DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SAHIBZADA AJIT SINGH NAGAR (MOHALI)
Consumer Complaint No.115 of 2016
Date of institution: 01.03.2016 Date of decision : 31.01.2017
Balbir Kaur through her attorney Jarnail Singh resident of House No.276, Phase-2, Mohali.
……..Complainant
Versus
Bajaj Allianz General Insurance Company Ltd., 2nd Floor, Bajaj Finserve Building Behind Weikfield, I.T. Park, Off Nagar Road, Viman Nagar, Pune 411014.
………. Opposite Party
Complaint under Section 12 of
the Consumer Protection Act.
Quorum
Shri Ajit Pal Singh Rajput, President
Mrs. R.K. Aulakh, Member
Present: Shri Jarnail Singh authorised representative of the complainant.
Shri Simrandeep Singh, counsel for the OP.
ORDER
By Ajit Pal Singh Rajput, President
Complainant Balbir Kaur has filed this complaint through her husband Jarnail Singh, against the Opposite Party (hereinafter referred to as the OP). The brief facts of the complaint are as under:
The daughter of the complainant purchased Ex India Travel Health Insurance Policy from the OP for her mother i.e. the complainant on 30.10.2014. The OP had assured the complainant and her daughter that it is a cashless policy. The complainant visited Australia from 04.11.2014 to 19.05.2015. During her stay in Australia, the complainant consulted a doctor for treatment. But the policy issued by the OP was not honoured there and the complainant had to pay AUD 234.10 to the doctor for consultation from her own pocket. After coming back to India, the husband of the complainant supplied the required documents to the OP on 25.07.2015 alongwith his cancelled crossed cheque for reimbursement of the amount. However, the OP vide e-mail dated 28.01.2016 informed the complainant that the case was closed due to non submission of documents. Despite sending numerous e-mails the OP has not reimbursed the amount to the complainant. Hence the complaint for giving directions to the OP to refund her amount of Rs.12,875/- (AUD 234.10) alongwith interest @ 18% per annum from the date of payment; to pay her Rs.1,00,000/- for mental agony and harassment and Rs.5,000/- as litigation expenses.
2. The OP has pleaded in preliminary objections of the written statement that claim of the complainant has not been repudiated till date but had been closed for non supplying of requisite documents and for not replying to the queries of the OP. On merits, the OP has pleaded that the policy was issued to the complainant subject to its terms and conditions. The sum assured under the policy is in USD (USA Dollars). The complaint has been filed for AUD 234 (Australian Dollor) and if the same is converted into USD which comes to 191.564 US Dollars as on January 21, 2015. The complainant has not supplied the original invoice of payment of 234 AUD inspite of issuance of letters dated 09.07.2015 and 28.01.2016. Thus, denying any deficiency in service on its part, the OP has sought dismissal of the complaint.
3. Evidence of the complainant consists of her affidavit Ex.CW-1/1; copies of insurance policy Ex.C-1; letter Ex.C-2; prescription slips Ex.C-3 and C-4; payment receipts Ex.C-5 to C-9; cancelled cheque Ex.C-10; letter Ex.C-11; e-mails Ex.C-12 to C-32 and receipts Ex.C-33 and C-34. In rebuttal the OP has tendered in evidence affidavit of Sarpreet Kaur Ahluwalia, its Assistant Manager Ex.OP-1/1; affidavit of Yogesh Ramesh Kankariya Ex.OP-1/2; insurance policy Ex.OP-1; terms and conditions Ex.OP-2; claim form Ex.OP-3; reminder dated 09.08.2015 Ex.OP-4 and letter dated 28.01.2016 Ex.OP-5.
4. Authorised representative of the complainant has argued that at the time of issuance of the policy, it was conveyed that it is a cashless policy. However, when the complainant consulted a doctor abroad at that time it was revealed that it was not a cashless policy. The complainant had to pay the amount from her own pocket and she had to face harassment and mental agony due to not honouring the claim of the complainant. The authorised representative further submitted that inspite of submission of the requisite papers; the OP had not honoured the claim.
5. On the other hand, the learned counsel for the OP has argued that the complainant herself is responsible in delay in settling her claim as she has not supplied the original invoice of Ex.C-6 i.e. the prescription slip. Thereafter, the claim of the complainant can be processed under the terms and conditions of the policy.
6. After hearing the authorised representative of the complainant, ld. Counsel for the OP and going through the pleadings, evidence, written submissions as well as oral submissions, we find force in the submissions made by authorised representative of the complainant. After coming from abroad, the complainant vide her letter registered letter dated 25.07.2015 Ex.C-2 had submitted the required documents to the OPs alongwith doctor’s original prescription (3) pages and original receipt of payment (4) pages. The complainant has also proved on record the photocopy of the prescription which is Ex.C-6 and payment receipt Ex.C-7. The OP has not produced any evidence that it had not received letter Ex.C-2 from the complainant. Since the complainant has proved submission of original prescription slip of the doctor and receipt of payment of consultation charges to the OP vide Ex.C-2 and has also produced on record photocopies of these documents, we hold that the OP was duty bound to honour the claim of the complainant under terms and conditions of the policy.
7. Accordingly, in view of our aforesaid discussion, we direct the OP to settle the claim of the complainant as per terms and conditions of the policy. We further direct the OP to pay to the complainant a lump sum compensation of Rs.10,000/- (Rs. Ten thousand only) for mental agony, harassment and costs of litigation. Hence the present complaint is hereby allowed.
The OP is further directed to comply with the order of this Forum within 45 days from the date of receipt of this order, failing which the OP shall be liable to pay 9% interest per annum on the cost awarded from the date of order till actual payment.
The arguments on the complaint were heard on 23.01.2017 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.
Pronounced
Dated: 31.01.2017
(A.P.S.Rajput)
President
(Mrs. R.K. Aulakh)
Member
