Chandigarh

DF-I

CC/211/2016

Sh. Parshotam Tandon - Complainant(s)

Versus

The Oriental Insurance Company - Opp.Party(s)

Munish Goel

24 Apr 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

 

 

                               

Consumer Complaint No.	:	CC/211/2016
Date of Institution	:	28/03/2016
Date of Decision	:	24/04/2017

 

Sh. Parshotam Tandon s/o Sohan Lal Tandon r/o H.No.186, Sector 11A, Chandigarh.

…..Complainant

V E R S U S

1.     The Oriental Insurance Company, Regd. and Head Office, A-25/27, Asaf Ali Road, New Delhi through its Chairman/Director/Authorised Signatory.

2.     The Oriental Insurance Company, Divisional Office-2, SCO No.48-49, Sector 17-A, Chandigarh through its Senior Divisional Manager/Authorised Signatory.

……Opposite Parties

CORAM :	S.S. PANESAR	PRESIDENT
	MRS.SURJEET KAUR	MEMBER
	SURESH KUMAR SARDANA	MEMBER

 

                                                                       

ARGUED BY	:	Sh. Munish Goel, Counsel for complainant
	:	Sh. R.C. Gupta, Counsel for OPs.

 

Per S.S. Panesar, President

1.         The facts of the consumer complaint, in brief, are that the complainant opened an account with the Oriental Bank of Commerce on 3.4.2012 upon which he was provided with a medi-claim policy, issued by the OPs, on payment of premium. The complainant was absolutely fit and fine at the time of taking the policy.  In continuation of medi-claim policies issued by the OPs, the complainant suffered viral fever in June 2015 and started having palpitations in July 2015. He was admitted in PGI Chandigarh on 5.7.2015 and was discharged on 19.7.2015.  The complainant submitted a claim of Rs.38,663/- with the OPs.  Subsequently, the complainant was admitted with Fortis Escorts Heart Institute, Delhi on 6.9.2015 and discharged on 9.9.2015. After contacting the OPs, the complainant submitted his claim form for refund of Rs.70,521/-. Vide letter dated 21.9.2015, the OPs sought a number of documents which were provided by the complainant vide letter dated 29.10.2015. Thereafter, the complainant wrote a number of letters to the OPs, but, despite that his genuine claim was not paid.  Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of OPs, the complainant has filed the instant complaint.
2.         OPs in their written statement have not disputed the factual matrix. It has been averred that the claims submitted by the complainant for different sums are under consideration of the competent authority, but, for non-cooperation from the insured.  The complainant has failed to provide the requisite documents at the earliest possible with regard to the claim lodged by him. It has been contended that insurance is purely a matter of good faith and the complainant has not come to the Forum with clean hands. Pleading that there is no deficiency in service or unfair trade practice on their part, OPs prayed for dismissal of the complaint.
3.         Rejoinder was filed by the complainant denying all the averments in the written reply of the OPs.
4.         The parties led evidence in support of their contentions. 
5.         We have gone through the record and heard the arguments addressed by the learned Counsel for the parties.
6.         During the course of arguments, counsel for the complainant has contended that during the pendency of this complaint, the OPs (insurer) have made payment to the tune of Rs.90,000/- against the two medical claims filed by the complainant. The complainant had to file this complaint on 28.3.2016 and he has been continuously pursuing the same in this Forum till date. The OPs have been contesting the claim tooth and nail since then.  The complainant had to engage a counsel and he has also spent heavily on the litigation, as such, the complainant is entitled to compensation to the tune of Rs.2.00 lakh on account of mental and physical pain as well as inconvenience caused to him due to the deficient services of the OPs, besides litigation expenses.
7.         Keeping in view the fact that the complainant has been made to file the complaint for reimbursement of two insurance claims, and the fact that payment to the tune of Rs.90,000/- has been admittedly made recently during the fag end of the proceedings, shows recalcitrant attitude of the OPs. The complainant is not only entitled to compensation on account of deficient services, but, he is also entitled to litigation expenses, of course, compensation has to be reasonable and commensurate with the loss occasioned to the complainant on account of deficient services.
8.         In view of the above discussion, the present consumer complaint deserves to succeed and the same is partly allowed. OPs are directed as under:-

(i)     To pay to the complainant Rs.10,000/- as compensation for mental agony, physical pain and inconvenience caused due to deficient services;

(ii)    To pay to the complainant Rs.5,000/- as costs of litigation. 

9.         This order be complied with by OPs within thirty days from the date of receipt of its certified copy, failing which, they shall make the payment of the amount mentioned at Sr.No.(i) above, with interest @ 9% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(ii) above.
10.         The certified copies of this order be sent to the parties free of charge. The file be consigned.

 

	Sd/-	Sd/-	Sd/-
24/04/2017	[Suresh Kumar Sardana]	[Surjeet Kaur]	[S.S. Panesar]
hg	Member	Member	President