Delhi

New Delhi

cc/263/2013

GAURAV MALHOTRA - Complainant(s)

Versus

Oriental Insurance Ltd. - Opp.Party(s)

27 Nov 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

           (DISTT. NEW DELHI),‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE, NEW DELHI-110001

 

Case No.C.C./263/2013                                          Dated:   

In the matter of:

SHRI GAURAV MALHOTRA,

D-70, Ajay Enclave,

Delhi.

 

                                                           ………..COMPLAINANT

 

VERSUS

 

DIVISIONAL MANAGER,

Oriental Insurance Company Ltd.,

K-37, Chaudhary Bldg.,

Connaught Place,

New Delhi

….... OPPOSITE PARTY

ORDER

President: C.K. CHATURVEDI

         The complainant had a family floater policy covering self, his mother Usha Malhotra and father.  The policy was first time taken on 18/8/2010to 17/8/2011, it was renewed a 18/8/2011 for a period to 17/8/2012 and for 18/8/12 to 17/8/13 ;and for 29/8/12 to 28/8/13.  Thus there was a gap of about 11 days in the last policy.  The gap occurred due to stopping of cheque by misunderstanding, and on 25/8/12 issue gave another cheque for against which policy was issued.  He requested for condonation of delay of 11 days, as assured by the Agency of Insurance.  The OV vide its letter dated 6/12/12, stated that payment was stopped by one of the insured i.e. Usha Malhotra who was dependent mother.  The company regretted inconvenience.  This amounts to condonation of delay is continuity  of policy in 4^th year.

          It is stated that mother Usha Malhotra, was to be admitted in hospital for CAD, and had to spend Rs. 2,82,455/- which was informed to OP.  The OP did not respond.  He filed this complaint. In reply OP stated that under clause 2.3 of the policy, the CAD surgery was excluded in first two years of this policy.  The complainant in rejoinder states that this clause was not explain to him, nor formed part of insurance and his attention was not drawn to it.

         We have heard both the parties and perused the record it is seen that even if clause 2.3 is applied , it is not applicable  after first two year of the policy.  In this case the policy was in 4^th years, with a technical gap of 11 days, for which OP has accepted  cheque and did not issue condonation letter, but regretted in-convenience. The cheque of Gaurav Malhotra, could not have been stopped by his mother policy.  OP is wrong to say that it was not condoned.

          In our considered view, the OP has acted imperfectly in its services and caused deficiency in service, by not settling the claim so far, on grounds of no claim filed.  Holding OP guilty,  we direct OP to settle the claim of Rs. 2,85,455/- by reimbursing it to the complainant.   We award consolidated compensation of Rs. 50,000/- including of litigation expanses.

       

 

 

          If OP request any more documents will supply or OP will get from the hospital itself.

         The orders be complied in 30 days.

 

 

(C.K.CHATURVEDI)

President

 

 

 

(RITU GARODIA)

Member