BEFORE THE DISTRICT CONSUMER FORUM, NEW DELHI
COMPLAINT NO. OF 2015
IN THE MATTER OF
Shri Kamal Kishore Aggarwal
R/o F-2637A, Palam Vihar,
Gurgaon
Meera Aggarwal
w/o Shri Kamal Kishore Aggarwal
R/o F-2637A, Palam Vihar,
Gurgaon
Complainants
Versus
Oriental Insurance Company Limited
Through its Chairman/ Manager,
C/o A-25/27,
Asaf Ali Road.
New Delhi – 110002 Opposite Party
COMPLAINT UNDER SECTION 12 OF THE CONSUMER PROTECTION ACT
AGAINST THE ORIENTAL INSURANCE COMPANY LTD FOR GRANT OF
COMPENSATION AND CLAIM AMOUNT.
MOST RESPECTFULLY SHOWETH :
1. That the complainant is a consumer as per the definition of a consumer as given in a
consumer protection act being a policy holder of Mediclaim Policy vide policy no.
272900/48/2015/3608 for the period of 24/06/2014 to 23/06/2015 (midnight) issued by
the opposite party in favour of the complainant for sum insured amounting to Rs
4,00,000/-. Photocopy of the insurance is enclosed herewith as Annexure – A.
2. That it is respectfully submitted that the complainant is a regular customer of opposite
party since 24/06/2011 to till date and it is not out of place to mention here that there is
not even a single day break in the said policy and the complainant used to pay the
premium very diligently. This fact can be verified from Annexure -A also.
3. That the complainant’s wife suddenly faced some problem in her eyes. Hence she
visited Vision Eye Centre Hospital and consulted with the doctor on 25/02/2015 and
accordingly doctor diagnosed Branch Vein Occlusion prescribed her to get admitted for
surgery of Re: Intravitreal (Inj Lucentis). After consultation the complainant no.2 got
admitted in the Vision Eye Centre Hospital firstly on 04/03/2015 and thereafter on
21/04/2015 and discharged on 5/3/2015 and 22/04/2015. Copy of discharge summary
and treatment recode is enclosed herewith as Annexure – B & C.
4. That accordingly on 4th March 2015 and 22/04/2015 the invoice regarding the
hospitalization was prepared and accordingly the complainant made the final payment
of Rs. 61,650/- . Copy of the invoice enclosed herewith as Annexure D to G (colly).
5. Thereafter the complainant through his agent contacted the TPA i.e. M/S Medi Assist
TPA Pvt. Ltd of the insurance company and fulfilled all the formalities for getting the
claim against the said policy, which were demanded by the opposite party through their
TPA.
6. Thereafter the TPA of the opposite party without going through the claim properly
rejected the genuine claim of the complainant and sent the repudiation letter through
mail to the complainant vide email dated 5 th March 2015. Copy of email/ repudiation
letter dated 5th March 2015 is enclosed herewith as annexure H.
7. That thereafter the complainant and his wife visited several times and tried to contact
the respondents for his hard earned money, which they duped from him and further
spend their time and money on the same, but nothing was happen. Hence they cheated
the complainant and grabbed her hard earned money.
8. That it is respectfully submitted that the complainant is a very loyal customer of the
opposite parties for many years still he was unnecessarily harassed and no proper reply
was given to his letters/requests. By not attending the claim by the officials of the
insurance company, the owner of the policy holder gets unnecessary trouble and
mentally torturing.
9. That the cause of action against the opposite party arose on various dates from 4 th
March 2015 to 22nd April 2015, when the complainant was admitted in the hospital due
to ill health, then cause of action against the opposite party arose on various dates
when the complainant was unnecessarily harassed for not replying or settling the claim
even after passing of almost one year.
10. That the cause of action has arisen within the territorial jurisdiction of the Hon’ble
District Forum.
11. That there has been no delay in filing the present complaint.
12. That no other similar complaint has either been filed before any other district forum or
the same is pending before any District Forum.
13. That there is no relief, which does not fall within the purview or power of this forum is
being claiming by the complainant through the complaint.
PRAYER
It is therefore most respectfully prayed that in view of the above facts and
circumstances mentioned above this Hon’ble Forum may kindly be pleased to :-
a. Pass an order against the insurance company to pay an amount of Rs. 61,650/- (Rs
Sixty One thousand Six hundred fifty only) being the claim amount to the complainant.
b. Allow interest at the rate of 18% per annum from April 2015 till the date of submission of
the present complaint and pass an order in favour of the complainant and against the
Opposite Parties with a direction to the Opposite Parties to pay the complainant said
interest.
c. Allow damages for causing harassment, business loss due to negligence of the
opposite parties to the extent of Rs. 50,000/- (Rs. Fifty Thousand Only) and Pass an
order in favour of the complainant and against the Opposite Parties for deficiency of
service as well as for adopting unfair trade practice.
d. Allow the Cost of Litigation and pass an order in favour of the complainant and against
the Opposite Parties with a direction to the Opposite Parties to pay the litigation cost.
e. Allow pendalite interest at the rate of 18% per annum from the date of submitting the
present complaint till the date of payment and pass an order in favour of the
complainant and against the Opposite Parties in this regard.
f. Pass such further order/orders as this Hon’ble Forum may deem fit and proper in the
facts and circumstances of the case and in the interest of the justice.
Filed by :
COMPLAINANT
THROUGH
COUNSEL
PLACE : NEW DELHI
DATE : 21-05-2015
VERIFICATION
Verified at Delhi on this the …….. day of May 2015 that the contents of Para No. 1 to 10
of the complaint are true and correct to the best of my knowledge and those of para 11 to 13 of
the complaint are based on legal advice, which I verify believing to be true. Last Para is prayer
clause to this Hon’ble Court.
COMPLAINANT
BEFORE THE DISTRICT CONSUMER FORUM, NEW DELHI
COMPLAINT NO. OF 2014
IN THE MATTER OF
Shri Kamal Kishore Aggarwal
R/o F-2637A, Palam Vihar,
Gurgaon
Meera Aggarwal
w/o Shri Kamal Kishore Aggarwal
R/o F-2637A, Palam Vihar,
Gurgaon
Complainants
Versus
Oriental Insurance Company Limited
Through its Chairman/ Manager,
C/o A-25/27,
Asaf Ali Road.
New Delhi – 110002 Opposite Party
AFFIDAVIT
I, Shri Kamal Kishore Aggarwal s/o Late Shri G.M. Agarwal aged about 61 years
R/o F-2637A, Palam Vihar, Gurgaon, do hereby solemnly affirm and declare as under:
1. That the above named deponent is the complainant and thus she is fully conversant
with the facts and circumstances of the case and she is competent enough to swear this
affidavit.
2. That the accompanying Complaint under Section 11 of consumer Protection Act has
been drafted by my counsel under my instructions and the contents of the same are true
and correct.
DEPONENT
VERIFICATION
Verified at New Delhi on this …… of May, 2015 that the contents of para 1 to 2 of the
above affidavit are true to the best of my knowledge and belief and nothing material has
been concealed therefrom.
DEPONENT
