DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi-110016.
Case No.482 of 2011
Smt. Anshumala
W/o Sh. Ranbir Sharma
R/o E-86, Bengali Colony
Mahavir Enclave, New Delhi
Also at:
537, Sector 22-A, Gurgaon ….Complainant
Versus
The Oriental Insurance Company Ltd.
Pankaj Plaza, Plot No.04
IInd Floor, Sector-4,
Dwarka, New Delhi-110075 ……Opposite Party
Date of Institution : 13.12.11 Date of Order : 23.03.16
Coram:
Sh. N.K. Goel, President
Ms. Naina Bakshi, Member
O R D E R
The case of the Complainant, in short, is that she had obtained a group medical insurance policy covering risk of hospitalization and domiciliary hospitalization for all family members (total 4) including herself from the OP vide policy No.214500/48/2010/748 with coverage of Rs.3 lacs. On 31.12.10, she fell down and received severe injuries in her left leg. She went to Umkal Hospital and Metro Heart Institute for check up and it was told by the doctor after X-Ray that there was a fracture in the bone and needed POP plaster. Her leg was plastered and she was advised to take medicines and bed rest for atleast six weeks. She has stated that she sent a request to the OP about the estimate expenses but the OP did not give any reply. She was forced to pay Rs.42,000/- in cash (to the hospital) due to non approval of the claim by the OP. Hence, pleading deficiency in service on the part of OP, the complaint has been filed with the following prayer:-
- Direct the OP to pay to the Complainant, claim amount of Rs.42,000/- as per the terms and condition of the policy with interest @ 12% p.a. till the date of payment.
- Direct the OP to pay a sum of Rs.50,000/- as compensation to the Complainant.
- Direct the OP to pay Rs.20,000/- as litigation cost to the Complainant.
In the written statement OP has stated that as per term and condition No.1 of the insurance policy “notice should be given in writing to the Company immediately upon the occurrence of any accidental loss or damage in the event of any claim.” The Complainant was guilty of violation of terms and conditions as till date the Complainant has not lodged any such claim with the OP. OP has stated that the Complainant had not lodged any claim with the OP nor any document regarding treatment and expenses has been supplied to OP. Hence there is no deficiency in service or unfair trade practice on the part of OP. OP has prayed for dismissal of the complaint with cost.
No rejoinder has been filed on behalf of the Complainant.
Complainant has filed her own affidavit in evidence while affidavit of Sh. Dayanand Sakkerwal, Divisional Manager has been filed in evidence on behalf of the OP.
Written arguments have been filed on behalf of the parties.
We have heard the arguments on behalf of the OP and have also gone through the file very carefully.
It is not disputed by the OP that the Complainant had taken a group medical insurance policy, covering risk of hospitalization and domiciliary hospitalization for all family members (total 4) including herself from the OP vide policy No.214500/48/2010/748 with coverage of Rs.3 lacs. The Complainant has filed various documents relating to the Unkal Hospital and Metro Heart Institute but she has not filed any document to show that she had filed any claim application with the OP. Therefore, the Complainant has failed to prove deficiency in service or unfair trade practice on the part of OP. Hence, we dismiss the complaint with no order as to costs.
Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations. Thereafter file be consigned to record room.
Announced on 23.03.16.
(NAINA BAKSHI) (N.K. GOEL) MEMBER PRESIDENT
Case No. 482/11
23.3.2016
Present – None.
Vide our separate order of even date pronounced, the complaint is dismissed. Let the file be consigned to record room.
(NAINA BAKSHI) (N.K. GOEL) MEMBER PRESIDENT
