Haryana

Yamunanagar

CC/514/2010

Tara Chand s/o Sh.Sunder Lal - Complainant(s)

Versus

OIC - Opp.Party(s)

S.S.Saini

23 May 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                    Complaint No.  514 of 2010.

                                                                                    Date of institution:26.05.2010.

                                                                                    Date of decision: 23.05.2016.

Tara Chand aged about 37 years son of Shri Sunder Lal, Resident of Village Khurdban Dera, Sub Tehsil Radaur, Tehsil Jagadhri, District Yamuna Nagar.

 

                                                                                                                                                                       …Complainant.

                                    Versus

 

1. The Oriental Insurance Company Limited, New Delhi D.O. 14, 80 First Floor, F.I.E. Patpar Ganj, Industrial Area, Delhi-110092 through its Managing Director.

 

2. The Oriental Insurance Company Limited, through its Branch Manager, Branch Office at Court Road, Jagadhri Tehsil Jagadhri, District Yamuna Nagar.

 

                                                                                                                                                                       …Respondents.

 

BEFORE: SH. ASHOK KUMAR GARG, PRESIDENT

                 SH. S.C.SHARMA, MEMBER.

 

Present: Sh. Surjit Singh Saini, Advocate, counsel for complainant.   

              Sh. V.K.Sharma, Advocate, counsel for respondents.

 

ORDER

 

1.                     Complainant Tara Chand filed the present complaint under section 12 of the Consumer Protection Act, 1986.

2.                     Brief facts of the present complaint, as alleged by the complainant, are that complainant obtained two insurance policies, out of these one is named Nagrik Suraksha Policy, from the respondent No. 1 (hereinafter referred as Op No.1 Insurance Company) bearing Cover Note No. 270000381215 and policy bearing No. 271700/48/2009/1142 valid from 10.10.2008 to 9.10.2009 for a total sum insured of Rs. 2,50,000/- (Rs. 2,00,000/- on account of personal accident plus Rs. 50,000/- for hospitalization) and second policy namely G.P.A (Annexure C-3) for a sum of Rs. 3,00,000/- only for personal accident coverage w.e.f. 10.10.2008 to 9.10.2009 from the office of Op No.1. At the time of issuance of these policies, the official of OPs assured the complainant that if there will be any type of mis-happening to the complainant, they will pay the entire amount as well as hospital’s expenses, if any, up to Rs. 50,000/-. On 26.12.2008, at about 4.30 P.M, the complainant was going on his motorcycle then suddenly a stone hit to his eye and he got injuries in his eye. The complainant got himself medically examined from the Sanjeevani Eye Care Maternity Hospital, Kanhiya Sahib Chowk, Yamuna Nagar on 27.12.2008 and continued to take medicine from there. Not only this, he also spent amount on medicine etc. All the prescription slips, medical bills as well as laboratory reports are attached with the present complaint. The complainant contacted the OP No.2 and showed him all his bills as well as reasons of injuries and requested to compensate the complainant as per terms and conditions of the policy. OP No.2 asked the complainant to write a letter in the name of Op No.1 and further asked to fill the Form as provided by them. Subsequently, the complainant wrote a letter and submitted the same to OP No.2. Complainant also got himself medically examined from Mukand Lal General Hospital, Yamuna Nagar and got assessed his disability to the tune of 30%/50% (not clear) on account of side of one eye. Thereafter, the complainant moved an application to the OPs to release/reimburse the medical expanse as well as to pay compensation alongwith original prescription slip, bills and other necessary documents alongwith policy, but till today nothing has been done by the OPs. Hence, this complaint.

3.                     Upon notice, Sh. Jai Deep Garg appeared on behalf of OPs on 05.07.2010, however, no written statement was filed within the stipulated period, so, the defence of the OPs was struck off vide order dated 27.09.2010. After that Smt. Aruna Sharma appeared on behalf of OPs and filed her vakalatnama on 29.10.2013 and tendered into evidence affidavit of Gurmej Singh, Deputy Manager, OIC as Annexure RW/A and documents such as Photo copy of Insurance policy alongwith terms and conditions as Annexure R-1 and R-2 and closed the evidence on behalf of OPs.

4.                     To prove the case, counsel for the complainant tendered into evidence short affidavit of complainant as Annexure CX and documents such as  Photo copy intimation letter dated 05.01.2009 sent to OP No.1 Insurance Company New Delhi as Annexure C-1, Photo copy of Insurance policy bearing No. 271700/48/2009/1142 as Annexure C-2, Photo copy of second Insurance policy bearing No. 271700/48/2009/1148 as Annexure C-3, Photo copy of claim form as Annexure C-4, Photo copy of OPD slip of Sanjeevani Hospital dated 31.01.2009 as Annexure C-5, Photo copy of medical bills as Annexure C-6 and C-7, Photo copy of OPD slip dated 23.01.2009, 07.01.2009 & 27.12.2008  as Annexures C-8 to C-10 respectively, Photo copy of Laboratory report as Annexure C-11, Photo copy of Lab charges receipt as Annexure C-12, Photo copy of medicine bill as Annexure C-13, Photo copy of concession certificate as Annexure C-14, Photo copy of ration card as Annexure C-15, Photo copy of vote identity card as Annexure C-16, Photo copy of Pass book of PNB as Annexure C-17, Again photo copy of intimation letter dated 05.01.2009 as Annexure C-18 and closed the evidence on behalf of complainant.

5.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very carefully and minutely.

6.                     It is not disputed that complainant obtained two insurance policies out of these one is named Nakrik Suraksha Policy (Annexure C-2) for a sum of Rs. 2,50,000/- covering the risk of Rs. 2,00,000/- on account of personal accident and Rs. 50,000/- on account of hospitalization and second policy namely G.P.A (Annexure C-3) for a sum of Rs. 3,00,000/- only for personal accident coverage w.e.f. 10.10.2008 to 9.10.2009 from the office of Op No.1 i.e. Oriental Insurance Company Ltd. New Delhi.

7.                     The only grievances of the complainant is that when he was going on the motorcycle on 26.12.2008 then suddenly a stone hit his eye and he got injuries in his eye. He got himself medically examined from the Sanjeevani Eye Care and Maternity Hospital, Kanhiya Sahib Chowk, Yamuna Nagar on 27.12.2008 and submitted all the bills and treatment chart to Op No.1 Insurance Company which is evident from Annexure C-1 Intimation Letter dated 05.01.2009 and medical bills and prescription slip Annexure C-5 to C-13 but despite lodging the claim with the OPs Insurance Company till date no claim has been paid to the complainant by the OPs Insurance Company.

8.                     On the other hand, learned counsel for the OPs hotly argued at length that although the defence of the OPs Insurance Company has been struck off even then the claim of the complainant is not maintainable and draw our attention towards affidavit filed on behalf of Ops wherein it has been mentioned that “ No pre or post hospitalization is covered” and moreover, no outdoor treatment is payable as per exclusion clause No.11 and as such the complainant has not fulfilled the requirements under the policy in question and is not entitled to any claim and referred the terms and conditions of the policy Annexure R-1 wherein it was so mentioned. 

9.                     After hearing both the parties, we are of the considered view that the learned counsel for the complainant has totally failed to convince this Forum and referred any documents from which it is evident that complainant remained admitted for a single day in any hospital as no discharge certificate has been filed or any certificate issued by the doctor in respect of admission in the hospital has been filed. The complainant has only filed some OPD slips in which some medicines have been prescribed by the Doctor of Sanjeevani Hospital. Mere filing the copy of OPD slips and some medical bills it cannot be presumed that complainant remained admitted in the Hospital. In the absence of any cogent evidence, that complainant lost his one limb i.e. sight of one eye claim is not payable as per the terms and conditions of the insurance policy in question. Even, the complainant has also failed to prove that any amount has been charged on account of operation or hospital charges by the Sanjeevani Eye Care and Maternity Hospital, Yamuna Nagar. The complainant has tendered into evidence only some bills Annexure C-6, C-7, C-12 and C-13 of petty amount i.e. Rs. 374/-, Rs. 363/-, Rs. 200/- and Rs. 478/-. From these bills, it cannot be presumed that the complainant remained admitted in the hospital or got any operation whatsoever. Further, from the perusal of the disability certificate Annexure C-14 it is also evident that this certificate has been obtained just to get the pension under the scheme of Government for handicapped persons and in this certificate also it is nowhere mentioned that the complainant has lost his one eye sight completely.

10.                   In the circumstances noted above, we are of the considered view that the complainant has totally failed to produce any cogent evidence to prove his case. Hence, we have no option except to dismiss the complaint of complainant.    

11.                   Resultantly, we find no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 23.05.2016.

                                                                                    (ASHOK KUMAR GARG)

                                                                                     PRESIDENT

 

 

                                                                                    (S.C.SHARMA)

                                                                                     MEMBER