BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 82 of 2018
Date of Institution : 05.03.2018
Date of Decision : 27.05.2019
Om Parkash Doda son of Sh.Bishan Dass Doda resident of village Humayukhera Tehisl Ellanabad & District Sirsa, Haryana.
……Complainant.
Versus
- PNB- Oriental Royal Mediclaim through its President or Executive Director/Head, SCO 174-75, Red Square Market, Railway Road, Hisar District Hisar (Haryana).
- M/s Medi Assist India, through its Manager/Head, No.4/1, IBC Knowledge Park, Tower “D” 4th Floor Bannerghatta Road, Banglore-560029.
- The Oriental Insurance Company Limited through its Branch Manager, SCO 174-75 Red Square Market Railway Road, Hisar District Hisar (Haryana).
- Punjab National Bank Branch Sirsa Road, Ellenabad Tehsil Ellenabad and District Sirsa through its Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA………………. ……PRESIDENT.
SH. ISSAM SINGH SAGWAL ………MEMBER.
MRS. SUKHDEEP KAUR……………..MEMBER.
Present: Sh. S.S.Kathuria, Advocate for the complainant.
Opposite parties No.1 & 2 exparte.
Sh.Ravinder Monga, Advocate for opposite party No.3.
Sh.R.K.Chaudhary, Advocate for opposite party No.4.
ORDER
The case of the complainant, in brief, is that the complainant and his wife Smt.Bimla Rani had purchased PNB-Oriental Royal Medi-claim Policy Nos. 261500/48/2015/24 and further policy No.261500/48/2016/20 and further policy No.261500/48/2017/68 for a sum of Rs. 2 lacs w.e.f. 10.04.2014 and in the year 2015 he had paid Rs.3320/- (mode yearly) and further premiums had also been paid by the complainant to the ops on 05.04.2016 and further premium of Rs.4709/- was deducted by Op No.4 from account No.487900010002866 of complainant and in this way, the policy of the complainant and his wife is continue from 2014 till date. On 12.04.2016, wife of complainant suddenly fell ill and was admitted in Sanjivani Hospital Sirsa and after investigation, the doctors advised for surgery, which was done in the hospital and she remained admitted in the hospital from 12.04.2016 to 18.04.2016 and got further treatment for two months. The complainant had spent Rs.48,559/- on the treatment and medicines. He lodged claim with Ops and also supplied all the requisite documents but the Ops have repudiated the claim on 10.04.2016 with the reasons that the policy of the complainant was expired on 10.04.2016 rather the policy was continue as further premium was deduced from the above said bank account of complainant by Op No.4 on 05.04.2016 but the Ops have deliberately showed the policy discontinue and showed further from 22.04.2016 to 21.04.2017. The complainant requested the Ops to pay the claim amount and even got served legal notice upon them but to no avail. The act and conduct of the Ops clearly amounts to deficiency in service and unfair trade practice on their part. Hence, this complaint.
2. On notice, Ops No.3 & 4 have appeared and filed their separate replies whereas notices sent to Ops No.1 & 2 through registered post were not received back after lapsing of period of 30 days, therefore, they were proceeded against exparte vide order dated 21.11.2018.
3. OP N.3 in its written statement has submitted that the present complainant is not maintainable and the complainant is estopped from filing the present complaint by his own act and conduct. The complainant had purchased insurance policy bearing No.261500/48/2015/24 commencing from 11.04.2014 to 10.04.2015, further policy No. 261500/48/2016/20 commencing from 11.04.2015 to 10.04.2016, thereafter he purchased policy No.261500/48/2017/68 commencing from 22.04.2016 to 21.04.2017. The policies were subject to agreed terms and conditions. As per complainant himself, his wife suddenly fell ill and admitted in the hospital on 12.04.2016. The policy No.261500/48/2017/68 was commencing from 22.04.2016 to 21.04.2017, therefore, the answering Op could not identify the liability as the period of hospitalization from 12.04.2016 to 18.04.2016 was not covered under the policy period. Other contentions have been controverted and prayer for dismissal of the complaint has been made.
4. Op No.4 in its written statement has submitted that the complainant had purchased a PNB Oriental Royal Medi-claim policy from 11.04.2014 to 10.4.2015 and further for the period of 11.04.2015 to 11.04.2016. The renewal of the policy is not automatic and the premium due must be paid by the proposer to the company before the due date. As per record, the amount in credit in the account of the complainant was less than of Medi-Claim premium and on 05.04.2016, the complainant deposited a sum of Rs.5,000/- and on the demand of the complainant the replying Op had issued a DD for Rs.4709/- in favour of Oriental Insurance Company on 05.04.2016 which was sent immediately for renewal of medi-claim policy. Without the consent of the proposer, the replying Op was not bound for renewal of the policy. There is no deficiency in service on the part of replying Op. Other contentions have been contoverted and prayer for dismissal of the complaint has been made.
5. Thereafter, the parties have led their respective evidence. The complainant tendered his affidavit Ex.CW1/A and documents Ex.C1 to Ex.C30. On the other hand, op no.4 tendered affidavit of Sh. Tara Chand, Branch Manager Ex.R1 and copies of documents Ex.R2 to Ex.R5. OP no.3 tendered affidavit of Sh. Sushil Kumar, Malhotra, Divisional Manager Ex.RW2/A and documents Ex.R6 to Ex.R8.
6. We have heard learned counsel for the parties and have perused the case file carefully.
7. As per averments in the complaint, complainant and his wife had purchased PNB-Oriental Royal Medi-claim Policy Nos. 261500/48/2015/24 and further policy No.261500/48/2016/20 and further policy No.261500/48/2017/68 for a sum of Rs. 2 lacs w.e.f. 10.04.2014 and in the year 2015 he had paid Rs.3320/- (mode yearly) and further premiums had also been paid by the complainant to the ops on 05.04.2016 and further premium of Rs.4709/- was deducted by Op No.4 from account No.487900010002866 of complainant and in this way, the policy of the complainant and his wife was continue from 2014 to up to date. It is proved fact on record that on 12.4.2016 Smt. Bimla Rani wife of complainant suddenly fell ill and she was admitted at Sanjivani Hospital, Sirsa for treatment. She had got surgery and remained there from 12.4.2016 to 18.4.2016 and as per averments of the complainant he spent an amount of Rs.48,559/- on the treatment of his wife. He lodged claim with the ops, but however, claim of the complainant was refused on the ground that policy of the complainant was expired on 10.4.2016.
8. Learned counsel for complainant has contended that as per record, draft of premium amount was issued on 5.4.2016 from bank i.e. op no.4 and same was sent on the same day to insurance company, but however, the op no.3 has issued the policy w.e.f. 22.4.2016 to 21.4.2017.
9. On the other hand, there is specific plea of the insurance company that policy was not valid on the day of admission of the wife of complainant. Further is no liability of op no.3 to pay any claim. There is also specific contention of learned counsel for Punjab National Bank Branch Sirsa road, Ellenabad i.e. op no.4 that it is not legal obligation of the bank to get the policy renewed rather it is duty of the complainant himself to pay premium and to get the policy renewed. On the request of complainant, a demand draft was issued on 5.4.2016 and same was sent to the concerned quarter on the same day.
10. It is proved fact on record that previous policy of complainant was valid till 10.4.2016 and thereafter policy number 261500/48/2017/68 was issued for the period 22.4.2016 to 21.4.2017. So, since it is proved fact on record that policy was not valid on the day of admission of wife of complainant, as such there is no liability of op no.3 insurance company to reimburse the expenditure of the treatment of wife of complainant.
11. Whereas, the liability of Punjab National Bank op no.4 is concerned, the complainant has not placed on record any cogent and convincing evidence or other documents from which it could be presumed that it was legal obligation of the Punjab National Bank to get the policy renewed of the complainant, though bank had issued demand draft on 5.4.2016 and same was sent to the insurance company on same day which is evident from the copies of documents Ex.R3 and Ex.R4 and this fact has also been deposed by Sh. Tara Chand, Branch Manager in his affidavit Ex.R1.
12. In view of the above discussion, it appears that complainant has failed to prove his case against the opposite parties and the complaint of the complainant does not appear to be maintainable and same is hereby dismissed but with no order as to costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:27.05.2019. District Consumer Disputes
Redressal Forum, Sirsa.
Member Member
DCDRF, Sirsa DCDRF, Sirsa
