Haryana

Karnal

CC/53/2020

Sahab Singh - Complainant(s)

Versus

Tata AIG General Insurance Company Limited - Opp.Party(s)

Joginder Singh

07 Apr 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 53 of 2020

                                                        Date of instt.22.01.2020

                                                        Date of Decision:07.04.2023

 

Sahab Singh son of Shri Sapatar Singh, resident of village Muana, District Jind, Aadhar no.5058 2172 1000.

 

                                               …….Complainant.

                                              Versus

 

1.     TATA AIG General Insurance Co. Ltd., unit no.5, 2^nd floor, N.K. Tower, G.T. Road, Panipat, Haryana through its Divisional Manager.

2.     TATA AIG General Insurance Co. Ltd. unit nos.810-816, 8^th floor, world Trade tower, plot no.C-001, Sector-16.Noida, 201301 (U.P.) through its Regional Manager.

3.     The Branch Manager, Axis Bank Ltd. village Bastali Branch, Block Nissing, District Karnal.

                                                                      …..Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act, 1986 and after amendment Under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.

              Shri Vineet Kaushik……Member

                   

Argued by: Shri Joginder Singh, counsel for complainant

                   Shri Naveen Khetarpal, counsel for the OPs no.1 &2.

                    OP no.3 given up.

 

                    (Jaswant Singh President)

 

ORDER:   

                

                The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant has two joint account nos.916030026294943 and 9160100033340962 with his brother namely Raj Singh with the OP no.3. The OP no.3 is tied up with the OPs no.1 and 2. At the time of opening of said account, on the advice of OP no.3, brother of complainant purchased a policy in his name “Medi Prime bearing no.0285294236 from the OPs on 08.06.2018 and paid Rs.7224/-as premium. Said policy was commenced from 08.06.2018 to 07.06.2019 for a sum insured of Rs.two lacs. On 12.01.2019, the brother of complainant namely Raj Singh fell ill due to multiple varying sized acute non-hemorrhagic infarcts in right cerebellar hemisphere, superior cerebellat vermis in midline, left side of mid brane, bilateral thalami in para medial location, bilateral pariento occipital cortical subcortical regions, and bilateral medical temporal cortical subcortical regions. And multiple small varying sized area of Ischamemia in periventricular subcortical white matter of bilateral fronto poariental regions and he remained under the treatment of Holy Help Hospital, 5, Dabra road, Hissar, as indoor patient from 12.01.2019 to 30.01.2019 and during this period patient spent huge amount of more than Rs.four lacs on his treatment, hospital charges, medicines, testing charges, attendant charges, transportation, special diet etc. During said period, the complainant approached the OPs and intimated regarding the illness of said Raj Singh and for making payment of Rs.two lacs as per terms and conditions of said policy but OPs postponed the matter on one pretext or the other, inspite of completing all the formalities in this regard. OP no.1 issued claim ID no.19031500180 in the name of said Raj Singh as per said policy. Unfortunately, Raj Singh expired on 09.02.2019. Complainant being nominee of said Raj Singh, so many times contacted and requested the OPs to settle the claim but OPs did not pay any heed to the genuine request of the complainant, rather OPs no.1 and 2 intimated to the complainant that above claim has been repudiated on 21.05.2019. Then complainant sent a legal notice dated 26.11.2019 through his counsel to the OPs but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs no.1 and 2 appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action and concealment of true and material facts. On merits, it is pleaded that present complaint is premature as till date complainant has not provided requisitioned documents to OPs to take the action on the claim as per terms and conditions of the policy. It is further pleaded that after getting the intimation regarding claim of the complainant, OP requested the complainant to provide requisitioned documents to process the claim of the complainant but complainant did not provide the same, perforce OPs sent letter dated 18.04.2019 to provided requisitioned documents i.e. duly filled and signed CKYC form alongwith self attested valid proof of identity and proof of address of main policy holder/proposer Raj Singh and to submit the treating doctors certificate mentioning past history duration and 1^st consultation letter of Cerebrovascular accident/cerebral infraction. But complainant has not provided the same, perforce claim of the complainant was rejected, vide letter dated 21.05.2019 by OPs, as per terms and conditions of the policy. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OP no.3 given up by the complainant being unnecessary party, vide his separate statement dated 08.03.2021.

4.             Parties then led their respective evidence.

5.             Complainant has tendered into evidence his affidavit Ex.CW1/A, copy of bank account Ex.C1, copy of blank cheque Ex.C2, copy of PAN card Ex.C3, copy of Aadhar card Ex.C4, copy of policy bond Ex.C5, copy of death certificate Ex.C6, copy of legal notice Ex.C7, postal receipt Ex.C8, copy of treating doctor report Ex.C9, copy of MRI dated 12.01.2019 Ex.C10, copy of hospital treatment report Ex.C11, copy of MRI dated 15.01.2019 Ex.C12 and closed the evidence on 04.04.2021 by suffering separate statement.

6.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Amit Chawla Ex.RW1/A, copy of letters dated 18.04.2019 and 21.05.2019 Ex.R1 and Ex.R2, copy of insurance policy Ex.R3, copy of insurance policy Ex.R4 and closed the evidence on 02.09.2022 by suffering separate statement.

7.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

8.             The claim of the complainant has been repudiated by the OPs on 21.05.2019 on the following ground, which is reproduced as under:-

1.     kindly submit the treating doctors certificate mentioning past history duration and 1^st consultation letter of Cerebrovascular accident/cerebral infraction

2.     submitted CKYC is incomplete. Kindly provide duly filled and signed CKYC form alongwith self attested valid proof of identity(PAN) and proof of address (voter ID/passport/driving licence/bank pass book) of main policy holder/proposer Raj Singh.

 

 

9.             The complainant had not supplied the abovementioned documents to the OPs and in the absence of abovesaid documents the claim of the complainant could not be processed by the OPs.

10.           In the whole complaint, it is nowhere mentioned that complainant had supplied the required documents to the OPs. In para no.4 of the complaint, it is only mentioned that complainant contacted and requested so many times to the OPs to settle the claim. But in the whole complaint, it is nowhere mentioned that when the complainant has submitted the claim form alongwith required documents. Hence it appears that complainant has not supplied the required documents to the OPs. Thus, the present complaint at this stage is premature.

11.           In view of the above observation, the present complaint is disposed off with the liberty to the complainant to submit the documents as required by the OP and after receiving the same, OPs are hereby directed to settle the claim of the complainant within 30 days. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:07.04.2023                                                                     

                                                                President,

                                                    District Consumer Disputes

                                                    Redressal Commission, Karnal.

 (Vineet Kaushik)      

                        Member