State Consumer Disputes Redressal Commission
Smt. Sunita Jain vs United India Insurance on 17 December, 2009
BEFORE
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CIRCUIT BENCH,
RAJASTHAN, JAIPUR
Appeal No. 1481/2004
Smt.
Sunita Jain D/o Shri Manak Chand Jain, C/o Verdhman Medical &
Provision Store, SDMH Campus, Jaipur.
..Appellant-Complainant
VS
United
India Insurance Co. Ltd, Divisional Office: 1, Digambar Dharamshala
Ke Uppar, M.I. Road, Jaipur through Regional Manager.
..Respondent-Opposite Party
Before:
Mr.
G.S. Hora, Presiding Member
Mr. Sikandar Punjabi, Member Present:
Mr. Kamal Chamariya, counsel on behalf of Mr. Jitendra Mitruka for the Appellant.
Mr. Amar Nath Pareek, counsel for the Respondent ORDER Dated: 17.12.2009 PER Mr. G.S. HORA, PRESIDING MEMBER This appeal is against the order dated 7.7.2004 passed by the learned District Forum, Shivir, Jaipur whereby the complaint of the Complainant was dismissed. On the basis of Mediclaim policy , the Complainant had claimed a sum of Rs. 52,020.78 spent by her on her treatment taken in Santokba Durlabhji Memorial Hospital (SDMH), Jaipur. The learned District Forum dismissed the complaint on the ground that no document in support of her claim has been filed by the Complainant. Even the bills relating to the treatment have not been produced.
The learned counsel for the Appellant submitted that the Complainant had submitted all the bills before the Insurance Co. but the Company repudiated the claim of the Complainant on filmsy grounds. The learned counsel submitted that details of the policy, cover note and discharge ticket were also submitted to prove that the Complainant remained under treatment for a period from 21.8.1998 to 24.8.1998 and incurred expenditure but in absence of any reply from 2 the Respondent, the learned District Forum declined to accept the version of the Complainant. The learned counsel further submitted that the required documents could have been got produced from the Respondent.
We have given thoughtful consideration to the arguments advanced by the learned counsel for the Appellant.
When the claim is preferred by the policy holder essentially the relevant documents are submitted before the Insurance Co. The Insurance Co. should have been asked to produce all those vouchers and documents which were submitted by the Complainant instead of dismissing the complaint on the ground of non-production of relevant documents.
In view of above observations, we set aside the impugned order of the learned District Forum and remit back the case to the learned District Forum to decide the matter afresh keeping in view the observations made above.
Parties are directed to appear before the learned District Forum, II, Jaipur on 01.02.2010. .
Member Presiding Member Hira Lal