Deepak Aggarwal complainant has filed the present complaint against the titled opposite parties U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short, the C.P.Act.) in which he has prayed that the opposite parties be directed to pay the claim amount of Rs.50,713/- to him. Opposite parties be further directed to pay Rs.50,000/- as compensation for unnecessary harassment, physical pain and mental agony suffered by him and  Rs.5,000/- as litigation expenses, in the interest of justice.

2.          The case of the complainant in brief is that he had taken health protection policy as Hospitalization Benefit policy No.401211/48/12/8500001075 for the period from 13.12.2010 to 12.12.2011, policy no.401211/48/12/8500000777 for the period from 13.12.2011 to 12.12.2012 and policy no.401211/48/12/8500000514 for the period from 13.12.2012 to 12.12.2013 from the opposite parties. He had paid installment of Rs.6000/- per annum approximately regularly without any fault. He has further pleaded that on 21.6.2013 he fell ill and suffering from the deceases and admitted in the Ohri Chest and Multi-specialty Hospital G.T.Road, Opp. Railway Workshop Putlighar Amritsar, where the specialist doctor has investigated the whole reason of decease and treated him. After complete treatment, he has discharged from the hospital on 25.6.2013. He has spent Rs.50,713/- on his treatment. Thereafter, he requested the opposite parties no.1 and 2 for issuance of claim regarding expenses of hospital alongiwth the whole original file containing 67 pages + 2 X-rays, which was spent on him at the time of his illness on which the opposite parties no.1 and 2 appointed a surveyor. He rejected his claim without any reason and cause. A letter dated 12.2.2014 was sent him by the opposite party through Sh.N.K.Malhotra CEO to him with the remarks ‘NO CLAIM’. Thereafter, since then he visited to the office of the opposite party several times for his legal and genuine claim but the opposite party did not bother about it and only harass him. The opposite parties have intentionally, willfully and deliberately did not make the payment of his insurance claim, to which they are legally bound to pay the same. There is deficiency in service on the part of the opposite parties.

3.       Upon notice the opposite parties appeared and filed the written reply through their counsel by taking the preliminary objections that as per the terms and conditions of the policy of the insurance the complaint is not payable. The insured suffered from (COPD) CHRONIC OBSTRUCTIVE PULMONAY DISEASE, which in normal words is called CHRONIC SINSITIS AND BRONCHIAL ASTHEMA. As the very name suggests these types of diseases do not develop in a short period. Since these are chronic in nature they develop with continued and frequent illness. The disease is more than 5-6 years old. Although, the policy of the complainant was in 3^rd year of inception at the time of his admission in hospital but least 4 years of policy inception was required and the complaint is also not maintainable because the insured/complainant was requested to submit certain certificate from the doctor who had treated him vide letters dated 16.11.2013, 02.12.2013, 20.12.2013 and finally on 23.01.2014, but he neither produced the require certificate nor did he respond to the letters. Hence, his claim was repudiated as per terms and conditions/contract of insurance and the complaint is vague and silence about the type of disease the complainant suffered and was treated for and hence the same is liable to be dismissed. On merits, it was submitted that insured was requested to submit certain certificate from the doctor who had treated him vide dated 16.11.2013, 02.12.2013, 20.12.2013 and finally on 23.01.2014, but he neither produced the require certificate nor did he respond to the letters. Hence, his claim was repudiated as per terms and conditions/contract of insurance. Other averments made in the complaint have been denied. Lastly, the complaint has been prayed to be dismissed with costs. 

4.       Complainant tendered into evidence his own affidavit Ex.CW1, alongwith other documents Ex.C1 to Ex.C43 and closed the evidence. 

5.       Sh.Parveen Chadha, Branch Manager tendered into evidence his own affidavit Ex.OP1/A alongwith other documents Ex.OP1 to  Ex.OP12 and  closed the evidence.

6.       We have carefully gone through the pleadings of the parties; arguments advanced by their respective counsels and have also appreciated the evidence produced on record with the valuable assistance of the learned counsels for the purpose of adjudication of the present complaint.

7.          From the pleadings and evidence on record it is an admitted case of both the parties that the complainant had taken health Protection Policy from the opposite parties no.1 & 2. It is the case of the complainant that on 21.6.2013 he fell ill and was admitted in the Ohri Chest & Multispeciality Hospital, Amritsar and got treatment. As per the advice of doctor, the complainant got his x-ray, City Scan etc. done of the different parts of his body and as such spent Rs.50,713/- from his own pocket. That after getting discharged on 25.6.2013 he approached opposite parties no.1 & 2 and even submitted his original file containing 67 pages and Two X-rays for the release of claim. The opposite party declared the claim as ‘No Claim’ vide letter dated 12.2.2014.

8.       On the other hand, the opposite party has mainly argued that the claim was repudiated due to non-submission of certain certificate from the doctor who had treated him. Various letter dated 16.11.2013, 2.12.2013, 20.12.2013 and finally on 23.1.2014 were written to the complainant in this regard.

9.       From the entire above discussion without expressing our opinion on the merits of the case we find that it is a fit case which can be decided by giving directions to the parties. We find that all the relevant documents are already on record and documents seem to have been in possession of each of the parties to the litigation. Hence we dispose of this complaint with directions to opposite parties to decide the claim of the complainant within 30 days from the receipt of copy of orders. The complainant is also directed to co-operate with the opposite party in finally deciding the claim and not to create any hindrance in the process.

10.     Copy of the order be communicated to the parties free of charges. File is ordered to be consigned to the record room.  

       (Naveen Puri)

                                                                          President.

ANNOUNCED:                                        (Jagdeep Kaur)

March 20,2015.                                                 Member.

*MK*