Haryana

Kurukshetra

CC/120/2022

Naresh Pal S/o Narsi Dass - Complainant(s)

Versus

Star Health And allied Insurance complany - Opp.Party(s)

R.K.Singhal

12 Apr 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KURUKSHETRA.

 

                                                                   Complaint No.:    120 of 2022.

                                                                   Date of institution:  31.03.2022.

                                                                   Date of decision: 12.04.2022

 

Naresh Pal s/o Shri Narsi Dass, r/o 26, Grain Market, Ladwa, District Kurukshetra.

 

                                                                                                …Complainant.

                                                     Versus

 

Star Health and Allied Insurance Company Ltd., 2^nd Floor, SCO No.44, Sector-17, HUDA, Kurukshetra, through its Branch Manager.

...Respondent.

 

CORAM:   NEELAM KASHYAP, PRESIDENT.    

                   NEELAM, MEMBER.

                   ISSAM SINGH SAGWAL, MEMBER.           

 

Present:       Shri R.K. Singhal, Adv. for the complainant.

         

ORDER:

 

                   Brief facts of the complaint are, complainant along with his wife purchased a Cashless Family Health Optima Insurance plan from the OP vide Policy No.P/211120/01/2020/009694 after paying premium of Rs.20077/- with the validity period of policy w.e.f. 20.02.2020 to 19.02.2021. On 19.7.2020, wife of complainant suffered acute illness and taken to BS Heart Care & Multispeciality Hospital, Kurukshetra, where she was examined by Dr. Pawan Bansal and admitted there on the same day in emergency ward and discharged on 24.7.2020 with the advise for follow up treatment. His wife had suffered DCMP disease, which was newly detected and same was mentioned on the discharge summary. Thereafter, he lodged the claim with the OP and requested cashless treatment, but the OP did not give any response and the complainant paid the same to the hospital. The complainant submitted the claim form along with all relevant documents with the OP for reimbursement, but the OP instead of reimbursing the same to him, repudiated his claim vide letter dated 29.10.2020 on the ground, his wife was suffering from pre-existing disease. Thereafter, an application was filed by the complainant before Permanent Lok Adalat, Public Utility Services, Kurukshetra on 03.2.2021 and the same was dismissed by the Permanent Lok Adalat on 03.1.2021. The litigation before Permanent Lok Adalat was pre-litigative litigation and said litigation is not a bar for filing the present complaint before Consumer Commission as additional remedy. Repudiation of his claim by the OP is an act of negligence and deficiency in service on the part of OP, which aggravated mental agony to the complainant, necessitating him to file the present complaint.

2.                In the Tax Invoice, complainant is shown to be resident of District Karnal. Moreover, the repudiation letter dated 29.10.2020 was also sent by the OP to the complainant on his Karnal address, whereas, contrary to it, in the complaint, complainant has shown himself to be resident of Kurukshetra, so the complainant has not come before this Commission with clean hands and concealed the true and material facts from this Commission.

3.                Complainant himself admitted in Para No.11 of the complaint that an application was filed by him before Permanent Lok Adalat, Public Utility Services, Kurukshetra on 03.2.2021, which was dismissed by the Permanent Lok Adalat on 03.01.2021. However, once the matter in question has already been agitated by the complainant before the Permanent Lok Adalat, therefore, this Commission has no jurisdiction to entertain the present complaint again on this very ground. Section 11 of CPC, is relevant in this regard, which reads as under:-

                   “No Court shall try any suit or issue in which the matter directly and                   substantially in issue has been directly and substantially in issue in a                   former suit between the same parties, or between parties under whom                    they or any of them claim, litigating under the same title, in a Court             competent to try such subsequent suit ...

 

4.                In view of above discussion, the present complaint is not fit for admission, so the same is hereby dismissed, at the stage of admission, on the ground of concealment of facts as well as jurisdiction. However, the complainant shall be at liberty to raise his grievances before proper Court of competent jurisdiction. File be consigned to the records.

Dated: 12.04.2022.

    

                                                                                       (Neelam Kashyap)               

(Neelam)                    (Issam Singh Sagwal)                   President,

Member.                    (Member).                                    DCDRC, Kurukshetra.           
 

 

 

 

 

Typed by: Sham Kalra, Stenographer.