Punjab

Ludhiana

CC/19/273

Pankaj - Complainant(s)

Versus

Religare Health Insurance Co.Ltd - Opp.Party(s)

Anju Khullar Adv.

14 Nov 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

 

Consumer Complaint No. : 273 of 06.06.2019

Date of Decision       : 14.11.2019 

Pankaj aged about 30 years son of Parmod Kumar R/o Plot No.19, Street No.4, Hira Nagar, Kakowal Road, Ludhiana.

….. Complainant

Versus

Religare Health Insurance Company Limited, Vipul Tech Square, Tower-C, 3^rd Floor, Sector 43, Golf Course Road, Gurgaon-122009.

2^nd Address: 5^th Floor, 19, Chawla House, Nehru Place, New Delhi-110019, through representative.

3^rd Address: San Plaza Building, SCO-13, 3^rd Floor, Feroze Gandhi Market Road, Ludhiana, Punjab-141001 through its authorized representative.

 

…Opposite parties

 

          (Complaint U/s 12 of the Consumer Protection Act, 1986)

 

QUORUM:

SH.G.K.DHIR, PRESIDENT

MS.JYOTSNA THATAI, MEMBER

 

COUNSEL FOR THE PARTIES:

 

For complainant             :         In person with Ms.Anju Khullar, Advocate

For OPs                          :         Sh.G.S.Kalyan, Advocate

 

PER G.K DHIR, PRESIDENT 

1.                          Complainant is holder of Religare Health Insurance Policy CL No.10151207 issued by OP in his name. Assurance at the time of issuance of the policy was given regarding reimbursement of incurred expenses in medical emergencies etc. On 3.2.2018, complainant was admitted in Mohan Dai Oswal Hospital, because of sufferance from Ketamine injury and Carm Guidance PRP 4 Ml in each heel. Complainant was discharged from the hospital on 4.2.2018. An amount of Rs.31,264/- was incurred as medical expenses on this treatment. On submission of claim, same was rejected vide letter received by the complainant on 5.3.2018. However, earlier in year 2017, when the complainant got similar treatment, then his claim was sanctioned by OP. By claiming that OP failed to perform their part of contract and by claiming that deficient services provided by OP, this complaint filed for seeking reimbursement of incurred medical expenses along with compensation for mental agony and harassment of Rs.50,000/- and litigation expenses of Rs.22,000/-.

2.                Op appeared through counsel and without filing written reply, offer was given on 29.10.2019 to the effect that OP ready to settle claim by paying the amount of Rs.32,906/- as      full and final settlement of claim within 30 days from receipt of copy of order. That offer was accepted by the complainant by suffering statement on 7.11.2019, but with rider that amount of compensation and litigation expenses also should be allowed. So, virtually dispute remains as to whether complainant is entitled to any amount of compensation and litigation expenses or not.

3.                Counsel for OP prays  for  grant of time for filing the written statement, so that Op may present their case, but necessity of obtaining written statement is not at all there because offered amount has been accepted. Whether or not complainant entitled to any amount of compensation and litigation expenses, that can be determined from the facts apparent on the face of record. In case, time would have been granted to OP to file the written statement, then more time would have been consumed, resulting in further harassment of complainant. So, to avoid that counsel for OP not permitted to file written statement.

4.                Arguments on question of compensation amount and litigation expenses heard and record gone through carefully.

5.                This complaint was filed on 6.6.2019 and counsel for OP appeared on 18.10.2019 and on the next adjourned date of 29.10.2019, offer was made by counsel for OP for settlement of claim by paying Rs.32,906/- to complainant within 30 days from the date of receipt of copy of order. So, it is obvious that OP instead of contesting the claim, as a goodwill gesture, has given offer for settling the claim. That offer has been accepted and as such direction need  be  issued  to OP to pay the settled amount of Rs.32,906/- to complainant within 30 days from the date of receipt of copy of order.

6.                As without filing written statement, offer was made and same accepted and as such same shows the anxiety of OP to settle the claim at the earliest by not dragging the complainant in further litigation. In view of that certainly lenient view required to be taken in matter of imposition of costs of litigation and compensation amount for harassment. Rather, Op avoided to harass the complainant and that is why offer for settlement given immediately after appearance by counsel for OP. However, had that offer been made before filing of complaint or claim would not have been repudiated on 5.3.2018, then occasion with the complainant to file the complaint was not there. No copy of repudiation letter produced on record by the complainant and as such submission of counsel for OP has force that virtually repudiation has not been done till date and that is why offer of settlement made at the earliest. In view of this false plea taken in the complaint also, there is need to grant lesser amount of compensation and litigation expenses. Op by giving offer tried to mitigate the sufferings of complainant and as such allowing of composite amount of Rs.2000/- as compensation for mental agony and harassment and litigation expenses will be sufficient. No other worth-mentioning point argued.

7.                Therefore, as a sequel of the above discussion, complaint allowed with direction to Ops to pay Rs.32,906/- to complainant within 30 days from the date of receipt of copy of order.  Composite compensation for mental agony and harassment as well as litigation expenses of Rs.2,000/- (Rupees Two Thousand only) more allowed in favour of complainant and against Ops. Payment of amount of compensation for harassment and litigation expenses be made by Ops to complainant within 30 days from the date of receipt of copy of order. Copies of order be supplied to parties free of costs as per rules.

8.                File be indexed and consigned to record room.

 

 (Jyotsna Thatai)                                     (G.K.Dhir)

 Member                                                  President

Announced in Open Forum

Dated:14.11.2019

Gurpreet Sharma.