Delhi

East Delhi

CC/159/2017

TRIPTI GUPTA - Complainant(s)

Versus

BANK OF BARODA - Opp.Party(s)

23 Apr 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

C.C. NO. 159/17

 

Mrs. Tripti Gogia

W/o Late Shri. Ashwani Kumar Gogia

R/o House No. 3, Chawla Park

Chander Nagar, Delhi- 110051

                                                               ….Complainant

Vs.    

1. Bank of Baroda

Through its Chief Manager

Branch Jheel Kuranja

435/1, Jheel Khuranja,

Delhi-110051

 

2. National Insurance Company Ltd.

Through its Manager

Direct Agent Branch XXVIII

Eleventh Floor

Scope Minar, North Tower, Core-2,

Laxmi Nagar District Centre,

New Delhi- 110091                                                          …Opponents

 

Date of Institution: 24.04.2017

Judgement Reserved on: 23.04.2019

Judgement Passed on: 29.04.2019

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By: Harpreet Kaur Charya (Member)

 

JUDGEMENT

          The present complaint has been filed by Ms. Tripti Gogia, the complainant against Bank of Baroda, OP-1 and National Insurance Co. Ltd., OP-2, with prayer for directions to OPs to reimburse the medical and hospitalization bill of Rs. 1,65,648/- alongwith interest @24% per annum till realization, to continue the policy by accepting the renewal premium of Rs. 4,845/- for the year 2016-2017, Rs. 2,00,000/- as compensation on account of mental torture and harassment and         Rs. 55,000/- as litigation expenses.

          The complainant is a widow lady having a saving account bearing no. 21380100013912 with OP-1 since 22.07.2011. It has been stated that OP-1 has been appointed as an agent of OP-2 for the purpose of selling mediclaim policies and for collection of premium. Baroda Health Policy, effective from 20.12.2011 was issued, after the complainant was explained the benefits of the same, which was specially designed for the account holder of OP-1, it covered the hospitalization expenses of the account holder, spouse and two dependent children. The said policy being a Floater Policy was to provide cashless access of services in network hospitals/ nursing homes. The said policy was renewed from time to time and lastly it was renewed with policy bearing no. 36170150150000383 valid from 20.12.2015 to midnight of 19.12.2016, with sum insured of                   Rs. 3,00,000/-. A premium of 4,828/- was debited from the account of the complainant on 26.11.2015 and a premium certificate alongwith receipt dated 15.11.2015 bearing no. 361701811510000720 was issued by OP-2. The complainant has stated she was hospitalized in Shri Ram Hospital and Heart Institute, Krishna Nagar due to heart attack and remained admitted from 29.09.2016 to 05.10.2016 for which bill of Rs. 72,799/- was raised by the hospital. It has been further stated that cashless was denied and further the claim of the complainant was repudiated despite of the fact that the hospital was duly covered under the policy. Again, the complainant was admitted in the same hospital for a period from 05.11.2016 to 12.11.2016 due to sudden Anaphylactic Shock/ Antral Gastritis/ ACS for which bill of          Rs. 59,240/- was raised, which was again repudiated.  It has also been stated that the complainant incurred expenses worth Rs. 10,619/- on account of medicines and Rs. 22,990/- for several tests and OPD visits post hospitalization. The complainant was constrained to borrow money for the payment of her treatment and hospitalization bills totaling to Rs. 1,65,648/-. OP-1 was apprised vide letter dated 03.10.2016 where the complainant was requested to approach OP-2 for reimbursement. OP-1 vide its letter dated 19.10.2016 requested OP-2 that the policy was renewed by payment of premium of             Rs. 4,824/- through bankers cheque bearing no. 564307 dated 26.11.2015. Another letter dated 28.10.2016 was sent by the complainant, which was replied by the Chief-Manager of OP-1 vide reply dated 07.11.2016 wherein it was stated that they had issued a banker cheque in favour of OP-2 and consequently OP-2 had issued the policy no. 36170150150000383 for a period from 20.12.2015 to 19.12.2016.

          Legal notice dated 24.02.2017 was sent to OPs, which was replied by OPs vide reply dated 14.03.2017 by OP-2 and 21.03.2017 by OP-1 respectively. Complainant has annexed the copy of Baroda Health Policy valid from 20.12.2015 to 19.12.2016, copy of pass book of savings bank account, premium certificate issued by OP-2, copy of collection receipt dated 15.12.2015 issued by OP-2, copy of letters dated 03.10.2016, 19.10.2016, 28.10.2016 exchanged between the complainant and OP-2. Legal notice dated 24.02.2017 alongwith postal receipts and its reply by OP-1 and OP-2 dated 14.03.2017 and 21.03.2017 respectively.

          Written Statement was filed on behalf of OP-1, where they have taken several pleas in their defence such as; the complainant had not approached Forum with clean hands; OP-1 had never issued mediclaim policy to the complainant rather its role was limited only with respect to forwarding of premium amount to OP-2, which was duly forwarded by them. It was submitted that OP-1 had never received any communication regarding the dishonour of bankers cheque from OP-2 and the same was not even communicated to the complainant. It was denied that OP-1 was authorized to sell mediclaim policies or collection of premium. It was submitted that the said health policy had been launched exclusively for account holders and the role of OP-1 was limited only to the extent of forwarding the premium amount to OP-2. It was further submitted that upon receipt of the letter dated 03.10.2016 OP-1 asked OP-2 to look into the matter. It was also submitted that there was no difficieny in services as OP-1 had issued the bankers cheque no. 564307 dated 26.11.2015 for Rs. 4,824/- towards the renewal of the complainant’s policy which was duly accepted by OP-2 and consequently the policy was renewed.

          Letter dated 13.10.2016, 19.10.2016, 17.11.2016 to OP-2, reply to the Legal notice issued by complainant have been annexed with their reply.

          National Insurance Company Ltd., OP-2 also filed their reply, where they have submitted that insurance is a contract and payment of premium on time was necessary for a valid insurance contract and since the complainant had paid a cheque of Rs. 4,824/- as premium of policy and the same was dishonoured thus, the policy stood cancelled. The same was intimated to the complainant as well as OP-1. It was admitted that the complainant had given a cheque no. 564307 dated 26.11.2017 for Rs. 4,824/ drawn on Bank of Baroda, Jheel Khuranja, Delhi in favour of National Insurance Company Ltd. towards the renewal premium, however, the said cheque was returned unpaid by the bank with remarks “Contact Drawer/ Drawee Bank and present again on 18.12.2017”. It was submitted that since the bankers cheque was dishonoured the policy stood cancelled since inception alongwith the cover note for Rs. 4,824/-and the complainant was advised to return the certificate of insurance and policy alongwith Rs. 100 towards bank charges, but the complainant did not do so. It was also submitted that it was the negligence and deficiency on the part of OP-1 and if any liability arose it was that of OP-1 because of the negligence of the   OP-1, the cheque had got dishonoured. Rest of the contents have also been denied.

          Rejoinder to the Written Statements of OP-1 and OP-2 respectively was filed. The complainant has re-affirmed the contents of the complaint and has denied those of the Written Statement.

          Evidence by way of affidavit was filed by the complainant, where she has deposed on oath the contents of the complaint and has relied on copy of the policy bearing no. 36170150150000383 as Ex.CW1/1 alongwith health card issued by OP-2 as Ex.CW1/2, copy of the bank pass book Ex.CW1/3 (Colly. 8 pages), collection receipt bearing no. 361701811510000720 dated 15.12.2012 and premium certificate for the purpose of deduction under Section 80 D of Income Tax Act, 1986 as Ex.CW1/4 and Ex.CW1/5. Discharge card dated 05.10.2016 in IPD final bill (Colly. 6 pages )  have been exhibited as Ex.CW1/6 to Ex.CW1/7, discharge card dated 12.11.2016 and IPD final bill (Colly. 4 pages) Ex.CW1/8 to Ex.CW1/9, medicine and bills paid for several tests and OPD visits as Ex.CW1/10 (Colly. 10 pages) and summary of hospitalization and medical expenses totaling to Rs. 1,65,648/- as Ex.CW1/11 (Colly. 2 pages), copy of letter dated 03.10.2016, 19.10.2016, 07.11.2016 have been exhibited as Ex.CW1/12 to Ex.CW1/15. Legal notice dated 24.02.2017 alongwith postal receipts are Ex.CW1/16  to Ex.CW1/17 (Colly. 2 receipts).

          OP-1 has got examined Shri Mayank Kumar (Employee code          no. 65569, Chief-Manager, who has reiterated the submissions made by them in their Written Statement, he has got exhibited copy of the letter dated 13.10.2016 as Ex.OPW1/1, copy of letter dated 19.10.2016 and 07.11.2016 as Ex.OPW1/2 and Ex.OPW1/3 respectively. Reply to Legal notice dated 24.02.2017 has been exhibited as Ex.OPW1/4.

Shri Raghunath Pawar, AO Legal was examined on behalf of OP-2, who has also deposed on oath the contents of their Written Statement.

We have heard the arguments on behalf of Ld. Counsel for Complainant and Ld. Counsel for OP-1 and Ld. Counsel for OP-2.The complainant is aggrieved by non-settlement of her claim by OP-2 on the pretext that the policy bearing no. 36170150150000383 for a period from 20.12.2015 to 19.12.2016 was cancelled as the bankers cheque issued for the payment of premium got dishonoured. If we look Ex.CW1/3 (Colly. 8 pages) the account of the complainant, maintained with OP-1, has been debited by Rs. 4,824/-. OP-1 has also supported the case of the complainant stating that the premium had been duly forwarded to OP-2 by way of bankers cheque bearing no. 564307 of date 26.11.2015. This fact has been admitted by OP-2 i.e. National Insurance Co. Ltd. However, the defence of OP-2 is regarding the dishonour of the bankers cheque, therefore, due to  non-payment of premium the policy issued to the complainant stood cancelled. If we look at the Written Statement filed on behalf of OP-2, they has stated that the cheque was returned unpaid by the bank with remark “Contact drawer/ drawee bank and present again on 18.12.2017”. Relying on this OP-2 has placed nothing on record to prove that OP-1 or complainant was informed regarding the dishonour of the cheque. Although, the complainant has placed Endorsement Letter, where it has been mentioned that the policy was deemed to be cancelled due to dishonour of cheque w.e.f. 20.12.2015 as well as letter dated 20.12.2015, but these two documents have been printed on 26.11.2016.

The fact that OP-1 had issued the bankers cheque has been admitted by OP-2, so it was the duty of OP-2 to inform the complainant or OP-1 in case of dishonour of the bankers cheque which they have failed to. Thus, OP-2 is held deficient in delivering services.

Therefore, in the facts and circumstances of the present complaint, we direct OP-2 to accept the premium of Rs. 4,845/- from the complainant and reimburse the claim filed by the complainant as per policy terms and conditions, deeming the policy to be enforced for the period 20.12.2015 to 19.12.2016. Since, OP-2 failed to settle the genuine claim of complainant we award compensation of Rs. 20,000/- on account of mental harassment and agony, inclusive of litigation expenses.

This order be complied within 30 days from the date of receipt of the order else 20,000/- shall carry interest @9% per annum from the date of order till realization.

Copy of the order be supplied to the parties as per rules.

          File be consigned to Record Room.

 

      

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

          Member                                                                               Member    

                                       (SUKHDEV SINGH)

                                            President