MS. NIPUR CHANDNA, MEMBER
ORDER
10.07.2024
1. The complainant has filed the present complaint alleging deficiency in service on the part of OP. In brief the facts of the complaint are that complainant is the mediclaim policy holder of OP Ins. Co. vide policy bearing no. 271700/48/2022/165 w.e.f. 24.04.2021 to 23.04.2022. It is alleged by the complainant that she is the mediclaim policy holder of OP Ins. Co. since 2017.
2. On 14.04.2021 complainant’s husband got admitted in Sir Gangaram city Hospital for treatment and discharged on 20.04.2021. The total expenses incurred in the hospitalization was Rs. 2,76.903/-. The complainant lodged the reimbursement claim with OP vide claim no. 211400023464 and submit all the requisite medical record and bills to OP Ins. Co. Vide letter dated 13.05.2022 the OP Ins. Co. repudiated the claim of the complainant on false and flimsy ground. The complainant served the legal notice dated 11.04.2022 to OP Ins. Co. thereby requesting it to reconsider the claim but all in vain. Being aggrieved by the repudiation of the claim complainant approached this Commission for redressal of her grievance.
3. The present complaint case is on admission stage. We have heard counsel for complainant Sh. Akash on admission as well as limitation and have perused the record.
4. Perusal of the record shows that complainant has placed on record the copy of medical bills and treatment record of her husband, copy of repudiation letter dated 13.05.2022 in support of her contention. It is argued by Ld. Counsel for complainant that since vide letter dated 13.05.2022 OP Ins. Co. has repudiated the claim in question the present complaint case is well within limitation.
5. Let us peruse the relevant provision in respect of limitation provided under Consumer Protection Act, 2019.
As per section 69 of Consumer Protection Act, 2019: -
- The District Forum, the state commission or the National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.
- Notwithstanding anything contained in subsection (1). A complaint may be entertained after the period specified in sub-section (1), if the complainant satisfies the District Forum, the state commission or the National Commission , as the case may be, that he had sufficient cause for not filing the complaint within such period: provided that no such complaint shall be entertained unless the National Commission , the State Commission, as the case may be records its reason form condoning such delay.
6. A perusal of the aforesaid statutory position reflects that the complaint should be preferred within a period of two years of the accrual of cause of action.
7. Admittedly, on 14.04.2021 complainant’s husband got admitted in Sir Gangaram city Hospital for treatment and discharged on 20.04.2021. The complainant lodged the reimbursement claim with OP vide claim no. 211400023464. The copy of the repudiation letter dated 13.05.2022 placed on record by the complainant clearly states that the claim no. 211400023464 was already closed by OP Ins. Co. on 30.01.2022, hence, we are of the considered opinion that the substantive cause of action for filing the present complaint arose on 30.01.2022. The complainant ought to have file the present complaint on or before 30.01.2024, which complainant failed to do. The complainant has filed the present complaint on 27.05.2024 i.e. after the delay of 04 months that too without citing any cogent reason for such delay, the present complaint is therefore barred by limitation, hence, dismissed.
File be consigned to record room.
8. Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving the application from the parties in the registry. Order be uploaded on www.confonet.nic.in.
Announced in open Commission on 10.07.2024.
Sanjay Kumar Nipur Chandna Rajesh
President Member Member
