DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

PATIALA.

                                      Consumer Complaint No. 408 of 3.10.2019

                                      Decided on:         6.1.2023

Sant Kaur, aged 66 years, wife of Sh.Rupinder Singh, resident of Chagall House, Ragho Majra, Patiala.

                                                                   …………...Complainant

                                      Versus

1. Oriental Insurance Co. Ltd.,126, Chhoti Baradari, 1^st Floor, Patiala, through its Senior Branch Manager.
2. Oriental Insurance Co. Ltd., The Mall, Opposite Polo Ground, Patiala through its Divisional Manager.

                                                                   …………Opposite Parties

Complaint under the Consumer Protection Act

QUORUM

                                      Sh. S.K.Aggarwal, President

                                      Sh.G.S.Nagi,Member  

ARGUED BY

                                      Sh.Sukhwant Singh Hundal, counsel for complainant.

                                      Sh.D.P.S.Anand, counsel for OPs.

 ORDER

                                      S.K.AGGARWAL,PRESIDENT

1. The instant complaint is filed by Smt. Sant Kaur w/o Sh.Rupinder Singh        (hereinafter referred to as the complainant) against Oriental Insurance Company (hereinafter referred to as the OP/s) under the Consumer Protection Act ( for short the Act).
2. It is averred that the complainant is holder of mediclaim insurance policy bearing No.233503/2017/888 for the period from 13.2.2017 to 12.2.2018 with the entry of previous year policy bearing No.233503/2016/790.
3. It is averred that in the month of June,2017 complainant detected disease of cancer. She got treatment from Tata Memorial Hospital, Dr. E.Borges Marg, Parel,Mumbai-400012 and spent an amount of Rs.1,55,840/- for the same. The amount of treatment was submitted to the hospital through card issued by hospital having case No.CP/18413.
4. It is further averred that the complainant intimated the OPs regarding the disease of cancer and its treatment from above said hospital who gave assurance of transferring the amount of Rs.1,00,000/- in the card but all in vain and she after the treatment and before discharge from hospital on 25.6.2017 paid all the dues from its own pocket.
5. It is further averred that on 27^th June,2017 she lodged his claim of Rs.1,55,840/- with the OPs and also submitted all the requisite documents. She also made number of visits and telephonic call to the OPs for the payment of this amount but the OPs every time put off the matter on one pretext or the other. There is thus deficiency in service on the part of the OPs and unfair trade practice which caused mental agony and harassment to the complainant. Consequently, prayer has thus, been made for the acceptance of the complaint.
6. Upon notice, OPs appeared through counsel and filed the written statement taking  various  preliminary  objections.
7. On merits,  it is stated that the OPs have issued Medi claim insurance policy (individual) in favour  of complainant for the period from 13.2.2017 to 12.2.2018 covering the risk of hospitalization expenses for medical/surgical treatment of the complainant for  a sum of Rs.5 lacs only. Further the OPs have denied all other averments made in the complaint and prayed for the dismissal of the complaint.
8. In evidence, the complainant through his counsel has tendered her affidavit,Ex.CA, copy of insurance policy (three pages),Ex.C1, copy of smart card (2 pages),Ex.C2, copy of letter dated 27.6.2017, Ex.C3, copy of letter dated 29.3.2018,Ex.C4, copy of summary of transactions/bills (pages 1 to 5),Ex.C5 and closed the evidence.
9. On the other hand, the OPs through their counsel have tendered affidavit, Ex.OPA of Mukesh Malhotra, Divisional Manager alongwith documents,Ex.OP1 copy of policy with conditions,Ex.OP2 copy of letter dated 15.3.2019 and closed the evidence.
10. We have heard ld.counsel for the parties and have also gone through the record of the case, carefully.
11. Admittedly, the complainant is holder of mediclaim insurance policy,Ex.C1 issued by the OPs valid for the period from 13.2.2017 to 12.2.2018. During this period the complainant was detected as cancerous and reported to Tata Memorial Hospital, Mumbai  for treatment, as is evident from the document,Ex.C2.The complainant then lodged the claim with the OPs vide letter,Exs.C3 & C4.She also submitted bill,Ex.C5 (pages5) to the tune of Rs.1,55,840/- for payment from the OPs. The OPs had raised various queries for the settlement of the claim and closed the same as “No Claim” vide letter ,Ex.OP2.
12. On perusal of the record and hearing ld.counsel  for the parties, it transpires that there is no dispute regarding the issue of mediclaim insurance policy and the treatment taken by the complainant  from Tata Memorial Hospital, Mumbai for which claim was lodged by the complainant with the OPs.
13. Now the question arises for determination is to for how much amount the complainant is entitled .
14. The complainant has prayed for the payment to the tune of Rs.1,55,480/- alongwith interest from the OPs. On a specific query put to the ld. counsel for the OPs, he could not deny this fact. Therefore, there is no reason or occasion for the OPs to deny the plea of the complainant for recovery of Rs.1,55,840/- from the OPs alongwith interest. Consequently, we allow the complaint with a direction to the OPs to pay to the complainant Rs.1,55,480/-alongwith simple interest @6% per annum from the date of lodging the claim till the time of its disbursal, within a period of 30 days from the date of the receipt of certified copy of this order.           
15.           The instant complaint could not be disposed of within stipulated period due to heavy rush of work, Covid protocol and for want of Quorum from long time.
85109252238716.  
85109252238717.  

                                              G.S.Nagi                           S.K.AGGARWAL

                                              Member                          President