BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.447 of 2016
Date of Instt. 01.112016
Date of Decision: 14.01.2019
Lekh Raj aged about 48 years son of Sh. Karam Chand resident of VPO Gumtala Tehsil Philaur District Jalandhar.
..........Complainant
Versus
1. The Bajaj Allianz General Insurance Company Ltd 2nd Floor Satnam Complex, BMC Chowk, G. T. Road, Jalandhar, through its Branch Manager.
2. The Bajaj Allianz General Insurance Company Ltd GE Plaza, Airport Road, Yerwada, Pune-411006.
3. The Capital Local Area Bank Ltd, VPO Kandola Kalan PS Nurmahal, District Jalandhar through its Manager.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Jyotsna Thatai (Member)
Present: Sh. H. S. Saini, Adv Counsel for the Complainant.
Sh. R. K. Sharma, Adv Counsel for the OPs No.1 and 2.
Sh. Chandandeep Singh, Adv Counsel for the OP No.3.
Order
Karnail Singh (President)
1. This complaint has been filed by the complainant, wherein alleged that the complainant was having business dealing with the branch office of OP No.3 and as such, the branch manager of the OP No.3 become familiar with the complainant. The OP No.3 personally and on behalf of the OP No.1 and 2 allured the complainant to have an Insurance Policy from the bank and also assured the complainant that this policy will give a many fold returns and profits, whatsoever is invested by the policy holder i.e. the complainant including Medical Expenses, Ambulance Expenses and Medical Check up expenses. The complainant believed the representations made by the OP No.3 on behalf of the OPs No.1 and 2 and have obtained an Insurance Policy from the OPs No.1 and 2 bearing No.OC-16-1202-8401-00000201 dated 26.12.2015, for a sum of Rs.2,00,000/-, after making a payment of premium of Rs.7675/- as yearly premium.
2. That in the month of May, 2016, the complainant fell ill and got his medical treatment from Dr. H. S. Ghuman, Spine and Ortho Care 76- Gurjaipal Nagar, Cool Road, Jalandhar and spent a sum of Rs.1,51,855/-. The complainant approached the OP No.1 and requested them to prepare a medical claim, to the tune of Rs.1,51,855/- as he has spent the said amount on his medical treatment and the complainant is fully insured for medical expenses as per the terms and conditions of the above said policy. But to the utter surprise of the complainant that the officials of the OP No.1 told the complainant that there is no such policy exists in the name of the complainant. Thereafter, the complainant approached the OP No.3 and enquired about the insurance policy referred to above, but the officials of the OP No.3 dilly delayed the matter on one pretext or the other and put off the complainant on false excuses.
3. That thereafter the complainant requested the OP No.3 to release the medical expenses to the complainant. Despite the repeated requests of the complainant, the OP No.3 has not admit the claim of the complainant for the reasons best known to them. The complainant is now shuttling between the office of the OPs No.1 and 3 and to its higher officers, but none of the officer are giving any reply. The complainant is now suffering from mental agony, financial loss and tension that too without his any fault, and this act and conduct of the OPs amounts to deficiency in services and negligence and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay Rs.5,00,000/- as compensation to the complainant on account of deficiency and negligence.
4. Notice of the complaint was given to the OPs and accordingly, OPs No.1 and 2 appeared through its counsel and filed joint written reply, whereby contested the complaint by taking preliminary objections that there is no deficiency of service or unfair trade practice on the part of the Insurance Company. Hence, the complaint is liable to be dismissed and further alleged that the claim of the complainant is not repudiated, therefore, there is no cause of action accrued to the insured to file consumer complaint. The complaint is premature and hence, liable to be dismissed in limine. It is further averred that the complaint against the OP No.1 and 2 is not maintainable as no intimation in regard to illness of the complainant was ever given to the OP nor any claim has been lodged by the complainant with the OP No.1 and 2 with regard to the treatment of the complainant and as such, the complaint is liable to be dismissed. There is a condition in the insurance policy that a notice/intimation shall be given in writing to the company immediately in the event of any claim and as such, the complainant cannot take advantage of his own wrong. On merits, the purchase of the policy by the complainant is admitted, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
5. OP No.3 filed its separate reply and contested the complaint by taking preliminary objections that no cause of action accrued to the complainant against the OP and on merits, it is admitted that the complainant purchased insurance policy, but from OP No.1 and 2 and the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
6. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence two affidavits Ex.CA and Ex.CB alongwith some documents Ex.C-1 to Ex.C-22 and closed the evidence.
7. Similarly, counsel for the OPs No.1 and 2 tendered into evidence affidavit of Miss Sarpreet Kaur Ahluwalia as Ex.OP/A along with some documents Ex.OP/1 and Ex.OP/2 and then closed the evidence.
8. Similarly, counsel for the OP No.3 tendered into evidence affidavit Ex.OP3/A and closed the evidence.
9. We have heard the argument from respective counsel for the parties and also gone through the case file very minutely.
10. The complainant alleged in the complaint that he purchased insurance policy after paying premium thereon, but unfortunately, the complainant fell ill in the month of May, 2016 and got treatment from Dr. H. S. Ghuman, Spine and Ortho Care, Gurjaipal Nagar, Cool Road, Jalandhar and spent huge amount of Rs.1,51,855/- and accordingly, the complainant submitted a medical claim to the OP No.1, but the OP No.1 did not hear the grievances of the complainant and due to non-cooperating with the complainant, complainant suffered a mental agony, financial loss and tension and claimed the said medi-claim as well as compensation from the OP.
11. The case of the complainant refuted by the contesting OPs No.1 and 2, simply on the ground that the complainant never gave any intimation in regard to felling ill or getting treatment of such illness from Dr. H. S. Ghuman nor any claim has been lodged by the complainant with the OPs No.1 and 2 and as such, no cause of action accrued to the complainant to file a consumer complaint rather the instant complaint is premature, hence liable to be dismissed.
12. We have sympathetically considered the plea taken by the OP and find that the complainant has not brought on the file any documents where-from we can ascertain that the complainant had ever gave intimation in regard to his illness and admission in the hospital, to the OP No.1 or 2. The complainant has not also brought on the file any claim form, copy of the claim form, which was submitted to the OP. So, from these facts, we can easily conclude that the plea taken by the OP that the complainant never gave intimation in regard to his illness and admission in the hospital nor submitted any insurance claim, if so, then obviously the instant complaint is pre-mature because the complainant is required to submit in writing insurance claim along with other relevant documents, to the OP No.1 and 2 for deciding the same and thereafter, a cause of action accrued to the complainant to file a consumer complaint. So, with these observations, the instant complaint of the complainant is disposed of with the direction to the complainant to submit an insurance claim in a proper form along with the documents, whatsoever required to the OPs No.1 and 2, within 15 days from the date of receipt of the copy of this order and after receiving the required documents from the complainant, the OPs No.1 and 2 are directed to decide the insurance claim of the complainant within 30 days from the date of receipt of the documents, failing which the OPs No.1 and 2 will liable to pay compensation of Rs.20,000/- to the complainant. It is further ordered that if the complainant will not satisfy with the settlement of the claim made by the OP, then complainant is at liberty to file a fresh complaint. This complaint could not be decided within stipulated time frame due to rush of work.
13. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jyotsna Thatai Karnail Singh
14.01.2019 Member President
