Delhi

West Delhi

CC/08/956

KAILASH CHAND BANSAL - Complainant(s)

Versus

SEEMA GARG - Opp.Party(s)

11 May 2016

ORDER

 CONSUMER DISPUTES REDRESSAL FORUM (WEST)

GOVERNMENT OF NCT OF DELHI

150-151, Community Centre, C-Block, Janak Puri, New Delhi – 110058

 

                                                                                     Date of institution           : 14.11.2008

 

Case. No.DF-III/956/2008/                                                                    Date of order                    : 11.5.2016

In the matter of :-                         

            Kailash Chand Bansal,

            V-61, Sector –A,

            Bhagwati Vihar, Near 36 Market,

            Uttam Nagr, New Delhi-59

…….Complainant

VERSUS

  1. Smt. Seema Garg,

Agent: Reliance General Insurance,

Q-172, Vikas Vihar, Uttam Nagar,

New Delhi-59.

 

  1. E-Meditech Solution Ltd.,

45,Nthupur Road, DLF Phase-III,

Gurgaon-122002.

 

  1. Reliance General Insurance,

Reliance Center, 19,Walchand Hira Chand Marg,

Ballard Estate, Mumai-400038.                                                                …..Opposite Parties

 

(R.S. BAGRI, PRESIDENT)

 

 

            O R D E R     

 

            Brief facts giving rise to the present complaint are that Kailash Chand Bansal herein complainant purchased mediclaim product policy ‘Reliance Health wise Policy Gold’   of Reliance General Insurance - Opposite Party-3 through Satish Kumar agent of opposite party-No.3.  The Opposite Party-3 through the agent issued policy No.  282550078308  on annual premium of Rs.1985/- effective from 26.12.2007 upto 25.12.2008. 

 

 

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            On 22.4.2008,  the complainant was hospitalised in Shree Jeevan Hospital, Delhi.  He was discharged on 28.4.2008.   After discharge  from the hospital  , he submitted his claim on 26.5.2008 with Opposite Party-3  through Satish Kumar.   But till 7.8.2008 said  Satish Kumar didn’t forward his claim, therefore, he himself lodged the claim to  Meditech Solution Ltd. Opposite Party-2 (TPA).  But the Opposite Party-3 has neither accepted nor rejected his claim till date despite personal interactions. 

 

            Hence, the present complaint for directions to Opposite Party-3 to entertain his claim, pay Rs.20,362/- of medi claim and compensation of  Rs.50,000/- for mental pain, agony  and harassment and Rs.10,000/- as litigation expenses.

 

            Notice of the complaint was sent to the  Opposite Parties.   Sh. Satish Kumar  and Opposite Party-3 filed their separate written statements contesting the complaint and raising preliminary objections that no proposal or premium is received  from the  complainant, therefore, there is no contract of insurance between Opposite Party-3 and complainant.   Hence, there is no question of settling the claim.  The complainant is not a consumer within the definition of Consumer Protection Act.   The alleged services availed by him are without consideration.  The Opposite Party-3 also raised objections that adjudication of disputed question of facts requires detailed   evidence, examination and cross examination of witnesses, therefore, cannot be adjudicated in summary trial proceedings by this Forum.  

 

            Sh. Satish Kumar in  his reply asserted that he is not agent of Opposite Party-3 whereas his wife Smt. Seema Garg is agent of Opposite Party-3.   Therefore, vide order dated 17.11.09 Smt. Seema Garg was substituted as Opposite Party-1.

 

            Smt. Seema Garg, Opposite Party-1 while replying the complaint submitted that complainant purchased policy through her.  She admitted that policy No.282550078308 for the period 26.12.07 to 25.12.08 was given  against premium of Rs.1985/- paid through Bank

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draft No.042030 dated 16.1.08.  The complainant was  hospitalised on 22.4.08 and submitted medical claim of Rs.20362/- on 26.5.08 with necessary documents to Opposite Party-3.But the claim was not reimbursed by Opposite Party-3 for reasons best known to them.   The Opposite Party-1 asserted that  a letter was written to Opposite Party-3 to know status of the policy of the  complainant.   The Opposite Party-3  admitted that both cases are under process and will be settled soon and drafts of premium are  already submitted to Opposite Parties.  The Opposite Party-3 provided a sales handover sheet dated 20.2.08 which shows that the draft No.042030 dated 16.1.08 was under process.  The Opposite Party-1  further submitted that the Forum directed Mundka Corporation Bank  to clarify status of the draft No.042030  dated 16.1.08.  The Corporation Bank intimated that  the draft No.042030  dated 16.1.08 in favour of Reliance General Insurance Company Ltd. has not been en-cashed till date.  Therefore, it appears that Opposite Party-3 has not sent draft to the bank for encashment.   Hence the dispute is between complainant, Opposite Party-2 and Opposite Party-3.  There is no deficiency of service on part of Opposite Party-1.  

 

            The complainant filed rejoinders to the replies of Opposite Party-1 and Opposite Party-3.  He controverted the stand taken by the Opposite Party-1 and Opposite Party-3 and reiterated his stand taken in the complaint.  

 

            The complainant in support of his version filed his affidavit dated 13.5.09 , wherein he has once again narrated the facts of the complaint and prayed for directions to Opposite Parties to entertain his claim and pay claim amount of Rs.20362/-, compensation of Rs.50,000/- for mental pain, agony and harassment and Rs.10,000/- as cost of litigation.     The complainant in support of his case relied upon copy of policy card,  copy of claim form, copy of acknowledgement letter and copy of visiting card of Opposite Party-1.  

 

            Smt. Seema Garg, Opposite Party-1,  in support of her case filed affidavit dated 8.6.09   along with copy of letter to Opposite Party-3, copy of sales handover sheet dated 20.2.08 and copy of application and pay order.   She narrated facts of her reply    and asserted that mediclaim policy of complainant  and his wife were renewed for which forms

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were filled up and two different drafts No.042029 and 042030  dated 16.1.08  were issued by Corporation Bank Mundka, New Delhi of Rs.1985/- each in favour of Opposite Party-3.   She further asserted that the said drafts were submitted with the concerned department of Opposite Party-3 and after checking the forms mediclaim kits No.282550078308 and 282550078309 were issued to the complainant.   On hospitalisation of the complainant, he was physically verified by the officials of the concerned department of Opposite Party-2 and Opposite Party-3.   Therefore, there is no negligence and deficiency of service on part of Opposite Party-1. 

 

            Sh. Ranjan Sinha, Manager legal of Opposite Party-3 filed affidavit dated 30.6.09  in support of their case and deposed that no proposal form and premium was received from the complainant.   Therefore, there is no contract of insurance between the complainant and Opposite Party-3.   Hence, there is no question of settling  the claim and complaint may be dismissed.

 

            From the complaint, replies,  documents relied upon by complainant and Opposite Party-1, it reveals that kit of insurance policy No.282550078308  in favour of complainant was issued by Opposite Party-1 against the premium of Rs.1985/-  paid through bank draft No.042030 dated 16.1.08 in favour of Reliance General Insurance Company Ltd.  Opposite Party-3  has not submitted the draft  for encashment.              The complainant submitted claim of Rs.20362 with Opposite Party-3.  But the claim of the complainant is not entertained and reimbursed by Opposite Party-3.  

 

            We have heard  complainant and Opposite Party-1 in person and counsel for Opposite Party-3  and gone through the record carefully and thoroughly.  We are of the opinion that complainant has filed form for renewal of the policy with premium of Rs.1985/- vide draft No.042030  dated 16.1.08.  

 

 

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            The draft and form were submitted to the concerned officers of the Opposite           Party-3.   From report of Corporation Bank it is evident that the draft was not submitted by Opposite Party-3 and cleared by them.  Once the complainant completed the formalities, it was for Opposite Party-3 to get the draft encashed.  But they failed in their duty.  Hence,   there is negligence on part of Opposite Party-3.   Therefore, in our opinion there exist contract of insurance between the complainant and Opposite Party-3.   The Opposite Party-3 cannot run away from their responsibility and liability by merely pleading  that there is no contract of insurance between them and the complainant.   Therefore, there is deficiency in service on part of Opposite Party-3.    Hence, the complainant has suffered mental pain, agony and harassment and loss of medical claim of Rs.20362/-.   

 

            In light of above discussion and observations, the complaint succeeds.  Therefore, the Opposite Party-3  is directed to consider and decide the claim of complainant within 30 days  from receipt of copy of this order and thereafter within 10 days pay the claim of the complainant with interest  at the rate of 9% per annum from the date of filing the complaint till actual payment and compensation of Rs.15,000/- for mental agony  and harassment  including litigation expenses.  

 

Order pronounced on   : 11.05.2016

 

  • Compliance of the order be made within the 30 days after receipt of the order.

 

  • Copy of order be sent to the parties free of cost.

 

  • File be  consigned to record.

 

 

 

 

(PUNEET LAMBA)                               (URMILA GUPTA)                   ( R.S.  BAGRI )

  MEMBER                                            MEMBER                               PRESIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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