CONSUMER DISPUTES REDRESSAL FORUM (CENTRAL)

ISBT KASHMERE GATE DELHI

CC/98/2016

No. DF/ Central/                                                                      Date

Sh. Prateek Bansal

S/o Sh, Brij Mohan

R/o 1078/23, Near SBI Bank,

Gur Mandi, Sonepat, Haryana-131001.                               …..COMPLAINANT      

 VERSUS

The Oriental Insurance Company Ltd.

C.B.O. 21, 10184, Arya Samaj Road,

Karol Bagh, New Delhi-110005.

The Vipul Medcorp TPA Private Ltd.

515, Udyog Vihar Phase-V,

Gurgaon, Haryana-122016.                                           …..OPPOSITE PARTIES

Quorum  : Ms. Rekha Rani, President

                 Mr. R.S. Nagar, Member

                 Ms. Manju Bala Sharma, Member

ORDER

Ms. Rekha Rani, President

1. Instant complaint was filed by Sh. Prateek Bansal (in short the complainant) under Section 12 of the Consumer Protection Act, 1986 as amended up to date pleading therein that complainant is a medicalim policy holder of OP1 vide policy no. 272203/48/2015/2264 covering period from 29.03.2015 to 28.03.2016and OP2 is a T.P.A. of OP1.  Complainant was hospitalized in Ekansh Nursing Home on 15.10.2015 and on 16.10.2015 he informed OP1.   Complainant was discharged on 24.10.2015 and he submitted his claim of Rs. 85,542/- along with original mediclaim documents to OP2.  OP2 raised one query dated 07.11.2015 which was duly replied and requested documents were sent to OP2 and till date OPs have not settled his claim.  The instant complaint is filed seeking direction to OPs to pay to the complainant Rs. 85,542/- along with interest @ 18% per annum, Rs. 50,000/- as compensation for deficiency in service with interest @ 18% per annum and Rs.25,000/- as litigation expenses.

2.       On receipt of notice, OP filed reply.  Parties filed evidence by way of affidavits.  We have heard Sh. Sandeep Kumar, counsel for complainant and Sh. Niket Anand, counsel for OP.

3.       OP vide their reply stated that complainant has filed the instant complaint in haste without giving a reasonable time to OPs to settle the claim which was finally done on 14.03.2016 by transferring the amount of Rs. 82,132/- in the account of the complainant.  It is denied that there was any deficiency of service on their part.

4.       Our predecessor bench had directed the complainant to file rejoinder vide their order dated 08.07.2016.  The case was adjourned to 09.08.2016 for filing the rejoinder.  On 09.08.2016, last opportunity was granted to him to fill the same and the case was adjourned to 07.10.2016.  On 07.10.2016, our predecessor bench observed that he did not want to file rejoinder.

5.       It escaped notice of our predecessor bench that OP had made payment of Rs. 82,132/- on 14.03.2016 itself which fact was not disputed by the complainant.  Complainant deliberately avoided filing rejoinder although he sought two adjournments for the purpose of filing rejoinder.  Today we asked learned counsel for complainant as to whether the payment of Rs. 82,312/- was made in the account of the complainant.  Learned counsel for complainant stated that it was made on 14.03.2016.  When we asked learned counsel as to whether any further payment was made to the complainant he said ‘No’ which is contrary to the record of the complainant himself.  We confronted learned counsel for complainant to Para 8 of his written arguments wherein it is pleaded that an amount of Rs.3,410/- was also paid by OPs to the complainant.  It is not pleaded as to when the payment was made nor learned counsel for complainant could inform us about the date of credit of the said amount.  Complainant himself has stated in Para 8 of the written arguments that he is only asking for compensation and litigation expenses.

6.       OP had made the payment even before notice of the instant complaint was received by them.  Order dated 14.05.2016 of our predecessor bench indicated that OPs were served on 17.05.2016.  As per the admitted fact, payment of Rs. 83,312/- had already been made before the notice of the complaint was served on the OPs so it cannot be said that OPs made the payment only when they came to know about filing of the instant complaint. 

7.       Complainant himself has stated in Para 7 of the complaint that OP2 had raised a query dated 07.11.2015.  He responded to the same and sent requested documents to OP2 on 23.11.2015.  He filed the instant complaint on 09.03.2016 without waiting for reply of the OP.  OP had not repudiated his claim nor did he serve any notice on them.

8.       In view of the above discussion the complaint is dismissed. Copy of this order be sent to the parties as statutorily required. File be consigned to record room.

Announced on this ______   Day of  _______   2019.