Delhi

New Delhi

CC/958/2009

Mohmad Mumtaz Khan - Complainant(s)

Versus

M/S. Oriental Insurance Company Pvt.Ltd. - Opp.Party(s)

04 Nov 2019

ORDER

 

 

                                          CONSUMER DISPUTES REDRESSAL FORUM-VI(DISTT. NEW DELHI),

‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN,

I.P.ESTATE, NEW DELHI-110002.

 

C.C.No.958/2009

 Mohd. Mumtaz Khan,

S/o Sh. S.N. Khan.,

R/o E-62, Abdul Fazal Enclave,

Jamia Nagar, Delhi-110025.

                               ….Complainant

Vs.

The Oriental Insurance Co. Ltd.,

A-159, Vikas Marg,

New Delhi.

  Opposite Party

ARUN KUMAR ARYA, PRESIDENT

O R D E R

 The complainant has filed the present complaint against the OP under section 12 of Consumer Protection Act, 1986. The facts as alleged in the complaint are that the complainant had taken an individual policy from the OP vide policy No.271701/4B/2007/227 for the period of 24.6.2006 to 25.4.2010 and the premium was paid against the above policy by the complainant. OP has not issued any terms and conditions of the aforesaid policy and only issued a computerized policy to the complainant. 

2.     On 31.6.2008, the complainant met with an accident and the FIR was lodged. After the accident, the complainant became cataleptic and he was immediately admitted to Vimhans hospital.  The complainant was discharged from the hospital on 2.9.2008 and then he rushed to “Bone and Joint Clinic” and was advised for surgery by the doctors. He was operated on 21.9.2008 by the Adams hospital. The complainant spent an amount of Rs.31,776.80/- for his treatment.   Through the complainant submitted all the original documents and bills with the OP for imbursement of claim. The claim was repudiated by the OP vide its letter dt. 16.2.2009 on the ground that “NO CLAIM DUE TO LATE INTIMATION”,  whereas, the intimation was given on the same day by the father of the complainant.  The denial of the claim by the OP is highly illegal, uncalled and unwanted, the complainant, therefore, approached this Forum for redressal of his grievance.

3.       During the course of the arguments, the counsel for OP alongwith Sh. Kushal Kumar, A.M. appeared,  OP was directed to  take instructions to settle the issue, after deliberation,  on 13.7.2019, the officer of the OP along with counsel deposited the cheque dt. 3.5.2019 for a sum of Rs.20,000/- in favour of  complainant.  However, the complainant refused to accept the same.  

4.     We have heard argument advance at the Bar by the complainant as well as the counsel for OP and have perused the record.

5.     It is argued on behalf of complainant that he has made the payment to the tune of Rs.31,776.80/- to the hospital, hence, he is entitled for the same along with interest and litigation cost.  It is further argued on behalf of complainant that he had intimated to the OP Co. about the accident well within time and the repudiation was unjustified and on frivolous ground and prayed that the relief claim be granted. 

 

6.     It is argued on behalf of OP that the complainant has failed to inform the OP Co. within 7 days of accident, hence, his claim was closed as NO CLAIM vide letter dt. 16.2.2009. However, on the direction of hon’ble Forum, the complainant submitted his documents to the OP and accordingly, claim was processed and the cheque dt. 3.5.2019 for a sum of Rs.20,000/- was prepared  in favour of  complainant as per the policy terms and conditions.

 

7.     We have gone through the complaint as well as annexures attached by it, the complainant has failed to place on record any documents which shows that he approached the OP within the stipulated period.  On the other hand, despite delay in intimation, the OP Co. settled the claim of the complainant to the tune of Rs.20,000/-, as per policy in which it is that hospitalized section is covered  to the tune 20% of the sum insured i.e Rs.20,000/-. Since, the complainant has failed to intimate the OP Co. about the accident well within time, hence, in our view, the claim was rightly settled in his favour and he is not entitled for the interest as claimed by him. However, keeping in view, the fact that the present complaint was filed in the year 2009, we think it appropriate to grant the litigation cost to the complainant.

 

In view of the above, we direct OP Insurance Co. as under:

 

1. Pay to the complainant a sum of Rs.20,000/- against the claim in question by issuing afresh cheque.  Office is directed to release a cheque dt. 3.5.2019 to the OP Insurance Co. as and when demanded by it.

 

ii)      pay to the complainant a sum of Rs.5,000/- on account of litigation charges and harassment.

 

 

A copy each of this order each be sent to both parties free of cost by post. Orders be also sent to www.confonet.nic.in. File be consigned to record room.

Pronounced in open Forum on 04/11/2019.

 

 

(ARUN KUMAR ARYA)

PRESIDENT

                                   (NIPUR CHANDNA)                                  (H M VYAS)

                                  MEMBER                                                          MEMBER