Haryana

Karnal

CC/447/2022

Rohit Gupta - Complainant(s)

Versus

Star Health And Allied Insurance Company Limited - Opp.Party(s)

P.K. Bhandati

04 Aug 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                          Complaint No. 447 of 2022

                                                          Date of instt.03.08.2022

                                                          Date of Decision 04.08.2022

 

Rohit Gupta son of late Shri Raman Kumar, resident of House no.874, Sector-13, Urban Estate, Karnal.

                                                 …….Complainant.

                                              Versus

 

Star Health and Allied Insurance Company Limited SCO 242, 1^st floor, Sector-12, opposite Mini Secretariat, Karnal-132001 through its Sr. Branch Manager.

 

                                                                        …..Opposite Party.

 

      Complaint u/s 35 of the Consumer Protection Act, 2019

 

Before   Sh. Jaswant Singh……President.       

      Sh.Vineet Kaushik ………..Member

              Dr. Rekha Chaudhary…….Member

 

 Present:  Shri P.K.Bhandari, counsel for complainant.

                                        

                (Jaswant Singh President)

ORDER:                    

 

                Complaint presented today. It be checked and registered.

            The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred as to ‘OP’) on the averments that father of complainant namely late Shri Ram Kumar had died on 26.03.2022 and the present complaint is being filed by the complainant being one of his legal heir. Father of complainant had been purchasing health policy and it has been running continuously for more than 10 years from the National Insurance Company. Lateron, he had got ported his health policy to the OP. At the time of porting the policy, OP had seen the entire record and further got verified from previous insurance company. The OP also got physically examined the father of the complainant from the doctor on its panel. At the time of taking the policy, the agent of the OP while taking the signature of the father of complainant on the forms, he did not tell about the entire terms and conditions of the OP company. The father of complainant had paid a sum of Rs.49341/- including GST to the OP. After few days of receipt of premium amount, the father of complainant had received two health insurance cards first in the name of Raman Kumar, second was in the name of mother of complainant namely Anita Gupta. It was also told to him that these cards are meant to be used in the hospitals while taking treatment and it will help the consumer in reimbursement of the claim from the OP. It is further alleged that father of complainant was hospitalized at Amritdhara Hospital, Karnal for the period 10.11.2021 to 30.11.2021 as he was suffering from fever and lateron it was diagnosed as Dengue. The intimation in this regard was given to the OP, because the said hospital was not on the panel of the OP. Thereafter, OP said that after discharge from the hospital, he would submit complete record of treatment, bills etc. and further assured that the OP would reimburse the entire amount. The father of complainant (since deceased) had submitted the claim with the OP on 13.12.2021 and demanded a sum of Rs.7.00 lacs. It is alleged that OP had issued a letter dated 18.01.2022 for providing additional documents. It was told to the OP that father of complainant is not having any OPD slip, treatment record etc. as demanded by them because the father of complainant faced never such disease earlier. So far as the present disease is concerned, he was admitted in the hospital in emergency, as such, he was never treated in the OPD, as such no OPD record of present record is available. But OP did not satisfy and ultimately repudiated the claim of the complainant, vide letter dated 05.02.2022 on the  ground that non-submission of documents. Thereafter, complainant approached to the Ombudsman and they have also passed the award against the complainant on the flimsy ground, vide order dated 31.05.2022. The reason given by the OP and Insurance Ombudsman are not sustainable because the OP had insisted them to supply the previous treatment record of father of complainant whereas father of complainant had never been admitted in the hospital for such disease in the past and he went for the treatment of Dengue and all the complications occurred during treatment. As such the repudiation letter dated 05.02.2022 and order dated 31.05.2022 passed by Ombudsman are illegal, null and void, ab-initio and not binding on the rights of the complainant. There is deficiency in service on the part of the OP. Learned counsel for the complainant further submits that the complainant is  competent to file the present complaint without impleading the another legal heirs of the deceased and in this regard he relied upon the case laws titled as Narayani Amma Versus Saraswathy Amma A.S. No.112 of 1985, date of decision 31.10.1990 of Hon’ble High Court Kerala;  Suman Kumar @ Suman Singh Versus Mand Kishore and Ors in W.P. © 6701/2018 decided on 06.11.2020 of New Delhi High Court and Chalasani Seetharama Swamy Versus Chintapalli Ramachandra Rao A.S. No.1276 of 1982, date of decision 30.06.1994 of Hon’ble high Court Andhra Pradesh.

2.             Arguments on the point of admissibility heard.

3.             Admittedly, there are others LRs of deceased Raman Kumar. The complainant is not the nominee in the policy in question of the deceased and nominee is still alive. In the whole complaint, the complainant has neither disclosed the names and particulars of others legal heirs of deceased nor placed on record their affidavits.  The possibility for filing the present complaint without the knowledge of the others legal heirs cannot be ruled out. Others legal heirs cannot be deprived of their rights. The present complaint is bad for non-joinder of necessary parties. In this regard, we have relied upon the case law of Hon’ble Supreme Court of India in case titled as Executive Officer, Arulmigu, Chokkanatha Swamy Koli Trust Virudhunagar Versus Chandran & Ors 2017 (2) CCC 048; S.M. Kalim Versus S.K. Sarfudin 2014 (4) CCC 060 (Patna); Smt. Mala Jona Vs. Smt. Shanti Devi Parakh 2016 (Suppl.) CCC 536 (Chhattisgarh); Karedla Parthasaradhi Vs. Gangula Ramanamma 2015 (1) CCC 341 (S.C); Narbdeshwar & Ors. Versus Ram Naresh Chaudhari 2019 (2) CCC 817 (Allahabad); M.Narayana Vs. Smt. Ramakka 2017 (1) CCC 317 (Karnataka).

4.             The complaint is at an initial stage i.e. at the stage of admission. Keeping in view the ratio of the law laid down in aforesaid judgments, facts and circumstances of the present complaint, in the interest of justice and for avoiding the further complications and litigations, it would be justified if the complaint be dismissed at the stage of admission, with the liberty to the complainant to file a fresh complaint alongwith others legal heirs, if so desired. Order accordingly. The party concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 04.08.2022

                                                                President,

                                                      District Consumer Disputes

                                                      Redressal Commission, Karnal.

 

 

             (Vineet Kaushik)     (Dr. Rekha Chaudhary) 

                   Member                  Member