Haryana

Karnal

CC/298/2021

Ganga Ram Mittal - Complainant(s)

Versus

Reliance General Insurance Company Limited - Opp.Party(s)

Amit Sharma

01 Jul 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 298 of 2021

                                                        Date of instt.29.06.2021

                                                        Date of Decision:01.07.2022

 

Ganga Ram Mittal son of Raj Kumar, aged 46 years resident of house no.238, near Jain School, Dharamvir Colony, Gharaunda, District Karnal (Haryana) 132114.

       

               …….Complainants.

                                              Versus

 

1.     Reliance General Insurance Company Ltd. City Centre, Correspondence Unit, IInd & IIIrd floor, Winway Building, 11/12 Block no.4 Old no.67, South Tukoganj, near Madhumilan Square, Indore, Madhya Pradesh.

2.     Arun Mittal son of Shri Satpal Mittal (Agent of Reliance General Insurance Company) resident of House no.3, Devi Mandir Road, Vijay Nagar, Panipat.

                                                                   …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President

      Dr. Rekha Chaudhary…….Member

                   

Argued by: Complainant in person with Shri Amit Sharma, Adv.

                   Opposite parties exparte (vide order Dt. 22.03.2022)

 

                    (Jaswant Singh President)

 

ORDER:   

                

                  The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant had purchased a medical insurance policy from the OP no.1 through its agent i.e. OP no.2, which is Reliance Health Gain Policy, bearing no.271122028280000049, valid from 05.06.2020 to 04.06.2021. The complainant was having valid medical insurance policy of same company in continuation, vide previous policy no.267819000357401. The said health policy was a family floater plan and covered all 5 family members of the complainant’s family i.e. Ram Mittal (self), Raj Rani (spouse), Piryanka (Daughter), Ritika (daughter), Umesh (son). The sum assured was Rs.3,00,000/-. On 19.08.2020, the wife of complainant became ill (got high grade fever, vomiting, severe abdomen pain) and for the said illness, complainant alongwith his wife visited to Dr. G.C. hospital, Panipat. After checkup, the doctor advised for further diagnoses with immediate effect. The complainant and his wife went to Madhumita Diagnostic center where CT Throat +Layres and Barium Swallow Tests were conducted and further medications were provided by the doctor to complete a course of five days medicines at home. But even after taking the treatment of five days, the wife of complainant did not get any kind of relief. On 24.08.2020, complainant and his wife visited the Cygnus Maharaja Aggarsain Hospital, Karnal for the second opinion and met with Dr. Parvesh Malik. As per advice of Doctor, complainant’s spouse Raj Rani got admitted to the hospital on the same day i.e. 24.08.2020 and remained admitted till 27.08.2020. The complainant has spent Rs.33604/- in the said hospital on the treatment of his wife. Thereafter, the wife of complainant went to the hospital for follow up treatment as advised by the treating doctor and spent Rs.11,232/-. In this way complainant spent total Rs.44836/- on the treatment of his wife. After completion of treatment, complainant lodged claims of all medical expenditure incurred on diagnose and treatment to OP no.1. OP no.2 being an agent of OP no.1 collected all the original documents i.e. Room and Nursing Charges, doctor visit, laboratory tests expenditure, investigation, medicines and pre-post hospitalization expenses that had incurred by the complainant during the course of diagnose/treatment. Thereafter, complainant visited the office of OPs several times and requested to reimburse the amount incurred by him on the treatment of his wife but OP did not pay any heed to the request of the complainant and lingered the matter on one pretext or the other. In this way there is deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OPs did not appear and opted to be proceeded against exparte, vide order dated 22.03.2022 of this Commission.

3.             Complainant has tendered into evidence his affidavit Ex.CW1/A, copy of insurance certificate Ex.C1, copy of Tests/scan done by Madhumita Diagnostic Center Ex.C2, copy of hospitalization bills and treatment record of Cygnus Maharaja Aggarsain Hospital Ex. C3, copy of post hospitalization consultation bills Ex.C4, copy of health claim form Ex.C5 and closed the evidence on 10.05.2022 by suffering separate statement.

4.             We have heard the learned counsel for the complainant and have also gone through the case file carefully.

5.             As per the version of the complainant he had purchased a medical insurance policy from OP no.1 on 05.06.2020, valid till 04.06.2021 for the duration of one year. On 19.08.2020, the complainant’s spouse got ill and she has taken treatment and spent a total amount of Rs.44836/- in various hospitals.

6.             It is evident from the insurance cover note Ex.C1 that complainant has purchased the insurance policy.  It is also evident from the medical report Ex.C2 to Ex.C4. The complainant has incurred the abovesaid amount on the treatment of his wife.

7.             The onus to prove his case was lied upon the complainant, but complainant has miserably failed to prove his case by leading any cogent and convincing evidence. There is nothing on file to prove that complainant has intimated the OP and OP had repudiated the claim of the complainant. The complainant has also failed to produce on record repudiation letter. Thus in view of the above, we are of the considered view that present complaint is premature at this state and hence deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated the order accordingly, and the file be consigned to the record room, after due compliance.

Announced

Dated:01.07.2022.

                                                                       

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

     

                (Dr. Rekha Chaudhary)      

                      Member