Haryana

StateCommission

A/946/2014

The Oriental Insurance Company Ltd. - Complainant(s)

Versus

Shri Ajit Singh - Opp.Party(s)

24 May 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA

                                       

First Appeal No.946 of 2014

Date of Institution:17.10.2014

Date of Decision:24.05.2016

 

1. The Oriental Insurance Company Ltd., Branch Office Ghantaghar Chowk Bhiwani.
2. The DM Oriental Insurance Company Ltd. Divisional Office 14 G-80, F.I.E. Industrial Area Partap Ganj New Dedlhi 110092.

Both through shri S.P.Singh, Regional Manager, The Oriental Insurance Company Ltd. Regional Office, LIC Building, II floor, Jagadhri Road, Ambala Cantt.

     …..Appellants

                                                Versus

Shri Ajit Singh S/o Sh. Lachhman Singh R/o Village Dadma Tehsil Tosham, Distt. Bhiwani.

         …..Respondent

CORAM:     Mr. R.K.Bishnoi, Judicial Member.
                   Mrs.Urvashi Agnihotri, Member.

 

Present:-     Mr.D.C.Kumar, Advocate for the appellants.

Mr.Mohit Mehra, Advocate counsel for the respondent.

 

O R D E R

 

URVASHI AGNIHOTRI MEMBER:

 

1. The Oriental Insurance company Ltd. and Anr.–OPs are in appeal against the Order dated 07.08.2014 passed by the learned District Consumer Disputes Redressal Forum (for short ‘District Forum’), Bhiwani, whereby the complaint of Ajit Singh - Complainant has been allowed and OPs has been directed to pay the insured sum along with interest @12% per annum from the date of filing of this complaint till its realization, Rs.17398/- for medical expenses and Rs.2,200/- as litigation expenses.  
2. Briefly stated, the Douphin Touch Network Pvt. Ltd. Co. launched a Nagrik Suraksha Policy for the welfare of general public in the period of four years for a sum of rupees one lac for each member vide which a sum of Rs.80,000/- for accidental insurance and Rs.20,000/- for medical expenses incurred due to accident. The complainant further alleged that he purchased the above said policy from the respondents company and deposited a sum of Rs.4000/- vide receipt No.024799 dated 03.10.2006. The complainant further alleged that on 22.03.2009 he met with an accident and sustained grievous injuries and admitted to Soni Ortho & Trauma Research Centre, Hisar and remained hospitalized till 24.03.2009. It is further alleged the information was given to the respondents company and after completion of all the formalities the claim was submitted. The complainant further alleged that the respondents issued a letter dated 25.05.2009 requiring necessary documents and in compliance of this letter all the original documents were submitted with the respondents company. The complainant further alleged that he visited the office of respondents several times and requested to pay the insured amount alongwith medical expenses incurred due to accident but they did not pay any heed.  The complainant further alleged that he had also got served a legal notice through his counsel, but of no use. Aggrieved against this act of the OP, the complainant approached the District Forum claiming the sum assured alongwith compensation for harassment and litigation expenses alleging deficiency in service on the part of the OP.
3. According to the OP, the OP had written a letter dated 25.05.2009 to complainant to fulfill the required documents and produced the original treatment record well within time but he failed to submit the required documents. It is further alleged that the respondents company had also written several letters to submit the required documents, but he has supplied only two x ray films and except this no other documents have been received by the insurance company. Moreover, as per admission card the name of the patient has been mentioned as Wazir Singh aged 35 years. Therefore, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of the OP and as such, he is not entitled for any compensation.  However, the learned District Forum rejected the pleas raised by the OP and accepted the complaint vide order dated 07.08.2014.

 

4. Against this Order, the OP has filed Appeal before us contending that the learned District Forum has accepted the complaint without any legal justification. The appellant reiterating his submissions as made by him before the District Forum has contending that the documentary proof produced by the complainant was not enough to establish his identity i.e. Ajit singh or Wazir Singh, therefore, the appeal should be accepted and the complaint should be dismissed.
5. We have heard the learned counsel for the parties and have also gone through the record. We find that the complainant – respondent has produced on record more than two dozen documents to prove that Ajit Singh and the Wazir Singh are two names of one and the same person i.e. the complainant. Moreover, it is not only the number of documents, but their authenticity and evidentially value, which conclusively prove the assertion of the complainant e.g. the copy of the Voter Card, Ration Card, PAN Card, Affidavit of the Sapanch  and copy of the Matriculation Certificate etc. that is why the appellant in their grounds of appeal before us has half heartedly pleaded that since the complainant did not die in the accident and had only suffered certain injuries on the body, he was entitled only to proportionate compensation. It would be relevant to reproduce here  para No.7 of the grounds of appeal:-

“7. That the Forum has erred in awarding for payment of insured sum which is payable only in case of death of the insured as a result of an accident. In this case the complainant Wazir Singh has suffered injuries on his body and if at all any claim is ordered to be made, though not admitted he is only entitled for payment of hospitalization expenses to the tune of 20% of the sum insured that is Rs.20,000/- (maximum). Since he has spent only an amount of Rs.17,398/- for his treatment / medical expenses, he is not entitled to the payment / reimbursement of note more than the said amount, as per terms and conditions of the policy”.

            In view of the aforesaid overwhelming evidence, we find that the complainant has successfully established his identity as Ajit Singh @ Wazir Singh and entitled to the following relief:-

1. To pay Rs.17398/- for medical expenses incurred due to accident  along with interest @9% from the filing of the complaint before the District Forum till its realization, and 
2. to pay Rs.5000/- as litigation expenses.

 

Consequently the impugned order dated 07.08.2014 passed by the learned District Forum stands modified accordingly.

 

May 24th, 2016

Mrs.Urvashi Agnihotri, Member, Addl.Bench

R.K.Bishnoi, Judicial Member Addl.Bench

S.K.