Haryana

Yamunanagar

CC/447/2023

Waryam Singh S/o Banta Singh - Complainant(s)

Versus

Star Health & Allied Insurance Company Ltd. - Opp.Party(s)

Complainant inperson

08 Dec 2023

ORDER

CC No. 447 of 2023

Waryam Singh Vs. Star Health

 

Present:       Complainant in person.

 

                  Complaint presented before the registry of this Commission on 6.12.2023 and put up before this Commission on today itself. It is hereby ordered to be registered against the registration number already allotted by the registry of this Commission.

                   Heard.

               As per the version of the complaiant, he lodged his claim of approximately of Rs.30,000/- with the respondents, under the Health Policy No.P/211130/01/2022/000785, valid with effect from 25.5.2021 to 25.5.2023, with sum assured of Rs.5,00,000/-. (Copy of the same is not placed on record).

             From the perusal of the pleading of the complainant, it is crystal clear, the respondents have not settled the claim of the complainant, in either way, in other words, neither, it repudiated nor accepted the claim and from the pleading of the complainant, submission of his claim with the respondents, under the policy, as pleaded in Para No.3 & 4 of the complaint, is also doubtful. The complaint of the complainant on face of it, is pre mature and is liable to be rejected. However, in order to avoid any sort of prejudice to the complainant as well as respondents, and to maintain the balance and to avoid the multiplicity of litigation, this Commission is of firm view, in case, appropriate directions are given, to both of the parties, it will suffice the purpose and ends of justice will meet. No notice at this stage is required to the respondents, affording it opportunity being heard, because, at this stage, no adverse order is being passed against the respondents.

                   Without commenting on the merit of the case, present complaint is rejected, it being pre mature and complainant is directed to submit his claim form (paper) and KYC document, medical bill, copy of policy, etc. with the BM of the respondent No.2, within the period of 15 days from today, if already not submitted and thereafter, on receipt of claim papers from the complainant, as mentioned hereinbefore, respondent No.2 shall decide the claim case of the complainant, in either way, within the period of 40 days, in either way, i.e. negative or positive, by passing speaking order, which shall be communicated to the complainant, as per the address disclosed by the complainant, in the complaint. If, the complainant is not satisfied from the decision of the respondent or his claim is not settled, in any way, within the period given by this Commission, then, he shall be at liberty, to file a present complaint, against the respondents, disclosing the particulars of the present complaint and its fate and will attach the copy of the order, with the same. Certified copy of this order be supplied, to the complainant, free of cost and also one certified copy of this order be sent to the respondent No.2, by this office, for information and necessary action.

Announced in Lok Adalat:

 

                                                                                      President,

                                                                                      DCDRC, YNR,

L.Member                                Member                       08.12.2023.

 

Typed by: Aarti.