Smt. Mandeep Kaur wife of Sh. Jaswinder Singh Arora, 169-A , Ranjit Avenue, Amritsar.
…Complainant
Versus
- ICICI Lombard General Insurance co. Ltd. through its director, Manager, authorized signatory or any other authorized person, ICICI Lombard House, 414-Veer Savarkar Mrg, Near siddhi Vinayak Temple, Prabhadevi, Mumbai-400025,
- ICICI Lombard General Insurance Co. Ltd. through its Manager/ authorized signatory having office at Ranjit avenue B Block, Amritsar.
- Falck global Assistance Department c/o Falck India Pvt. Ltd. through its manager or any other authorized officer, Upper Floor, the Peach tree Block-C, Sushant Lok-1 Sector 43, Gurgaon, Haryana-122015
- Thomas cook, through its Manager/ authorized officer, Lawrence Hotel Building, near domino’s Pizza, Opposite State Bank of India, Lawrence Road, Amritsar.
…Opposite Parties
Complaint Under Section 12 and 13 of the Consumer Protection Act.
Quorum: Sh. Charanjit Singh, President
Ms. Nidhi Verma, Member
For Complainant Sh. Rajesh Bhatia Advocate
For Opposite Party Nos.1, 2 Sh. Amit Bhatia Advocate
For Opposite Party No.3 Exparte
For Opposite Party No. 4 Ms. Navjot Kaur Chabba advocate
PER:
Charanjit Singh, President;
1 The present complaint has been received from the District Consumer Disputes Redressal Commission Amritsar by the order of the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh for its disposal.
2 The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 and 13 against the opposite parties on the allegations that the complainant obtained a Travel Insurance Policy bearing certificate No. 4110/000052/268624/00/000 in her name from the opposite party No. 1 through opposite party No. 4 which was valid from 23.12.2016 to 4.3.2017. The complainant paid a sum of Rs.3,193 for the aforesaid policy. After obtaining the aforesaid policy, the complainant alongwith her husband namely sh. Jaswinder Singh went to Aukland (New Zealand) but unfortunately, the complainant fell ill in Auckland and she was taken to hospital for her treatment. She got her treatment from ONEHUNGA MEDICAL PRACTICE, DR. KASHYAP MBBS, MS, FRNZCGP, 147 the Mall, Onehunga, Auckland and for her treatment the complainant has spent a sum of Rs. 1,36,000/- approximately at Auckland. During the treatment of the complainant, she was fully insured with the opposite party No. 1 and after coming back to Amritsar, the complainant lodged her medical claim with the opposite party No. 1 to 3. The opposite party No. 3 deals with the claim matters of opposite party No. 1 and whatever required documents were demanded by the opposite parties for the release of genuine claim amount of the complainant, the same were duly supplied to the opposite parties by the complainant but till date no claim amount has been paid by the opposite parties to the complainant. The complainant has many times approached the opposite party and requested to release the payment of her genuine medical claim and in this regard so many e mails have also been sent to the opposite parties, but all the times, the opposite parties used to put off the matter on one pretext or the other and till date no claim amount has been released by the opposite parties which clearly proves the negligence and deficiency in service on the part of the opposite parties, which is seriously causing mental tension, pain, agony, harassment to the complainant. The complainant is legally entitled to get her genuine medical claim and she is further entitled to be compensated on account of mental tension, pain, agony and harassment suffered by her due to the deficiency in service on the part of the opposite parties. The complainant has prayed the following reliefs:-
(a) The opposite parties may kindly be ordered/ directed to release the genuine medical claim amount of the complainant to the tune of Rs. 1,36,000/- alongwith interest @ 18% p.a. till the actual realization.
(b) Compensation to tune of Rs. 40,000/- may kindly be awarded to the complainant.
(c) Litigation expenses to the tune of Rs. 22,000/- may be awarded to the complainant.
3 After formal admission of the complaint, notice was issued to Opposite Parties and opposite parties No. 1 and 2 appeared through counsel and filed written version and contested the complaint by interailia pleadings that the present complaint is not legally maintainable as the same is an abuse of process of law. The complainant has not come to this commission with clean hands and had suppressed the true and material facts from the notice of this commission. The complainant has concealed and has suppressed the material and relevant fact of the case. The complaint has been filed with malafide and dishonest intention and has not only concealed the material facts from this commission but has also twisted and distorted the same to the suit as per their own convenience and to mislead this commission. The complainant has acted in bad faith with respect to subject of this complaint and has approached this commission with unclean hands, hence, in view of doctrine of clean hands “One who comes unto equity must come with clean hands”. The contract of insurance between the opposite parties and the complainant is governed by its policy terms and conditions. Thus the words in an insurance contract must be given paramount importance and interpreted as express without any addition, deletion or substitute. The complainant has violated the terms and conditions of the policy, as such, the complaint be dismissed. In the present case, the complainant has lodged his claim with the opposite parties No. 1, 2 and after receiving the claim from the complainant, the opposite parties have sent many backup letters, through which the opposite parties No. 1, 2 have asked for documents but despite of receiving those letters the complainant has failed to supply the documents. The opposite parties No. 1, 2 have sent letters dated 2.2.2017, 17.2.2017 and 6.3.2017 and in the above said letters, the opposite parties No. 1 and 2 had asked for the payment receipts of NZD 2656.20, but despite of receiving those letters, the complainant has failed to supply the said documents and due to that reason the claim of the complainant was treated as withdrawn and in this regard one intimation / closure letter dated 21.5.2017 was served upon the complainant. As such, the present complaint is not maintainable as there is no deficiency in service on part of the opposite parties No. 1, 2. The opposite parties Nos. 1 and 2 have denied the other contents of the complaint and prayed for dismissal of the same.
4 The opposite party No. 4 appeared through counsel and filed written version and contested the complaint by interailia pleadings that the averments made there in do not substantiate any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance, which is required to be maintained by or under any law for the time being in force or as undertaken preferred by the opposite party No. 4 in pursuance to its contract with the complainant or otherwise in relation to the services provided by the opposite party No. 4. The consumer complaint is not maintainable against the opposite party No. 4 as the opposite party No. 4 had neither any role in the claim process nor is aware of the communication exchanged between the complainant and opposite parties No. 1 to 3 with respect to the complainant’s claim. The privity of contract is directly between the insurer and insured and the opposite party No. 4 cannot be made liable for the alleged deficiency in services merely because the insurance policy was sold by it. Sale of the travel insurance policy issued by ICICI Lombard in favour of the complainant and her husband Sh.Jaswinder Singh Arora. The opposite party No. 4 had duly explained all the terms and conditions of the policy in question to the complainant and her husband and it was clarified that in case any claim is raised, the same would be directly settled by the insurer on its terms and conditions and the opposite party No. 4 has no role to play in any manner whatsoever. The complainant after fully understanding the terms and conditions of the policy paid the premium for the same. The complainant has not given any detail of her alleged illness in Auckland. Nor any document has been placed on record in support of the bald averments. The complaint do not pertain to opposite party No. 4 and thus needs no reply. The opposite party No. 4 would only like to state that as admitted by the complainant, since the opposite party No. 4 has no role in the claim settlement process therefore, it has no knowledge about the veracity of the claim of the complainant and is not in a position to comment upon the same. No act or conduct of the opposite party No. 4 can be termed as negligence or deficiency in services as the alleged claim has to be settled by opposite party Nos. 1 to 3. Thus, the opposite party No. 4 is not guilty of causing the alleged mental tension, pain, agony, harassment to the complainant and is therefore, not liable to pay any amount towards he alleged medical claim or compensation. The opposite party No. 4 has denied the other contents of the complaint and prayed for dismissal of the same.
5 Notice of this complaint was issued to the opposite party No. 3 but the opposite party No. 3 did not appear despite due service, therefore, the opposite party No. 3 was proceeded against exparte by this commission.
6 To prove his case, the complainant has tendered in evidence affidavit of complainant Ex. CW1/A alongwith documents i.e. emails Ex. C-1 to Ex. C-4, copies of boarding pass Ex. C-5 to Ex. C-7, copy of the ticket stamp Ex. C-8, copy of New Zealand entry stamp Ex. C-9, copy of the e-mail Ex. C-10, Ex. C-11, copy of e-mail id Ex/ C-12, copy of the bill dated 23.1.2017 Ex. C-13, copy of information sheets Ex. C-14 and Ex. C-15, copy of boarding pass Ex. C-16 to Ex. C-18, copy of e-mails Ex. C-19 and Ex. C-20, copy of the certificate of insurance Ex. C-21 and Ex. C-22, copy of the information sheet Ex. C-23, copy of information of flight Ex. C-24, copy of agreement of debt outstanding Ex. C-25, copy of the letter dated 2.6.2017 Ex. C-26, copy of the e-,mils Ex. C-27 to Ex. C-31, copy of patient slip Ex. C-32, copy of tax invoice Ex. C-33 and C-34, copy of cancellation cheque Ex. C-35 and closed the evidence. On the other hands, opposite parties No. 1 and 2 tendered in evidence affidavit of Vikash Goyal, Manager Legal Ex. OP1, 2/1 and closed the evidence. The opposite party No. 4 tendered in evidence affidavit of Vaibhav Sareen, Sr. Manager Thomas Cook (India) Ltd. Ex. OP4/1, copy of I.D. Card Ex. OP4/2 and closed the evidence.
7 We have heard the Ld. counsel for the complainant, opposite parties NO. 1, 2 and 4 and carefully gone through the record on file.
8 From the combined and harmonious reading of pleadings and documents placed on record is going to prove that the complainant purchased Travel insurance policy bearing certificate No. 4110/000052/268624/00/000 in her name from the opposite party No. 1 through opposite party No. 4, which was valid from 23.12.2016 to 4.3.2017. The said policy was purchased by the complainant by paying a premium of sum of Rs. 3,193/-. Thereafter, the complainant alongwith her husband namely Sh. Jaswinder Singh went to Auckland (New Zealand). The complainant fell ill in Auckland and she got her treatment from ONEHUNGA MEDICAL PRACTICE, DR. KASHYAP MBBS, MS, FRNZCGP, 147 the Mall, Onehunga, Auckland and spent a sum of Rs. 1,36,000/-. Thereafter, the complainant lodged her medical claim with opposite parties NO. 1 to 3 and supplied all the required documents which were demanded by the opposite parties for the release of genuine claim of the complainant but no claim amount has been paid by the opposite party till date. On the other hands, the opposite party has taken the stand that in the present case, the complainant has lodged his claim and after receiving the claim the opposite party 1 and 2 have sent many back up letters through which opposite parties No. 1,2 have asked for some documents but despite of receiving those letters, the complainant has failed to supply the required documents. The opposite parties have sent letters dated 2.2.2017, 17.2.2017 and 6.3.2017. The opposite parties No. 1 and 2 had been asked for payment receipts of NZD 2656.20 but despite receiving those letters, the complainant has failed to supply those documents and due to this reason the claim of the complainant was treated as withdrawn and in this regard one intimation/ closure letter dated 21.5.2017 was served upon the complainant.The stand of opposite party No. 4 is that there is no deficiency on the part of the opposite party No. 4 as the complaint is not maintainable against the opposite party No. 4 as the opposite party No. 4 has neither any role in the claim process nor aware of the communication exchanged between the complainant and opposite parties No. 1 to 3 with respect to the claim
9 But we are not agreed with the stand taken by the opposite parties No. 1 and 2 that the complainant has not supplied the required documents as asked by them. The complainant has placed on record the mails Ex. C-1 to C-4, C-10, C-11, C-12, C-19, C-20, C-27 to C-31, which were sent by the opposite parties No. 1 and 2 to supply required documents and from the perusal of said emails it clearly proves that the claimant has time to time replied to the opposite parties and sent all the scanned documents which were necessary to settle the claim. As per, the opposite party Nos. 1 and 2, they sent some letters dated 2.2.2017, 17.2.2017 and 6.3.2017 whereby the complainant was asked to supply the payment receipts of NZD 2656.20 but neither the opposite parties have placed on record any such letter nor any postal receipts on the record to prove that they have sent these letters. As such, there is deficiency in service as well unfair trade practice on the part of the opposite parties and we are of the opinion that the complainant has sent all the related documents with regard to the settlement of the claim but the opposite parties have not settle the claim within time as the complainant has already sent the required document which were asked to supply time to time. The complainant has placed on record the bill Ex. C-13 for an amount of NZD 2656.20. It has been observed in appeal No.215 of 2015 with First Appeal No. 230 of 2015 dated 30.09.2015 in case titled as United India Insurance Company Limited Vs Jaswant Rai Verma with Jaswant Rai Verma Vs United India Insurance Company Limited, by Hon’ble State Consumer Disputes Redressal Commission, U T, Chandigarh that Consumer Protection Act, 1986 Section 2 (1) (g) Insurance Regulatory and Development Authority Regulations, 2002-Insurance Claim-theft of vehicle-Investigator appointed by Insurance Company – Untraced report not filed by Police – State Commission held that as per Insurance Regulatory and Development Authority Regulations, 2002, in special circumstances of the case, the Surveyor could take six months for submission of his report, from the date of his appointment – Even on receipt of untraced report on 11.12.2014 opposite party did not decide the claim – this amounted to deficiency in service and unfair trade practice by OP – The District Forum, erred in awarding interest @ 12% per annum on the IDV of the vehicle from the date of lodging the claim – It should have awarded after six months from the date of lodging the claim by the complainant – thus impugned order needs modification.
As such, in the present case, the opposite party has not decided the claim within stipulated period despite that the complainant has submitted all documents, therefore, the act of the opposite party amounts deficiency in services, unfair trade practice.
10 In view of above statement, the present complaint is allowed and the opposite parties No. 1 and 2 are directed to make the payment of Rs. 1,36,000/- to the complainant. The present complaint against the opposite parties No. 3 and 4 is dismissed. The complainant has also been harassed by the opposite parties No. 1, 2, as such, the complainant is also entitled to Rs. 7,500/- ( Rs. Seven Thousand Five Hundred only) as compensation on account of harassment and mental agony and Rs. 7,500/- (Rs. Seven Thousand Five Hundred only) as litigation expenses. Opposite Parties No. 1, 2 are directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation. Copy of order be supplied by the District Consumer Disputes Redressal Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar.
Announced in Open Commission
25.05.2022
