DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

PATIALA.

                                      Consumer Complaint No. 39 of 7.2.2018

                                      Decided on: 20.9.2021

Dilbar Singh aged about 27 years, resident of village Kasyana, Tehsil and District Patiala (Punjab).

                                                                   …………...Complainant

                                      Versus

1. Veera Sports, Principal office at Door No.860/A, Road No.45, Jubilee Hills, Hyderabad-500033 through its Managing Partners.
2. National Insurance Co. Ltd., through Divisional Office of Patiala at Leela Bhawan Market, Patiala through its Divisional Manager.
3. Medi Assist Insurance TPA, SCO 37, IInd Floor, Sector 31-D, Chandigarh Tell 0172-4669506, Mob. 8283809623 through its Directors/Managing Director.

                                                                   …………Opposite Parties

Complaint under the Consumer Protection Act

QUORUM

                                      Sh. Jasjit Singh Bhinder, President

                                      Dr.Harman Shergill Sullar,Member 

ARGUED BY

                                       Sh.J.S.Aujla,counsel for complainant.

                                      Sh.Alok Mathur, counsel for OPs No.2&3.

                                      Complaint against OP No.1 dismissed as withdrawn

                                      vide order dated 19.12.2019

 ORDER

                                      JASJIT SINGH BHINDER,PRESIDENT

1. The brief facts of the case are that the complainant is a Kabaddi Player. It is averred that OP No.1 being organizer of Men’s kabaddi league, engaged the complainant on  contract basis for Pro kabaddi season-3 vide contract dated 24.10.2015 and in pursuance of the contract, the OP No.2 through OP No.3 insured the complainant w.e.f.21.12.2015 to 23.6.2016 for any injury during this period and was accordingly insured vide policy No.552900/46/15/8500000125 under which in case of any injury the complainant can get himself treated at any hospital anywhere in India. It is averred that the complainant joined the camp. It is further averred that the complainant suffered ACL injury during pro kabaddi season-3 on his left knee. Intimation regarding injury was given to OP No.1. The complainant was given first aid  by initially treated at the medical camp of pro kabaddi season-3 and thereafter due to seriousness of injury he was got admitted in Chawla Nursing Home and Hospital, Sector 61, Mohali where surgery was conducted on his left knee and the complainant remained admitted there from 27.3.2016 to 2.4.2016 and Rs.1,11,654/- spent on his treatment. The complainant intimated the OPs in this regard but no amount was paid by the OPs to the complainant or the hospital. However, vide letter dated 17.3.2016 the OPs repudiated the claim and the complainant himself paid Rs.1,11,654/- to the hospital.
2. It is further averred that the complainant filed claim with the OPs and also completed the requisite formalities but of no avail. The complainant also got served legal notice dated 23.8.2017 upon the OPs in this regard but to no effect. It is averred that the act and conduct of the OPs shows mal practice and deficient of service on their part. Hence this complaint with the prayer to accept the same by giving directions to the OPs to pay the amount of Rs.1,11,654/- alongwith interest @18% per annum w.e.f. 2.4.2016; to pay Rs.3,00,000/-as compensation and Rs.11000/-as costs of litigation.
3.                    Notice of the complaint was given to OPs No.OP No.2&3 appeared and filed the written reply, whereas complaint against OP No.1 has been dismissed as withdrawn vide order dated 19.12.2019.
4. In the written statement filed by OP No.1 it raised preliminary objections with regard to the maintainability of the complainant.
5. On merits, it is admitted that an insurance policy bearing No.552900/46/15/8500000125 was issued by the OP in the name of Uurmi Systems Private Limited, Hyderabad for the period from 24.6.2015 to midnight of 23.6.2016 and the complaint is bad for non joinder of this party. It is admitted that the claim of the complainant was repudiated vide letter dated 17.3.2016 and finally vide closure letter dated 5.9.2016, the claim of the complainant was treated as no claim due to non submissions of required documents and the fault lies with the complainant. There is no deficiency of service on the part of the OP. After denying all other averments, the OP has prayed for the dismissal of the complaint.
6. In the written reply filed by OP No.3 it also raised preliminary objections with regard to the maintainability of the complaint. On merit, it also filed reply on the same facts as is filed by OP No.2 and after denying all the averments has prayed for the dismissal of the complaint.
7. In support of the complaint, the ld. counsel for the complainant has tendered in evidence Ex.CA affidavit of the complainant alongwith documents Exs.C1 to C12 and closed the evidence.
8. On the other hand, the ld. counsel for OPs No.2&3 has tendered in evidence Ex.OPA affidavit of Parmod Kumar Jain, Sr.Divisional Manager NIC, Ex.OPB affidavit of Sh.Dayanad A Kallinpur alongwith documents Exs.OP1 o OP7 and closed the evidence.
9. We have heard the ld. counsel for the parties and have also gone through the record of the case, carefully.
10. The ld. counsel for the complainant has argued that the complainant is a kabaddi player and OP No.1 is organizer of men’s kabaddi league who engaged the complainant on contract basis vide contract dated 24.10.2015.The ld. counsel further argued that in pursuance of the contract, OP No.2 through OP No.3insured the complainant w.e.f.21.12.2015 to 23.6.2016 for any injury during this period. The ld. counsel further argued that the complainant suffered ACL injury on his left knee and admitted in Chawla Nursing Home & Hospital, Mohali for treatment for the period from 27.3.2016 to 2.4.2016 and he has to pay Rs.1,11,654/-.The ld. counsel further argued that he gave intimation to the OPs of his admission in the hospital and after discharge also requested to pay the amount but the amount was not paid. So the complaint be allowed.
11. On the other hand, the ld. counsel for OPs No.2&3 has argued that the complaint is bad for non joinder of necessary and M/s Uurmi Systems Private Limited is necessary party. However, it is admitted that the insurance policy was issued by the insurance company. The ld. counsel further argued that the complaint has been rightly repudiated and the same be dismissed.
12. To prove the case Dilbar Singh has tendered his affidavit, Ex.CA and he has deposed as per the complaint.Ex.C1 is contract by the complainant with Veera Sports.Ex.C2 is deficiency letter sent to Sh.Dilbar Singh, Ex.C3 is policy, Ex.C4 is repudiation letter dated 17.3.2016, Ex.C5 is insurance document, Ex.C6 is legal notice, Ex.C10 is bill of Chawla Nursing Home of Rs.1,00,100/-, Ex.C11 is also document of Chawla Nursing Home, Ex.C12 is receipt of Chawla Nursing Home.
13. On the other hand OPs No.2&3has tendered affidavit Ex.OPA of Sh.Parmod Kumar Jain  who has deposed as per the written statement, Ex.OPB is affidavit of Sh.Dayanand A Kallianpur, who has also deposed as per the written statement, Ex.OP1 is repudiation letter dated 17.3.2016, Ex.OP2 is deficiency letter, Ex.OP3 is closure letter, Ex.OP4 is insurance policy issued by National Insurance Co. Ltd for the period from  24.6.2015 to 23.6.2016 in which Dilbar Singh was also insured for Rs.3,00,000/-.Ex.OP5 is Group Mediclaim Insurance policy.
14. From the documents of the insurance company, it is clear that Dilbar Singh alongwith team members was insured in a Group Insurance Policy issued by National Insurance Co.Ltd. from 24.6.2015 to 23.6.2016.There were 215 employees and 275 dependents were insured  for Rs.3lacs and Rs.5lacs each and total sum insured was Rs.6,67,00,000/-. So it is clear that Dilbar Singh was insured with Group Mediclaim Insurance policy of National Insurance Co. Ltd. for Rs.3lac. As per the documents of the complainant he was injured and was treated at Chawla Nursing Home, Mohali and his claim was wrongly repudiated by the OPs No.2&3 despite the fact that he was insured with them. So there is deficiency of service on the part of OPs No.2&3 and are liable to pay the claim amount.
15. So, in view of our above discussion, the complaint stands allowed and the OPs No.2&3 are directed to pay the amount of Rs.1,00,100/- to the complainant alongwith interest @6% per annum from the date of repudiation i.e.17.3.2016 till payment and also to pay Rs.10,000/-as compensation and further Rs.10,000/-as litigation expenses.  

Compliance of the order be made by the OPs No.2&3 within a period of 45 days from the date of the receipt of the certified copy of this order.

ANNOUNCED

DATED:20.9.2021       

                             Dr.Harman Shergill Sullar              Jasjit Singh Bhinder

                                    Member                                       President