D.O.F:15/07/2022
D.O.O:06/02/2023
IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KASARAGOD
CC.No.153/2022
Dated this, the 6th day of February 2023
PRESENT:
SRI.KRISHNAN.K :PRESIDENT
SRI.RADHAKRISHNAN NAIR.M : MEMBER
SMT.BEENA.K.G : MEMBER
Daya V.K, aged 58 years,
W/o A. Keshavan Embrandiry,
Attupurathillath, : Complainant
Pattena,
P.O. Nileshwar- 671314
And
ICICI LOMBARD General Insurance Company Ltd.,
ICICI LOMBARD House,
414 Veer Savarkar Marg, : Opposite Party
Prabhadevi,
Mumbai – 400025
IRDAI Registration No.115.
ORDER
SRI.RADHAKRISHNAN NAIR.M : MEMBER
The complaint is filed under section 35 of Consumer Protection Act 2019 on the ground of service deficiency on the part of Opposite party.
The fact of the case in brief is that the complainant took an international group overseas travel insurance policy of opposite party through the Tour Company, namely, Benny’s Royal Tours Ernakulam. The policy certificate was issued on 12.01.2022 on payment of premium amount Rs.1,678/-.The original policy certificate No.SX40283502 was collected on 16.07.2022. There were 25 members in the tour group of the complainant including her husband. The complainant had taken necessary RTPCR Covid certificate, 48 hours before the commencement of tour from KDC lab, Kanhangad with negative result. After finishing Egypt Tour the complainant and her group had to enter Jordan which is a country in the Middle East. There was a cruise ship to connect Nuweiba Port in Egypt to Aqaba Port in Jordan. Before entering Jordan they have to undergo another RTPCR test in the cruise ship by the Jordan health department. Out of 25 members in the group 7 members showed RTPCR test positive. As per the rules prevailing in Jordan country and after disembarking the cruise ship, 7 positive members were immediately taken in to custody by Police and health department of Jordan Government and were taken in isolation and separated from the remaining group and kept in a separate hotel with strict vigilance at individual cost. The complainant’s group were deprived of joining the remaining group to finish the tour itinerary from 23.01.2022. This has created mental tension and financial loss. The original tour has ended on 26.01.2022. The flight tickets of the 7 positive members including complainant were cancelled / modified and re issued from AMMAN airport to Mascot and from Mascot to Cochinfrom the original return ticket. Another RTPCR test was done on complainant on 28.01.2022 which was negative. There after the complainant and the group proceeded to India and reached on 30.01.2022 without completing the remaining tour programme in Jordan. After reaching India the complainant submitted claim form for the insurance benefits with all original documents to the opposite party through registered post. But till date the claim is not sanctioned. In spite of several requests. As per the terms of the insurance policy the complainant is eligible for 1000 US dollars with deduction of 100 dollars in trip cancellation /interruption clause. The trip interruption was due to unforeseen contingency due to covid positive. The complainant and her group have taken all precaution during their journey to prevent Covid. The complainant restricts her claim to 226 US Dollars with Rs.15,993/- as additional expense and return tickets date change penalty to individual member. 226 US dollars include transfer from Aqaba from AMMAN, accommodation for 4 nights, transfer from AMMAN to airport and cost of RTPCR test. Return ticket date change penalty is Rs.15,993/-. As per the clause No.3 of terms and conditions of the policy, “the company shall settle the claim within 30 days from the date of receipt of last necessary document in accordance with provision of regulation 27 of IRDAI (health Insurance Regulation) Act 2016. In case of delay in payment of claim the company shall be liable to pay interest from the date of receipt of last necessary documents to the date of payment of claim at the rate of 2% above the bank rate”. Insured Journey is interrupted due to unexpected sickness of Covid-19. The denial or failure to process the genuine claim within a reasonable time is service deficiency on the part of the opposite party. Hence, this complaint is filed for a direction to the opposite party to pay an amount of Rs.15,993/- along with 226 US Dollars with 9% interest from the date of filing till payment along with Rs.50,000/- as compensation and costs.
The notice to the opposite party was duly served but they remained absent. The name of the opposite party was called and set ex parte.
The complainant filed proof affidavit in lieu of chief examination. The documents produced by the complainant marked as Ext.A1 to A9. The Ext.A1 is the Aadhar card of the complainant. Ext.A2 is the certificate of insurance, Ext.A3 is the Tour Programme issued by Benny’s Royal Tour Pvt.Ltd, Ext.A4 is RTPCR Test positive report dated 14.01.2022, Ext.A5 is RTPCR Test positive report Dated 23.01.2022, Ext.A6 is a copy of Travellers Ticket, Ext.A7 is RTPCR Test Report dated 28.01.2022, Ext.A8 is a copy of postal receipt, Ext A9 is the insurance claim submitted by the complainant.
Based on pleadings and documents, the following issues are framed for consideration.
1. Whether there is any service deficiency on the part of the opposite party ?
2. If so, what is the relief?
For convenience, both these issues are considered together.
The specific case of the complainant is that the Insured Journey of their group has been interrupted due to unexpected pandemic of Covid-19. The complainant and her group had taken all precaution during their journey to prevent Covid. There were 25 members in the tour group of the complainant including her husband. The complainant had taken necessary RTPCR Covid certificate 48 hours before the commencement of tour from KDC lab, Kanhangad with negative result. After finishing Egypt Tour the complainant and her group had to enter Jordan which is a country in the Middle East. There was a cruise ship to connect Nuweiba Port in Egypt to Aqaba Port in Jordan. Before entering Jordan they have to undergo another RTPCR test in the cruise ship by the Jordan health department. Out of 25 members in the group 7 members showed RTPCR test positive. As per the rules prevailing in Jordan country and after disembarking the cruise ship, 7 positive members were immediately taken in to custody by Police and health department of Jordan Government and were taken in isolation and separated from the remaining group and kept in a separate hotel with strict vigilance at individual cost. The complainant’s group were deprived of joining the remaining group to finish the tour itinerary from 23.01.2022.This has created mental tension and financial loss. The original tour has ended on 26.01.2022. The flight tickets of the 7 positive members including complainant were cancelled / modified and re issued from AMMAN airport to Mascot and from Mascot to Cochin from the original return ticket. Another RTPCR test was done on complainant on 28.01.2022 which was negative. There after the complainant and the group proceeded to India and reached on 30.01.2022 without completing the remaining tour programme in Jordan.
After reaching India the complainant submitted claim form for the insurance benefits with all original documents to the opposite party through registered post. But till date the claim is not sanctioned. In spite of several requests. As per the terms of the insurance policy the complainant is eligible for 1000 US dollars with deduction of 100 dollars in trip cancellation / interruption clause. The trip interruption was due to unforeseen contingency due to covid positive. The complainant submit that the denial or failure to process the genuine claim within a reasonable time is service deficiency on the part of the opposite party. As per the clause No.3 of terms and conditions of the policy, “the company shall settle the claim within 30 days from the date of receipt of last necessary document in accordance with provision of regulation 27 of IRDAI (Health Insurance Regulation) Act 2016. In case of delay in payment of claim the company shall be liable to pay interest from the date of receipt of last necessary documents to the date of payment of claim at the rate of 2% above the bank rate”.
The complainant produced the documents Ext.A1 to Ext.A9 to prove her case, Considering the facts and circumstances of the case and in the absence of rebuttal evidence in this case, this commission is of the view that the complainant is entitled for the insurance benefit and denial or not processing of the claim in time is service deficiency on the part of the opposite party. The complainant states that she restricts her claim to 226 US Dollars with Rs.15,993/- as additional expense and return tickets date change penalty to individual member. The complainant prays for a direction to the opposite party to pay USD226 and Rs.15,993/- with 9% interest and a compensation of Rs.50,000/-and cost.
The value of USD 226 = INR 18,643/- at present rate. This commission hold that the complainant is entitled to get an amount of Rs.18,643/-and Rs.15,993/- with interest.
Also she is entitled to compensation for mental agony and hardships and an amount of Rs.20,000/- is a reasonable compensation in this case.
Hence in the result, the complainant is allowed and the opposite party is directed to pay a total amount of Rs.34,636 /- (Rupees Thirty Four Thousand Six Hundred and Thirty Six only) with an interest at the rate of 9% per annum from 15.07.2022, the date of complaint, to the date of payment. The opposite party is also directed to pay of Rs.20,000/- (Rupees Twenty Thousand only) towards compensation and Rs.5,000/- (Rupees Five Thousand only) as costs.
Time for compliance is 30 days from receipt of copy of this judgment.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Exhibits
A1: Aadhar card of the complainant
A2: Certificate of insurance
A3: Tour Programme issued by Benny’s Royal Pvt.Ltd
A4: RTPCR test positive report dated 14/01/2022
A5: RTPCR test positive report dated 23/01/2022
A6: Copy of Travellers Ticket
A7: RTPCR test positive report dated 28/01/2022
A8: Copy of postal receipt
A9: Insurance claim submitted by the complainant
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Forwarded by Order
Ps/ Assistant Registrar
