DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

PATIALA.

                                      Consumer Complaint No. 377 of 14.9.2016

                                      Decided on:   29.3.2019

1.       Swaranjit Singh aged 65 years S/o Sh.Mohinder Singh.

2.       Mrs.Avinash Chugh aged 60 years W/o Sh.Swaranjit Singh

           both R/o House No.255, Majithia Enclave, Patiala.

                                                                   …………...Complainants

                                      Versus

1.       The Oriental Insurance Company Pvt. Ltd. Sai Market Lower Mall, Patiala through its Sr.Divisional Manager.

2.       The Oriental Insurance Company Regd.Head Office A-25/27, Asf Ali Road, new Delhi, through its CMD.

3.       Medi Assist India TPA Ltd. S.C.O.521, Sector-70, Near JLPL Office, Mohali through its Incharge.

                                                                   …………Opposite Parties

                                      Complaint under Section 12 of the

                                      Consumer Protection Act, 1986.

QUORUM

                                      Sh. M.P.Singh Pahwa, President

                                      Smt. Inderjeet Kaur, Member

                                      Sh.B.S.Dhaliwal, Member      

ARGUED BY

                                      Sh.K.S.Sidhu, counsel for complainants.

                                      Sh.D.P.S.Anand, counsel for OPs No.1&2.

                                      OP No.3 ex-parte.

 ORDER

                                    SH. M.P.SINGH PAHWA,PRESIDENT

1. This is the complaint filed by Swaranjit Singh and Mrs.Avinash Chugh       (hereinafter referred to as the complainants) against The Oriental Insurance Company Pvt. Ltd. and others (hereinafter referred to as the OP/s).
2. Briefly the case of the complainants is that they are getting mediclaim insurance policy from the OPs for the last 3-4 years. Previously they got insured themselves vide insurance policy No.233500/48/2015/2379, for the period from 4.2.2015 to 3.2.2016 by paying Rs.6830/-  for sum assured of Rs.5 lac.At that time, doctors of the OPs got the complainants medically examined.
3. It is pleaded that in the first week of August/2015, complainant No.2 felt pain in lower back radiating to right leg on 5.8.2015. She got admitted in Columbia Asia Hospital, Patiala and was discharged on 6.8.2015. Complainants spent Rs.22881/- on the treatment. Complainant No.1 lodged the claim with the OPs vide letter dated 5.8.2015 and submitted the following documents:

1. Claim form
2. Discharge report of Columbia Asia Hospital, Patiala
3. Final bill receipt of Rs.22880/- dated 6.8.2015
4. Medical reports
5. Policy copy

4. It is further pleaded that the OPs got investigated the claim through investigator who found the claim genuine. Complainants completed all the formalities as desired by the investigator and OP no.3, vide letters dated 17.9.2015 and 2.11.2015.After completing all the formalities, complainants visited the office of OPs but they remained silent on the matter. Complainants also requested for settlement of claim vide letters dated 14.11.2015 and 11.3.2016 but the OPs have not paid the genuine claim. The complainants also submitted cancelled cheque vide letter dated 25.5.2016 for crediting the amount in their favour.
5. It is alleged that by not making the payment of genuine claim, OPs have committed deficiency in service. Complainants have also suffered lot of harassment and mental agony. Hence this complaint for release of sum of Rs.22881/- with interest @18% per annum; Rs.10,000/- for harassment and mental agony and Rs.5500 /- costs of litigation.
6. Upon notice, none appeared on behalf of OP No.3. As such OP No.3 was proceeded against exparte on 28.10.2016. OPs No.1&2 appeared through counsel and contested the claim by filing the written reply. In reply the OPs raised preliminary objections that the complaint is not maintainable. The complainants have failed to submit the original paid receipt of hospital bill of Rs.22880/- in spite of various requests and the claim was closed as no claim. Thereafter, on request of the complainants, it was reopened. But again the complainants failed to supply the original hospital receipts of payments, which are required  as per condition No.5.5 of the policy. Again the claim is under closure status. The company is ready to process the claim subject to furnishing of documents by the complainants. That the insurance is a contract of indemnity. It has to be viewed as a normal contract as per Indian Contract Act. Any violation of the Insurance Contract by the parties to the contract of insurance, the contract becomes void and the insurance company would not be liable to answer the claim of the other party; that the complainants have no locus standai to file the case against the OPs.
7. On merits, the OPs have denied all the material averments and reiterated their stand as taken in the preliminary objections. In the end, the OPs prayed for the dismissal of the complaint.
8. Parties were afforded opportunity to produce their evidence.
9. In support of their case, the complainants tendered into evidence  affidavit of Swaranjit Singh, Ex.CA,  copy of policy, Ex.C1, copy of discharge summary, Ex.C2, copy of application, Ex.C3,copies of letters, Exs.C4 to C8, copy of pass book,Ex.C9.
10. The OPs tendered into evidence affidavit of Madhu Kaul,Ex.OPA, copy of insurance policy with terms and conditions, Ex.OP1, copy of letter dated 17.9.2015, Ex.OP2 , copy of letter dated 21.11.2015, Ex.OP3 and closed the evidence.
11. We have heard the ld. counsel for the parties and gone through the record of the file carefully.
12. The ld. counsel for the complainant has submitted that the insurance is not disputed. Lodging of the claim is also not disputed. Although the OPs have reimbursed the claim but it has been reimbursed after filing of the complaint and at a belated stage. Therefore, the complainants are entitled for compensation for this delay in releasing the payment. To support this submission, the ld. counsel for the complainants has cited 1998(2)CLT 489 United India Insurance Co.Ltd. Vs. M.K.J.Corporation and 1(2007)CPJ 3(NC) Maya Appliances Pvt.Ltd. Versus United India Insurance Company Ltd.
13. On the other hand, the ld. counsel for the OPs has submitted that complainants have not brought the true facts before the Forum. The complainants have concealed the fact that they could not submit the documents as called for. Complainants themselves have placed on record copies of letters dated 17.9.2015 and 21.11.2015. Even otherwise also the complaint has become infractuous as the complainants have accepted the paid amount without any protest. Now the complainants cannot raise any claim regarding compensation for alleged delay in payment.
14. We have given careful consideration to the rival submissions.
15. The case was filed by the complainants for getting reimbursed of the amount spent on treatment. Counsel for the complainant has admitted that the claimed amount has already been paid by the OPs and now the complaint is regarding compensation on account of delay in releasing of the payment.
16. The complainants have claimed release of the payment with interest and compensation due to suffering of mental tension etc. The complainants have already accepted the amount paid by the OPs .There is nothing to show that the claimed amount was accepted under protest. It is to be inferred that the claim  has already been satisfied. Therefore, the complaint has become infractuous and as such stands dismissed.
17. Certified copies of this order be sent to the parties free of cost under the Rules. Thereafter, file be indexed and consigned to the Record Room.

ANNOUNCED

DATED:29.3.2019       

 B.S.Dhaliwal                         Inderjeet Kaur              M. P. Singh Pahwa

       Member                                 Member                                      President