BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.:153 of 2012.
Date of Institution: 19.03.2012.
Date of Decision:19.07.2016
Krishan aged 38 years son of Shri Satnarain, resident of Gali Chokhan Lohar Bazar, Bhiwani.
….Complainant.
Versus
- United India Insurance Company Limited Branch Redcross Bhawan, Mini Zoo Road, Bhiwani through Branch Manager.
- Divisional Manager United India Insurance Company Limited, Opposite D Park Delhi Road, Rohtak.
- Vipul Medcrop TPA Pvt. Ltd., B-416, Ansal Chamber I, Bhikakamaji Place, New Delhi-110066, through its Chief Executive Officer.
…...Opposite Parties.
COMPLAINT U/S 12 OF CONSUMER PROECTION ACT.
BEFORE: - Shri Rajesh Jindal, President
Ms. Anamika Gupta, Member
Smt. Sudesh, Member.
Present:- Shri Pardeep Vashisth, Advocate, for complainant.
Shri R.K. Sharma, Advocate for Ops no. 1 & 2.
OP no. 3 exparte.
ORDER:-
Rajesh Jindal, President:
The case of the complainant in brief, is that the OP is liable to indemnify the expenses incurred by the complainant on his treatment during the hospitalization from 25.01.2011 to 30.01.2011, under the terms and conditions of the policy obtained by the complainant from the OP. It is alleged that OP is liable to pay Rs. 28,397/- to the complainant and the OP has wrongly repudiated the claim of the complainant. The complainant further alleged that due to the act and conduct of the respondents, he had to suffer mental agony, financial loss and physical harassment. Hence, it amounts to deficiency in service on the part of respondents and as such he had to file the present complaint for seeking compensation.
2. On appearance, the OPs no. 1 & 2 filed written statement alleging therein that the complainant has not come to the Forum with clean hands. It is submitted that the complainant failed to intimate his hospitalization in the hospital within 24 hours after admission as per terms and conditions of the insurance policy and also failed to provide the requisite documents. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of opposite parties and complaint of the complainant is liable to be dismissed with costs.
3. In order to make out his case, the counsel for complainant has tendered into evidence documents Annexure 1 to Annexure 34 alongwith supporting affidavit.
4. In reply thereto, the counsel for opposite parties placed on record Annexure R-1 to Annexure R-4 alongwith supporting affidavit.
5. We have gone through the record of the case carefully and have heard the learned counsels for the parties.
6. Learned counsel for the complainant reiterated the contents of the complaint. He submitted that the OP is liable to indemnify the expenses incurred by the complainant on his treatment during the hospitalization from 25.01.2011 to 30.01.2011, under the terms and conditions of the policy obtained by the complainant from the OP. He submitted that OP is liable to pay Rs. 28,397/- to the complainant and the OP has wrongly repudiated the claim of the complainant.
7. Learned counsel for the Ops reiterated the contents of reply. He submitted that under the terms and conditions of the policy the complainant was bound to inform the OP about his hospitalization within 24 hours. The OP has repudiated the claim of the complainant as the complainant has violated the terms and conditions of the policy and as such there is no deficiency on the part of OP.
8. In the light of the pleadings and arguments of the parties, we have examined the relevant material on record. The plea of the OP regarding the intimation by the complainant regarding his hospitalization on 29.01.2011 is not controverted by the complainant. The complainant is not disclosed the nature of deceased for which he has taken the treatment. The condition No. 5.3 of the policy reads as under:-
“Upon the happening of any event which may give rise to a claim under this policy notice with full particulars shall be sent to the TPA named in the schedule immediately and in case of emergency Hospitalization, within 24 hours from the time of Hospitalization.”
9. Admittedly, there is delay on the part of the complainant to give intimation for his hospitalization to the OP. Considering the facts of the case, we partly allow the complaint of the complainant and award Rs. 10,000/- as lumpsum compensation to the complainant. The OP is directed to pay the said amount of award to the complainant within 60 days from the date of passing of this order, failing which the amount of award will carry interest @ 6 per cent per annum till the date of payment. Certified copies of the order be sent to the parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 19.07.2016. (Rajesh Jindal)
President,
District Consumer Disputes
Redressal Forum, Bhiwani.
(Anamika Gupta) (Sudesh)
Member. Member.
