Haryana

Ambala

CC/421/2018

Heena Bhikhlal - Complainant(s)

Versus

ICICI Lombard - Opp.Party(s)

A.B. Kapoor

25 Nov 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

                                                          Complaint case No.: 421 of 2018.

                                                          Date of Institution           :  18.12.2018.

                                                          Date of decision    :  25.11.2019.

Heena Bhikhlal Patel w/o Bhikha Mal Patel House No.15, Arya Nagar, Ambala Cantt.

          ……. Complainant.

                                                Versus

 

1. I.C.I.C.I. Lombard through his branch office opposite Municipal Corporation Sadar Zone Triloki Building Ambala Cantt. (insured Policy No.4110/0-SOTCST/P/45986/00/000) Card No./UHID No.LT7000483 Period of Insurance from 4^th May, 2017 to 24^th May, 2017.

 

2. SOTC travel service Pvt. Ltd. Shop No.11/12, Mahaluxmi Complex GRD Floor Kala wad Road, Opp. Cent Mery School, Rajkot Gujrat.

 

3. I.C.I.C.I. Lombard House Office at-414, Veer Savarkar Marg, Near Sidhivinayak Temple, Parbhadevi Mumbai 400052 (insured Policy No.4110/0-SOTCST/P/45986/00/000) Card No./UHID No.LT17000483 Period of insurance from 4^th May, 2017 to 24^th May, 2017.

 

               ….…. Opposite Parties.

Before:        Smt. Neena Sandhu, President.

                   Smt. Ruby Sharma, Member.

Shri Vinod Kumar Sharma, Member.         

                            

Present:       Shri A.B. Kapoor, Advocate, counsel for the complainant.

Shri Rajesh Kumar, Advocate, counsel for the OPs No.1 & 3.

Shri Shubham Aggarwal, Advocate, counsel for the OP No.2.

 

Order:        Smt. Neena Sandhu, President

Complainant has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

1. To pay Rs.40,000/- as cost of the treatment.
2. To pay Rs.25,000/- as compensation for the mental agony and physical harassment suffered by him and litigation cost.

 

Brief facts of the case are that the complainant booked a Europe holiday trip through SOTC Travel service Pvt. Ltd. Rajkot i.e. OP No.2. The cost of the insurance of the passenger was included in the cost of the trip. The OP No.2 had taken the medical insurance for the complainant from the ICICI Lombard i.e OPs No.1 & 3.  The said medical policy was valid for the period from 23.04.2017 to 24.05.2017. The complainant started her journey on 23.04.2017 by air from Ahmedabad to Bombay and from Bombay to Muscat-Oman and further from Muscat-Oman to London, United Kingdom. When the complainant was about to fly from Zurich-Switzerland to Muscat, unfortunately, she fell sick and admitted in hospital at Zurich-Switzerland Airport. Complainant was treated by the Doctors at the Airport for which she incurred an expenses of (469US Dollars) approximately Rs.40,000/-.  Immediately, after coming back from the trip she inquired from SOTC regarding reimbursement of the amount incurred by her on her treatment. Despite of submitting of all the documents issued by the Airport Authority hospital of Zurich-Switzerland with the OPs, they did not reimburse the medical expenses which she incurred on her treatment.   A legal notice dated 24.07.2018 was served upon the OPs, but of no avail. By not paying the medical claim the OPs have committed deficiency in service. Hence, the present complaint.

2.                 Upon notice, OPs No.1 & 3 appeared through counsel and filed written version and have raised preliminary objections regarding maintainability; jurisdiction; not coming to this Forum with clean hands and suppressing true and material facts. On merits, it is stated that as per the rules and regulations the complainant had to submit all the requisite documents to the concerned office of OP No.1 and 3, but till date the complainant has not submitted the requisite documents. The OP no.1 and 3 are not in a position to proceed with the claim of complainant unless & until the complainant furnish the requisite documents with them. Despite several requests complainant failed to submit all the requisite documents and as such they cannot be held liable for the fault of the complainant. Rest of the allegations levelled by the complainant were denied for lack of knowledge and prayer has been made for dismissal of the present complaint filed by the complainant against them.

                   Upon notice, OP No.2 appeared through its counsel filed written version raising preliminary objection regarding maintainability. On merits, it is admitted that complainant had booked a tour for herself and her husband to Europe named “Romanchak Europe: scheduled to depart on 5^th May, 2017. Complainant had booked the aforesaid tour programme after reading, understanding and accepting the booking terms and conditions and how to book rules, which constitute contractual relations between the parties and governed the mutual rights and liabilities of the parties. Further admitted that cost of the tour includes the general travel insurance of the passenger. Further stated that OP no.2 is a mere tour operator, who assists their travellers in applying for standard travel insurance policy from an independent Insurance Company. Furthermore, there exists a direct contractual relationship between the travellers and Insurance Company with respect to the policy coverage. Complainant had obtained the standard travel insurance policy based on her own criteria, requirement and risk. To avail travel Insurance, the OP No.2 engaged the OP No.1, which is a registered Insurance Company under Insurance Act, 1938 and is also governed with all rules, regulations, guidelines issued by IRDA and other Law under force, as may be applicable from time to time. It is further stated that the complainant approached it to enquire about the reimbursement of the medical expenses incurred by her on her treatment at Airport Medical Centre post Zurich-Flughfel Switzerland. The OP No.2 advised the complainant to take up the matter with the Insurance Company directly, because so far as for medical Insurance Policy, the complainant had no privity of contract with it but with the Insurance Company. Further stated that all claims, disputes of whatsoever nature relation to the Tours marketed/coordinated by SOTC Travel Ltd. The Courts, forums and tribunals in Mumbai, India alone shall have exclusive jurisdiction to the exclusion of all others. All tours are subject to laws, rules of RBI/GOI. OP No.2 is not accountable to pay any amount as claimed by the complainant. Rest of the allegations levelled by the complainant were denied for lack of knowledge and prayer has been made for dismissal of the present complaint filed by the complainant against it.

3.                The Ld. counsel for the complainant tendered affidavit of complainant as Annexure CA alongwith documents as Annexure C-1 to C-18 and closed his evidence. On the other hand, learned counsel for OP No.2 tendered affidavit of Dinesh Byndoor, Manager-Legal, SOTC Travels Limited, Authorized Representative as Annexure OP2/A and closed the evidence on behalf of OP No.2. On the other Ld. counsel for OPs No.1 & 3 tendered affidavit of Nishant Gera, Authorized Officer/Manager Legal, ICICI Lombard General Insurance Co. Ltd. as Annexure OP1/A alongwith document Annexure OP1/1 to OP1/4 and closed the evidence on behalf of OPs No.1 & 3.

4.                We have heard the learned counsel of the parties and carefully gone through the case file.

5.                The Ld. counsel for the complainant argued that the complainant booked a tour of Europe through OP No.2. The insurance of the traveller was included in the said tour package. The OP No.2 had taken a travel insurance policy for the complainant from the OP No.1 and 3. The said policy was valid for the period from 23.04.2017 to 24.05.2017. When the complainant was about to board a flight from Zurich-Switzerland to Muscot, unfortunately she fell sick and admitted in the hospital at the Zurich-Switzerland airport and paid four sixty nine US dollars i.e. approx. Rs.40,000/- for her treatment.  When she reached back, she immediately contacted the OPs and requested them to reimburse the amount, which she had incurred on her treatment, but the OPs paid no heed to her request.

                             The Ld. counsel for the OP No.2 argued that the OP No.2 is mere a tour operator and not a insurer. Thus, it is not liable to reimburse any amount to the complainant, incurred on her treatment during the said tour and prayed for dismissal of the present complaint against it with costs filed by the complainant.

                   The Ld. counsel for OP No.1 and 3 argued that as per the terms and conditions of the policy, it was incumbent upon the complainant to submit the requisite documents with the concerned office of OP No.1 and 3. Despite of issuance of several letters regarding furnishing of requisite documents, the complainant has not submitted the said documents till date. Until and unless the complainant submits the requisite documents, they would not be in a position to settle the medical claim of the complainant. There is no deficiency on their part. The present complaint may be dismissed with special costs.

6.                          Admittedly, complainant booked his Europe tour from the OP No.2. It is also admitted fact that, she had taken a travel insurance policy (Annexure C-7) from the OPs No.1 and 3 for sum assured of 1,116 US Dollars for the period from 04.05.2017 to 24.05.2017. As per the complainant, during the subsistence of the said policy, she got sick, when she was about to fly from Zurich-Switzerland to Muscot. She was admitted in the hospital at the Zurich-Switzerland airport & spent four sixty nine US dollars i.e. approx. Rs.40,000/- on her treatment. To prove this fact she has placed on record some photographs of her admission in the hospital (Annexure C-15 & C16), the receipts of payment of 469.65 USD (Annexure C-17& C-18) to the Airport Medical Centre, Zurich-Flughafen, a medical report issued by Med. Pract., Adrian Walther C/o Airport Medical Centre and a certificate that she is Fit-to-Fly annexed alongwith C-18. From the documents referred to above it has been proved beyond any doubt that the complainant took treatment from the hospital at the Zurich-Switzerland airport & had spent four sixty nine US dollars. Rs.40,000/-. As such, there is no requirement to come to the conclusion that the complainant is entitled for reimbursement of the amount incurred on her treatment. We did not smack any misrepresentation on the part of the complainant. As such, we hold that the OPs No. 1 & 3 were liable to reimburse four sixty nine US dollars to the complainant. By not doing so the OPs No.1 & 3 had committed deficiency in service, thus they are liable to reimburse the amount in rupees equivalent to four sixty nine US dollars. They are also liable to compensate the complainant for the mental agony & physical harassment suffered by her alongwith litigation expenses. Since, the liability to pay medical expenses was of the insurer i.e OPs No.1 & 3 and not of SOTC travel service Pvt. Ltd. i.e. OP No.2, therefore, the present complaint filed against them, is liable to be dismissed.

7.                In view of the aforesaid discussion, we hereby dismiss the present complaint against the OP No.2 and allow the same against the OPs No.1 & 3. They are directed in the following manners:-

1. To reimburse the amount to the complainant in rupees equivalent to four sixty nine US dollars.  
2. To pay Rs.4,000/- as compensation for mental agony and physical     harassment suffered by the complainant.
3. To pay Rs.3,000/- as litigation expenses.

 

                   The OPs No.1 & 3 are further directed to comply with the aforesaid directions within the period of 30 days from the date of receipt of the certified copy of this order, failing which, the awarded amount shall carry interest @ 9% per annum for the period of default. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on :25.11.2019.

 

 

 

          (Vinod Kumar Sharma)            (Ruby Sharma)               (Neena Sandhu)

              Member                                  Member                       President