Chandigarh

StateCommission

A/2/2021

Senior Branch Manager, The Oriental Insurance Company Ltd. - Complainant(s)

Versus

Nirankar Singh - Opp.Party(s)

Sahil Abhi Adv.

21 May 2021

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

Appeal No.	02 of 2021
Date of Institution	17.12.2020
Date of Decision	21.05.2021

 

1. Senior Branch Manager, The Oriental Insurance Company Limited, Director Agents Branch, Sector 20-C, Chandigarh.
2. The Oriental Insurance Company Limited, through its Managing Director Regd. and Head Office, A-25/27, Asaf Ali Road, New Delhi – 110002.
3. M/s Rakasha TPA Private Limited, through its Managing Director, SCO 39, 1^stFloor, Sector 26, Chandigarh – 160047.                                                   

…..Appellants/Opposite Parties

Versus

Nirankar Singh, Resident of SCF 71-74, Phase 10, Mohali.                                          

…..Respondent/Complainant            

BEFORE:  JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

                MRS. PADMA PANDEY, MEMBER

                RAJESH K. ARYA, MEMBER

               

 

Argued by:  Sh. Sahil Abhi, Advocate for the appellants.

Sh. Ajay Pal Singh, Advocate for the respondent.

 

                       

PER PADMA PANDEY, MEMBER

              This appeal is directed against an order dated 16.10.2020, rendered by District Consumer Disputes Redressal Commission-I, UT, Chandigarh (hereinafter to be called as the District Commission only), vide which, it allowed the Consumer Complaint bearing No.260 of 2019, filed by the complainant, with the following directions: -

“11. In the light of above observations, we are of the concerted view that the Opposite Parties are found deficient in giving proper service to the complainant. Hence, the present complaint of the Complainant deserves to succeed against the Opposite Parties, and the same is partly allowed, qua them. The Opposite Parties are, jointly and severally, directed to:-

[a]   To immediately settle the claim of the Complainant;;

[b]   To pay Rs.15,000/-on account of deficiency in service and causing mental and physical harassment to the Complainant; 

[c] To pay Rs.10,000/- as cost of litigation;

12.    The above said order shall be complied within 30 days of its receipt by the Opposite Parties; thereafter, Opposite Parties shall be liable for an interest @12% p.a. on the amounts mentioned in sub-para [a] & [b] above from the date of repudiation, till it is paid, apart from costs of litigation of Rs.10,000/-.”  

2.        The facts, in brief, are thatcomplainant obtained one “Happy Family Floater Policy” from Opposite Party No.1, with the hope, at the time of need, he would get quality medical care without putting himself under much financial burden. It was stated that on being diagnosed with a “Psychiatric Problem” he applied for medical claim under the aforesaid Policy, but the same was erroneously repudiated by the Opposite Parties vide order dated 27.09.2018 (Annexure C-1) on the ground that the disease of the complainant was excluded per Clause 4.8 of the Policy. It was further stated that thecomplainant accordingly made representation dated 28.09.2018 vide Annexure C-2 to the Opposite Parties, stating that medical insurance also covers under Mental Healthcare Act, 2017 and that his claim was also covered under the directives issued by the IRDAI, but nothing positive could come out. It was further stated that the aforesaid acts of the Opposite Parties, amounted to deficiency, in rendering service.
3. Opposite Parties filed their reply and admitted the factual matrix of the case. It was stated that the case summary dated 04.06.2018 clearly mentions “Senile Dementia” under the heading ‘diagnosis and the same is excluded as per clause 4.8 of the Policy.  It was further stated that the claim of the complainant was rightly repudiated vide letter dated 15.03.2019. Pleading that there is no deficiency in service or unfair trade practice on their part, Opposite Parties have prayed for dismissal of the complaint.It was further stated that there is no deficiency in service on their part, and the Opposite Parties had prayed for dismissal of the complaint.
4. The partiesled evidence, in support of their case.
5. After hearing the Counsel for the Parties, and, on going through the evidence, and record of the case, the District Commission, allowed the complaint, as stated above.
6. Feeling aggrieved, the instant appeal, has been filed by the appellants/Opposite Parties.
7. We have heard the Counsel for the parties, and have gone through the evidence, and record of the case, carefully.
8. After giving our thoughtful consideration, to the contentions, advanced by the Counsel for the appellants, and the evidence, on record, we are of the considered opinion, that the appeal is liable to be dismissed, for the reasons to be recorded hereinafter.
9. On-going through the records of the learned District Commission, we find that the appellants have repudiated the claim of the respondent as per clause 4.8 of the term and conditions of the policy. Further the appellants have taken a plea that Mental Health Care Act 2017 has come into force from 16.08.2018 and the policy, in question, had lapsed on 07.07.2018, but reality is that the respondent fell mentally ill within the said policy period and thereafter, lodged the claim with the appellants. The appellants have repudiated the claim of the respondent taking the flimsy plea as above, which is highly deficient and indulgence into unfair trade practice. Thus, deficiency in service is writ large on the face of the appellants and therefore, the appeal deserves to be dismissed.
10. No other point, was urged, by the Counsel for the parties.
11. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. The order of the District Commission is upheld.
12. Certified copies of this order, be sent to the parties, free of charge.
13. The file be consigned to Record Room, after completion.

 

Pronounced.

21.05.2021   

 

                    

                                                      Sd/-

                        [JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

                                                                         Sd/-

[PADMA PANDEY]

MEMBER

 

                                                                              Sd/-

[RAJESH K. ARYA]

 MEMBER

 

GP

 

                       

STATE COMMISSION

M.A.No.16 of 2021

In

APPEAL No.2 of 2021

(The Oriental Insurance Company Ltd. Vs. Nirankar Singh)

 

Argued by:

 

Sh. Sahil Abhi, Advocate for the appellants.

Sh. Ajay Pal Singh, Advocate for the respondent.

 

Dated    the   21^st day of  May, 2021

                               

            Since the Appeal No.2 of 2021 has been dismissed, with no order as to cost and the order passed by the District Commission has been upheld, as such, this application stands dismissed being rendered infructuous.

            Let this file tagged with the Appeal file.

 

Sd/-                        Sd/-                              Sd/-

(PADMA PANDEY)	(JUSTICE RAJ SHEKHAR ATTRI)	(RAJESH K. ARYA)
MEMBER	PRESIDENT	MEMBER

 

 

 

 

 

Gp