EA 28/ 2016  

                        Parbodh Chander Bali     Vs.  Branch Manger, ICICI

Present: DH/complainant  in person.

             Sh.Amit Bhatia, Advocate, counsel for JD/ Opposite Party

The JD/Opposite Party has filed the application for dismissal  of the execution being fully satisfied  on the ground that the present execution has been filed by DH against the order  of Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh. In compliance of the order, the JD has made the payment of Rs.96,682/-, the detail of which as under:

i)       Equipment charges                                               Rs. 3500/-

ii)      Operation Theatre Charges                        Rs.12000/-

iii)     Consultation Visit Charges                        Rs.4000/-

iv)     Medicine Pharmacy Charges                      Rs. 3682/-

v)      Anesthetist Charges                                    Rs.17000/-

vi)     Procedure Charges                                               Rs.1500/-

vii)    Room Charges                                            Rs. 20000/-

viii)   Surgeon Charges                                        Rs.35000/-

and thereafter payment of Rs.1,63,118/- (Rs.1,58,118/- for implants and Rs.5000/- for procedure charges) have been made by JD/Opposite Party in total a sum of Rs.2,59,800/- was made by JD/Opposite Party after deducting the amount as per  rules. The claim of the complainant/DH has already been made by the JD/Opposite Party. The policy of the complainant/DH is also activated by the JD after receiving the cheque. It is therefore, prayed that the execution filed by the decree holder may kindly be dismissed with costs.   

2.       Notice of the application was given to complainant/DH and they filed the reply taking certain preliminary objections inter alia therein that Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh decided the matter by passing its judgement on 16.11.2015 with clear directions to OP for timely compliance of order by all means with 45 days of receipt of its certified copy. Defiantly, no compliance was made by OP within time schedule as directed by Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh. Whereas the complainant received the copy of the order by post on 22.12.2015 and complainant right on the very day complied with complainant part as per order of Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh and dispatched a cheque of Rs.15000/- as renewal premium of joint policy; that when after waiting for more than 45 days, Opposite Party did not care for the orders of Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh to comply with and nothing was heard from Opposite Party, the complainant filed application under section 27 of the CPA on 15.2.2016. Since the appearance of JD/Opposite Party personally and through OP’s counsel in this complaint matter, more than 3 months have passed and about 12 hearings have been taken up, but JD/ Opposite Party had neither come with clean hands nor has genuinely acted to comply with the order. Rather JD/Opposite Party is keeping dilly-dallying tactics to defy the order of Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh and to deprive the complainant of his award within  time frame as ordered by Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh; that this application which JD/Opposite Party has moved, lies at this stage of hearing in Forum and it is just to delay to comply the award and to misguide the Forum with sheer abuse of process of law. He has not attached any documentary evidence to prove averments made in said application itself prove that application is not legally and judiciously tendered by JD/Opposite Party before this Forum. On merits, it is submitted that JD/Opposite Party has not attached any policy terms against  which he has made the bifurcations and calculation of amounts paid, item wise. The JD/Opposite Party has not attached the policy terms calculator as well as complainant’s claim and then could compare the claim filed and claimed accepted. These calculations averred in application filed by JD/Opposite Party, are whimsical, erroneous and without any documentary bases, hence not admissible argument of JD/Opposite Party, hence denied. The complainant has a genuine claim for Rs.285638/- as per policy terms and conditions. There are two parts of claim. First part of claim is hospitalization charges Rs.2,76,956/- and second part is post hospitalization charges Rs.8,682/-. The total claim comes to Rs.2,85,638/-. The JD/ Opposite Party has not made any calculations on those bases. The OP has deducted some amounts from claim, but had not made any calculation or information that why and what amount has been deducted and what rest of amount is being paid, item wise. JD/Opposite Party has not appended any calculating documents which were desired. Hence it is denied for want of documents and is replied in this way that on 17.5.2016 an amount of Rs.96,682/- and on 2.6.2016 an amount of Rs.1,63,118/-  were  transferred online to saving bank account. As such, an amount of Rs.2,59,800/- has been credited to in total. But no written information or claim settlement letter has been sent to complainant by post or otherwise to account for the payments correctly and precisely. The balance amount of Rs.25,838/- from the claim filed  and the accrued interest from dated 19.8.2011 on the whole of payable amounts has not been paid and JD/Opposite Party is to make the payment to comply with award in toto. In this way, the complainant has prayed to direct OP to make the payment of balance amount of Rs.25,838/- alongwith accrued compound interest @ 2% per month from the date of filing the claim for all unpaid claim amounts, till date of final payment. Opposite Party be also directed to supply clearly the comparative statement of claim filed and claim settled quoting the policy clauses to make clear his stand. 

3.       We have heard the DH in person and Sh.Amit Bhatia, Adv.Counsel for the JD.

4.       Vide order dated 16.11.2015, Hon’ble State Commission, Punjab, had directed the DH to deposit the premium amount sent back to him by JD within 30 days period from the date of receipt of certified copy of the order. After receipt of premium, the Opposite Party shall renew the above said health Insurance Policy. In this case, the DH has paid the premium during the pendency of this execution application to the JD through their counsel. During the course of arguments, ld.counsel for the JD handed over the online copy of the renewed policy to the DH in the Forum itself. It is further stated on behalf of the JD that original policy document would reach the DH in due course. Besides that, the JD has also settled the health claim amount payable to the DH as per the directions of Hon’ble State Commission, by making credit of Rs.1,63,118/- on 2.6.2016 directly in the saving bank account of the DH, copy of the detailed statement is placed on record. In this way, besides Rs.96,682/-, the detail of which has been given above, the JD has also made payment of Rs.1,63,118/- i.e. Rs. 1,58,118/- for implants and Rs.5000/- for procedure charges have been paid by JD to DH and in all, a sum of Rs.2,59,800/- has been paid to DH as insurance claim. The insurance company was to settle the claim as per order of  State Commission, Punjab, and they have disbursed the amount of Rs.2,59,800/-. The stand of the DH that the sum of Rs.25,838/- is still due which the JD has declined, was also payable. But however, the DH could approach  the appropriate Forum by filing fresh complaint to challenge the deduction, if wrongly made by JD.   Since the appellate court has directed the JD to settle the insurance amount which stood settled. Therefore, this execution application can not proceed any further. Further contention of the DH that the JD should have renewed the insurance policy till date without charging any premium, does not fall within the purview of this Forum because Executing Court can not go behind the order under execution. This Forum is supposed to execute the order  as it is, which in our view has been executed. As the present execution application stands satisfied in view of the order under execution, consequently, the application for dismissal of the instant complaint being fully satisfied is liable to be allowed and the same allowed accordingly. As a sequel to the order on application, instant execution application also stands satisfied and is dismissed accordingly. File is ordered to be consigned to record room after compliance.          

Announced in Open Forum

Dated: 18.07.2016.                                                                                                                               

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