Punjab

Ludhiana

CC/17/312

Tej Bhan Tayal - Complainant(s)

Versus

Punjab National Bank - Opp.Party(s)

19 Sep 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

                                                            Complaint No: 312 dated 20.04.2017.                                                               Date of decision: 19.09.2017.    

         

Tej Bhan Tayal aged 72, Resident of 386, St. No.6, Vijay Nagar, Samadhi Road, Khanna.                                                                                                                                                                                 ..…Complainant

                                                  Versus

1. Punjab National Bank, Rajguru Nagar, Ludhiana through its Branch Manager.
2. The Oriental Insurance Company Limited, above Fine Furniture, Opp. Chhabra Hospital, Bus Stand Road, Ludhiana, through its Divisional Manager.
3. Medi Assist Insurance, TPA Pvt. Ltd., Head Office:- Tower D, 4^th Floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore-560029, through its Manager/Director/Managing Director/Authorized Signatory.

 

…..Opposite parties 

                              Complaint under Section 12 of Consumer Protection Act.

QUORUM:

SH. G.K. DHIR, PRESIDENT

SH. PARAM JIT SINGH BEWLI, MEMBER

COUNSEL FOR THE PARTIES:

For complainant               :         Sh. Narinder Singh, Advocate.

For OP2                           :         Sh. Rajeev Abhi, Advocate.

For OP1 and OP3            :         Complaint against OP1 and OP3 not admitted.

 

ORDER

PER G.K. Dhir, PRESIDENT

1.                 Complaint under Section 12 of The Consumer Protection Act, 1986 (herein-after in short to be referred as ‘Act’) filed by complainant by pleading that he purchased mediclaim policy No.233902/48/2017/858 for self by paying premium as demanded by OP2. Validity of the policy was for the period from 12.05.2016 to 11.05.2017. Complainant was admitted in SPS Hospital, Ludhiana on 06.08.2016 with acute Coronary Syndrome for which he underwent CAG and PCI as a life saving measure and thereafter, discharged on 10.08.2016 after incurring huge expenses on treatment. Complainant claimed Rs.2,75,135/- from OPs by submitting the claim and thereafter, got assurance from OP3 that claim will be settled by OP2. Despite submission of all the documents, OPs failed to settle the claim by making payment and that is why this complaint filed after sending notice dated 01.02.2017 and reminder dated 06.03.2017.

On application for dismissal of complaint dated 27.07.2017 filed by OP2

2.                 Application has been filed by claiming that after settling the claim amount, a sum of Rs.2,72,451/- has been paid to complainant on 14.07.2017 in full and final settlement of the claim by crediting the amount in the account of complainant through NEFT and as such, complaint deserves dismissal.

3.                 In reply to this application, it is claimed that deficiency in service on the part of OP2 is there because of the unexplained delay in paying the medical reimbursement insurance claim amount. Complainant after his discharge from SPS Apollo Hospital on 10.08.2016 had been running from pillar to post, but OP did not bother for reimbursement of the medical claim despite repeated reminders and that is why complainant forced to file this complaint. Present application alleged to be filed by OP2 just for avoiding costs and compensation with regard to the mental pain and agony suffered by him.

4.                 Arguments on the application as well as in the complaint were heard together. Complainant suffered statement on 08.09.2017 having received the amount of Rs.2,71,451/- on 14.07.2017 through NEFT under protest because of the amount being lesser than actual amount of medical reimbursement. As per that recorded statement of complainant, the amount was paid after a long time during pendency of the complaint resulting in his unnecessary harassment, sufferance of mental pain and agony and as such, prayer made for directing OPs to pay compensation of Rs.2 Lac along with litigation expenses and heavy costs. In view of receipt of this amount, it is vehemently contended by Sh. Rajeev Abhi, Advocate representing OP2 that there is no deficiency in service on the part of OP2 because claim after being registered was processed and thereafter, settling the amount, same has been paid and as such, complaint has become in-fructuous. Even if the settled amount of Rs.2,72,451/- has been received by the complainant on 14.07.2017 through NEFT, but despite that the amount was not settled earlier to the filing of this complaint on 20.04.2017, despite the fact that complainant sent letter dated 01.02.2017 through registered post and even sent reminder notice dated 06.03.2017 through registered post. Copies of both these notices along with postal receipts are there on the record. So certainly submission advanced on behalf of complainant has force that amount has been paid after much delay despite the fact that all the queries qua submission of documents or otherwise put forth by OP, stood closed on 27.11.2016. Reference of the closure of these queries on 27.11.2016 specifically made in the above pointed reminder letter dated 01.02.2017. Even complainant sent letter dated 27.11.2016 for requesting for early settlement of the claim and as such, it is obvious that complainant had to suffer mental pain and agony owing to non settlement of the claim at the earliest and that is why he has to file this complaint. Due to this conduct of OP2 in not settling and paying the amount at the earliest, certainly complainant entitled for compensation for mental harassment and to litigation expenses, but of meager amount by keeping in view the fact that amount has been paid without filing written statement and after putting in appearance by OP2 through counsel on 10.07.2017, but before the next fixed date of 27.07.2017 itself. So application for dismissal of complaint is not maintainable, but complainant entitled to meager amount of litigation expenses and compensation for mental agony and harassment only. It is the case of complainant that he submitted claim of Rs.2,75,135/-, the amount incurred on medical treatment. The amounts certainly are not payable regarding expenses borne on purchase of the gloves, disposable syringes etc. like material as per terms and conditions of the policy and as such, by keeping in view that fact in mind, there is no escape from the conclusion that paid amount of Rs.2,72,451/- is quite appropriate.

5.                 As a sequel of above discussion, application for dismissal of the complaint dismissed and complaint disposed of in terms that complainant only entitled to compensation for mental harassment and agony of Rs.2,000/- (Rupees Two Thousand only) and also to litigation expenses of Rs.2,000/- (Rupees Two Thousand only). Payment of these amounts be made within 30 days by OP2 from the date of receipt of copy of order. Copies of the order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

 

                                         (Param Jit Singh Bewli)                      (G.K. Dhir)

                                         Member                                              President

Announced in Open Forum.

Dated:19.09.2017.

Gobind Ram.