Haryana

Yamunanagar

CC/461/2012

Seema - Complainant(s)

Versus

Orietnal Insurance Company Ltd. - Opp.Party(s)

Sh. R.S. Ahluwalia

21 Mar 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                          Complaint No. 461 of 2012.

                                                                                          Date of institution: 10.05.2012

                                                                                          Date of decision: 21.03.2017

 

Seema wife of Late Shri Jai Kumar, resident of village Masana Jatta, Tehsil Jagadhri, District Yamuna Nagar, since deceased now represented through her following Legal Heirs: -

 

1. Lakhvinder Kaur, minor daughter aged about 13 years.
2. Deepanshu minor son aged about 3 years.
3. Gurdev Devi wife of Kulwant.

     Minors through Gurdevi being grandmother and natural guardian of the minors.

 

…Complainant.

                                       Versus

1. The Oriental Insurance Co. Ltd. Divisional office, Opp. Madhu Hotel, Jagadhri Road, Yamuna Nagar.
2. The Oriental Insurance Co. Ltd. having its Registered office at 7037, A-25/27, Asaf Ali Road, New Delhi.

 

                                                                                                            ...Respondents

BEFORE:         SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                         SH. S.C.SHARMA………………………….MEMBER.

 

Present:           Sh. VK Saini, Advocate for complainant.

                         Sh. Sanjay Sharma, Advocate for OPs.

 

ORDER  (Ashok Kumar Garg, President)

 

1                      The present complaint has been filed by Smt. Seema widow of deceased Shri Jai Kumar. However, lateron complainant Smt. Seema Rani expired during pendency of complaint and her legal heirs No.I to III were impleaded who hereinafter will be referred as complainants.

2.                     Brief facts of the present complaint, as alleged in the complaint, are that husband of the complainant got insured himself during his life time under Nagrik Suraksha Individual Policy bearing No. 271700/48/2010/1515 issued by the respondent (hereinafter referred as OPs Insurance Company). Unfortunately, husband of the complainant met with an accident on 01.03.2010 and sustained injuries and remained admitted in Sharma Hospital Jagadhri from 01.03.2010 to 28.03.2010. Even, thereafter also, the deceased Jai Kumar remained under treatment of Sharma Hospital and others hospital as OPD patient for several months and spent near about Rs.1,00,000/- on his treatment. The deceased Jai Kumar informed the Insurance Company about his accident and requested to pay compensation to him on account of injuries sustained in accident and completed all the formalities but despite completing all the formalities, the OPs Insurance Company put off the matter one pretext or the other and ultimately refused to pay the same without disclosing any reason. After that, Shri Jai Kumar insured died on 31.03.2011 and in this regard information and concerned record was also sent to the office of OPs Insurance Company which was duly received by them but even then they did not bother to pass any claim. Hence, this complaint for directing the OPs insurance company to pay insurance amount of Rs.1,00,000/- on account treatment, medicine etc., charges against the policy in question to the complainants and also to pay Rs.40,000/- on account of mental agony and pay Rs.5500/- as litigation expenses.

3.                     Upon notice, OP Insurance Company appeared and filed its written statement taking some preliminary objection such as complaint is not maintainable; the present complaint is without any cause of action; complainant has not come to the court with clean hands and on merit all the contents of the complaint were denied being matter of record and for want of knowledge. Further, it has been submitted that the assertion of the complainant is wrong as no documents have been provided by the complainant to the OPs Insurance Company, lastly it has been mentioned that there was no deficiency in service or unfair trade practice on the part of the OPs and prayed for dismissal of the complaint.

4.                     In support of his case, learned counsel for the complainant tendered into evidence affidavit of Smt. Seema (now deceased) as CW/A and photocopy of miscellaneous letter issued by so called DTN Company as Annexure C-1, photocopy of proposal Form for obtaining Nagrik Suraksha Individual Policy as Annexure C-2, photocopy of Ration Card as Annexure C-3, photocopy of letter dated 02.12.2010 issued by Insurance company as Annexure C-4, certificate issued by Sarpanch as Annexure C-5, photocopy of death certificate of Jai Kumar as Annexure C-6, photocopy of ration card as Annexure C-7, photocopy of letter written by deceased Jai Kumar as Annexure C-8, carbon copy of letter of one Rakesh Kumar as Annexure C-9, photocopy of letter issued by OPs Insurance Company dated 08.02.2011 as Annexure C-10, photocopy of affidavit of Smt. Seema as Annexure C-11 and closed the evidence on behalf of complainant.

5.                     Learned counsel for the OPs Insurance company placed on file affidavit of Shri Gurmej Singh, Deputy Manager as Annexure RW/A, photocopy of letter issued by OPs Insurance Company dated 23.04.2010 as Annexure R-1, photocopy of letter dated 08.02.2011 as Annexure R-2, photocopy of another letter as Annexure R-3, photocopy of notice to repudiate the claim as Annexure R-4 and closed the evidence on behalf of OPs.

6.                     We have heard the learned counsels of both the parties and have gone through the pleadings as well as documents placed on the file very carefully and minutely.

7.                     It is pertinent to mention here that firstly the present complaint was filed by Smt. Seema being widow of Shri Jai Kumar as the said Jai Kumar expired on 31.03.2011 due to natural death ( as stated by learned counsel for the complainant). After that, the complainant Smt. Seema also expired during the pendency of present complaint and her LRs mentioned at Serial No.I to III of the head note were impleaded through Smt. Gurdevi being grandmother and natural guardian of the minors.

8.                     The only version of the complainants is that Shri Jai Kumar met with an accident on 01.03.2010 and due to the injuries suffered by him, remained admitted in hospital from 01.03.2010 to 28.03.2010 and even after that also obtained the treatment from other hospitals and spent near about Rs.1,00,000/- on his treatment and after that he (now deceased) lodged the claim with the OPs Insurance Company for reimbursement of medical expenses, but the OP Insurance Company refused to pay the same. Learned counsel for the complainant draw our attention towards the letter dated 23.11.2009 (Annexure C-1) and proposal Form as (Annexure C-2) and letter dated 02.12.2010 (Annexure C-4) and argued that complainants are entitled to get the claim on account of reimbursement of medical expenses, but the version of the complainant is not tenable as the complainants have totally failed to place on file any copy or photocopy of Insurance, cover note/policy in question. Further, the complainants have also failed to place on file any treatment record of any hospital or bills of the expenses during the hospitalization in support of their version mentioned in the complaint. Further, the complainants have also failed to place on file any copy of DDR/PMR/FIR to prove that deceased Jai Kumar met with an accident on 01.03.2010 as alleged in the complaint, since from the filing of present complaint on 10.05.2012 till today not a single application was moved on behalf of the complainants to summon the record of Insurance policy in question from OPs Insurance Company, due to the reason best known to the complainants. The documents whatsoever have been placed on file by the complainants in support of their case, are not sufficient to hold that the complainants are entitled to get some amount on account of expenses of medical treatment from the OPs Insurance Company particularly in the absence of any Insurance policy particular/medical treatment papers issued by any hospital.

9.                     In the circumstances noted above, as no cogent evidence has been placed on file by the complainant, hence, we are of the considered view that complainant is not entitled to get any relief.

10.                   Resultantly, in the circumstances noted above, the complaint of the complainants has no merit and the same is hereby dismissed with no order as to cost. Copies of this order be supplied to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Pronounced in open court: 21.03.2017.

                                                                                          (ASHOK KUMAR GARG)

                                                                                           PRESIDENT

                                                                                          DCDRF Yamuna Nagar

 

 

                                                                                          (S.C.SHARMA)

                                                                                           MEMBER