The Chandigarh Consumer Forum has directed an insurance firm to reimburse the medical claim and pay Rs 25,000 to a Swiggy employee.
Hardev Singh of Chandigarh stated that he joined as delivery boy with BUNDL Technologies Private Limited cum Swiggy on December 14, 2017 and was provided an insurance cover by the firm from the date of his joining, valid till August 13, 2019. The policy covered his entire family.
Singh further stated that he was admitted in PGI, Chandigarh on August 24, 2018 for a plastic surgery due to a burn injury and was discharged on September 6, 2018 and then was again admitted in PGI, Chandigarh on September 14, 2018 for another plastic surgery due to another burn injury and was discharged on September 22, 2018, for which he paid the bills of Rs 31,105 from his own pocket. He thus filed a claim to the company, but to no avail. He then filed a formal complaint at the forum on January 21, 2019.
Swiggy did not appear in the court despite due service therefore it was proceeded exparte, whereas IFFCO-TOKIO, the insurance company in reply submitted that the claimed documents were not submitted, therefore, the claim was not allowed and the District Forum at Chandigarh has no jurisdiction.
The forum after hearing the arguments held that though insurance firm has taken the stand in its written reply that certain documents viz. original discharge summary, claim intimation details and original investigation reports were not supplied by the complainant, but, no documentary proof in the shape of some communication has been placed on record.
“If the claim submitted by the complainant was not accompanied by the requisite documents, OP-2 (being insurer) was required to seek the same through some writing. Otherwise also, copies of most of the documents in support of his claim were annexed by the complainant along with the present consumer complaint. In the light of those documents and to prove its bonafide, OP-2 could have easily processed and reimbursed the claim of the complainant during the pendency of the instant consumer complaint, but, it failed to do so.”
The forum thus ordered the insurance firm to process and reimburse the admissible claim of Hardev Singh along with interest at 9 per cent from November 21, 2018 till realisation, and also to pay Rs 15,000 as compensation and Rs 10,000 as cost of litigation.