Delhi

East Delhi

CC/484/2013

ANUP KR. SHARDA - Complainant(s)

Versus

BAJAJ ALLIANZ INS. - Opp.Party(s)

13 Dec 2017

ORDER

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

 

C.C. NO.484/13

Shri ANUP KUMAR SHARDA

R/O B-1/26-A, GALI NO.9,

PALAM DABRI ROAD DASRATH PURI

1.  

  

 

Vs

 

 

M/S BAJAJ ALLIANZ INSURANCE CO. LTD.,

601, KARKARDOOMA

NEW DELHI

                                                                                                   ….Opponent

 

 

Date of Institution: 07.06.2013

Judgment Reserved for: 13.12.2017

Judgment Passed on: 20.02.2018

CORUM:

Sh. SUKHDEV SINGH                  (PRESIDENT)

Dr. P.N. TIWARI                          (MEMBER

Ms. HARPREET KAUR CHARYA (MEMBER)

 

Order By: Ms. Harpreet Kaur Charya (Member)

JUDGEMENT

The present complaint has been filed by Shri Anup Kumar Sharda, alleging deficiency in services on the part of M/S Bajaj Allianz Insurance Company Ltd., (OP), with the directions to OP to pay Rs.16,866/- along with interest @ 24/%, Rs.1,00,000/- as compensation on account of mental pain and agony and Rs.15,000/-as cost of litigation.

The facts of the present complaint are that the complainant opted for “Travel Elite Silver Insurance Plan” as he was travelling to Toronto. The policy no. OG-13-11-02-9910-00003142 was issued for the period from 21.06.2012 to 12.09.2012 or date of return of the insurer (whichever was earlier), annexed as Annexure-A. On 01.07.2012, the complainant had some problem for which he was admitted at Marrkham Stouffville Hospital and was discharged on 02.07.2012. It has been stated that the complainant was surprised to know that the policy was not cashless, thus, he had to make payment to the hospital. It has been further stated that OP was intimated vide claim reference no. OC-13-1100-9910-0000-0119 which was settled after several requests, finally the claim of USD 3979/- was passed instead of claim submitted by the complainant being CAD 4254.92, thus, the complainant has alleged that the OP has deducted USD 307.22/- in arbitrary manner and there has been a delay of twelve months in settlement of the claim, which amounts to deficiency in service. It is also been stated that the terms and conditions were never issued to the complainant, hence the complainant has prayed for directions to OP to pay Rs.16,866/- along with 24% interestthereon, Rs.1,00,000/- on account of mental agony, pain and suffering, loss of business and Rs.15,000/- as cost of litigation expenses.

The complainant has annexed the policy documents, copy of the passport, treatment details of Marrkham Stouffville Hospital, payment receipt, claim form dated 11.10.2012, E.mail dated 07.12.2012, claim closure dated 18.01.2012, letter dated 07.02.2013 written by the complainant to OP requesting for settlement of the claim, treatment papers of the complainant and claim approval note with the complaint.

OP filed their reply upon service of the summon where they took several pleas in their defence such as the claim of the complaint was settled as per terms and conditions of the policy of the insurance no. OG-13-1102-9910-0000-3142, the same was sent along with terms and conditions. The claim submitted by the complainant was for CAD 4254.92 which was settled for USD 3979.8 on receipt, relevant documents from the complainant as per terms and conditions of the policy. It was further submitted that the sum of USD 100 was deducted towards policy deductable as conditions no. 2.1.5 & 23.18 & condition no.3 of claim procedure and CAD 202.22 was deducted on account of non submission to original bills along with payment receipts and as per condition no. 5 & 6 original bills were requested to be submitted and as claim of the complainant has been settled under terms and conditions, no deficiency in services can be attributed to them.

The policy documents alongwith terms and conditions have been annexed asAnnexure-A by the OP.

The complainant in his Rejoinder to the written statement reiterated the averments made in the complaint and denied those of the written statement.

Evidence by way of affidavit was filed by the complainant and he got examined himself and stated on oath the contents of the complaint.

OP examined Shri Sudeep Kumar who has also reiterated the contents of their reply and has got exhibited the policy with terms and conditions as Ex.R I, claim approval note as Ex. RII, letters dated 15.11.2012, 03.12.12, 18.01.2012 Ex.R III to Ex. R V. Reading of Para 7 of the affidavit filed by OP reveals that the facts of some other complaint have been written in their evidence, which cannot be read as part of the present complaint.

We have heard the arguments of Ld. Counsel for the complainant and have perused the material placed on record. The grievance of the complainant is that his claim has been settled for a lesser amount then he actually paid for. If we look at the claim approval note that is Ex. R II, it reveals that USD 100 has been deducted under policy deductible head which is in conformity with the policy terms and conditions. Now as far as non-payment of CAD 202.22 was concerned it has been stated to be deducted on account non-payment of original bills. The said deduction, is arbitrary as nowhere in clause 5, it has been mentioned as to what percent of claim amount shall be deducted on non-filing of original bills. OP has in an arbitrary manner deducted CAD 202.22, therefore, we direct OP to pay Rs.11,376.38 (CAD 202.22 x 54.9). We further award Rs.10,000/- as compensation for mental agony inclusive of litigation expenses.

Copy of this order be sent to both the parties as per law.

File be consigned to R/R

 

 

 

 (Dr. P.N. TIWARI)                                             (HARPREET KAUR CHARYA)              

       MEMBER                                                                            MEMBER              

 

 

                                                           (SUKHDEV SINGH)

                                              PRESIDENT