Delhi

StateCommission

FA/12/893

SPUTNIK MEDICAL RESERCH FOUNDATION - Complainant(s)

Versus

PRAVEEN KR. GARG & ORS. - Opp.Party(s)

28 Nov 2016

ORDER

IN THE STATE COMMISSION: DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

                                                             Date of Decision: 28.11.2016

First Appeal No. 893/2012

(Arising out of the order dated 29.08.2012 passed in Complaint Case No. 986/2009 by the District Consumer Disputes Redressal Forum V (North West) CSC-Block, Shalimar Bagh, Delhi-110088)

In the matter of:

Sputnik Medical Research Foundation

B-21, Oriental Apartments

Sector-9, Rohini

Delhi-110085                                                                           .........Appellant

 

Versus

 

1. Parveen Kumar Garg

Kothi No. 300, Ambika Vihar

Paschim Vihar

New Delhi-110063

 

2. Genins India Ltd.

B-127, Sector-2

•  

 

3. The Oriental Insurance Co. Ltd.

Do-9, 1/28, Sunlight Insurance Building

Asaf Ali Road, New Delhi-110002                                    ..........Respondents

                                                                  

CORAM

N P KAUSHIK                         -                  Member (Judicial)

 

1.         Whether reporters of local newspaper be allowed to see the judgment?                   Yes

2.         To be referred to the reporter or not?                                                                  Yes

 

N P KAUSHIK – MEMBER (JUDICIAL)

 

JUDGEMENT

1.     Present appeal is directed against the orders dated 29.08.2012 passed by the Ld. District Forum V (North-West) Shalimar Bagh Delhi-110088. Vide impugned orders following directions were passed by the District Forum:

“1. Pay to the complainant a sum of Rs. 75,350/- alongwith interest @ 10% from the date of filing this complaint i.e. 3.7.2009 till payment.

2. Pay to the complainant a sum of Rs. 10,000/- as compensation.

3. Pay to the complainant a sum of Rs. 5000/- as cost of litigation.”

 

2.     Facts in brief of the case are that the complainant Sh. Parveen Kumar Garg admittedly purchased a policy from Sputnik Medical Research Foundation, the appellant herein. It was a group medi-claim policy. It covered the complainant Sh. Parveen Kumar Garg and his wife. During the subsistence of the policy and on 11.01.2009, wife of the complainant delivered a baby and also underwent a surgery for removal of uterus. An expenditure of Rs. 75,350/- was incurred. Complainant supplied the documents to the TPA i.e. OP-2. His claim was not settled. Hence he filed the complaint. Appellant did not put in appearance in the District Forum. He was proceeded against ex-parte. TPA/OP-2 filed his defence and raised a plea that the complainant had supplied the original of the discharge summary. It was also submitted by the OP-2 that the complainant had failed to give a declaration that he did not have more than two living children, prior to the delivery in question.
3.     Ld. District Forum allowed the complaint observing that the OP-2 had failed to place on record any document to show that the claim was admissible only if the complainant had less than two living children at the relevant time. It was further observed by the Ld. District Forum that the claim could not be denied for want of the original of the discharge summary. TPA could have collected the same from the nursing home concerned.
4.     Present appeal has been filed on the grounds inter-alia that the cover note and policy were issued by the Oriental Insurance Co. Ltd. and not by the appellant. Appellant simply acted as prime-insured in the group medi-claim policy. Contention of the appellant is that the complainant/respondent ought have impleaded Oriental Insurance Co. Ltd. in the original complaint.
5.     I have heard at length the arguments addressed by the counsel for the appellant Sh. Trilok Chand Advocate and a representative of the appellant Sh. Narendra Bansal. Complainant/respondent addressed the arguments in person.
6.     Appellant has failed to place on record any document in support of his contention that there existed any agreement directly between the complainant and the Oriental Insurance Co. Ltd. The agreement placed on records is signed by the appellant herein and not by the Oriental Insurance Co. Ltd.
7.     Perusal of the reply filed by the TPA in the District Forum shows that it has not supported the contention of the appellant herein. For these reasons, I am of the considered opinion that the appeal is devoid of merits. The same is hence dismissed.
8.     Copy of the orders be made available to the parties free of costs as per rules and thereafter the file be consigned to Records.

 

 

(N P KAUSHIK)

MEMBER (JUDICIAL)

6.