Haryana

Karnal

86/2009

Garg Dental Clinic - Complainant(s)

Versus

HDFC Bank ., United India Insurance Company Limited - Opp.Party(s)

Rakeshwer Jain

31 Aug 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                          Complaint No.86 of 2009

                                                               Date of instt. 4.02.2009

                                                               Date of decision: 28.09.2015

 

Dr.Sanjeev Garg, Garg Dental Clinic, SCO 31, Sector 14, Urban Estate, Karnal.

                                                   ……….Complainant.

                             Versus

 

1.HDFC Bank through its Manager/Authorized Representative, Kunjpura Road, Branch, Karnal District Karnal.

 

2.United India Insurance Company Ltd. Through its Divisional Manager, GT Road, Karnal.

                                                           ……… Opposite parties.

 

                    Complaint U/s  12  of the Consumer

                     Protection Act.

 

Before          Sh.K.C.Sharma……. President.

                   Sh.Anil Sharma ………Member.

                   Smt.Shashi Sharma…..Member.   

         

 

 Present:       Sh.Sudhakar Mittal Advocate for the complainant.

                   Sh.D.P.Kharb Advocate for OP no.1.

                   Sh.Y.P.Arora Advocate for OP No.2.

.

 

ORDER:

 

                        This complaint has been filed u/s 12 of the Consumer Protection Act

(herein after referred to as the Act) by the complainant on the averments that he was holder of HDFC International Gold Card bearing No. 5176-5210—154-6128 issued by the Opposite Party ( in short OP) No.1, who had tie up with OP No.2 regarding medi claim insurance policy of the card holders.   Under the said policy, any person holding International Gold card issued by the OP no.1 would be automatically entitled to medi claim.  On 10.6.2007, he met with an accident while driving car  and received multiple grievous injuries on various parts of his body. He remained hospitalized   at Fortis Hospital Mohali  from 10.6.2007 to 18.6.2007 and incurred medical expenses to the tune of Rs.1,47,682/-. It has further been pleaded that complainant had obtained another Medi-claim policy with another company and lodged his medi-claim before that

 

 

company, which reimbursed to him an amount of Rs.1,15,000/- .The balance amount of Rs.32682/- was paid by him. Apart from that he also paid Rs.2200/- as Ambulance charges. Thereafter, he lodged his claim with Ops under International Gold Card for the balance amount of Rs.34882/-, but his claim  was repudiated on flimsy ground that Card issued to him was never activated by him. The card issued was very much activated with his own code number in the SIM  and used the same on different occasions.  Even otherwise,  the activation  or non activation on his part did not make any difference as minimum amount remained in his account and  such condition was never intimated to him. The  OP repudiated the claim in order to escape from contractual liability, which amounted to deficiency in service and unfair trade practice.

 

2.                OP No.1 appeared and filed written statement disputing claim of the complainant. Objections have been raised that complaint is not maintainable as there was no deficiency in service on the part of OP no.1; that this Forum has no jurisdiction to entertain the present complaint; that complainant does not fall within the purview of the  Consumer against OP no.1 as it never undertook to provide any insurance services to him; that complainant has suppressed the material facts and that the complaint is frivolous and abuse of the process of law.

 

                   On merits, it has been submitted that complementary medical insurance policy was provided to the complainant through OP no.2. OP no.1 was not liable to provide cover of any risk as per the terms of the insurance policy. The medical insurance policy was subject to activation of Gold Card which means “first usage at the retail merchant establishments or first cash withdrawal from the ATM or an approved balance transfer from the other credit cards or payment of the first minimum amount due ( as reflects in the first statement)”.  OP no.2 enquired  status of the gold card from OP no.1. Accordingly, the OP no.1 checked the status of the card, which was not activated and intimation was sent to OP no.2, who repudiated the claim of the complainant.  The complainant had not used debit card  upto 3.5.2008 and thus the card was not activated at the time of alleged accident, which took place on 10.6.2007.  All other allegations made in the complaint have not been admitted.

 

3.                OP No.2 filed separate written statement controverting the claim of the complainant. Objections have been raised that complaint is not maintainable as the complainant is neither consumer nor the OP no.2 is service provider within the meaning of the Act; that  the complainant has no loucs standi  to file the present complaint; that this Forum has no jurisdiction to entertain  and try the present  complaint and that the complainant is estopped from filing the present complaint by his own acts and conduct.

 

                   On merits, it has been submitted that the complainant neither gave any intimation nor lodged any claim with the OP no.2, therefore, question of deficiency in services on the part of OP no.2 did not arise at all.  The OP no.2 had not issued medi-claim policy to the complainant as alleged in the complaint Moreover,   complainant was reimbursed for an amount of Rs.1,50,000/- by his insurance company and he is not entitled to recover the balance amount of Rs.32685/- from OP no.2. The other allegations made in the complaint have been denied.

 

4.                In evidence of the complainant, his affidavit Ex.CW1/A and documents Ex.C1 to Ex.C10 have been tendered.

 

5.                On the other hand, in evidence of the Ops, affidavit of Sh. Sunil Bajaj, Legal Manager of OP no.1 Ex.O1 and documents Ex.O2 to Ex.O6 have been tendered.

 

6.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

 

7.                There is no dispute between the parties regarding the fact that complainant was issued International Gold Card by OP No.1, who had tie up with OP No.2 regarding medical insurance policy of the card holders and under  that policy  the person having International Gold Card would be automatically entitled  for medical insurance.  As per version put forth by OP no.1, the medical insurance policy was provided to the complainant complementary through OP no.2 as per terms and conditions mentioned in the card  Member agreement book let.  On enquiry of the status of the gold card by Op no.2,  the status was checked and it was found that card was not activated and intimation was accordingly given to Op no.2, who repudiated the claim of the complainant.

 

8.                The copy of card member agreement Ex.O6 shows that insurance cover was to be made available only upon activation of HDFC bank credit card.  Therefore,  the material question which arises for consideration is whether  International Gold card issued to the complainant by OP no.1 was activated before the date of his accident.

 

9.                In Ex.O6, under head “Insurance benefits”, meaning of activation has also been clarified as “first usage at the retail merchant establishments or first cash withdrawal from the ATM or an approved balance transfer from the other credit cards or payment of the first minimum amount due ( as reflects in the first statement)”.

 

10.               The complainant had met with an accident on 10.6.2007. The complainant in para no.6 of the complaint submitted that he activated his card with own code number in the SIM and used the same on different occasions. However, no evidence worth the name has been produced by the complainant to show that International Gold Card was used by him  for any transaction prior to the date of accident. Even if, he had activated his own code number in the SIM, then also the same does not fall within the meaning of activation as given in the  card member agreement.  As per  document Ex.C8  the first transaction of Rs.648/- was made  on 14.6.2008 i.e. after a period of more than one year from the date of accident. Under such circumstances, we have no hesitation in concluding that complainant has not been able to establish that gold card was activated by him before the date of accident i.e. 10.6.2007, as per its meaning given in the  card member agreement. Therefore, insurance cover as per terms and conditions of the insurance company was not available to him on the date of accident. Consequently, repudiation of the claim by the OP no.2 on the ground that card was not activated by him on the date of accident, cannot be termed as illegal and unjustified. Therefore, no deficiency in service or unfair trade practice on the part of the Ops is established.

 

11.               As a sequel to the foregoing discussion, we do not find any merit in the present complaint, consequently, the same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:28.09.2015                                                                             

                                                                (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

 (Anil Sharma)       (Smt.Shashi Sharma)    

   Member.                             Member.

 

 

 

 

 

 

 

Present:        Sh.Sudhakar Mittal Advocate for the complainant.

                   Sh.D.P.Kharb Advocate for OP no.1.

                   Sh.Y.P.Arora Advocate for OP No.2.

 

 

                        Arguments heard. Vide our separate order of the even date, the present complaint has been dismissed.  The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:28.09.2015                                                                             

                                                                (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

 (Anil Sharma)       (Smt.Shashi Sharma)    

   Member.                             Member.