DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

BATHINDA

C.C. No. 136 of 08-05-2018.

Decided on : 31-01-2022.

Lokesh Kumar Gupta aged about 49 years son of Sh.Kanti Parshad, resident of H. No. 30584, Street No. 5/7, Jogi Nagar Bathinda.

........Complainant

Versus

1. Bajaj Finance, near Hanuman Chowk, Bathinda through its Branch Incharge/ Authorized Representative.

2. Harpreet Singh ( mob. No. 7009844841) C/o Bajaj Finance, near Hanuman Chowk, Bathinda. (deleted vide order dated 9-5-2018)

3. Parwinder Singh Mob. No. 9780701081 C/o Bajaj Finance, near Hanuman Chowk, Bathinda. (deleted vide order dated 9-5-2018)

4. Future General Insurance Solutions Pvt, Ltd, Chandigarh through its Branch Manger.

5. Max Bupa Health Insurance Co. Ltd, Chandigarh through its Branch Manager.

.......Opposite parties.

Complaint under Section 12 of the Consumer Protection Act, 1986

QUORUM

Kanwar Sandeep Singh, President

Sh. Shivdev Singh, Member.

Smt. Paramjeet Kaur, Member

Present

For the complainant : Sh. Pardeep Sharma, Advocate

For the opposite parties : Sh. K K Vinocha, Advocate, for OP No.1

OPs No.2 &3 deleted.

OP No. 4 exparte.

Sh. Ashok Bharti Advocate, for OP No. 5

ORDER

Kanwar Sandeep Singh, President

1. The complainant Lokesh Kumar Gupta (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986 (Now C.P. Act, 2019, here-in after referred to as 'Act') before this Forum (Now Commission) against Bajaj Finance and others (here-in-after referred to as opposite parties).

2. Briefly stated, the case of the complainant is that he received repeated messages from opposite party No.1 that the complainant is eligible to get personal loan of Rs. 2,67,000/- without furnishing any collateral security which is re-payable in 30 equal monthly installments of Rs. 10,198/- each and the concerned officials of the opposite party No.1 allured the complainant to visit their office at Bathinda and to contact with opposite party No.1 to avail the aforesaid personal loan of Rs. 2,67,000/-. The complainant visited the office of opposite party No.1 at Bathinda and he was again assured that the complainant will be given personal loan of Rs.2,67,000/- which is to be re-paid in installments of Rs. 10,198/- each in 30 months. The complainant bonafidely agreed to avail the said personal loan and the officials of opposite party No.1 obtained the signatures of the complainant on various blank printed forms and documents and also obtained three blank signed security cheques drawn on bank of India, Bathinda in the lst week of March, 2017 and assured the complainant that the said amount shall be credited in the account of the complainant with Bank of India.

3. It is alleged that on 27-3-2017, the complainant received a sum of Rs.2,49,299/- from opposite party No.1 in his account with Bank of India Bathinda. The opposite party No.1 deducted a sum of Rs.17,700/- without disclosing any reason. The complainant approached opposite party No.1 to inquire about the amount of Rs. 17,700/- deducted from the loan amount of Rs. 2,67,000/- but the opposite party No.1 failed to disclose any cogent reason. On great persuasion by the complainant, the concerned officials of the opposite party No.1 proclaimed that the said amount has been deducted on account of purchase of a health insurance policy for the period of 30 months under which the complainant will be entitled to get the insurance claim in case of any type of illness/operation/surgery etc., The opposite party No.1 and its officials failed to disclose complete particulars of the said insurance policy. They further proclaimed that in case of any such problem to the complainant, the insurance claim is to be lodged with the opposite party No.1 and the same will be got paid from the concerned insurance company by opposite party No.1 and copy of the policy cannot be supplied as it is group insurance policy. The complainant being a layman, bonafidely believed the opposite parties. Thereafter opposite party No.1 again deducted a sum of Rs. 2,480/- and Rs. 172/- on 11-4-2017 from the account of the complainant without any reason and prior intimation to the complainant. The complainant repeatedly requested the opposite parties to disclose the reason of deducting the aforesaid amount of Rs, 2480/- and Rs, 172/- but to no effect. The complainant has already repaid about 12/13 installments of Rs, 10,198/- each to opposite party No.1 and always remained ready and willing to pay the remaining installments.

4. It is alleged that the complainant suffered from heart problem on14-09-2017 and was got admitted in Adesh Institute of Medical Sciences and Research, Barnala Road, Bathinda. The complainant undergone Angiography and was advised for PTCA and stenting for which he was required to spend approx. Rs,1,80,000/- besides other misc, expenses of medicines. The complainant spent approx. Rs.10,500/- for Angiography on 14-09-2017. The complainant approached the opposite parties and submitted the claim for the reimbursement of the amount spent by him, but the opposite parties have failed to honour the aforesaid claim of Rs,10,500/- already spent by the complainant and also refused to provide any medical insurance for PTCA and stenting and proclaimed that there is no such policy for the same.

5. The complainant further alleged that he made repeated requests to the opposite party to admit his lawful claim, but the opposite parties failed to honour the claim of the complainant for angiography already got done by him and as such, the complainant also stopped the installments of the opposite parties. The opposite parties now making threatening calls to complainant to settle the loan account in full and final otherwise to face the consequences. The complainant is ready and willing to settle the loan account in full and final after settlement of insurance claim by the opposite parties.

6. On this backdrop of facts, the complainant has prayed for directions to the opposite parties to pay insurance claim regarding his illness and also pay him compensation to the tune of Rs.2,00,000/- in addition to Rs, 5500/- as litigation expenses.

7. On the statement of learned counsel for complainant, names of opposite parties No 2 & 3 were deleted from the array of the opposite parties. Upon notice, none appeared on behalf of opposite party No. 4, as such, exparte proceedings were taken against opposite party No. 4.

8. Upon notice the opposite parties No. 1 & 5 put in appearance through their respective counsel and contested the complaint by filing written reply. In written reply, the opposite party No.1 raised preliminary objections that the opposite party No.1 i.e. Bajaj Finance Ltd is non banking Finance Company, registered with RBI and also registered under the Companies Act; that the opposite party denies all the allegations, averments, submissions and statement made in the complaint and that the relationship between the complainant and the opposite party is pursuant to contract entered into between the parties hereto.

9. On merits, the opposite party No.1 admitted that the complainant availed a personal loan vide loan account No. 488PMT36801587 for an amount of Rs, 2,67,000/- dated 26^th March, 2017. The monthly EMI to be paid was Rs. 10,198/-. The opposite party No. 1 submitted that the signing on the blank cheques and other documents were part of the availing the loan. An amount of Rs.2,49,499/- was disbursed to the complainant's account and the differential amount of Rs. 17,700/- was deducted towards the incidental and other processing charges which are mandatory and deducted only after the consent of the complainant and the same is evident in the statement of account as well.

10. The opposite party No. 1 pleaded that as per record available at the end of the opposite party, the complainant has availed two insurance policies i.e. Future General Life Ins. for Rs. 4651/- & Max Bupa Health Ins. for Rs. 2205/-.

11. It is further pleaded that the said amount as alleged i.e. Rs,172/- and Rs. 2480/- has not been deducted by the opposite party No. 1. No such amounts are getting reflected in the statement of account as well. It is also pleaded that the complainant has been a defaulter for the EMI No. 11, 12 and 13 due to the reason of insufficient funds and as a result the bunching charges of Rs, 600/- has been deducted along with EMI amount of Rs. 10,198/-. Hence, the other charges so deducted has been made by the complainant's banker and the issue shall be taken up accordingly. The complainant suffered from some medical/ heart problem and is also entitled to get the claim benefit but the same is rejected as on date as the complainant has never registered the claim either with the opposite party No. 1 nor with the insurance partner i.e. the Max Health Insurance. After controverting all other averments, the opposite party No. 1 prayed for dismissal of complaint.

12. The opposite party No. 5 filed separate written reply raising preliminary objections that the complaint filed by the complainant is not maintainable and the complainant has suppressed material facts from this Commission ; that the policy under question is a Group Health Policy which was issued by the company wherein the primary insured is the complainant and the Group policy holder is Bajaj Finance Limited. The policy was issued on the basis of duly filled Enrollment form for Group Health Insurance received from the complainant. As per the terms of the policy contract if the policy is not suitable, the policy holder may get his/her policy reviewed by returning the policy and policy documents within 15 days from the day, the policy holder received the policy. The insurance company will return the premium paid to the policy holder after making certain deductions specified therein.

13. It is pleaded that the opposite party No.5 has not received any claim pertaining to the said Angiography /hospitalization till date and hence, the complainant is required to prove his averments by producing evidence in record. The complainant had not submitted any requisite documents, hence, it was impossible for opposite party company to assess the case of complainant and to put it under the process of payment without the knowledge for the claim or without receiving any document from the complainant. In the absence of any claim the opposite party No. 5 is not in a position to assess the claim.

14. The further preliminary objections are that the policy is a legal contract between the policy holder and insurance company and the parties to the said contact are bound by its terms and conditions; that the complaint has been filed with ulterior motive and malafide intention to cause harassment and prejudice to opposite party No. 5.

15. On merits, the opposite party No. 5 has pleaded that the complainant had full knowledge of the terms and conditions of the policy and only after going through the same, he opted for the policy. The opposite party No. 5 had sent the certificate of insurance along with the policy terms and conditions to the complainant which implies that the complainant was in actual knowledge of the governing terms and conditions of the insurance policy and the same cannot be now refuted at such later stage. The complainant has alleged in the present complaint that he had informed the company about his angiography but opposite party No.5 has not received any claim pertaining to the said Angiography/hospitalization till date and hence, the complainant is required to prove his averments by producing evidence on record. The complainant had not submitted any requisite documents .

16. It is further pleaded that whenever any claim is submitted a thorough investigation has to be done regarding the same, the identity of the claimant has to be verified, the genuineness of the claim has to be verified, the status of the policy has to be checked and if it is in accordance with the policy terms and conditions , then only the claim can be processed. The opposite party No.5 has strictly acted as per the terms and conditions of the policy contract. The terms of the policy are in the nature of a contract and their interpretation has to be made in accordance with the strict constructions of the contract. After denying all other averments of the complainant, the opposite party No. 5 prayed for the dismissal of the complaint.

17. In support of his complaint, the complainant has tendered into evidence his affidavit dated 19-07-2018 (Ex.C-1), photocopy of payment receipts (Ex.C-2 & C-3), photocopy of scale invoices (Ex.C-4 & C-5),photocopy of bank pass book (Ex.C-6) and closed the evidence.

18. In order to rebut the evidence of complainant, the opposite party No. 1 tendered into evidence affidavit of Shivani Garg dated 14-06-2018 (Ex.OP1/1), photocopy of account statement ( Ex. OP-1/2), photocopy of enrollment form ( Ex. OP-1/3), photocopy of enrollment for group health insurance ( Ex. OP-1/4), photocopy of policy document ( Ex. OP-1/5), photocopy of special power of attorney ( Ex. OP-1/6), photocopy of account statement ( Ex. OP-1/7) and closed evidence.

19. Opposite party No.5 also tendered into evidence photo copy of letter ( Ex. OP5/1), photo copy of certificate ( Ex. OP5/2), photo copy of terms and conditions ( Ex. OP5/3), affidavit of Ms. Chandrika Bhattacharyya dated 25-02-2019 () Ex.OP-5/4), photo copy of letter of authorization( Ex. OP5/5) and closed evidence.

20. We have heard learned counsel for the parties and gone through the record.

21. In the case in hand, the grudge of the complainant is that he availed loan facility i.e. Rs.2,67,000/- from opposite party No. 1 and while disbursing loan amount, opposite party No. 1 deducted a sum of Rs. 2480/- and thereafter Rs. 172/- from loan amount of complainant. When complainant inquired from opposite party No. 1 regarding deduction of said amounts from his loan amount, it was intimated to him that said deductions have been made on account of health insurance of complainant. The complainant alleged that he suffered heart problem on 14-9-2017 and took treatment from Adesh Institute of Medical Sciences & Research and incurred Rs. 10,500/- on his treatment, but the opposite parties failed to honour his claim.

22. The opposite party No. 1 i.e. Bajaj Finance, has admitted in its written version that complainant has availed two insurance policies i.e. Future General Life Ins. : Rs. 4651/- (opposite party No. 4) & Max Bupa Health Ins. : Rs. 2205/- (opposite party No. 5) and was insured under these Health Insurance Policies. The opposite party No. 1 has pleaded that complainant who had undergone medical emergency was supposed to claim the entire reimbursement with Insurance Companies (Opposite parties No. 4 & 5), but the complainant has never registered the claim either with opposite party No. 1 or with Insurance Companies (opposite parties No. 4 & 5).

23. The opposite party No. 5 i.e. Max Bupa Health Insurance, in its version has also admitted that policy under question is a Group Health Insurance policy wherein primary insured is complainant and Group policy Holder is Bajaj Finance Limited. The opposite party No. 5 has also pleaded that it has not received any claim pertaining to the said Angiography/hospitalization. The opposite party No. 5 has further pleaded that complainant had not submitted any requisite documents (medical and other), hence it was impossible for the opposite party to assess the case of complainant and to put it under the process of payment without the knowledge of the claim or without receiving any document from the complainant. Whenever any claim is submitted a thorough investigation has to be done regarding the same, the identity of the claimant has to be verified, the genuineness of the claim has to be verified, the status of the policy has to be checked and if it is in accordance with the policy terms and conditions, then only the claim can be processed.

24. A perusal of file reveals that the complainant has not placed any document on file to prove that he has submitted his claim either with the opposite party No. 1 or with opposite parties No. 4 & 5. Although at this stage, complaint is pre-mature, but the lapse/deficiency on the part of the opposite parties can not be denied as opposite parties have not provided copy of insurance policy to complainant to make him aware about the procedure and terms and conditions for filing the claim in case of any health issue.

25. Resultantly, this complaint is partly allowed with Rs. 10,000/- and cost and compensation against opposite parties No. 1, 4 & 5. The complainant is directed to submit his claim in question with the opposite parties No.1, 4 & 5 and opposite parties No. 4 & 5 are directed to settle claim of complainant within 45 days from the date of submission of claim.

26. The compliance regarding cost and compensation be made be by the opposite parties 1, 4 & 5 jointly and severally within 45 days from the date of receipt of copy of this order.

27. The complaint could not be decided within the statutory period due to heavy pendency of cases.

28. Copy of order be sent to the parties concerned free of cost and file be consigned to the record.

    Announced :

    31-1-2022

    (Kanwar Sandeep Singh)

    President

     

     

    (Shivdev Singh)

    Member

     

    (Paramjeet Kaur)

    Member