PER SHRI. G.H. RATHOD – HON’BLE  MEMBER

 1)        By this complaint the Complainant has prayed that the Opposite Parties be held guilty of deficiency in service as per the provisions of the Consumer Protection Act, 1986 (referred to as the Act).  The Complainant has also prayed to direct the Opposite Parties to pay Rs.10,092/- to  reimburse  the  medical  expenditure amount incurred by the Complainant with interest @ 18% p.a. from 09/11/2009 till its realization.  It is also prayed that the Opposite Parties be directed to pay Rs.20,000/- towards cost and expenses incurred for this proceedings. It is further prayed that an amount of Rs.15,000/- be granted to the mental agony suffered by the Complainant.

 2)        According to the Complainant, he is a consumer within the meaning and definition under Sec.2(1)(d) of the Act.  The Opposite Parties are guilty of deficiency in service.  It is submitted that the Complainant had taken policy from the Opposite Party No.1 for the period 30/03/2009 to 29/03/2010.  It is alleged that the Complainant had submitted his claim to Opposite Party No.2 for Rs.17,839/- out of which an amount of Rs.7,727/- was sanctioned by the Opposite Party No.2 on 22/03/2010 and forwarded cheque of HDFC Bank, dtd.19/03/2010 alongwith their claim settlement voucher. The Opposite Party has deducted Rs.10,112/- from the claim amount claimed by the Complainant. The Complainant wrote letter to the Opposite Party No.2 on 16/04/2010 and asked the Opposite Party No.2 to pay the balance amount. The Opposite Parties did not respond to the request made by the Complainant.  It is alleged that the attitude of the Opposite Parties is nothing but deficiency in service.  The Complainant has therefore, prayed for grant of the reliefs mentioned in para 1 of this order.

3)        The Opposite Party No.1 contested the claim by filing written statement and affidavit of the Divisional Manager.  It is contended that the complaint is frivolous and unduly motivated.  According to the Opposite Party No.1, the Opposite Party No.2 by letter dtd.20/03/2010 informed the detail reasons for deduction of Rs.3,500/- for the report not attached to the claim and Rs.1,000/- consultation paper not given, Rs.20/- Misc. Charges and Rs.5,592/- towards surcharge which was not payable and therefore, the entitlement of the claim was held to the tune of Rs.7,727/-.  In the said letter it was also mentioned that encashment of cheque shall discharge the liability of insurer under the said claim. The Opposite Party No.2 also informed to the Complainant that if he did not object to the claim settled by the Opposite Parties within 10 days otherwise the same shall be deemed as the acceptance of full and final settlement of the said claim.  It is contended that the Complainant mischievously filed the present complaint in July, 2011.  It is thus, submitted that there is no deficiency in service on the part of the Opposite Party No.1.    

 4)        The Opposite Party No.2 remained absent though served with notice as complaint proceeded ex-parte against Opposite Party No.2.  The Complainant has filed his affidavit of evidence.  The Complainant has submitted by letter dt.10/10/2012 that whatever documents and affidavit which he has filed may be taken into consideration and he does not want to make oral argument.  Such type of submission has made on 09/01/2013. The Ld.Advocate Shri. Anand Kumar argued on behalf of Opposite Party No.1 and submitted that as the Complainant did not raise any objection to the claim settled by the Opposite Party No.2 within 10 days, the Complainant is not entitled for the claim made in this complaint. 

 5)        Upon going through the claim settlement voucher placed on record by the Complainant, it appears that the Opposite Party No.2 has specifically given the reasons as to why the amount of Rs.10,112/- has been deducted.  In the said letter it was also informed to the Complainant that any disagreement about the settlement shall be intimated to Opposite Party No.2 within 10 days otherwise the same shall be deemed as the acceptance by the Complainant.  The Complainant has not produced on record the copy of the policy and proved that whatever deductions which are mentioned in the claim settlement voucher letter dtd.20/03/2010 are against the terms of the policy.  Furthermore, it appears from the letter produced by the Complainant at Sr.No.3 to the complaint that he has raised the objection or disagreement about the settlement made by the Opposite Party No.2 on 16/04/2010 i.e. more than 27 days from the letter issued by the Opposite Party No.2 of the claim settlement voucher.  We therefore, hold that the Complainant has failed to prove that the Opposite Parties have wrongly deducted the amounts by mentioning the reasons for such deductions in the claim settlement voucher and the same are contrary to the terms of the policy issued by the Opposite Party. We thus, hold that the Complainant has failed to prove his entitlement on the basis of the terms of the policy as well as though he was intimated that he should raise his disagreement within 10 days upon receiving claim settlement voucher from Opposite Party No.2 but he did not raise any objection within that stipulated time  and  thus, the claim  made  in  the complaint cannot be granted.  In the result the following order is passed –

O R D E R

i.                    Complaint No.241/2011 is dismissed with no order as to cost.

ii.                 Certified copies of this order be furnished to the parties.