and now nothing is remaining unpaid and, hence, the complaint of the complainant is liable to be dismissed”.
None has been appearing on behalf of OP-2 since after 17.7.2012. Therefore, OP-2 was proceeded exparte vide order dated 11.9.2012 by our predecessors.
Complainant has filed rejoinder reiterating the averments made in his complaint.
Complainant has filed his own affidavit in evidence relying upon Annex. CW1 (Colly), CW/2 (Colly), CW/3 (Colly), CW/4 (Colly). Sh. Surender Bhatawa, Senior Divisional Manager of OP has tendered evidence by way of affidavit.
Written arguments have been filed by both the parties.
We have heard the arguments of the counsel for the complainant and OP-1 and have also perused the record very carefully.
Now, we straightway formulate the question as to whether the relief prayed for by the complainant is admissible or not?
The first and foremost question which arises for consideration is whether OP was justified in admitting the claim for Rs. 3739/- against the claimed amount of Rs. 30,457/- and also whether mere dispatch of the cheque of Rs. 3739/- which was returned back undelivered was sufficient discharge of legal obligation on the part of the OPs.
The OP-1 has not adduced any documentary evidence in its written statement and evidence to justify the deduction of Rs. 26,718/- so much so that the OP-1 has not bothered to reproduce the relevant exclusion clause of the insurance contract whereby the complainant was not entitled for the full amount claimed and was entitled only for Rs. 3739/-, which in our opinion, is not only gross dereliction of professionalism but sheer arbitrary decision. If this attitude of the insurance companies is allowed to continue unabated, we are afraid that no citizen of this country would like to avail the services of insurance companies.
Secondly, before closing the case of the complainant on the pretext of return of remitted cheque, it was incumbent upon the OP-1 to have checked the correct mailing address of the complainant and sent another communication. To some extent, we also blame complainant to have not given his current mailing address to OP-1, if any.
In view of above discussion, we allow the complaint and direct OP-1 to pay Rs. 30,457/- to the complainant along with interest @ Rs. 6% p.a. w.e.f. 20.11.2008 i.e. the date of passing of the claim for Rs. 3739/- and Rs. 15,000/- towards compensation for mental agony and legal expenses within 30 days of receipt of copy of this order failing which OP-1 shall become liable to pay the said amount along with interest @ Rs. 9% per annum from 20.11.2008 till its realization.
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 04.06.16.
(S.S.FONIA) (N.K. GOEL) MEMBER PRESIDENT
Case No. 757/10
04.06.2016
Present – None
Vide our separate order of even date pronounced, the complaint is allowed. OP No. 1 is directed to pay Rs. 30,457/- to the complainant along with interest @ Rs. 6% p.a. w.e.f. 20.11.2008 i.e. the date of passing of the claim for Rs. 3739/- and Rs. 15,000/- towards compensation for mental agony and legal expenses within 30 days of receipt of copy of this order failing which OP-1 shall become liable to pay the said amount along with interest @ Rs. 9% per annum from 20.11.2008 till its realization. Let the file be consigned to record room.
(S.S.FONIA) (N.K. GOEL) MEMBER PRESIDENT
