Order no.  2               Date:22.04.2024

Ld. Advocate for the complainant is present.

The case is taken up for admission hearing.

Perused. Considered. Heard complainant.

On scrutiny of the record we find that the complaint application has not been signed by the complainant on every page.

The complainant submits that he has obtained a medical insurance of Bajaj Allianz Life Insurance Company Limited/opposite party and the effective period of insurance was on and from 06.08.2022 to 05.08.2023. The complainant submitted a claim for reimbursement of domiciliary treatment within the validity period of insurance with the opposite party. But the opposite party has not settled the claim for which the complainant approached before the Insurance Ombudsman, Kolkata. The Insurance Ombudsman vide its order dated 29.09.2023 observed and recommended that the complainant shall submit all claim documents through email to the representative of the respondent within 15 days and the opposite party was recommended to settle the claim as per policy conditions within 15 days from the receipt of the documents from the complainant.

Nowhere in the complaint application, the complainant stated that as per direction of ombudsman he has submitted all relevant documents with the opposite party. The order of Insurance Ombudsman dated 29.09.2023 reveals that the opposite party alleged that the complainant has not submitted the claim documents for which they could not register the claim and assess as per the policy terms and conditions.

Till date the opposite party has not declined the claim of the complainant.

The fact as narrated by the complainant clearly reveals that the complainant has no cause of action to file the case against the opposite party.

Therefore the case cannot be admitted and liable to be rejected.

Hence, it is

ORDERED

that the complaint case be and the same is dismissed as not maintainable in law.