BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.:519 of 2010.
Date of Institution: 26.08.2010.
Date of Decision:.13.05.2016
R.C. Ahlawat aged 52 years, Branch Manager, Life Insurance Corporation of India, S.O. Meham, District Rohtak.
….Complainant.
Versus
- The New India Assurance Company Limited having its Divisional Office, Gagan Building, G.T. Road, Karnal through its Divisional Manager.
- The New India Assurance Company Limited through its Branch office at Bhiwani, through its Branch Manager.
- Life Insurance Corporation of India, having its Divisional Office at SCO 3-4-5 Sector 1 Rohtak through its Senior Divisional Manager.
- Life Insurance Corporation of India, having its Branch Office at Rohtak, through its Chief Manager.
…...Opposite Parties.
COMPLAINT U/S 12 & 13 OF CONSUMER PROECTION ACT.
BEFORE: - Shri Rajesh Jindal, President
Smt. Ansuya Bishnoi, Member
Present:- Shri A.L. Hans, Advocate, for complainant.
Shri Satender Proxy Counsel of
Shri A. Sardana, Advocate for OP no. 1 & 2.
Shri N.S. Vijayrania, Advocate for Ops no. 3 & 4.
ORDER:-
Rajesh Jindal, President:
Brief facts of the present case are that on 10.04.2008 he developed heart problem and heart pain and reported himself to Dr. V.K. Chugh, Chugh Hospital. It is alleged that in the intervening night of 10/11.04.2008 as also in the evening about 7.30 p.m. of 11.04.2008 Dr. V.K. Chugh advised the complainant to have the opinion of Dr. R.K. Caroli Cardiologist of Delhi and got the requisite tests done as per his advise. It is alleged that on 12.04.2008 he got done the said heart test at Delhi Institute of Functional Imaging, Delhi as per advise of Dr. R.K. Caroli. It is alleged that after examining the report of Dr. R.K. Caroli, Dr. V.K. Chugh discharged the complainant from his hospital and thereafter the complainant again started the treatment prescribed by Dr. R.K. Caroli of Delhi. The complainant submitted his claim i.e. medicines for Rs. 14,037/- which he had occurred during the period 10.04.2008 to 13.04.2008. It is alleged that the complainant again developed chest pain and heart problem in the month of December 2009 and reported himself on 10.12.2009 to Dr. V.K. Chugh for treatment. After examining the complainant, Dr. V.K. Chugh advised him on the same day to have opinion from Dr. R.K. Caroli and he asked for a heart test (Stress Thallium) which test was got done on 20.12.2009. It is alleged that Dr. V.K. Chugh discharged him on 21.12.2009 and the complainant having taken treatment from Dr. V.K. Chugh as indoor patient from 19.12.2009 to 21.12.2009 submitted his medicines for Rs. 13967/- to the Ops for payment. It is alleged that the OP no. 1 acting illegally, arbitrarily, and against the terms and conditions of the insurance policy rejected the claim of the complainant. The complainant further alleged that due to the act and conduct of the respondents, he had to suffer mental agony, physical harassment and financial losses. Hence, it amounts to deficiency in service on the part of respondents and as such he had to file the present complaint.
2. On appearance, OPs no. 1 & 2 filed written statement alleging therein that the complainant has not come to this Forum with clean hands. It is submitted that the claim of the complainant has rightly been rejected and the order dated 02.03.2010 is quite just and legal and the complainant is not entitled to any claim and the amount of Rs. 14,037/- which has received wrongly is liable to be refunded by him. It is submitted that the complainant is not entitled to any claim on account of hospitalization charges for the period from 19.12.2009 to 21.12.2009. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of opposite party no. 1 & 2 and complaint of the complainant is liable to be dismissed with costs.
3. OPs No. 3 & 4 on appearance also filed separate written statement alleging therein that the answering respondent LIC is merely a middle man between the complainant and the Ops no. 1 & 2 and as per Memorandum of understanding, the answering respondents is to pay the claim after receipt of the same from the Ops no. 1 & 2. It is submitted that the OP no. 1 vide letter dated 02.03.2010 rejected the medical claim of the complainant for his hospitalization during the period from 19.12.2009 to 21.12.2009 and vide letter dated 29.03.2010 has taken the decision to recover the medical claim amount of Rs. 14,037/- already reimbursed to the complainant for his hospitalization during the period 10.04.2008 to 13.04.2008 and advised the answering respondents to recover from the complainant. It is submitted that the answering respondents is recovering the aforesaid amount from the salary of the complainant legally and according to the rules and the answering respondents as per Memorandum of understanding is bound to recover from the complainant. It is submitted that the answering respondent is following the directions given by the New India Assurance Company vide letter dated 29.03.2010 and 06.08.2010 and the answering respondents have just passed the recovery letter given by New India Assurance Company to the complainant. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of opposite party no. 3 & 4 and complaint of the complainant is liable to be dismissed with costs.
4. In order to make out his case, the counsel for complainant has placed on record documents Annexure C-1 to Annexure C-33 alongwith supporting affidavit.
5. In reply thereto, the opposite parties placed on record Annexure R1 to Annexure R6 alongwith supporting affidavits.
6. We have gone through the record of the case carefully and have heard the learned counsels for the parties.
7. Learned counsel for the complainant reiterated the contents of the complaint. He submitted that the allegation of the opposite parties are that the dead buffalo belongs to Nihal Singh the uncle of the complainant, is wrong and denied. He further submitted that the buffalo of Nihal Singh is insured with the Insurance Company.
8. Learned counsel for Opposite Parties reiterated the contents of their reply, respectively. Learned counsel for OP no. 1 submitted that the dead buffalo was got insured with the Ops and as per investigator report dated 05.09.2010 Annexure R1/2, the said buffalo belongs to Nihal Singh, the real uncle of the complainant. Moreover, the age and features of the insured buffalo also do not match with the dead buffalo. The tag of the buffalo of the complainant was freshly tagged to the dead buffalo as is evident from the Post Mortem Report dated 26.08.2010, Annexure C-2. He further submitted that the claim of the complainant was repudiated by the OP no. 1 vide letter dated 10.01.2011, Annexure R1/6.
9. In the light of the pleadings and arguments of the parties, we have examined the relevant material on record. The Post Mortem Report dated 26.08.2010, Annexure C-2 has been produced by the complainant. From the perusal of said PMR, the contention of the Ops that the tag freshly tagged is proved, because the Vaternary Surgeon in Column No. 2 of the PMR has clearly mentioned the said fact. The Investigator’s report dated 05.09.2010 Annexure R1/2 is also on the file. The complainant had opportunity to rebut the contention of the OP no. 1 that the dead buffalo belongs to Nihal Singh his uncle, by adducing the evidence of Nihal Singh in support of his pleadings, but no cogent evidence has been adduced by the complainant to controvert the contention of the OP no. 1. From the above discussion, we hold that the complaint of the complainant is devoid on merits and the same is hereby dismissed with no order as to costs. Certified copies of the order be sent to the parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 28.10.2015.
(Rajesh Jindal)
President,
District Consumer Disputes
Redressal Forum, Bhiwani.
(Ansuya Bishnoi) (Balraj Singh)
Member Member
