Date of Filing:14.08.2008<br /> Date of Order:31.01.2009<br /> <br /> <br /> <br /> BEFORE THE II ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE-20<br /> <br /> Dated: 31ST DAY OF JANUARY 2009<br /> PRESENT<br /> <br /> <br /> <br /> Sri S.S. NAGARALE, B.A, LL.B. (SPL.), President.<br /> Smt. D. LEELAVATHI, M.A.LL.B, Member.<br /> Sri BALAKRISHNA. V. MASALI, B.A, LL.B. (SPL.), Member.<br /> <br /> <br /> COMPLAINT NO: 1788 OF 2008<br /> <br /> <br /> Javeed Pasha<br /> S/o. Abdul Wahab<br /> R/at No. 452, 3rd Main Road<br /> Behind MMI School, C G Halli<br /> Bangalore 560 039 Complainant<br /> <br /> V/S<br /> The Manager<br /> Bajaj Allianz Life Insurance Co. Ltd.<br /> No. 36, I Floor, Cears Plaza<br /> Residency Road, Bangalore 560 025. Opposite Party<br /> <br /> <br /> ORDER<br /> By the President Sri. S.S. Nagarale<br /> <br /> This is a complaint filed under section 12 of the Consumer Protection Act 1986 claiming refund of Rs.2,119/- with interest and compensation.<br /> The brief facts of the case are that, the complainant has availed a Mediclaim Insurance Policy for an amount of Rs. 1,00,000/- from the opposite party Insurance Company by paying premium amount of Rs.2,119/- vide receipt No.7602360 dated 31/07/2007. The opposite party issued a medical policy card bearing No.BABCF 029519A valid from 22/08/2007. The Policy Number mentioned in that card was 0059103633. The said card was not activated till date and when it produced before the designated Hospital the authorities did not accept the same as it was not activated. The opposite party did not issue any original policy to the complainant till date. The complainant could not take the benefit of the medical insurance, as the opposite party did not issue the original insurance policy and was not activated. In spite of several reminders over phone, by personal visit by complainant the opposite party failed and neglected to issue the original policy and in the absence of original policy the claim is impossible. Hence, the complaint. <br /> 2. Notice was issued to opposite party. Opposite party put in appearance through learned advocate and defence version filed stating that complainant is a health card holder with the opposite party with policy No. 0050103633. There is a procedure with the opposite party that there will be intimation to every customer that after obtaining the health card from the opposite party in order to obtain benefits out of the said card they have to intimate the opposite party immediately after admitted in the Hospital. The opposite party sent the policy to the address of the complainant, but it was returned with a shara that there is “no such person” in the said address. Hence, there is no deficiency in service on the part of the opposite party. The complainant without following proper procedure to get the benefits filed this complaint. Even after discharge from the Hospital the complainant neither submitted any bills nor approached the opposite party in person. There is no need or practice of activating the card. Once the card is issued the question of activation does not arise at all, it will be activated immediately upon to the acknowledgement of the card by the customers. In view of all these reasons stated above, the opposite party prayed to dismiss the complaint. <br /> 3. Affidavit evidence of both the parties filed. Arguments are heard.<br /> 4. On perusal of the defense version, it is clear that the complainant has obtained mediclaim health card on 22/08/2007. The opposite party also admitted that it is the duty to render services to all the customers. The opposite party submitted that in order to obtain benefit out of the said card, card holders have to intimate the opposite party after having admitted in the Hospital. The opposite party has submitted that policy has been sent to the address of the complainant, but it was returned with a “Shara” that there is no such person. The opposite party submitted that the complainant without following the procedure to get the benefit under the policy has filed this complaint. It is the case of the opposite party that even after discharge from the Hospital the complainant neither submitted any bills nor approached the opposite party in person. As per the defense version, it is clear that the opposite party has not rejected or repudiated the claim of the complainant. Complainant has not at all submitted the claim before the opposite party. Therefore, the question of deficiency in service on the part of the opposite party does not arise. It is now for the complainant to submit claim before the opposite party along with necessary documents and bills etc.,. On production of the documents and claim petition, the opposite party is bound to consider the claim put up by the complainant and pay the amount as per law. With this direction the complaint deserves to be dismissed giving liberty to the complaint to approach the opposite party for getting the benefit. The complaint is being disposed off without passing any orders on merits. The present complaint is premature one. Therefore, it deserves to be dismissed. In the result, I proceed to pass the following:-<br /> ORDER<br /> <br /> 5. The Complaint is dismissed as premature one. However, the complainant is directed to approach the opposite party and put up his claim along with necessary documents for claiming medical insurance policy benefits. With this observation the matter is closed.<br /> 6. Send the copy of this Order to both the parties free of costs immediately. <br /> 7. Pronounced in the Open Forum on this 31ST DAY OF JANUARY 2009. <br /> Order accordingly,<br /> <br /> PRESIDENT<br /> We concur the above findings.<br /> <br /> <br /> MEMBER MEMBER<br /> Rhr.,<br />