Haryana

Yamunanagar

CC/83/2015

Nitin Bharti S/o Yash Pal Bharti - Complainant(s)

Versus

Reliance Life Insurance Company Ltd. - Opp.Party(s)

Balraj Rana

26 Oct 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA   NAGAR AT JAGADHRI.

 

                                                     Complaint No.83 of 2015.

                                                     Date of institution: 12.03.2015.

                                                     Date of decision: .   26.10.2017

Nitin Bharti, aged 44 years, son of Shri Yash Pal Bharti, resident of H.No.2425, Sector-17, Urban Estate, Jagadhri, District Yamuna Nagar, Mobile No.9215027017.

                                                                                                …Complainant.

                        Versus

1. Reliance Life Insurance Company Limited, 514-515-A, Ist Floor, D.K.Building, Model Town, Yamuna Nagar, through its Branch Manager.
2. The Reliance Life Insurance Company Limited, Registered Office H Block, Ist Floor, Dheeru Bhai Ambani Knowledge City, Navi Mumbai, Maharashtra-400710, through its M.D.
3. Reliance Life Insurance Company Limited, 9^th and 10^th Floor, Building No.2 R-Tech Park, Nirion Compound next to Hub Mall, Behind 1-Flex Building Gurgaon (Haryana), through its Manager. 

 

….Respondents.

BEFORE SH. SATPAL, PRESIDENT

                SH. S.C.SHARMA, MEMBER.

                SMT.VEENA RANI SHEOKAND, MEMBER.

 

Present:     Sh. Balraj Rana, Advocate, for complainant.   

                 Sh. K.K.Gupta, Advocate for the OPs.

               

                ORDER

         

(SATPAL, PRESIDENT)

                The complainant-Nitin Bharti has filed this complaint under section 12 of the Consumer Protection Act 1986, as amended up to date (hereinafter respondents will be referred as OPs). 

2.             Brief facts of the complaint, as alleged by the complainant, are that he purchased a Reliance Life Insurance Medical Policy bearing No.51379557 on 20.12.2013 for insured  a sum of Rs.2,00,000/- and paid first premium of Rs.4785.41 paise on the same day i.e. on 20.12.2013 and completed all the formalities as required by the Ops and the said policy was valid for the period w.e.f. 20.12.2013 to 20.12.2014.  It is alleged that he developed some infection in his abdomen and as a result of which , he was admitted in J.P.Hospital, Yamuna Nagar and remained as indoor patient from 23.05.2014 to 25.05.2014 and spent Rs.15,000/- on his treatment.  It is further alleged that the complainant lodged the claim with the Ops and submitted all the required documents but the Ops did not settle the claim of complainant.  So, it is a clear cut case of deficiency in service on the part of Ops and prayed for acceptance of complaint with the direction to Ops to release the amount of Rs.15,000/- in respect of medical bills and further to pay Rs.2,00,000/- as compensation for harassment and mental agony.  Hence, this complaint.

3.            Upon notice, the OPs appeared and filed their written statement raising preliminary objections with regard to locus-standi; maintainability; cause of action; the present complaint is pre-mature in nature as the claim of complainant has not been decided on merits, due to non-submission of the required documents; that on receipt of claim papers, the documents were forwarded to an independent TPA, duly licensed and registered from IRDA for adjudication of claim on merits being an expert but the complainant had failed to provide the documents demanded by an Independent TPA and hence, till date the claim of complainant has not been settled on merits.   There is no deficiency in service on the part of Ops.  On merits, the pleas taken in the preliminary objections are reiterated and so, prayed for dismissal of complaint.

4.             Ld. Counsel for the complainant tendered in evidence affidavit of complainant as Annexure-CA and documents Annexure-C1 to Annexure-C24 and closed evidence on behalf of complainant. 

5.             On the other hand, ld. Counsel for the Ops tendered in evidence affidavit of Sh. Sanjeev Kumar, Authorized Signatory as Annexure-RA alongwith documents Annexure-R1 to Annexure-R5 and closed evidence on behalf of Ops.    

6.             We have heard the ld. Counsel for both the parties and perused the record carefully and minutely.

 

7.             Ld. Counsel for the complainant reiterated all the points mentioned in the complaint.  He argued that the complainant purchased a Reliance Life Insurance Medical Policy bearing No.51379557 on 20.12.2013 for a sum of Rs.2,00,000/- and paid first premium of Rs.4785.41 paise on the same day i.e. on 20.12.2013 and completed all the formalities as required by the Ops and the said policy was valid for the period w.e.f. 20.12.2013 to 20.12.2014.  He further argued that the complainant  developed some infection in his abdomen and as a result, he was admitted in J.P.Hospital, Yamuna Nagar and remained as indoor patient from 23.05.2014 to 25.05.2014 and spent Rs.15,000/- on his treatment.  He further argued that the complainant lodged the claim with the Ops and submitted all the required documents but the Ops did not settle the claim of complainant.       

                On the other hand, ld. Counsel for the Ops argued that on receipt of claim papers, the documents were forwarded to an independent TPA, duly licensed and registered from IRDA for adjudication of claim on merits being an expert.  He further argued that some documents were demanded vide letter dt. 25.08.2014 and 16.09.2014, Annexure R3 and Annexure R4 respectively by an Independent TPA but the complainant had failed to provide the documents and hence, the claim file of complainant was closed vide letter dt. 30.09.2014, Annexure-R5.  However, it was made clear in the said letter Annexure R5 that “This letter does not in any way mean rejection of claim, the claim would be reopened once the required documents are submitted.

8.             After hearing ld. Counsel for both the parties and on perusal of record available on the file, the controversy between the parties is that whether the complainant is entitled for amount of Rs.15,000/- as claimed by him or not?

                It is an admitted fact of both the parties that the complainant purchased the policy in question from the Ops.  It is also an admitted fact that the complainant remained admitted in J.P.Hospital, Yamuna Nagar and remained as indoor patient from 23.05.2014 to 25.05.2014.  The contention of the Ops is that the complainant had not submitted the required documents, as demanded by them vide letters Annexure-R3 & Annexure-R4.  However, from perusal of the case file, it is clear that the complainant has placed all the documents/bills on record as Annexures C-18 to C-24 from which it is clear that the complainant had spent Rs.8012/- on his treatment.  So, we are of the considered view that the complainant is entitled for a sum of Rs.8012/-. 

9.             Thus, as a sequel of above discussion, we partly allow the complaint of the complainant  and direct the Ops to pay a sum of Rs.8012/- to the complainant alongwith interest @ 6% p.a. from the date of filing of the present complaint till its realization and further to pay Rs. 3300/- as litigation expenses .  Let the order be complied with within 30 days from the date of communication of this order.  A copy of said order be supplied to the parties free of cost.  File be consigned to record-room after due compliance.      

 

Announced in open court:

Dated: 26.10.2017

                                                              (SATPAL)

                                                              PRESIDENT.

 

 

(VEENA RANI SHEOKAND)          (S.C.SHARMA)

MEMBER                                            MEMBER