BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL

FORUM, MOGA.

Complaint No.148 of 2014

Instituted On:08.12.2014

Decided On: 03.03.2015

Harpreet Singh Brar aged 32 years son of Gurcharn Singh Brar resident of Village Kotla Rai Ka, Tehsil Baghapurana, District Moga, through his father Gurcharan Singh (duly authorised) resident of Village Kotla Rai Ka, Tehsil Baghapurana, District Moga.

……..Complainant

Versus

1.       United India Insurance Co. Limited., through its M.D/Secretary/Chairman, Regd. & Head Office at 24, Whites Road, Chennai-6000014. 

2.       United India Insurance Co. Limited, Divisional Office at 6-7, Shaheed Bhagat Singh Market, G.T.Road, Moga.

3.       The Regional Manager United India Insurance Co. Limited, Feroz Gandhi Market, Ferozepur Road, Ludhiana.

                                                                   ……… Opposite Parties

Complaint under Section 12 of the

        Consumer Protection Act, 1986.

Coram:       Sh.S.S.Panesar, President

                   Smt Vinod Bala, Member

                   Smt. Bhupinder Kaur ,Member

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Present:      Sh.Gurjit Singh Handa, Advocate counsel for the complainant.

                    Sh.Arun Sood, Advocate counsel for the opposite parties

ORDER

(S.S.Panesar, President)

The present complaint has been filed by Gurcharn Singh Brar authorized person under Section 12 of the Consumer Protection Act, 1986 (herein-after referred to as ‘Act’) against United India Insurance Co. Limited., through its M.D/Secretary/Chairman, Regd. & Head Office at 24, Whites Road, Chennai-600014 and others  (herein-after referred to as ‘opposite parties’)-OPs directing them to make payment of Rs.1,66,048/-, which were spent by the complainant on the treatment of his daughter as well as Rs.50,000/- as  compensation for causing mental tension and harassment  and also grant cost of litigation.

2.                Briefly stated, the complainant had purchased Health Insurance Policy bearing No.201200/48/13/06/00000128 from the opposite parties by paying premium of Rs.5148/, which was valid w.e.f. 24.07.2013 to 23.07.2014 in which complainant alongwith his family members were insured.  During the subsistence of the policy on 21.02.2014, at about          4 AM, the daughter of the complainant namely Ekmjot Kaur suffered from breathing problem and she was immediately taken to Pancham Hospital, Ludhiana, where she was medically checked up by the doctors. The doctors suggested the complainant to give steam regularly to Ekmjot Kaur and the Echocardiography of Ekmjot Kaur was got conducted in

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which  a sum of Rs.1600/- was incurred. It has been pleaded that the complainant supplied the original bills dated 21.02.2014 and 25.02.2014 to the opposite parties. Thereafter, the daughter of the complainant was still suffering from breathing problem and she remained admitted in Fortis Memorial Research Institute Gurgaon  for the period w.e.f. 08.04.2014 to 11.04.2014. The complainant spent an amount of Rs.1,63,998/- on her treatment. After completion of the treatment from the hospital, the complainant approached the opposite parties and also submitted all the requisite documents and bills for re-imbursement of the medi-claim under the policy. It has been pleaded that the complainant received a letter dated 18.11.2014 from the opposite parties, whereby the latter intimated the complainant that the claim file has been filed as “No Claim” due to no proper reply from the insured, which is wrong and illegal.  Due to the negligent act of the opposite parties, the complainant is suffering from mental and physical harassment and economic loss.  Hence the present complaint.

3.                Notice of the complaint was given to the opposite parties who appeared through their counsel Sh. Arun Sood Advocate and filed written reply contesting the same. They took up preliminary objections that the complaint is not maintainable; that the complainant has got no locus-standi; that the complainant has concealed the material facts from this Forum and  that the claim file of the complainant has rightly been closed as no claim,

due to no proper reply from the insured i.e. the complainant vide letter

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dated 18.11.2014. On merits, the opposite parties took almost the same and similar pleas as taken up in the preliminary objections. All the allegations made in the complaint were specifically denied being incorrect and it is stated that the complaint deserves to be dismissed.

4.                In order to prove his case, the complainant tendered in evidence affidavit of Gurcharan Singh  Ex.C-1 and copies of documents Ex.C-2 to Ex.C-30 and closed his evidence.

5.                To rebut the evidence of the complainant, the opposite parties tendered affidavit Ex.OP1to3/1 of Sh.Anoop Kumar Kanojia  Senior Divisional Manager and closed the evidence on behalf of the opposite parties.

6.                We have heard the learned counsel for the parties and have also carefully gone through the record.

7.                 The learned counsel for the complainant has vehemently contended that it is not disputed that the complainant alongwith his family members were under health insurance cover w.e.f. 24.07.2013 to 23.07.2014. During the subsistence of the policy on 21.02.2014, Ekmjot Kaur suffered from breathing problem and she got her treatment at Hospitals located at Ludhiana and Gurgaon respectively. The complainant spent an amount of Rs.1,66,048/- on the treatment of his daughter. The complainant submitted all the documents pertaining to the treatment to the opposite parties for making disbursement of the expenses. But, however, the opposite parties rejected the claim of the complainant on flimsy ground

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vide letters, copies whereof are Ex.C-2 and Ex.C-3 on record. The claim of the complainant was deemed to be closed by the opposite parties without assigning proper reason, which amounts to deficiency in service. The complainant is entitled to be re-imbursed medical expenses to the tune of Rs.1,66,048/- incurred by him on the treatment of Ekmjot Kaur insured alongwith compensation to the tune of Rs.50,000/- as well as litigation expenses to be assessed by this Forum. 

8.                On the other hand, the learned counsel for the opposite parties has vehemently contended that there is no deficiency in service on the part of the opposite parties. The complainant has concealed the material facts from the opposite parties and the claim file of the complainant has been rightly closed as ‘No claim’. It is contended that the complaint is nothing, but an abuse of process of law and it is requested that the complaint may be dismissed.   

9.                 We have given thoughtful consideration to rival contentions.

10.               There is no denying the fact that complainant Harpreet Singh Brar and his family members including Ekmjot Kaur minor daughter were under the insurance cover w.e.f. 24.07.2013 to 23.07.2014 on payment of Rs. 5148/- as premium. Copy of the insurance policy accounts for Ex.C-29. There is also no denying the fact that Ekmjot Kaur suffered from breathing problem and got treatment from hospitals at Ludhiana and Gurgaon respectively. Relevant copies of medical records as well as bills account for Ex.C-4 to Ex.C-24. The complainant submitted all the relevant documents

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for disbursement of the medical expenses incurred by him on the treatment of his minor daughter namely Ekmjot Kaur. But, however, the opposite parties closed the claim as ‘No claim’ vide letters Ex.C-2 and Ex.C-3 respectively on record without assigning any proper reason. The claim of the complainant that he incurred an amount of Rs.1,66,048/- on the treatment of Ekmjot Kaur, is not fully proved on record. However, from the perusal of the documents, Ex.C-5, Ex.C-7, Ex.C-15, Ex.C-16 and Ex.C-23, it comes that an amount of Rs.1,63,998/- has been incurred by the complainant on the treatment of Ekmjot Kaur minor. But, the opposite parties rejected the entire claim of the complainant without assigning any cogent reason, whereas, the opposite parties were under legal obligation to disburse an amount of Rs. 1,63,998/- to the complainant under medical insurance policy, copy whereof is Ex.C-29 on record. The contention of the opposite parties that since the claim has not so far been declined, but the same has been filed as ‘No claim’, therefore, time may be given to the opposite parties to reconsider the claim. But the argument does not appear to be sound because it is the case of the complainant that he submitted all the relevant medical record as well as the bills for re-imbursement of the medical expenses. However, the claim submitted by the complainant was filed as ‘No claim’ by the opposite parties without assigning any cogent reason. If the matter is again referred to T.P.A for passing an order on the claim, it would be nothing, but a wastage of time and energy because all the documents regarding the treatment were submitted by the complainant

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alongwith the claim & proper order could have been passed then & there. As such, we hold that the opposite parties are under legal obligation to refund the amount of Rs. 1,63,998/- incurred on the treatment of minor daughter Ekmjot Kaur and the instant complaint stands allowed accordingly. Since Ekmjot Kaur is minor, the amount granted vide instant award be kept in the shape of F.D.R. in some Nationalized Bank for the period until the minor attains the age of majority. Compliance of this order be made within a period of thirty days from the date of receipt its copy. Copies of the order be sent to the parties free of cost immediately and thereafter the file be consigned to the record room.

Announced in Open Forum.

Dated:03.03.2015.