Chandigarh

DF-I

CC/676/2017

Karnail Singh - Complainant(s)

Versus

IFFCO TOKIO General Insurance Co. Ltd. - Opp.Party(s)

Dinesh Chopra

10 Sep 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

 

 

                               

Consumer Complaint No.	:	CC/676/2017
Date of Institution	:	25/09/2017
Date of Decision	:	10/09/2018

 

Karnail Singh, R/o H.No.503, GH-14, Sector 24, Panchkula, District Panchkula (Haryana).

…..Complainant

V E R S U S

1.     IFFCO TOKIO General Insurance Co. Limited, IFFCO Tower II, Plot No.3, Sector 29, Gurgaon (Haryana) – 122001, through General Manager.

2.     IFFCO TOKIO General Insurance Co. Limited, Plot No.2B & 2C, Sector 28-A, Madhya Marg, Chandigarh, through Branch Head.

 … Opposite Parties

 

CORAM :	SH.RATTAN SINGH THAKUR	PRESIDENT
	MRS.SURJEET KAUR	MEMBER

 

                                                                       

ARGUED BY	:	Complainant in person.
	:	Sh. Rajneesh Malhotra, Counsel for Opposite Parties.

Per Surjeet Kaur, Member

1.         The facts of the Consumer Complaint, in brief, are that the Complainant was having a medi-claim policy from the Opposite Parties, covering himself and his wife upto Rs.2,00,000/-, w.e.f. 01.06.2014. The Complainant’s wife Mrs. Dawinder Kaur during visit to her daughter at Navi Mumbai fell sick on 05.02.2015 and got admitted in MGM Hospital at CBD Belapur, Navi Mumbai, which was nearest to the residence and due to need of hospitalization owing to her sickness. The Complainant incurred an amount of Rs.10,841/- on the treatment of his wife and submitted his claim, accompanied by all the relevant documents to the Opposite Parties, on 20.03.2015. Thereafter, the Opposite Parties demanded certain documents/clarifications from the Complainant, which were duly provided to them to process the claim. However, the Opposite Parties vide mail dated 27.07.2016 closed the claim of the Complainant as ‘No Claim’. In these circumstances, the Complainant got served a legal notice dated 23.11.2016 upon the Opposite Parties, but the same did not fructify. With the cup of woes brimming, the Complainant has filed the instant Consumer Complaint, alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of the Opposite Parties.
2.         Notice of the complaint was sent to Opposite Parties seeking their version of the case.
3.         Opposite Parties filed their reply admitted that the basic facts of the case. It has been pleaded that the medi-claim insurance policy in question was issued to the Complainant subject to the terms & conditions of the insurance policy. It has been urged that the Complainant failed to supply the requisite documents in order to process the claim under terms & conditions of above referred policy and as such the claim of the Complainant was closed as “No Claim” vide letter dated 02.06.2015. Pleading that there is no deficiency in service or unfair trade practice on their part, Opposite Parties have prayed for dismissal of the complaint.
4.         Controverting the allegations contained in the written statement and reiterating the pleadings in the Complaint, the Complainant filed the rejoinder.
5.         The parties led evidence in support of their contentions.
6.         We have gone through the entire record and heard the arguments addressed by the Complainant and Ld. Counsel for the Opposite Parties.
7.         In the present case, the first question for consideration is whether the present Complaint lies within the territorial jurisdiction of this Forum is not? The answer to the same is in affirmative. Clearly, as per Preliminary Objection No.5 of the Written Statement of the Opposite Parties, it has been stated that as per the memo of parties the Opposite Party No.1 is situated at Gurgaon and the Opposite Party No.2 is situated at Chandigarh. Thus, this Forum does not have the territorial jurisdiction to entrain and try the present Complaint. Contradictory to the same, further it has been mentioned that no cause of action has accrued to the Complainant at Panchkula to file the present Complaint before the District Forum. We feel that the Ld. Counsel for the Opposite Parties has not dealt the Complaint consciously, which is actually filed at Chandigarh and as per the admission as well as array of the parties originally mentioned in the Complaint itself this Forum has territorial jurisdiction to entertain and try the present Complaint.
8.         The next allegation by the Opposite Parties is that it was the Complainant himself who did not supply the requisite documents to them to process the claim. Perusal of the letter dated 5.5.2016 sent by the Complainant through registered post on 6.5.2015 (Pg. No.26 of the paper book) shows that the Complainant sent all the necessary documents to the Opposite Parties for processing his claim at the earliest. Thereafter, vide letter dated 20.05.2015 the Opposite Parties again sought indoor case papers and in this letter, the Opposite Parties themselves admitted that the claim papers were received by them on 30.03.2015 i.e. two months prior to the query in the said letter. Thereafter vide letter dated 06.06.2015 sent through registered post on 13.06.2015 the Complainant has mentioned that he had already submitted all the desired documents on 05.05.2015 and requested the Opposite Parties to settle the claim at the earliest. Finally, vide letter dated 02.06.2015, the Opposite Parties informed the Complainant that his claim has been closed as ‘No Claim’ as the documents required were not submitted.
9.         A careful scrutiny of the entire record placed before us shows that the Complainant had submitted all the requisite documents to the Opposite Parties earlier as well as after the filing of the present Complaint. As per the case of the Complainant he had purchased the policy in question by paying a premium of Rs.5,692/- and the policy ensures the treatment of the Complainant as well as his wife or anyone of them upto Rs.2,000,00/-. It is not the case of the Complainant that he did not pay the premium or his wife did not get the treatment. Even the bills filed to the tune of Rs.10,841/- has nowhere been rebutted by the Opposite Parties. Hence, the act of the Opposite Parties to avoid the settlement of the genuine claim of the Complainant deliberately despite receiving all the requisite documents, to our mind amounts to deficiency in service and their indulgence into unfair trade practice, which certainly has caused unprecedented physical and mental harassment to the Complainant and forced him to indulge in the present unnecessary litigation. 
10.         In view of the above, the complaint deserves to be allowed. Accordingly the complaint is partly allowed against Opposite Parties and they are directed as under:-

 

1. To pay Rs.10,841/- as medical claim to the Complainant, along with interest @9% p.a. from 02.06.2015 (when the case of the Complainant was closed as “No Claim”), till realization;
2. To pay Rs.5,000/-, as compensation for mental agony and physical harassment caused to the complainant and also for deficiency in providing service and adopting unfair trade practice.

 

3. To pay cost of litigation, to the tune of Rs.5,000/- to the complainant.

 

15.         The above said order shall be complied within 30 days of its receipt by the Opposite Parties; thereafter, they shall be liable for an interest @12% per annum on the amount mentioned in sub-para [i] above from 02.06.2015, till it is paid. The compensation amount as per sub-para [ii] above, shall carry interest @12% per annum from the date of institution of this complaint, till it is paid, apart from complying with the directions as contained in sub-para [iii] above. 

 

16.         The certified copies of this order be sent to the parties free of charge. The file be consigned.

		Sd/-	Sd/-
10/09/2018		[Surjeet Kaur]	[Rattan Singh Thakur]
		Member	President
“Dutt”