Haryana

Karnal

464/2013

Rajesh Madaan S/o M.C. Madaan - Complainant(s)

Versus

Reliance General Insurance CompanyLimited - Opp.Party(s)

Mohit Sachdeva

02 May 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                               Complaint No.464 of of 2013

                                                              Date of instt.: 29.11.2013

                                                                Date of decision:02.05.2016

 

Rajesh Madan son of Shri M.C. Madan resident of House no.44, opposite TVS Showroom, Arjun Gate, G.T. Road, Karnal.

 

                                                                                  ……..Complainant.

                                      Vs.

1. Reliance General Insurance Co.Ltd., through its Branch Manager, SCO 145-146, Second Floor, Sector 9-C, Madhya Marg, Chandigarh.

2. Vishal Bhaskar, Sales Manager, Reliance General Insurance Company Ltd., House no.1, near Kaithal Fly Over, Prem Nagar, Karnal.

2^nd Address

Reliance General Insurance Co. Ltd. (RGICL) 1^st floor, Rattan Tower, Civil Line, near Namdev Chowk, Jalandhar, Punjab.

                                                                                      ……… Opposite Parties.

 

                     Complaint u/s 12  of the Consumer Protection Act.

 

Before                   Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-       Sh.Pardeep Kapoor Advocate for the complainant.

                     Sh. Pankaj Malhotra  Advocate for the Opposite parties.

 

 ORDER:

 

                   This complaint has been filed by the complainant u/s 12 of the Consumer protection Act 1986, on the averments that he purchased Medi claim policy plan of opposite party no.1 from the opposite party no.2, vide policy no.282510356960 on 15.11.2008, for assured sum of Rs.2 lac. He deposited regular annual premiums and the policy was to expire on 14.11.2013. He was admitted in All India Institute of Medical Sciences (A.I.I.M.S.) Delhi on 12.12.2012 and treated there for MVR With #27 SJM with Sub Total Chordal Preservation with LA Clot Removal LAA Litigation and discharged on 20.12.2012. An amount of Rs.89,959/- was spent by him on his treatment. He had given intimation regarding his admission in the hospital, telephonically to opposite party no.1 through its sales manager Vishal Bhaskar i.e. opposite party no.2, on 12.12.2012. Opposite party no. 2 assured him that he would give intimation to opposite party no.1 by e-mail. Thereafter, he lodged claim with the opposite party no.1 for reimbursement of the expenses incurred on his treatment and completed all the formalities, but no step was taken by opposite party no.1 for settlement of the claim. Ultimately, he got issued legal notice to opposite party no.1 on 1.7.2013, but the same also did not yield any result. Thus, there was deficiency in service on the part of the opposite parties, which caused him mental pain, agony and harassment apart from financial loss.

2.                Notice of the complaint was given to opposite parties. Opposite party no.1 put into appearance and filed written statement disputing the claim of the complainant. Objections have been raised that the complainant has no locus standi and cause of action to file the complaint; that the complaint is not maintainable; that the complaint is pre-mature; that the complaint is hopelessly time barred; that the complaint is bad for non-joinder of necessary parties; that the complainant is estopped from filing the complaint by his acts and conduct and that complicated questions of law and facts are involved, which cannot be decided by this forum under summary jurisdiction.

                   On merits, it has been submitted that the complainant was repeatedly asked to furnish the requisite documents for the processing the claim, but he maintained complete silence. Letters dated 26.3.2013, 20.5.2013 and 3.6.2013 were sent to him asking him to furnish the requisite documents, but he failed to furnish those documents. Therefore, his claim was closed, vide letter dated 3.6.2013. The other allegations made in the complaint have been denied.

3.                Opposite party no.2 did not file separate written statement, rather adopted the written statement filed by the opposite party no.1.

4.                In evidence of the complainant, his affidavit Ex.CW1/A and documents Ex. C1 to C13 have been tendered.

5.                On the other hand, in evidence of the opposite parties, affidavit of Abhliash Chander, Manager Ex.O1, affidavit of J.P. Singh Ex.OP2/A and document Ex.OP2 to O4 have been tendered.

6.                We have heard the learned counsel for the parties and gone through the case file carefully.

7.                There is no dispute between the parties regarding the facts that the complainant had obtained mediclaim policy from opposite party no.1, which was renewed from time to time and was valid upto 14.11.2013. As per the case of the complainant he remained admitted in AIIMS Delhi from 12.12.2012 to 20.12.2012 and spent an amount of Rs.89,969/- on his treatment. He lodged claim with the opposite party no.1 for reimbursement but the opposite party no.1 did not pay the claim. Opposite party no.1 closed the claim of complainant on the ground that letters were sent to him to submit requisite documents, but he failed to submit those documents despite reminders.

8.                The opposite party no.1 has produced the copies of letters dated 26.3.2013, 20.5.2013 and 3.6.2013 Ex.O2 to O4 respectively, asking the complainant to furnish details and the original papers. The copy of the letter dated 15.4.2013 Ex.C8 shows that the complainant had replied to the letter of the opposite party no.1 dated 26.3.2011. He gave reply to all the three items as mentioned in the letter dated 26.3.2013. He had attached the required documents received from AIIMS on 17.1.2013; that he had submitted all originals papers already to opposite party no.2 and that he had timely intimated to opposite party no.2 on 12.12.2012 at 7.00p.m. and next day the opposite party no.2 gave assurance for intimation. During the course of arguments learned counsel for the complainant also produced the speed post postal receipt dated 15.4.2013 regarding sending the said letter by the complainant to opposite party no.1. Thus, from the evidence of the complainant it is established that the complainant had clarified to opposite party no.1 that all the original documents were submitted by him to the opposite party no.2, who was sales manager of opposite party no.1 and completed all the requisite formalities. It is not in dispute that opposite party no.2 was not the sales manager of opposite party no.1. Therefore, after the letter dated 15.4.2013 sent by the complainant it was incumbent upon the opposite party no.1 to enquire from opposite party no.2 whether the original documents were submitted with him by the complainant or not, but there is no evidence which may show that any step was taken by opposite party no.1 in that direction. The pleadings and evidence of the complainant are definite that he had given intimation regarding his admission in the hospital to opposite party no.2 on 12.12.2012 itself. He had submitted the requisite documents to the opposite party no.1 alongwith his letter dated 15.4.2013. Original documents were already supplied by him to opposite party no.2. Under such circumstances, there was no occasion for opposite party no.1 to close claim of the complainant as no claim on 3.6.2013. Thus, the act of opposite party no.1 closing the claim of the complainant on 3.6.2013 was neither legal nor justified and the same amounted to deficiency in service.

9.                As a sequel to the foregoing discussion, we accept the present complaint and direct the opposite party no.1 to pay Rs.89,959/- to the complainant alongwith interest @ 9% per annum from the date of filing the complaint till its realization. We further direct the opposite party no.1 to  pay Rs.11,000/- to the complainant on account of mental agony and harassment suffered by him and for the litigation expenses. This order shall be complied within 30 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 2.5.2016

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member