District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 189/2021.
Date of Institution: 30.03.2021.
Date of Order:13.06.2023.
Smt. Kamlesh R/o H.No. 46, Village Chandawali Tehsil Ballabgarh, Distt. Faridabad.
…….Complainant……..
Versus
1. The Oriental Bank of Commerce (Now Punjab National Bank), Village Chandawali Branch, Tehsil Ballabgarh, Faridabad.
2. The Oriental Insurance Company Ltd., having its Branch office at: 5-B/4, B.P.Neelam railway Station Road, New Industrial Town, Faridabad, Haryana – 121001. Regd. & Head office at: Asaf Ali road, New Delhi through its Branch Manager.
…Opposite parties
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Deepak Kumar, counsel for the complainant.
Sh. Amit Bhalla, counsel for opposite party No.1.
Sh. N.K.Gupta, counsel for opposite party No.2.
ORDER:
The facts in brief of the complaint are that the complainant was holder of saving bank account No. 12682281004998 with the Oriental Bank of Commerce (Now Punjab National Ban), Village Chandawali Branch, Tehsil Ballabgarh, Faridabad. The complainant was also holder of Oriental Mediclaim policy – 2017 Group health insurance product (policy for bank account holders of OBC only) with opposite parties since the year , 2017. Previously complainant was holder of mediclaim policy vide policy No. 272400/48/2021/6626 of opposite parries, which was valid from 12.10.2019 to 11.10.2020. Premium of the said policy had deducted by opposite parties from the saving bank A/c. No. 12682281004998 of Oriental Bank of Commerce. As ending period of the above said policy was 11.10.2020, hence being a responsible customer/policy holder complainant had deposited the premium of the above said policy i.e. Rs.6,000/- on dated 22.09.2020 with the above said bank, so, the opposite parties could take the amount of premium of the above said policy from his said account as per the payment of previous policy and a sum of Rs.6099/- had debited from the account of the complainant on dated 24.09.2020. The complainant had received new policy bond regarding renewal of the above medical claim policy vide policy No. 272400/48/2021/8761 from the side of the opposite parties. On 2210.2020 the health condition of the complainant became critical upon which complainant had admitted with Zenith Hospital (P) Ltd., Mohana Road, Near Bank of Baroda, Ballabgarh, Distt. Faridabad on 22.10.2020 vide IPD NO. 11641 and remained admitted there upto 25.10.2020. The complainant was in impression that she had cashless treatment mediclaimn policy, hence the complainant had provided the policy documents to the said hospital but the complainant got shocked and surprised to know that such hospital had refused to accept the same by taking the plea that period of the said policy was start from 27.10.2020 and valid upto 26.10.2021. Due to which the complainant had born all the treatment charges i.e. Rs.19,349/- out of her own pocket. The opposite parties had done the act of cheating, forgery and breach of trust with complainant by not issuing the policy bond as continued period of previous bond as continued period of previous policy i.e. from 12.10.2020 and issued the policy bond which was valid from 27.10.2020 instead of 12.10.2020 rather complainant had deposited the premium of the said policy within prescribed period with her above said bank. The complainant many times contacted with opposite parties and requested the opposite parties to issue the new policy bond in which the above said mediclaim policy was valid form 12.10.2020 and also requested opposite parties to make the payment of treatment charges i.e. Rs.19,349/- alongwith interest from the date of making the payment i.e.25.10.2020 till its actual final realization. The complainant sent legal notice dated 17.02.2021 to the opposite parties through registered post but all in vain. The aforesaid act of opposite parties amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to:
a) another policy bond in which starting period of above said policy may 12.10.2020
b) Rs.19,349/- alongwith interest from the date of making the payment i.e. 25.10.2020 to till its actual final realization.
c) pay Rs.2,00,000/- as compensation for causing mental agony and harassment .
d) pay Rs. 21,000 /-as litigation expenses.
2. Opposite party No.1 put in appearance through counsel and filed written statement wherein Opposite party No.1 refuted claim of the complainant and submitted that the complaint was admitted to the extent that the complainant had availed the mediclaim policy of opposite party No.2. However, it was pertinent to mention that replying opposite party had only acted as an facilitating agent of opposite party No.2 in selling its policies to its account holder. After the sale of policy, rights and liabilities of the complainant and opposite party No.2 were governed by the contract entered into between the same. The reply opposite party was not liable for any act of omission or commission by any of the parties i.e complainant and opposite party No.2. It was submitted that with regard to payment of premium it was stated that a premium amount was paid by opposite party No.1 to opposite party No.2 by debiting the account of complainant as per the instruction of complainant. As per the instructions of the complainant sum of Rs.6099/- was debited from the account of the complainant and credited to the account of opposite party No.2 through NEFT vide UTR No. ORBCH20268079212 on 24.09.2020. It was submitted that replying opposite party was not concerned with regard to issuance of policy to the complainant. Opposite party No.1 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. Opposite party No.2 put in appearance through counsel and filed written statement wherein Opposite party No.2 refuted claim of the complainant and submitted that the complainant had not come with clean hands and concealed the material facts. The complainant was got admitted in hospital on 22.10.2020 where she was admitted upto 25.10.2020, the complainant was not insured with the answering opposite party. The answering opposite party had received the premium amount on dated 27.10.2020 vide collection No. IND2323009405 dated 27.10.2020 of Rs.6403/- and after receiving the premium amount the answering opposite party had issued a new policy No. 272400/48/2021/8761 valid from 27.10.2020 to 26.10.2021 and her previous policy was started from 12.10.2019 to 11.10.2020, so the complainant was not covered under the said policy. Opposite party No.2 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
4. The parties led evidence in support of their respective versions.
5. We have heard learned counsel for the parties and have gone through the record on the file.
6. In this case the complaint was filed by the complainant against opposite parties–The Oriental Bank of Commerce & another with the prayer to: a) another policy bond in which starting period of above said policy may 12.10.2020 b) Rs.19,349/- alongwith interest from the date of making the payment i.e. 25.10.2020 to till its actual final realization. c) pay Rs.2,00,000/- as compensation for causing mental agony and harassment . d) pay Rs. 21,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.CW1/A – affidavit of Smt Kamlesh, Ex.C-1 – legal notice, Ex.C-2 – postal receipt, Ex.C-3 & 4 – track consignments, Ex.C5 – insurance policy valid from 26.09.2016 to 25.09.2017, Ex.C-6 – insurance policy valid from 26.09.2017 to 25.09.2018, Ex.C-7 – insurance policy valid from12.10.2019 to 11.10.2020, Ex.C-8 – insurance policy valid from 27.10.2020 to 26.10.2021, Ex.C-9 – statement of account, Ex.C-10 – Reimbursement claim form,, Ex.C-11 - discharge patient bill, Ex.C-12 – discharge summary, Ex.C-13 – Claim, form – Part B, Ex.C-14 – test report, Ex.C-15 – Adhaar card, Ex.C-16 – postal receipts.
On the other hand counsel for the opposite party No.1 strongly agitated and opposed. As per the evidence of the opposite party No.1 Ex.RW-1/A – affidavit of Shri Arun Chaudhary, Manager, Punjab National Bank (Previously Oriental Bank of Commerce), Ex.R-1 – email dated 28.10.2020.
As per evidence of opposite party No.2, Ex.RW1/A – affidavit of Shri Ramesh Kumar, Senior Divisional Manager, The Oriental Insurance Co. Ltd.
7. The complaint was filed by the complainant with the prayer to: a) another policy bond in which starting period of above said policy may 12.10.2020 b)Rs.19,349/- alongwith interest from the date of making the payment i.e. 25.10.2020 to till its actual final realization.
8. The complainant in his evidence given legal notice to opposite party dated 17.2.2021 vide Ex.C1, insurance policy valid from 26.09.2016 to 25.09.2017 vide Ex.C5, insurance policy valid from 26.09.2017 to 25.09.2017 vide Ex.C6, insurance policy 12.10.2019 to 11.10.2019 vide Ex.C7, insurance policy valid from 24.09.2020 vide Ex.C8 in which has been written that “Premium receipt by NEFT through OBC Bank dated 24.09.2020 lapse period of 16 days is condoned by DM DO FBD C/A subject to there is no claim for lapse period NEFT UTR ORBCH2068079212 dated 24.09.2020 & ORBCH20297059647 dated 26.10.2020 Ballabgarh-121004”
As per statement of account vide Ex.C9 the money was deducted from the account of the complainant on 24.9.2020 for a sum of Rs.6099/-. There was enough balance to purchase the policy. The complainant is the policy holder for the same company since 2016. She is paying regularly from her account and the complainant is 65 years old. As per the IRDA, the complainant should be medically examined before issuing the policy. In this case, the complainant is paying premium regularly. It was the duty of the bank to deduct the amount from the account of the complainant as usual. It was also the duty of opposite party No.2 i.e Oriental Insurance Company Ltd. before issuing the policy they must medically examined and sends a notice to the complainant for the shortening premium. Due to this only opposite parties have repudiated the claim of the complainant as per the policy issued by opposite party from 27.10.2020 to 26.10.2021 and date of admission of the complainant is 22.10.2020. As per the previous record, she is a continuous policy holder and she is paying premium since 2016 regularly. In the interest of justice, the Commission is of the opinion that the complaint is allowed.
9. Opposite parties are directed to process the claim of the complainant and pay the medical bill to the complainant. Opposite party No.2 is also at liberty to recover 50% of the amount of the bill from opposite party No.1. There are no order as to costs because it was the duty of the complainant also to check the policy before receiving the policy. Compliance of this order be made within 30 days from the date of receipt of copy of this order. File be consigned to the record room.
Announced on: 13.06 .2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
