Haryana

Karnal

CC/428/2020

Rajan Pahwa - Complainant(s)

Versus

ANI Technology Private Limited - Opp.Party(s)

Parshant Pahwa

07 May 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 428 of 2020

                                                        Date of instt.14.10.2020

                                                        Date of Decision:07.05.2024

 

Rajan Pahwa aged about 27 years son of Krishan Kumar, resident of F-97, Subhash Gate, Karnal, Haryana-132001 (India). Aadhar no.7087 0656 171.

                                                                        …….Complainant.

                                              Versus

 

1. ANI Technology Pvt.Ltd. (OLA) Regent Incigina 414, 3^rd floor, IVth block, 17^th main 100 feet road Kora Mangala, Bangaluru through its Managing Director.

 

2. Acko General Insurance Company Ltd. unit no.301 and 302, 3^rd floor, F-wind, Lots Corporate Park, Goregaon (East) Mumbai through its Managing Director.

                                                                …..Opposite Parties.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.      

      Sh. Vineet Kaushik…….Member

      Dr.  Suman Singh…..Member

 

 Argued by: Sh. Parshant Pahwa, counsel for the complainant.

                    Shri Vikas Rana, counsel for the OP no.1.

                    Shri Naveen Khetarpal, counsel for the OP no.2.

 

                     (Vineet Kaushik, Member)

ORDER:  

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant is aged about 27 years and has been serving as Network Engineer in Team  Lease Associates Pvt. Ltd. and has been getting monthly salary of Rs.30000/-. On 29.01.2019, the complainant started his journey from Karnal to Hyderabad by air. On 03.02.2019 at 12.16 p.m. the complainant from his pick up address Reitz India Gate, Q City Nanakramguda booked an OLA Auto for going to Sikenderabad through OP no.1. OP no.1 send Auto bearing BR no.TS-13UB-2971 and an amount of Rs.264.02 was charged from the complainant while travelling in said auto, the same met with an accident in the area of Police Station Gachibowli, District Cyberabad and FIR no.115 dated 25.02.2019 was registered in this regard. In the said accident, complainant sustained serious and multiple injuries on his vital parts of body including multiple fractures on his left femur, and left knee. After accident, he was shifted to Continent Hospital, Hyderabad where he remained admitted for five days i.e. from 03.02.2019 to 08.02.2019. After discharge he came to Karnal but he had not recovered fully hence he started getting treatment from Amritdhara Hospital Karnal, Haryana and remained admitted there and his left leg was operated upon on 14.07.2019 and was discharged on 19.07.2019. Complainant has spent Rs.6,00,000/- on his treatment and treatment is still going on. Complainant has become permanently disabled upto the extent of 26% as per Disability Certificate issued by the Chairman Medical Board, (Civil Surgeon), Karnal. The complainant sustained said injuries while traveling in the Auto provided by OP no.1, which is insured with OP no.2 and as such OPs  are liable to indemnify complainant, hence complainant lodged a claim with OPs but OPs sanctioned the claim only for an amount of Rs.1,02,500/- with the observation that complainant has no partial disability hence as per policy the compensation of Rs.1,00,000/- only can be given to the complainant. Due to the fractures on the left leg of the  complainant, the complainant has become permanently disabled upto the extent of 26% and is not able to do work properly and walk like a normally. As per the policy of the OP no.1, if any person suffers partial disability, then he is entitled for compensation of Rs.5,00,000/-. Complainant has sent several mails to OPs for the payment of remaining amount and compensation of partial disability amounting to Rs.5,00,000/- but OPs did not pay any heed to the request of complainant and lingered the matter on one pretext or the other. Due to this act and conduct of OPs, complainant has suffered harassment mental pain and  agony. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OP no.1 appeared and filed its written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that as per the contents of FIR no.115 dated 25.02.2019, registered by the complainant’s colleague, Shri Chandan Jha, who was also injured in the same accident while travelling with the complainant, the incident occurred when the Driver Partner of the OP, in order to avoid an accident with rashly driven oncoming vehicle, turned his vehicle and hit the road divider.  It is further pleaded that OP no.1 is merely an electronic platform whose services are limited to facilitation of aggregation of vehicles and does not in any manner provide transportation services. The terms and conditions also clearly state that the OP does not guarantee or provide assurance in respect of the behavior or actions of its drivers/rider partner. It is further pleaded that the occurrence of the alleged accident and the determination of liability of the driver partner is a matter of detailed enquiry and trial before the appropriate Commission, i.e. MACT. Further, as stated above, OP is completely indemnified against any negligence of the driver in the performance of the service. It is further pleaded that OP does not have any such policy regarding providing of compensation amounting to Rs.5,00,000/- for partial disability. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.          

3.             OP no.2 filed its separate written version raising preliminary objections with regard to maintainability; cause of action; jurisdiction and concealment of true and material facts. On merits, it is pleaded that complainant was travelling in an Ola auto from –Reitz India Gate, Q City Nanakramguda, registration no.TS13UB2971 (Bajaj RE auto), on 03.02.2019 12.16 p.m. being driven by Mr. Shaikh when to save an accident with an oncoming car, which was being driven in a rash and negligent manner, the auto driver swerved the vehicle to the right, as a result of which, the auto hit the road divider, causing the auto to topple. He suffered injuries mentioned below in the aforesaid incident, as stated in the discharge summary:-

1.  Left Femur Shaft Comminuted Fracture.
2. Left PCL Minimally Displaced Avulsion Fracture.

Complainant underwent treatment for his injuries at M/s Continental Hospital, Gachibowli, Hyderbad from 03.02.2019 till 08.02.2019 post which the customer was discharged from the hospital in a stable condition. Complainant registered four claims with the OP, seeking reimbursement for the treatment costs incurred by him, stated as below with their respective statuses-

1. OLA20190203M7503MX0R3JHK7GNNJP/C1 registered on 27.02.2019-Claim paid.
2. OLA20190203M7503MX0R3JHK7GNNJP/C2 registered on 10.02.2019-claim withdrawn by customer.
3. OLA20190203M7503MX0R3JHK7GNNJP/C3 registered on 27.02.2019-Claim withdrawn by customer.
4. OLA20190203M7503MX0R3JHK7GNNJP/C4 registered on 27.02.2019-Claim withdrawn by customer.

            For claim no. OLA20190203M7503MX0R3JHK7GNNJP/C1, below is the sequence of events until the settlement of the claim-

27.02.2019 22.30-Customer called and informed about the policy TnCs, sum insured applicable, coverage, TATs and the pending documentation.

28.02.2019 15:01-letter of requirement sent to the customer.

01.03.2019 12.32-Claim file forwarded to the Medical Expert for verifying the medical admissibility.

01.03.2019 14.37-Medical Expert Opinion received.

01.03.2019 14.48-Claim file forwarded for approval by the claim handler

01.03.2019 16:14-Claim file approved for Rs.1,02,500/- (Rs.1,00,000/-=Accidental Medical Expense Reimbursement + Rs.2500/- = Hospital Daily Allowance) in favour of the claimant, Rajan Pahwa-Claim payment received by customer.

                From the above mentioned sequence, it is clearly evident that the claim upon receipt of complete set of documents on 28.2.2019 was expeditiously settled on 06.03.2019. The claim was settled to the maximum sum insured available to the customer, under the coverage of “Accidental Medical Expense Reimbursement’, of Rs.1,00,000/-+Hospital Daily Allowance. OP settled his claim for Rs.1,02,500/- with reason that the complainant is not partially disabled hence as per policy compensation of Rs.1,00,000/- can be given to the complainant. It is further pleaded that the office of OP did not receive any other claim from the customer till date, claiming for any sort of Disability suffered in this incident, neither did OP receive any such document signifying the nature or per centage of disability. OP has also never received any query from the customer with regard to the Permanent Total/Partial Disability compensation available in the insurance policy. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of payment receipt Ex.C1, copy of medical report Ex.C2, copy of FIR Ex.C3, copy of discharge summary Ex.C4, copy of admission form Ex.C5, copy of final bill Ex.C6, copy of bank statement Ex.C7, copy of Ola customer insurance Ex.C8, copy of medical bill payment receipt Ex.C9 to Ex.C33,  copy of disability certificate Ex.C34 and closed the evidence on 05.08.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OP no.1 has tendered into evidence affidavit of Sukirti Singh Ex.RW1/A, power of attorney dated 16.09.2022 Ex.OP1, Board Resolution dated 30,.09.2022 Ex.OP2, copy of user terms and conditions Ex.OP3, copy of auto subscription agreement Ex.OP4 and closed the evidence on 03.01.2023 by suffering separate statement.

7.             Learned counsel for the OP no.2 has tendered into evidence affidavit of Nilesh Ramchandani, Senior Manager Ex.RW1/A, copy of inpatient final bill Ex.R1, copy of discharge summary Ex.R2, copy of prescription slip Ex.R3, copy of letter dated 12.02.2019 Ex.R4, copy of Medico Legal Certificate Ex.R5, copy of Inches Healthcare Pvt. Ltd. opinion Ex.R6, copy of FIR Ex.R7, copy of Group Travel Policy Ex.R8, copy of terms and conditions of the policy Ex.R9 and closed the evidence on 14.06.2023 by suffering separate statement.

 8.            We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that on 03.02.2019, the complainant met with an accident in the area of Police Station Gachibowli, District Cyberabad and an FIR no.115 dated 25.02.2019 was registered in this regard. In the said accident, complainant has sustained serious and multiple injuries. After accident, he was shifted to Continent Hospital, Hyderabad. After discharge from the hospital, complainant came to Karnal but his illness could not be cured hence he started getting treatment from Amritdhara Hospital Karnal, and remained admitted there and his left leg was operated upon on 14.07.2019 and was discharged on 19.07.2019. Complainant spent Rs.6,00,000/- on his treatment. Complainant has become permanently disabled upto the extent of 26% as per Disability Certificate issued by the Chairman Medical Board, (Civil Surgeon), Karnal. The complainant lodged a claim with OPs but OPs sanctioned the claim only for an amount of Rs.1,02,500/- with the observation that complainant has no partial disability. As per the policy of the OP no.1, complainant is entitled for compensation of Rs.5,00,000/- but OPs did not pay the same and lastly prayed for allowing the complaint.

10.           Per contra, learned counsel for the OP no.1, while reiterating the contents of written version, has vehemently argued that OP no.1 is merely an electronic platform whose services are limited to facilitation of aggregation of vehicles and does not in any manner provide transportation services. The terms and conditions also clearly state that the OP does not guarantee or provide assurance in respect of the behavior or actions of its drivers/rider partner and lastly prayed for dismissal of the complaint qua OP no.1.

11.           Learned counsel for the OP no.2, while reiterating the contents of written version, has vehemently argued that on 03.02.2019, complainant was travelling in an Ola auto from –Reitz India Gate, Q City Nanakramguda, being driven by Mr. Shaikh. The said OlA met with an accident and complainant has suffered injuries in the said accident. The claim was settled to the maximum sum insured under the coverage of “Accidental Medical Expense Reimbursement’, of Rs.1,00,000/- and said amount was paid to the complainant and lastly prayed for dismissal of the complaint.

12.           Admittedly, on 03.02.2016, complainant started his journey from Karnal to Hyderabad by air and on the same day he also booked an OLA auto from –Reitz India Gate, Q City Nanakramguda through OP no.1. It is also admitted that the said Auto met with an accident. It is also admitted that an amount of Rs.1,00,000/- has already been paid by the OP no.2 to the complainant.

13.           The claim of the complainant was denied by the OP on the ground that OP no.2 neither received any claim documents with regard to partial disability nor the complainant is partial disable. In para no.2 of the preliminary objections OP no.2 itself has mentioned that complainant registered four claims with the OP but three claims have been withdrawn by the complainant. Meaning, thereby, complainant has lodged the claim with the OP. Moreover, it is also unbelievable an insured whose personal interest is involved for such huge amount why he will not lodge the claim to the insurance company for getting his claim amount and will indulge himself in unwanted litigations.

14.           Complainant has alleged that as per the insurance policy of OP, he is also entitled for claim for partial disability to the tune of Rs.5,00,000/- The onus to prove his version was relied upon the complainant. To prove his version, complainant has relied upon the Group Domestic Travel Policy-OLA Customer Insurance Ex.R8. The table of benefits of the said policy is reproduced as under:-

Accidental Medical Expenses                       Rs.1,00,000/-

Hospital Daily Allowance (Max 7 days)         Rs.    500/day

OPD treatment                                          Rs. 3,000/-

Ambulance and Emergency Evacuation        Rs.10,000/-

Accidental Death                                        Rs.5,00,000/-

Permanent Total Disability                          Rs.5,00,000/-

Permanent Partial Disability                   Rs.5,00,000/-

Repatriation of Mortal Remains                   Rs. 10,000/-

Missed Flight (domestic)                             Rs. 5,000/-

This policy covers insured person and Passengers riding under the same booking in the OLA trip.

Coverage Period: Insurance covers start when customer ‘s OLA trip starts and cover ends when the OLA trip ends, upto the maximum period of one day for city taxi.

15.           Further, to prove his Permanent Disability, complainant has relied upon the disability certificate Ex.C34. On perusal of said disability certificate, the complainant has been declared 26% permanent disable. As per Group Domestic Travel Policy-OLA Customer Insurance Ex.R8, the sum assured for Permanent Partial Disability is Rs.5,00,000/- but OP denied the same. Hence, the act of the OP no.2, while denying the claim of the complainant amounts to deficiency in service and unfair trade practice, which is otherwise proved genuine one. 

16.           As per Group Domestic Travel Policy-OLA Customer Insurance Ex.R8, complainant is entitled for Rs.5,00,000/- alongwith interest, compensation for harassment, mental pain and agony and towards the litigation expenses.

17.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OP no.2 to pay Rs.5,00,000/- (Rs. five lakhs only) to the complainant alongwith interest @ 9% per annum from the date of filing the complaint till its realization. We further direct the OP no.2 to pay Rs.25,000/- to the complainant on account of mental agony and harassment and Rs.11,000/- towards the litigation expenses. The complaint qua OP no.1 stands dismissed. This order shall be complied with within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:08.05.2024                                                                     

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)                (Dr. Suman Singh)

Member                                 Member