DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

U.T. CHANDIGARH

[1] Thapar University earlier known as Thapar Institute of Engineering and Technology (a deemed University), Nabha Road, Patiala, through its Registrar.

[2] Registrar, Thapar University earlier known as Thapar Institute of Engineering and Technology (a deemed University), Nabha Road, Patiala.

                                  ---Complainants

V E R S U S

[1] ICICI Lombard General Insurance Company Limited, ICICI Bank Towers, Bandra Kurla Complex, Mumbai – 400 051.

[2] ICICI Lombard General Insurance Company Limited, SCO No. 24-25, 1st Floor, Sector 8-C, Madhya Marg, Chandigarh – 160 009.

   ---Opposite Parties  

BEFORE:  SH. LAKSHMAN SHARMA            PRESIDENT

         SH. JASWINDER SINGH SIDHU     MEMBER

Argued By:    Sh. Vikas Mohan Gupta, Counsel for Complainants.

Sh. Sandeep Suri, Counsel for Opposite Parties.

PER JASWINDER SINGH SIDHU, MEMBER

1.      Setting aside the order dated 28.09.2012, passed by this Forum, the Hon’ble State Consumer Disputes Redressal Commission, U.T. Chandigarh vide its order dated 21.03.2013, remanded the case back to this Forum with a direction to decide the same, afresh, on merits, in accordance with the provisions of the Act.

2.      Complainants have filed the present complaint, against the Opposite Party on the ground that the Complainant on being approached by the Opposite Parties 1 & 2 through their Manager having their Branch Office at Chandigarh for Medi-Claim Insurance (Group) Policy for its Employees and their dependents, entitling them for the treatment in O.P.D., as well as hospitalization for the treatment taken from any hospital or doctor. The claim was to be sent in the performa to the Opposite Parties which was to be processed by them for payment. On the representation made by the officer of Opposite Party No.1 and 2, Complainants purchased Policy bearing no. 4015/0001996 for the period 30.6.2010 to 29.6.2008 and paid a premium of Rs.5,65,042/- (Annexure C-2). During the currency of this policy, certain claims were preferred with Opposite Parties by the Complainants on behalf of their employees who were insured. All claims except the ones mentioned in Annexure C-3 were paid, though with delay, however, despite notices dated 26.6.2009 and 5.2.2010 (Annexure C-4 to C-6), an amount of Rs.42,704/- still remains to be paid. A legal notice too was sent to the Opposite Parties which is Annexure C-7 to C-10.  Having failed in its efforts, the present complaint has been preferred. The Complainants also disclosed that they purchased another Policy bearing No. 4015/0002421 for the year 2008-2009, valid for the period 30.6.2008 to 29.6.2009 by paying a premium of Rs.6,65,414/- (Annexure C-11). Certain claims submitted on behalf of its employees through this Policy too were not paid and that a sum of Rs.62,057/- has bee withheld by the Opposite Parties, under this Policy, too. Details are at Annexure C-12 with the complaint. The Complainants issued reminders and then, legal notice dated 26.6.2009 (Annexure C-13 to C-15). Thus, the Complainants claim that an outstanding amount of Rs.1,04,761/- remains to be paid by the Opposite Parties towards the claim submitted with them and non-settlement of the claim amounts to deficiency in service on the part of the Opposite Parties. Hence, this complaint.

        The complaint of the complainants is duly verified and is supported by the detailed affidavit of Col. Jagdev Singh (Retd.), Registrar, Thapar Institute of Engineering and Technology (formerly Thapar University), Patiala.

3.      The Opposite Parties have contested the claim of the complainant by filing their joint reply, taking preliminary objections to the effect that the present complaint deserves to be dismissed on the short ground that the Complainants had joined several causes of actions pertaining to different persons who have undergone treatment and has combined all the claims of each different persons into one claim and has preferred to file this complaint. The present complaint deserves to be dismissed on account of mis-joinder of several causes of action, as 33 different claims have been combined together to file the present complaint. Even the present complaint is claimed to be barred by limitation as the present complaint which was preferred on 27.5.2010 could not be instituted for the cause of action that had accrued prior to 27.5.2008. It is also claimed that the names of the persons whose claim was raised have not been raised as party in the present complaint, nor there is an authorization on their behalf. It is also claimed that the present complaint is in the nature of a suit for recovery of amount, which deserves to be adjudicated upon by a civil court alone and not under the Consumer Protection Act, 1986. Hence, denying the claim of the Complainants, Opposite Parties have prayed for the dismissal of the present complaint.    

        On merits, the Opposite Parties have repeated their preliminary objections, while replying to the averments of the present complaint, in their para-wise reply. Thus, claiming no deficiency in service or unfair trade practice on their part, the answering Opposite Party has prayed for the dismissal of the complaint with heavy costs.  

        The reply of the Opposite Party is without any evidence.

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

5.      We have heard the learned counsel for the parties and have perused the record.

6.      The fact with regard to the Complainants having subscribed for two Medi-Claim (Group) Policies for its employees for the year 2007-08, starting 30.6.2007 to 29.6.2008 and another policy starting for the period 30.6.2008 to 29.6.2009 is admitted. Even the fact that different claims were lodged by the Opposite Parties, which arose under these two policies, too, is admitted. However, the basic question about the qualification of the Complainants to prefer the present complaint on behalf of all its constituent employees, on occasion of different cause of actions, having accrued on different dates during the currency of these two Policies, is objected upon by the Opposite Parties. At the same time, another objection with regard to the present complaint being barred by limitation has already been dealt with at length by our Hon’ble State Consumer Disputes Redressal Commission while giving its observations in F.A. No. 367 of 2012, which was preferred by the Complainant, when the present Consumer Complaint was dismissed on 28.09.2012 on aforementioned grounds. Hence, we move forward and decide the present complaint on merits.

7.      The facts with regard to the claims lodged by the Complainant for the reimbursement of hospitalization and OPD bills of its employees are detailed in para 3 and 5 with regard to the Policy No. 4015/0001996 of the year 30.6.2007 to 29.6.2008, for which a premium of Rs.5,65,042/- was paid. The amount claimed under this policy was to the tune of Rs.42,704/-; whereas, the claim lodged by the Complainant with the Opposite Parties under the policy bearing No. 4015/0002421 of the year 30.6.2008 to 29.6.2009 and a premium of Rs.6,65,414/- was paid while subscribing this policy, and an amount of Rs.62,057/- was claimed under the second policy.

8.      The Complainant on not being successful in getting any response from the side of the Opposite Parties also served two legal notices under respective claims vide Annexures C-4 and C-16 respectively, through speed post, receipt of the same are at Annexure C-6 & C-15 respectively. These legal notices were not replied by the Opposite Parties.

9.      The Complainants having registered their genuine grievance of non-payment of reimbursement amount preferred the present complaint. The Complainants have also categorically mentioned that all other claims were honoured by the Opposite Parties, but only a few were left un-addressed by them, thus giving a cause of action for filing the present complaint.

10.     The Opposite Parties while defending themselves, have taken few technical objections which have already been addressed and after the opinion of our Hon’ble State Commission, on these issues, the same are out rightly ignored. The Opposite Parties while claiming that the persons on whose behalf the claims have been lodged by the Complainants, are not their employees, but at the same time, the Opposite Parties did not bring on record any evidence to rebut the averments of the complaint, on this issue.

11.     The Opposite Parties while also claiming that no amount is payable to the Complainants have not cited any reason from the terms and conditions of the policy, to fortify their defence. However, it is important to mention here that the Opposite Parties have maintained a stoic silence all these years by not replying to the letters written by the Complainant for the reasons best known to themselves alone. In the given situation, the version/ written statement of the Opposite Parties which is neither verified nor is supported by any affidavit of the authorized representative of the Opposite Parties. Hence, in the absence of any cogent, reliable and trustworthy evidence, the reply/ version of the Opposite Parties, being devoid of any force, is outright rejected.

12.     In the given situation, the Opposite Parties having miserably failed to controvert the averments of the complaint, are held to be deficient in giving proper service to the Complainant, in not entertaining the genuine claims of the employees of the Complainant.

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

[a] To pay a sum of Rs.1,04,761/- (Rs.42,704/- + Rs.62,057/-) claimed by the Complainants;

[b] To pay Rs.25,000/-on account of deficiency in service; 

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

14.     The above said order shall be complied within 45 days of its receipt by the Opposite Parties; thereafter, they shall be liable for an interest @18% per annum on the amount mentioned in per sub-para [a] & [b] of para 13 above, apart from cost of litigation of Rs.10,000/-, from the date of institution of this complaint, till it is paid.  

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

Announced  

30^th April, 2013

Sd/-

(LAKSHMAN SHARMA)

PRESIDENT

Sd/-

 (JASWINDER SINGH SIDHU)

MEMBER