Haryana

Karnal

311/2010

Rajinder Kumar S/o jagdish Ram - Complainant(s)

Versus

Oriental Insurance Company Pvt. Ltd - Opp.Party(s)

J.P. Kashyap

18 Jan 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.  

                                                          Complaint No.311 of 2011

                                                          Date of instt.: 29.4.2010

                                                          Date of decision: 20.01.2016

 

Rajinder Kumar son of Shri Jagdish Ram  resident of village Phushgarh tehsil land district Karnal.

.                                                                   ……..Complainant    

                                      Vs.

The Oriental Insurance Company Limited GT Road, near Bus stand, Karnal through its Branch Manager.

                                                                           ……… Opposite Party

                     Complaint u/s 12  of the Consumer

                     Protection Act.

 

Before          Sh.K.C.Sharma……….President.                

                   Sh.Anil Sharma…….Member.

 

Present:-        Sh.J.P.Kashyap Advocate for the complainant.

                    Sh.Amit Gupta  Advocate for the Opposite Party

 

ORDER:        

                   This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the averments that he got himself  insured with the Opposite Party, vide insurance policy no.261300/48/2009/922  for the period of two years from 13.3.2009 to 12.3.2011, for a sum of Rs.two lac and premium of Rs.324/- was paid per annum. The said policy  was covering the  risk of accident also . On 14.1.2010, while he was going   from  Sector-6, Urban Estate, Karnal to Sector -7, and reached ahead of Amar Hospital, a scooty driven by a person rashly and negligently came  to wrong side of the road and hit him, due to which he fell down and sustained multiple serious  and grievous injuries on vital parts of his body including right foot. He was taken to Tagore Hospital, where he remained admitted  from 14.1.2010 to 20.1.2010. Thereafter, he got treatment as out door patient. An amount of Rs.15090/- was paid by him  as hospital charges. Apart from that he purchased medicines from the market. Thereafter he submitted claim to  the Opposite Party, but his claim was repudiated on 9.4.2010 illegally, malafidely and arbitrarily. In this   way, there was deficiency in services on the part of the Opposite Party, which caused him mental pain, agony and harassment apart from financial loss.

 

2.                 Notice of the complaint was given to the Opposite Party, who put into appearance and filed written statement controverting the claim of the complainant. Objections have been raised that the complaint is not legally maintainable; that the complaint is bad for mis joinder and non joinder of the necessary parties and that the complainant has not approached this Forum with clean hands.

 

                   On merits, it has been admitted that the complainant was issued  Nagrik Suraksha Individual Policy  for the period of 13.3.2009 to 12.3.2011.It has been submitted that the complainant informed the Opposite Party regarding the  injuries suffered by him in road side accident on 14.1.2010 and on receipt of the claim, Sh.M.S.Gujral was appointed  to investigate the claim, who made detailed enquiry   and verified the bills and submitted report dated 11.3.2010. As per his report, the bills submitted by the complainant in support of his claim were fabricated, therefore,  claim of the complainant was repudiated on 7.4.2010 and intimation thereof was given to him, vide letter dated 9.4.2010.The complainant cannot be allowed to take benefit of his own wrongs. The complainant has lodged false claim. The other allegations made in the complaint have been denied.

 

3.                 In evidence of the complainant, ,his affidavit Ex.PW1/A and documents Ex.C1 to Ex.C3 have been filed. Dr.Naresh Kaushal of Tagore Hospital, Karnal, has also been examined as PW-2.

4.                 On the other hand, in evidence of the Opposite Party affidavits of Shri Manraj Virk Assistant Manager and M.S.Gujral  Ex.R1 and Ex.R2  respectively and report of Shri M.S.Gujral Ex.R3 have been tendered. 

 

5.                 We have appraised the evidence on record,  the material circumstances of the case and the arguments advanced by the learned Counsel for the parties.

 

6.                 It is not in dispute that the complainant was insured by the Opposite Party for the period of 13.3.2009 to 12.3.2011 for a sum of Rs.two lac. As per the case of the complainant he sustained injuries in the accident on 14.1.2010 and remained admitted in Tagore Hospital, Karnal from 14.1.2010 to 20.1.2010 and paid Rs.15090/-  as hospital charges apart from purchasing medicines from the local market. On the other hand, the Opposite Party has submitted that after receiving the claim of the complainant Sh.M.S.Gujral was appointed as investigator and as per his report, the accident was genuine, but the record of Tagore Hospital was forged and fabricated.

 

7.                 The learned counsel for the Opposite Party vehemently argued that bill of  the hospital for Rs.15090/- was forged and fabricated, because PW-2 Dr.Naresh Kaushal  did not bring the counter foil of the bills and he did not deny that bill no.517 might have been issued on 21.1.2010, whereas the bill  of the complainant  bearing no.518 was issued on 20.1.2010. He even could not say that bill No.516 was issued on 6.2.2010 and that no date was mentioned on the bill nos.515 and 519 to 522. Thus, the bill Ex.C3 cannot be considered as genuine, rather it appears that the same has been fabricated in order to help the complainant. Therefore, the complainant is not entitled to get  any claim from the Opposite Party.

 

                             The argument advanced by the learned counsel for the Opposite Party cannot be accepted  under the facts and circumstances of the present case. The mere fact that doctor did not            bring the counter foil of the bill and could not say about the date of issuance of the  bill no.517, 515  and 519 to 522 does not lead to the conclusion that bill Ex.C3 bearing no.518 issued on 20.1.2010  regarding treatment of the complainant was forged and fabricated document. Doctor proved the discharge slip Ex.C2, wherein   this fact was mentioned that complainant remained admitted in the Tagore Hospital, Karnal from 14.1.2010 to 20.1.2010. History of injury of right foot suffered by the complainant in the accident and the treatment given to him were mentioned in the said discharge slip. The bill of Rs.15090/-  for hospitalization  and treatment of the complainant for the period of 14.1.2010 to 20.1.2010 cannot be considered on the higher side by any stretch of imagination.  Had the doctor intended to help the complainant to get more compensation, he could exaggerate  the bill to higher amount and would  not have  issued bill just for a meager amount of Rs.15090/-. The copy of the report of Sh.M.S.Gujral shows that he admitted the factum of accident as genuine.  In the accident, the complainant had suffered injuries and he  required treatment for the same. Therefore, there is no circumstance, which may even tend to show that  the amount of Rs.15090/- was not  charged by the doctor as hospitalization charges and the bill regarding the same was forged and fabricated.  Under such facts and circumstances, the act of the Opposite Party repudiating the claim of the complainant cannot be considered as legal or justified. In this way, the order of repudiation of the claim of the complainant amounted to deficiency in services.

 

9.                 As a sequel to the foregoing discussion, we accept the present complaint and direct the Opposite Party to make the payment of Rs.15090/- to the complainant alongwith interest @ 9% per annum from the date of filing of the present complaint i.e.  29.4.2010 till its actual realization. The complainant shall also lbe entitled for a sum of Rs.5500/- for the mental agony and harassment caused to him and for the litigation expenses. The Opposite Party shall make the compliance of this order within a period of thirty days from the date of receipt of the copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:20.01.2016

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

Present:-        Sh.J.P.Kashyap Advocate for the complainant.

                   Sh.Amit Gupta  Advocate for the Opposite Party

                  

                   Vide our separate order of the even date, the present complaint has been accepted. The parties concerned be communicated of the order accordingly and the file  be consigned to the record room after due compliance.

 

 

Announced
dated:20.01.2016

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.