Charanjit Singh, President;

1        The present complaint has been received from the District Consumer Disputes Redressal Commission Amritsar by the order of the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh for its disposal.

2        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 against the opposite party on the allegations that the complainant renewed a mediclaim policy from the New India Assurance Co. Ltd. vide policy No. 360500341426000000001 dated 28^th January 2015 for sum insured up to Rs. 2,00,000/- by paying total premium amounting to Rs. 12,230/-. On 8^th June 2015, the complainant met with a road accident. She while returning home from market was hit by a speeding car, after which the complainant fell on road and became unconscious. She was taken to Smt. Paarvati Devi Hospital, Amritsar immediately who after examining her critical position admitted her. There various tests were conducted and it was analyzed that she had got injury on upper jaw followed by multiple tooth loss, maxillary fracture and profuse bleeding. The complainant was given complete treatment and medication to stop bleeding and bony fragments were clinically removed by the doctor. The complainant was advised to stay under medical supervision for next 24 Hours and she was discharged from Hospital on next day i.e. on 9^th June 2015. The doctors advised the complainant to continue medicines for 2 weeks and advised 6 unit PFM Bridge for Anteriors after 15 days. The complainant filed a request to the insured company for settlement of her claim as she had incurred around Rs.35,000/- as total expenses including admission charges of Rs. 9,550/- , PFM Bridge costing Rs. 21,000/-, medicines and some tests (including X rays) the complainant submitted all original documents to the opposite party as per their demand after which she got letter “Re-First Reminder for claim” from the insured company dated 15^th September 2015 for submitting further documents and details. The letter demanded for the following documents

          1        Treating Doctors Certificate

          2        Copy of Indoor case papers and vital charting

          3        Copy of MLC/FIR

4        Treating Doctor’s certificate for complete treatment taken after accident except dental.

The complainant submitted all the original bills, documents, X Ray reports alongwith Doctor’s certification to the opposite party. The doctor clearly certifies that the patient was admitted on 8.6.2015 after reporting a road side accident following massive swelling of lip, bleeding and maxillary bone fracture of 21/12. The patient was discharged on 9.6.2015. On 9^th October 2015, the opposite party issued a letter “Re-Recommendation for non- payable” In this letter the insurance company fraudulently rejected the claimant’s claim. In the letter the opposite party gave the highly unjustifiable and wrong excuse that the complainant had not suffered maxillary fracture, but the reality is that she had suffered maxillary fracture and that too was clearly certified by the doctor who operated the complainant. So the opposite party had fraudulently rejected the claim. Also in the letter the opposite party rejected to pay the treatment of Teeth which they said is not covered in the claim. This is completely wrong as the terms and conditions clearly say that dental treatments are excluded expect necessitated by an accident and here treatment is being done only because of accident. The opposite party also rejected to pay the amount of admission charges which were around Rs. 10,000/- and other costs. The opposite party has wrongfully rejected the claim on their own wishful judgment without prior consideration of the facts, reports and advisory of the doctors operating upon the complainant. Due to this one sided wrongful Judgment of the opposite party, the claimant has suffered loss and injury due to deprivation, harassment, mental agony and loss of personal repudiation, for which she is entitled to compensation. The complainant prayed that this commission may be pleased to:

1.  Order the opposite party to pay all the medical expenses incurred by me under the terms of the contract of indemnity/ insurance as per the sum assured as compensation. The cost and expenses incurred are around Rs. 35,000/- the original bills of which are fraudulently kept by opposite party.
2.  Order the opposite party to pay Rs. 50,000/- as cost of mental agony and harassment and Rs. 15,000/- as cost of litigation.
3. Pass any other such order, as this commission may deem fit and proper in the interest of justice.

3        After formal admission of the complaint, notice was issued to Opposite Party and opposite party appeared through counsel and filed written version and contested the complaint by interalia pleadings that the complaint of the complainant is hopelessly time barred and as such, the same is liable to be dismissed. The complainant has not approached this commission with clean hands and has suppressed the true and material facts from the knowledge of this commission. On the perusal of the claim documents, it observed that the patient is diagnosed RSA Upper Jaw Injury and managed for the same (a) Since, there is discrepancies in the discharge summary which states that the is no maxillary fracture and the case is managed conservatively with IV Fluids Antibiotics and Analgesics but as per the query reply received states that patient has maxillary bone fracture wrt 12, 21 tooth and was operated upon for the removal of fractured bony fragments and fractured tooth fragments (b) as per the OPG, x-ray provided, there is no maxillary bone fracture  visible (c) as per OPG X-ray provided, the case is suggestive with chronic periodontitis with generalized bone loss (d) there is no MLC/FIR in case of RSA and in view of above medical details and observations, the claim is non payable as per clause 4.7 of policy terms and conditions which states that any dental treatment of surgery which is corrective, cosmetic or aesthetic procedure including wear and tear unless arises from disease or injury which requires hospitalization for treatment of any kind, unless requiring hospitalization is not payable. The complainant is estopped by his own act and conduct from filing the present complaint.  The opposite party has denied the other contents of the complaint and prayed for dismissal of the same. 

4        To prove her case, the complainant tendered in evidence her affidavit Ex. C-1 copy of policy schedule Ex. C-2, copy of the history sheet Ex. C-3, copy of the first reminder dated 15.9.2015 Ex. C-4, copy of the certificate issued by Parvati Devi Hospital Ex. C-5, copy of recommendation for non payment payable Ex. C-6 and closed the evidence.  Ld. counsel for the opposite party tendered in evidence affidavit of Sh. Satish Sharma Ex. OP1, policy schedule Ex. OP2, copy of terms and conditions Ex. OP3, affidavit of Dr. Rakesh Kalra Ex. OP4, copy of the letter dated 9.10.2015 Ex. OP5 and closed the evidence.

5        We have heard the Ld. counsel for the complainant and opposite party and have gone through the record on the file.

6        In the present case, insurance is not disputed. The opposite party has taken the objection that the present complaint is hopelessly time barred and is liable to be dismissed. Perusal of document i.e. Ex. C-6 i.e. recommendation for non payable letter is dated 9.10.2015 which has been placed on record by the complainant herself and the present complaint has been filed by the complainant on 7.12.2017. Section 24-A of the Consumer Protection Act, 1986, deals with limitation. It reads as under:-

“24A. Limitation period. – (1) The District Forum, the State Commission or National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.

(2)     Notwithstanding anything contained in sub-section (1), a complaint may be entertained after the period specified in subsection (1), if the complainant satisfies the District Forum, the State Commission or the National Commission, as the case may be, that he had sufficient cause for not filing the complaint within such period:

Provided that no such complaint shall be entertained unless the National Commission, the State Commission or the District Forum, as the case may be, records its reasons for condoning such delay.”

7        The provisions of Section 24A of the C.P. Act were interpreted by the Hon’ble Supreme in the judgment reported as “State Bank of India v. B.S. Agricultural Industries (I)” 2009 CTJ 481 (Supreme Court) (CP) in which it has been observed as under:-

“8. It would be seen from the aforesaid provision that it is peremptory in nature and requires consumer forum to see before it admits the complaint that it has been filed within two years from the date of accrual of cause of action. The consumer forum, however, for the reasons to be recorded in writing may condone the delay in filing the complaint if sufficient cause is shown. The expression, ‘shall not admit a complaint’ occurring in Section 24A is sort of a legislative command to the consumer forum to examine on its own whether the complaint has been filed within limitation period prescribed thereunder. As a matter of law, the consumer forum must deal with the complaint on merits only if the complaint has been filed within two years from the date of accrual of cause of action and if beyond the said period, the sufficient cause has been shown and delay condoned for the reasons recorded in writing. In other words, it is the duty of the consumer forum to take notice of Section 24A and give effect to it. If the complaint is barred by time and yet, the consumer forum decides the complaint on merits, the forum would be committing an illegality and, therefore, the aggrieved party would be entitled to have such order set aside.”

8        This view of law was reiterated by the Hon’ble Supreme Court in its judgment reported as “V.N. Shrikhande (Dr.) v. Anita Sena Fernandes” 2011 CTJ 1 (SUPREME COURT) (CP). It was held by the Hon’ble Supreme Court as under:-

“Section 24A(1) contains a negative legislative mandate against admission of a complaint which has been filed after 2 years from the date of accrual of cause of action. In other words, the consumer forums do not have the jurisdiction to entertain a complaint if the same is not filed within 2 years from the date on which the cause of action has arisen. This power is required to be exercised after giving opportunity of hearing to the complainant, who can seek condonation of delay under Section 24A(2) by showing that there was sufficient cause for not filing the complaint within the period prescribed under Section 24A(1). If the complaint is per se barred by time and the complainant does not seek condonation of delay under Section 24A(2), the consumer forums will have no option but to dismiss the same. Reference in this connection can usefully be made to the recent judgments in State Bank of India v. B.S. Agricultural Industries (I), 2009 CTJ 481 (SC)(CP)=(2009) 5 SCC 121 and Kandimalla Raghavaiah and Company v. National Insurance Company and another, 2009 CTJ 951 (SC)(CP)=(2009) 7 SCC 768.”

Therefore, the cause of action, if any, had accrued to the complainant on 9.10.2015 and the complaint should have been filed within two years from that date i.e. upto 8.10.2017. However, the complainant has filed this complaint only on 7.12.2017. It is, therefore, held that certainly this complaint has been filed beyond the period of limitation of two years as provided in Section 24-A of the C.P. Act.

9.       In view of the ratio of the law laid down in the above noted authorities and the discussion held above, we are of the opinion that the present complaint is not well within time and the same is dismissed being not filed well within time.  The parties are left to bear their own costs. Copy of order be supplied by the District Consumer Disputes Redressal Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar.

Announced in Open Commission

20.09.2022