Chandigarh

StateCommission

CC/345/2018

Harinder Kaur Gill - Complainant(s)

Versus

Bajaj Allianz General Insurance Company Ltd. - Opp.Party(s)

Sukhbir Singh, Adv.

29 May 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

                UNION TERRITORY, CHANDIGARH

 

Consumer Complaint No.	345 of 2018
Date of Institution	10.09.2018
Date of Decision	29.05.2019

 

Harinder Kaur Gill, aged 70 years, wife of Sh.Harninder Singh Gill, resident of House No.102, Sector 8-A, Chandigarh.

 

….…Complainant

 

V E R S U S

 

1]     Bajaj Allianz General Insurance Company Ltd. Regd. Office GE Plaza, Airport Road, Yerwada, Pune-411006 through its General Manager.

2]     Bajaj Allianz General Insurance Company Ltd., Branch Office : SCO No.215-217, Sector 34-A, Chandigarh.

.….. Opposite Parties

 

BEFORE: JUSTICE JASBIR SINGH (RETD.), PRESIDENT

                SMT.PADMA PANDEY, MEMBER                      

                SH.RAJESH K. ARYA, MEMBER

                                       

Argued by:   

 

Sh. Sukhbir Singh, Advocate for the complainant.

Sh. Rajesh Verma, Advocate for the Opposite Parties.

 

PER PADMA PANDEY, MEMBER

            In brief, the facts of the case are that the complainant went to USA in 2016 and before leaving, she took insurance policy bearing No.OG-17-1201-9910-00001076 dated 20.05.2016 by paying the premium of Rs.13,144/-. It was stated that on 14.07.2016, when the complainant was travelling in the car, driven by her brother, accident took place, due to which, she suffered injuries and was hospitalized. The hospital authorities raised a bill of US$1,24,000/- but she was not in a position to pay the hospital charges and even Opposite Parties were not to pay any amount to her immediately, therefore, on advice of her brother, US$100000 were got paid by the insurance company, with which the car of brother of the complainant was insured.   After coming back to India, the complainant claimed her claim from the Opposite Parties but they did not process the claim in a right and proper way within a reasonable time. It was further stated that at one point of time, the Opposite Parties put a condition on the complainant that she should personally go to USA for bringing the medical papers in respect of admission, treatment expenses and other documents etc. Therefore, the complainant went to USA for the said purpose, due to this, she spent a lot of money on air ticket charges, bus & taxi charges. The complainant also spent on medicines, therapy at home etc., due to which, she suffered a lot, as such, all the expenses incurred are payable by the Opposite Parties. According to the complainant, it was the duty of the Opposite Parties to settle the claim but they dilly dallying the matter on one pretext or the other. Due to the aforesaid act and conduct of the Opposite Parties, they were deficient, in rendering service, as also, indulged into unfair trade practice.  When the grievance of the complainant was not redressed, left with no alternative, a complaint under Section 17 of the Consumer Protection Act, 1986 (in short “Act” only), was filed.

2.           Opposite Parties in their joint written statement, have stated that the insured has misled the replying Opposite Parties in order to claim compensation, as she miserably failed to supply copy of the claim processed by the insurance company of the car of brother of the complainant, which met with an accident. It was admitted regarding issuance of the policy to the complainant and also receipt of premium. It was denied that the complainant met with an accident, suffered injuries, hospitalization and also raised a bill of USD 124000 as hospital charges.  It was also denied regarding the payment made by the insurance company of the car of brother of the complainant upto USD 100000. It was further stated that no details of the registration certificate of the car of brother of the complainant, insurance details of the car, which met with an accident and also discharge voucher so that the details of payment made by the insurance company can be verified by the replying Opposite Parties. It was further stated that the complainant  already availed the accidental benefits, medical expenses etc. from the insurance company of the car of brother of the complainant and there is no liability on the part of the Opposite Parties. It was denied that the complainant went to USA on the asking of the Opposite Parties for that purpose. It was further stated that in such an advanced technology prevailing now a days, the documents could be provided electronically without loss of time. It was further stated that since the amount of medical expenses have already been paid by the insurance company of the car of brother of the complainant, as such, the claim, as prayed for, in the complaint by the complainant under the policy is not permissible and the Opposite Parties are not liable to indemnify the same. It was further stated that the expenditures, as mentioned in the complaint, have been made without any evidence on record. It was further stated that the complainant has not suffered due to any act on the part of the Opposite Parties, as the complainant has failed to produce any document to substantiate her claim, as such, she is not entitled for any compensation towards harassment and litigation expenses. It was further stated that during the pendency of the complaint, the Opposite Parties paid to hospital USD 17464.87 (Annexure R-1). It was further stated that neither there was any deficiency, in rendering service, on the part of the replying Opposite Parties, nor they indulged into unfair trade practice.

3.           The Parties led evidence, in support of their case.

4.           We have heard Counsel for the parties and have gone through the evidence and record of the case, carefully. 

5.           Now the moot point for consideration before us is as to whether there was any deficiency in service on the part of the Opposite Parties, for which, the complainant is entitled to any compensation. Exhibit C-1 is a copy of policy document. From this document, it is proved that the complainant took policy bearing No.OG-17-1201-9910-00001076 dated 20.05.2016 for the period from 26.05.2016 to 22.09.2016, by paying premium of Rs.13,144/-. According to the complainant, she met with an accident on 14.07.2016, when she was sitting on the back seat of the car and another car driven by a lady, hit the car of brother of the complainant, due to which, she suffered injuries including three fractures on her one leg tibera. Because of seriousness of injuries suffered by the complainant, she was moved to Evergreen Hospital, in which, she remained for about 10 days and hospital authorities raised a bill of US$1,24,000. As per the complainant, she was unable to pay the said charges, therefore, US$100000 were got paid by the Insurance Company, from which the car of brother of the complainant was insured. It is relevant to note that back seat occupier, on which, the complainant was travelling in the car of her brother was insured to the extent of US$100000. After coming back to India, the complainant claimed policy amount from the Opposite Parties for medical, evacuation, repatriation for illness, accidental hospitalization expenses etc., their liability being 50000US$. The complainant even approached representative of the Opposite Parties for the claim amount but they did not pay any heed. According to the complainant, she also went to USA for procuring the documents, as sought by the Opposite Parties, for which, she has placed on record document (Exhibit C-6). The complainant also spent on therapy at home and paid Rs.600/- per visit to the therapist. Even she remained bed ridden for about 10 days or so and unable to normal walk. To prove this fact, the complainant also placed on record some documents. Moreover, the Opposite Parties vide email dated 11.04.2018 sent to the complainant by simply saying that they are coordinating with their overseas assistance department. For further clarification regarding the amount due, zimini order dated 11.12.2018 passed by this Commission reads thus :-

 

“Today in Court, a letter dated 21.06.2018 has been shown to us stating that the claim of the complainant to the extent of USD 17464.87 is admissible and will be processed for making the payment in facility (Accidental Hospitalisation $25,000) directly.

                   Counsel for the complainant states that no amount is payable to the hospital. Qua charging, USD 100000 was paid by the Insurance Company and rest of the amount was paid by his relatives.  If that is so, let an affidavit be filed to this extent by the complainant. In the meantime, directions are issued to the opposite parties to get clear cut instructions from the hospital where the complainant was admitted, whether any amount is due or not. The said intimation be produced before the Court on the next date of hearing, failing which, this Commission will order release of the above mentioned amount in favour of the complainant.

                   Adjourned to 10.01.2019.”

 

In terms of the order dated 11.12.2018 passed by this Commission, the complainant placed on record affidavit of Ms. Harjinder Kaur Gill, complainant alongwith Letter of Confirmation of outstanding amount dated 21.06.2018 as Annexure A/1, to show that amount of USD 17464.87 is still payable to the hospital till June, 2018, in which, the complainant underwent medical procedure. Not only this, on 21.02.2019, Counsel for the Opposite Parties filed an affidavit of Sh. Jai Singh, Senior Executive of Bajaj Allianz General Insurance Co. Ltd., SCO No.156-159, Sector 9-C, Chandigarh alongwith copy of certificate dated 29.01.2019, stating that still an amount of USD 17464.87 is found due for payment to the Hospital. On the next date of hearing i.e. 20.03.2019, Sh. Rajesh Verma, Advocate, Counsel for the Opposite Parties states that an amount of 1,00,000 US Dollars was paid to the Hospital by another Insurance Company and the Opposite Parties are ready to make the payment of balance amount to the Hospital whatever it may be, towards medical expenses as per terms and conditions of the Policy. Sh. Rajesh Verma, Advocate was directed to put on record proof of making the payment. On the next date of hearing i.e. 10.04.2019, Counsel for the Opposite Parties has placed on record the document Annexure R-1 alongwith reply showing that an amount of USD 17464.87 has been paid to the concerned hospital.  Not only this, at the time of arguments, it was stated by Counsel for the Opposite Parties that the entire liability stood paid to the concerned hospital and no amount is due now. No doubt, it is true that the entire liability stood paid to the hospital but very late because the complainant took the policy from the Opposite Parties on 20.05.2016 and accident took place in USA on 14.07.2016 but a perusal of Annexure R-1, clearly revealed that the payment of 17464.87 USD was made by the Opposite Parties on 27.03.2019 i.e. after more than 2 ½ years from the date of accident, which amounted to deficiency in service and indulgence into unfair trade practice on the part of the Opposite Parties, for which, the complainant is entitled for some compensation.

6.           For the reasons recorded above, the complaint is partly accepted, with costs. The Opposite Parties are jointly and severally directed, as under:-

1. To pay compensation, in the sum of Rs.1,00,000/- for causing mental agony and harassment, to the complainant, within 45 days, from the date of receipt of a certified copy of this order.
2. To pay cost of litigation, to the tune of Rs.25,000/- to the complainant.
3. In case, the payment of amounts, mentioned in Clauses (i) and (ii), is not made, within the stipulated period, then the Opposite Parties shall be liable to pay the aforesaid amounts with simple interest @12% p.a., from the date of filing the complaint, till realization, besides payment of litigation costs.

7.             Certified Copies of this order be sent to the parties, free of charge.

8.           The file be consigned to Record Room, after completion.

Pronounced.                                                                                    

29.05.2019                                                            

[JUSTICE JASBIR SINGH [RETD.]

                                                                                 PRESIDENT

 

                                                                                               

[PADMA PANDEY]

MEMBER

 

 

[RAJESH K. ARYA]

MEMBER

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