DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

PATIALA.

                                      Consumer Complaint No. 110 of 18.3.2019

                                      Decided on:      16.7.2021

G.S.Samrat (Gurdarshan Singh Samrat) aged 65 years s/o Sh.Babu Singh Samrat,R/o # 2157/2, St.Barbar, Near Krishna Lab, Sirhindi Bazar, Patiala.

Correspondence address: House No.12, Power Colony No.2, Badungar Patiala.

                                                                   …………...Complainant

                                      Versus

1. Heritage Health Insurance TPA Pvt. Ltd.(IDDA Licence No.008/CIN-085195WB1998PTC088562, Branch Office-411, Laxmideep Building, District Centre, Laxmi Nagar, New Delhi-110092 (Telephone No.011-43009540/41) through its Manager/Nodal Officer.
2. Heritage Health Insurance TPA Pvt. Ltd., Regd Office-McLEOD House, 3, N.S.Road, Kolkata-700001, India, through its Branch Manager/Incharge/MD
3. Heritage Health Insurance TPA Pvt. Ltd.Corporate Office-NICCO House, 5^th Floor, 2 Hare Street, Kolkata-700001, India through its CMD/Chairman.

                                                                   …………Opposite Parties

                                      Complaint under Section 12 of the

                                      Consumer Protection Act, 1986.

QUORUM

                                      Sh. Jasjit Singh Bhinder, President

                                      Sh.Vinod Kumar Gulati, Member                       

ARGUED BY                        

                                      G.S.Samrat, complainant in person.

                                      Sh.Narinder Singh, counsel for OPs.                   

 ORDER

                                      JASJIT SINGH BHINDER,PRESIDENT

1. This is the complaint filed by G.S.Samrat (hereinafter referred to as the complainant) against Heritage Health Insurance TPA Pvt. Ltd.(hereinafter referred to as the OP/s) under the Consumer Protection Act.
2. Briefly the case of the complainant is that he got himself insured with the OPs through his banker i.e. Allahabad Bank by depositing Rs.27,790/- for the year 2017-18.It is averred that on 10.4.2018 at about 9PM he was coming to his house on his scooter after his physical checkup from Dr.Sudhir Verma and he reached near 21 number railway phatak, Patiala suddenly a Bullet motor cycle bearing No.PB-11-Z-9654 came with rash and negligent driving struck with the scooter of the complainant from backside as a result of which the complainant fell down on the road and received spinal cord injury and other injuries on his body. He got his treatment from Klair Orthopedic Centre, Patiala and Rs.6358 were incurred on the treatment and is still under the follow up.The complainant informed the police. He also informed the OPs through email with the request to pay the medical claim .He also submitted all the required documents as per demand of the OPs through registered post but the OPs did not pay the medical claim. He also sent several emails in this regard but of no avail. There is thus deficiency in service on the part of the OPs which caused mental agony and harassment to the complainant. Hence this complaint with the prayer to accept the same by giving directions to the OPs to pay the medical claim of Rs.6358/- alongwith interest @18% per annum from the date of accident till its realization; to pay Rs.1,00,000/- as compensation for causing physical  and mental harassment.
3. Upon notice OPs appeared through counsel and contested the complaint by filing written reply.The OPs denied all the averments of the complainant and prayed for the dismissal of the complaint.
4. In support of the complaint, the complainant has tendered in evidence his Ex.CA alongwith documents Exs.C1 to C10 and closed the evidence.
5. On the other hand, the ld. counsel for the OPs has tendered in evidence Ex.OPA affidavit of Sh.Rajnesh Authorized representative of the OPs alongwith documents Exs.OP1 to OP2 and closed the evidence.
6. We have heard the complainant, the ld. counsel for the OPs and have also gone through the record of the case, carefully.
7. The complainant present in person has argued that he is holder of health insurance policy of OPs and had obtained the same through his banker i.e. Allahabad Bank by depositing Rs.27,790/-for the year 2017-2018.The complainant has argued that on 10.4.2018 at about 9AM he was coming to his house  on his scooter from Sadhbhavna Hospital,Patiala after his physical checkup and when he reached ear 21 number railway phatak, Patiala, a motorcycle came in high speed struck with his scooter as a result of which he received injuries. He got his treatment from Klair Orthopadic centre, Patiala and spent Rs.6358/- on his treatment. He sent various e-mailS and also bills to the OPs but the amount of the  bills have not been paid.
8. On the other hand, the OPs filed the written statement which is in hand and is not legible and is hard to read but everything is denied.
9. On the other hand, the ld. counsel for the OPs has argued that no amount has to be paid and the complaint be dismissed.
10. To prove his case, the complainant has tendered in evidence Ex.CA and has deposed as per his complaint,Ex.C1 the document of Heritage Health TPA Pvt. Ltd. in the name of complainant,Ex.C2 is the insurance premium for medical insurance scheme for retired officers/employees and the amount of Rs.27,790/- was deposited. Ex.C3 is the registration certificate of the scooter, Ex.C4 is Driving licence,Ex.C5 is receipt of Klair Orthopedic centre, Patiala in which there was compression of Dr.Klair, all the injuries have been shown it is accompanied by five medical bills,Ex.C6 is an application sent to SHO,Division No.4, Lahori Gate, Patiala,Ex.C7 is claim form, filed by Gurdarshan Singh Samrat, whereby he demanded Rs.6358/-,Ex.C8 is receipt of legal notice,Ex.C9 is e-mail sent to the OPs,Ex.C10 is bank statement.
11. On the other hand Mr.Rajnesh son of S.Madan Lal has tendered his affidavit, Ex.OPA and he has denied the whole story,Ex.OP1 is  medical insurance policy and Ex.OP2 is authorization letter.
12. Complainant Gurdarshan Singh Samrat, who has filed his complaint in person has pleaded that he received injuries when he was coming on his scooter on 10.4.2018 at about 9PM near 21 number railway phatak, Patiala and took treatment from Klair Orthopedic hospital, Patiala.He also produced the prescription slip of Klair Orthopedic Centre, Patiala wherein compression of bones has been shown and treatment is mentioned. It is also mentioned that patient was not under influence of alcohol etc. The prescription slip is accompanied by the medical bills.Ex.C7 is the claim form for health insurance policy whereby claim of Rs.6358/- was made. The written statement filed by the OPs is vague and is hand written. It is not legible and all the contents of the complaint have been denied and nothing on merits has been mentioned in detail. The affidavit, Ex.OPA has been filed by the OPs. The affidavit without pleadings cannot be looked into. So the contents of affidavit cannot be read as part of the evidence of the OPs. So it is clear that the complainant was insured with the OPs. He met with an accident and received injuries on the treatment of which he spent Rs.6358/-, the claim was filed which was denied by the OPs illegally.
13. So due to our discussion the complaint is partly allowed and the OPs are directed to pay the claim amount of Rs.6358/-to the complainant alongwith interest @6% per annum from the date of filing of claim i.e. 18.7.2018.The OPs are further directed to pay Rs.2500/- as compensation and another amount of Rs.2500/-as costs of complaint.      

Compliance of the order be made by theOPs within a period of 45 days from the date of the receipt of the certified copy of this order.

ANNOUNCED

DATED:16.7.2021

                                           Vinod Kumar Gulati        Jasjit Singh Bhinder

                                                    Member                                President