Punjab

StateCommission

FA/1358/2013

Oriental Insurance Company Limited & others - Complainant(s)

Versus

Vikas Kumar Bansal - Opp.Party(s)

Brig. B.S. Taunque, Retd.

06 May 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,    PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

                   First Appeal No.1358 of 2013

 

                                                          Date of Institution: 11.12.2013  

                                                          Date of Decision :  06.05.2015

 

 

1.       Oriental Insurance Company Limited, Branch Nabha Gate, Sangrur      through its Manager (Legal), Regional Office, SCO No.109-111,   Sector 17-D, Chandigarh.

 

2.       Oriental Insurance Company Limited, Branch K.C. Road, Near OBC     Bank, Barnala through its Branch Manager.       

                                                                                                                                                                                                                                                                             …..Appellants/Opposite parties

 

                                      Versus

 

 

Vikas Kumar Bansal aged about 47 years, son of Shri Raj Kumar Bansal, resident of C-883, Street No.2, Patel Nagar, Barnala.

 

                                                          …..Respondent/Complainant

 

         

First Appeal against order dated 12.11.2013 passed by the District Consumer Disputes Redressal Forum, Barnala

 

Quorum:-

 

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri Harcharan Singh Guram, Member

 

Present:-

 

 

          For the appellants            :         Sh. B.S. Taunque, Advocate

          For the respondent          :         Sh. Munish Goel, Advocate.

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

J.S KLAR, PRESIDING JUDICIAL MEMBER :-

         

          The appellants (the opposite parties in the complaint) have directed this appeal against the respondent of this appeal (the complainant in the complaint), challenging  order dated 12.11.2013 of Consumer Disputes Redressal Forum Barnala, accepting the complaint of the complainant directing OP No.1 and 2 to pay the amount of Rs. 2 lac to complainant along with interest @ 9% p.a till actual payment, besides Rs.10,000/- composite compensation for mental harassment. The instant appeal has been preferred against the same by OP No.1 and 2 in the complaint.

2.      The complainant Vikas Kumar has filed the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that complainant maintained saving account no.004000104213988 with OP No.4 and a Cashless Health Insurance Policy No.233599/48/2013/103 was purchased by OP No.4 for the period from 08.08.2012 to 07.08.2013  from OP No.1 through OP No.2 in the name of the complainant by debiting an amount of Rs.3320/- on 06.08.2012 from the said bank account of the complainant. The family members of the complainant were also covered under the said insurance policy. Health Card No.5007760218 valid from 08.08.2012 in the name of the complainant along with Health Cards in the names of family members of the complainant were issued by OP no.3, being third party administer of OP No.1 and 2. The insurer would pay hospitalization expenses for medical surgical treatment at any Nursing Home/Hospital in India, as in-patient under the above scheme. The complainant suffered from heart problem on 27.03.2013 and was admitted in Dr. Naresh Goel Hosopital situated at K.C Road Barnala, form where he was referred to Hero Heart Dayanand Medical College and Hospital Ludhiana, where he was admitted from 27.03.2013 to 01.04.2013.  The complainant was operated for CAD with Single Vessel Disease on 28.03.2013. That at the time of admission of complainant in Hero Heart  DMC Ludhiana, the authorities of said hospital were requested by the attendants of complainant to provide the cashless treatment to complainant and showed the insurance policy issued by OP No.1. Administrator/Medical Superintendent of DMC Ludhiana regretted that OP No.3 was not able to extend cashless hospitalization of the complainant on 28.03.2013  and complainant was advised to take treatment and to submit full claim papers to OP No.3 for possible reimbursement. The complainant lodged insurance claim on 04.04.2013 after discharge from said hospital and obtained medical certificate from Dr. Bishav Mohan of Hero DMC Heart Institute, Ludhiana , who treated the complainant on 08.04.2013. OP No.2 sent letter dated 10.05.2013 to OP No.1 holding insurance claim of the complainant as not tenable. The said letter was sent to the complainant through registered post on 18.05.2013, which was received on 20.05.2013 by the complainant. The complainant sent reminder thereto on 27.05.2013 and on 31.8.2013 to OP No.2 through registered post on 4.9.2013. The complainant also moved an application dated 05.08.2013 to the Chief Cardiologist, Hero Heart DMC Ludhiana for issuance of certificate, that the he was not a diabetic, vide No. HDHI/MRD/2013/1031. The amount of the premium was debited to the account of the complainant by PNB at Barnala and insurance policy was issued to complainant. Thus, complainant has filed the present complaint and prayed that the Ops be directed to pay the amount of insurance claim to the complainant.

3.      The opposite were set exparte before the District Forum Barnala during the proceeding of the case.

4.      The complainant tendered in exparte evidence the copy of passbook Ex.C-1, copy of insurance policy Ex.C-2, copy of Health Card Ex.C-3, copy of e-mail dated 28.03.2013 Ex.C-4, copy of claim form Ex.C-5, copy of Medical Certificate Ex.C-6, copy of medical bills Ex.C-7 to Ex.C-10, copy of Discharge Summary Ex.C-11, copy of MAID Card Ex.C-12, copy of letter dated 10.4.13 Ex.C-13, postal receipt Ex.C-14, copy of letter dated 10.5.2013 Ex.C-15, copy of registered envelop Ex.C-16, copy of clarification dated 27.5.13 Ex.C-17, copy of reminder dated 31.8.13 Ex.C-18, copy of postal receipt dated 4.9.13 Ex.C-19, copy of application dated 5.8.13 Ex.C-20, copy of certificate dated 6.9.13 Ex.C-21, affidavit of Vikas Kumar complainant Ex.C-22. On conclusion of exparte evidence and arguments, the District Forum, Barnala,  accepted the complaint of the complainant exparte directing the OP No.1 and 2 to pay the amount of Rs.2 lac along with interest @ 9% p.a from the date of admission in the hospital till actual payment, besides compensation of Rs.10,000/-. Dissatisfied with the exparte order of the District Forum, Barnala, the instant appeal has been preferred against the same by the OPs now appellants in this appeal.

5.      We have heard learned counsel for the parties and have also gone through the record of the case in this appeal. The submission of counsel for the appellant is that they have been wrongly set ex-parte by the District Forum in this case. The vehement submission of counsel for the appellant Sh. B.S Taunque raised before this Commission is that 30 days minimum time is required to appear before the District Forum at the notice stage by OP, but District Forum has not granted that required time under law and hence the order of the District Forum proceeding the OP exparte is not legal and sustainable. We have examined the record of the District Forum, the complaint was admitted on 01.10.2013 and notice was sent to OPs for 25.10.2013. On 25.10.2013 OP 1 and 4 were served whereas RC of OP No.2 and 3 were not received back and case was adjourned to 6.11.2013 for awaiting the RC of OP No.2 and 3. On the adjourned date on 6.11.2013, more than 30 days period had expired and RC were not received back either served or unserved and on that basis, OP No.2 and 3  were also set exparte. Now grievance of OPs now appellants is that minimum 30 days period is required to be given by the District Forum for appearance of OPs, but the District Forum had not granted this period.  Reference was made to law laid down by this Commission in Kakka Singh Vs… Saraj Singh & Anr reported in II(2011) CPJ 212 contending that on admission stage of complaint, sufficient time of 30 days is required to be given to rebut the allegations and matter was remanded by the State Commission on this point. The counsel for the appellant stressed on this authority and contended that in view of Section 13 of the Act, 30 days period is required to be given at least to the OPs to give his written version. Counsel for the appellants also referred to law laid down in Zanus Group  Vs. Gurbax Singh & others, reported in 2015(2) CLT Page 209 by this Commission wherein it has been held that Regulation 10 of the Consumer Protection Regulation 2005 - District Forum issued notice to the OP by passing the order  for issuing notice for 30 days period on 22.06.2012. RC/AD was not received back and case was adjourned for awaiting the same for 13.07.12. On 13.07.2012, OP was proceeded against ex-parte on the basis of the report "unclaimed" on the registered envelope. Our State Commission has held that this procedure is illegal because sending of notice to OP is not a bare formality and the real purpose is to make it aware of the fact that complaint has been filed against it  and that to answer the same, it is to appear before District Forum on a particular date. It was held in this authority that when the presumption of service was drawn by the District Forum on 13.7.2012, there was no such notice issued by the Forum for that date. It was held to be illegal by our own State Commission in the above-referred authority and matter was remitted to District Forum for fresh decision in accordance with the Consumer Protection Act and  Regulation of 2005.

6.      Tested on the touchstone of the above referred authority, we find that District Forum issued notice to the OPs on 1.10.2013 for 25.10.13, which was less than 30 days period; this is in direct violation of Regulation 10 framed under the Act by National Commission. It has been held to be an illegality even by own State Commission in the above-referred authority. Applying the yardstick of this authority to the fact-situation of the case in hand, we hold that District Forum adjourned the case from 01.10.12013 to 25.10.2013, which was less than 30 days period and hence it is illegal being the violation of the Regulation 10 of the Consumer Protection Regulation 2005. The District Forum also adjourned the case from 25.10.2013 to 6.11.2013 against other OP no.2 and 3 and their registered cover were not received back. We find that for 6.11.2013, no such notice was sent to OP No.2 and 3 by the District Forum. The above cited authority is fully applicable to the case in hand. The order of the District Forum cannot be sustained, in this appeal, being in direct violation of Regulation 10 of the Consumer Protection Regulation 2005. 

7.      As a result of our above discussion, we accept the appeal of the appellant and by setting aside the order of the District Forum concerned, we remit the case to above District Forum for fresh decision in accordance with law. Record be remitted to the above District Forum forthwith, so as to reach there immediately.

8.      The appellants have deposited an amount of Rs.25,000/- with this Commission at the time of filing the appeal. This amount with interest, if any, accrued thereon, be refunded by the registry to the appellants by way of crossed cheque/demand draft after 45 days from receipt of copy of this order.

9.      Both parties are directed to appear before the District Forum Barnala on 10.06.2015. In case, the parties could get the due notice of this date before District Forum, then District Forum shall summon them accordingly.

10.    Arguments in this appeal were heard on 04.05.2015 and the order was reserved. Now the order be communicated to the parties.

11.    The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

                                                                          (J. S. KLAR)

                                                             PRESIDING JUDICIAL MEMBER

                       

                                                              (HARCHARAN SINGH GURAM)

                                                                            MEMBER

 

May 06  2015.                                                                

(ravi)