Chandigarh

DF-I

CC/544/2014

Rajinder Partap Singh - Complainant(s)

Versus

HDFC ERGO General Insurance Company Ltd. - Opp.Party(s)

In person

23 Feb 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

============

Consumer Complaint  No	:	CC/544/2014
Date  of  Institution	:	14/08/2014
Date   of   Decision	:	23/02/2015

 

 

 

 

 

Rajinder Partap Singh S/o Wirsa Singh, R/o H.No.2652/1, Sector 47-C, Chandigarh.

…Complainant

Versus

 

HDFC ERGO General Insurance Company Limited, SCO No.124-125, Sector 8-B, Madhya Marg, Chandigarh – 160008.

 

     …Opposite Party

 

BEFORE:    SH. JASWINDER SINGH SIDHU  PRESIDING MEMBER

MRS.SURJEET KAUR                MEMBER

                     

Present:      Complainant in person.

Sh. Gaurav Bhardwaj, Counsel for Opposite Party.

 

 

PER JASWINDER SINGH SIDHU, PRESIDING MEMBER

 

 

1.      Sh. Rajinder Partap Singh, Complainant, has filed this Consumer Complaint under Section 12 of the Consumer Protection Act, 1986, against HDFC ERGO General Insurance Company Limited (hereinafter called the Opposite Party), alleging that he had taken a Travel Insurance Policy, from the Opposite Party, for his wife namely, Mrs. Raj Kahlon, who was to visit Canada. It has been asserted that after reaching Canada due to extreme cold in Calgary, she felt breathlessness and was taken to Emergency Hospital, Alberta. The Complainant spent Rs.1,37,183.40P on her treatment from 25.9.2013 to 23.3.2014. Accordingly, Claim bearing No.4 DEL 009108 was lodged with the Opposite Party, which was erroneously rejected. It has been further stated that the aforesaid acts of the Opposite Party amounted to deficiency in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, has not been redressed, left with no alternative, the Complainant has filed the instant complaint before this Forum, claiming various reliefs.       

 

2.      Notice of the complaint was sent to Opposite Party seeking its version of the case.

 

3.      Opposite Party has filed its reply, inter alia, admitting the factual matrix of the case. It has been pleaded that the wife of the Complainant was diagnosed to be suffering from CHF and she was earlier suffering from the said disease and was taking treatment for the same from Govt. Medical College & Hospital, Chandigarh as such the claim of the Complainant is not covered under the Travel Care Insurance Policy purchased by him. Denying all other allegations and stating that there is no deficiency in service on its part, Opposite Party has prayed for dismissal of the complaint.

 

4.      Parties were permitted to place their respective evidence on record in support of their contentions.

 

5.      We have heard the Complainant in person and Sh. Gaurav Bhardwaj, learned Counsel for the Opposite Party and have also perused the record.

 

6.      The Complainant has preferred the present Complaint on the ground that he had taken an Overseas Travel Insurance, for his wife for her travel to Canada, from the Opposite Party, through its Agent i.e. H.D.F.C. Bank Limited. The wife of the Complainant had fallen sick and was treated at Emergency Hospital, Alberta Health Service Urgent Care in Canada and incurred an expense of Rs.1,37,183.40P equivalent to $2286.39 (CAD). The Complainant claimed to have lodged the claim for the reimbursement of the expenses incurred by his wife, but the Opposite Party preferred to repudiate the claim, on the ground that insured Mrs. Raj Kahlon was suffering from a similar disease before her visit to Canada and she failed to disclose the same and suppressed this information from the Opposite Party. The Complainant claiming deficiency in service on the part of the Opposite Party has sought the relief quoted in his Complaint.

 

7.      The Opposite Party while replying to the allegations of the Complainant has claimed that the present Complaint is not maintainable, as the Complainant is not the insured and the policy in question has been issued in favour of Mrs. Raj Kahlon, who is not a Complainant in the present Complaint. The Opposite Party has also claimed that the present Complaint deserves dismissal, as the claim lodged with it was repudiated on the basis of concrete information about the pre-existing disease of Mrs. Raj Kahlon before her departure to Canada. The Opposite Party has alleged that at the time of subscribing for the policy this necessary information was not disclosed and therefore, the claim was repudiated as there was suppression of necessary information, as well as material facts on the part of Mrs. Raj Kahlon and thus, the claim was not payable. Claiming no deficiency in service on its part, the Opposite Party has prayed for the dismissal of the present Complaint qua it with exemplary costs.  

 

8.      We have perused the documents placed on record by the parties and also the respective pleadings. Though the Opposite Party has admitted to the fact the Mrs. Raj Kahlon, who was insured under the policy no. quoted by the Complainant. All other facts as mentioned in the Complaint with regard to the Complainant having subscribed for this policy and also with regard to the existence of the insurance agent namely H.D.F.C. Bank Limited, has not been answered by the Opposite Party either by rebutting the same or contesting in any other manner. Resultantly, we have no other option, but to believe the contents of the Complaint to that effect. Therefore, the Complainant having sought the policy in question for his wife, through H.D.F.C. Bank Limited (Agent of the Opposite Party) is certainly a Consumer qua it and is very much within his rights to file the present Complaint against it.

 

9.      The Opposite Party after having admitted the issuance of the policy, and declaring Mrs. Raj Kahlon – wife of the Complainant as insured under the quoted policy number, have not placed on record the Proposal Form through which the said Policy was solicited and on the basis of the information quoted in such a document the said Overseas Travel Insurance Policy was issued by the Opposite Party. In the absence of such a Proposal Form, or any such document, on the basis of which the Opposite Party had sought the information about the previous ailment or hospitalization of the proposer, the allegations of withholding necessary information cannot be saddled on the Complainant.

 

10.      It is not only the settled law, but also the principle of natural justice demands that if any allegation is to be leveled, for concealment of information or withholding of necessary information, there should be a pointed inquiry or question to that effect, which was necessary to the answered before processing of such insurance policy, and it is also necessary for the person whose such response, if required, had quoted such information which was at a later stage was found to be wrong. Therefore, in the absence of the Proposal Form for the said Policy or any document from the side of the Opposite Party to prove that the Complainant or the insured were asked to disclose such information, which they failed to quote, the Complainant cannot be held to have suppressed such material information leading to the repudiation of the claim.          

 

11.      The Opposite Party though has procured the information of the Complainant having visited the Govt. Medical College, & Hospital, Chandigarh, in the year 2012, but this document can only be used to find fault with the Complainant, if there is another document in possession of the Opposite Party before the issuance of the Policy, where the Complainant had deliberately preferred not to inform the Opposite Party about such ailment. Therefore, any evidence can only be appreciated if there is a material document to be rebutted by such an evidence, but as there is no such proof of withholding of material information of pre-existing disease from the side of the Complainant, this document Annexure OP-2 deserves no merit. It is also important to mention here that the Complainant has himself placed on this the same document (Pg.21-28 of the paper book), along with the present Complaint, which only confirms that if at all the Complainant wanted to hide such an information, there was no reason for him to place this document on record, if he knew that the same would be construed against him. As a matter of fact, the Opposite Party found it too convenient to use the same document against the Complainant.

 

12.      It is pertinent to mention here that as per the terms & conditions of the policy, issued to the Complainant, it was necessary for the Opposite Party to have a Proposal Form completed before its issuance. In Clause 8 of the General Conditions of the Travel Insurance Policy (Annexure OP-3), which is reproduced hereinbelow:- 

 

“8.   The Policyholder and Insured Person understand that if a proposal has been completed for this insurance, then all statements and all particulars provided in such proposal, and any attachments thereto, are material to the Company’s decision to provide this insurance. The Policy holder and Insured Person further understand that the Company has issued this Policy in reliance upon the truth of such statements and particulars.”

 

Therefore, if the Opposite Party has preferred not to place on record any such Proposal Form, through which the material information was sought from the Complainant before the issuance of the policy, the allegations of concealment of material facts do not hold ground and the repudiation of the claim of the Complainant on this score certainly amounts to deficiency in service on the part of the Opposite Party.

 

13.      In the light of above observations, we are of the concerted view that the Opposite Party is found deficient in giving proper service to the complainant. Hence, the present complaint of the Complainant deserves to succeed against the Opposite Party, and the same is allowed, qua it. The Opposite Party is directed to:-

[a]  To pay the claim amount of Rs.1,37,183.40P along with interest @9% p.a. from the date of lodging of the claim i.e. 19.11.2013 till it is paid;

 

[b]  To pay Rs.25,000/-on account of deficiency in service and causing mental and physical harassment to the Complainant; 

 

[C] To pay Rs.10,000/- as cost of litigation;

 

14.      The above said order shall be complied within 30 days of its receipt by the Opposite Party; thereafter, it shall be liable for an interest @18% per annum on the amount mentioned in sub-para [a] of Para 13 above from the date of lodging of the claim i.e. 19.11.2013, till it is paid. The compensation amount as per sub-para [b] of para 13 above, shall carry interest @18% per annum from the date of institution of this complaint, till it is paid, apart from cost of litigation of Rs.10,000/-.  

 

15.      Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

23^rd February,2015                                      

Sd/-

(JASWINDER SINGH SIDHU)

PRESIDING MEMBER

 

 

Sd/-

 (SURJEET KAUR)

MEMBER