DISTRICT CONSUMER DISPUTES REDRESSAL FORUM PALAKKAD
Dated this the 29th day of January 2011
Present : Smt.Seena H, President
: Smt. Preetha.G. Nair, Member
: Smt. Bhanumathi.A.K, Member Date of filing: 08/12/2009
(C.C.No. 162/2009)
Saliheen Abdhul Jabbar Zarenabegum
Baithulnoor, Behind Mariam College,
Vadakkupadam, Koduvayur Post
Palakkad, Kerala – 678 501 _ Complainant
(By Adv.Dhananjayan)
V/s
1.Manager
M/s.Reliance General Insurance Co.Ltd
Policy Issuing Office,
570 Rectifier House
Laiguti Cross Road
Wadala (W), Mumbai
(By Adv.S.Mammu)
2. Manager,
M/s.Reliance General Insurance Co.Ltd
(RGCL), Palakkad
Mangalam Towers, Opp.Town Bus Stand
TB Road, Palakkad 678 014
(By Adv.S.Mammu)
3. Manager,
M/s.SOS International
International SOS Service (India) P.Ltd
Suite No.605, 8th Floor
Copia Corporate Suite
Plot No.9, Jascofa District Centre
New Delhi – 110 025 - Opposite parties
O R D E R
By Smt.SEENA H, PRESIDENT
Complaint in brief :
Induced by attractive offers by 2nd opposite party complainant took a travel insurance policy known as Reliance Travel Care Insurance Policy vide Policy No.2209592817000002. 1st Opposite party is the registered office of 2nd opposite party. The period of coverage of the policy was from 9/3/2009 to 19/8/2009 and premium paid was Rs.4183/ The total sum insured was Rs,50,000/- Terms and conditions are specifically stated in the policy. Complainant has taken the policy to meet the unexpected contingent expenses during her visit to USA, Canada and United Kingdom. While the complainant was at UK, she had to take a treatment for her dental problem at London on 26/6/2009 from the Newham Family Dental care Centre, London. Receipt for the payment of the fees was also given. Complainant is entitled to get the medical claim from the opposite party. After reaching Palakkad on 14th August 2009 complainant preferred claim petition with the 3rd opposite party who is the claim department of 1st opposite party. Even though claim petition was received, opposite party has not satisfied the claim. Instead has sent letter asking more details like detailed medical record, original air ticket / boarding pass or copy of passport with exit and entry stamp, all original invoice and receipt paid for medical expenses relating to the claim and detail claim amount in actual currency. Complainant has sent all the original documents such as original invoice of air ticket, copy of air ticket, Visa page with seal and original hospital receipt etc. on 29/9/2009. Even then opposite party did not satisfy claim of the complainant. Again on 3/11/2009, 3rd opposite party sent a letter stating as the required details not furnished, they are treating the claim as withdrawn and closed. According to complainant, the act of opposite parties amounts to clear deficiency in service. Complainant is entitled for a sum of Rs.4,000/- for her medical treatment and Rs.10,000/- as compensation towards mental agony and damage.
3rd opposite party set exparte. 2nd opposite party filed version contending the following.
That the opposite party has admitted the Travel Insurance Policy issued to complainant for the period 9/3/2009 to 19/8/2009. 1st and 2nd Opposite party after the receipt of the claim petition has asked the complainant by way of letter to submit certain documents related to the claim, but complainant has submitted only documents related to the travel company has also submitted a receipt dated 29/9/09 issued from the hospital. But according to opposite parties as the alleged treatment was outside India, an unauthenticated document like receipt cannot be accepted as such without any supporting documents under the above circumstances opposite party has no other way but to close the claim. Hence there is no deficiency in service on their part.
Evidence led by the complainant consist of the proof affidavit and Ext.A1 to A7 documents . Opposite parties has not filed any chief affidavit. No documentary evidence on the side of opposite parties.
Now the issue that arise for our consideration are
1)Whether there is deficiency in service on the part of opposite
parties?
2)If so, what is the relief & costs complainant is entitled to ?
Issue No.1 & 2
The definite case of the complainant is that complainant availed a travel insurance policy from the opposite party for a sum of Rs.50,000/ during her visit at UK, she has undergone treatment for dental problem. Complainant approached opposite party with all the requisite documents, but they were not ready to settle the claim.
Opposite party on the other hand contented that complainant has only produced a receipt issued by the hospital for the proof of the medical treatment and as the treatment was availed outside India, an unauthenticated document like receipt is not acceptable without any supporting documents and hence claim was repudiated.
Heard both parties and has gone through the entire evidence on record.
Policy is seen to be admitted by both parties. The only point on which opposite party has repudiated the claim is with regard to the authenticity of the receipt issued by the hospital where the complainant has undergone treatment. According to opposite party more supporting documents to prove this aspect ought to have produced by the complainant. This contentions seems to be unacceptable. Ext.A7 is the letter issued by opposite party on behalf of opposite parties settling the claim for Rs.1202.74/- The said cheque is seen to be issued by 3rd opposite party on behalf of opposite parties during the pendency of the proceedings before the Forum. The act of opposite parties leads to the presumption that having satisfied with the genuineness of the claim only, opposite party has settled it even though for a lesser amount. Claim of the complainant is for £45.60 (equivalent. to Rs.3603/ Indian money) out of which opposite party has paid Rs.1202.74. An amount of Rs.2,439.03/ is seen to deducted for which no proper explanation is forthcoming on the part of opposite parties. Opposite parties has taken steps to settle the claim only after the initiation of the proceedings before the Forum. Hence, we find opposite party is deficient in their service.
In the result, complaint is allowed. Opposite parties jointly and severally directed to pay complainant an amount of Rs,2400.26 rounded to Rs.2400/- (Rs.3603 – Rs.1202.74) together with Rs.2,000/- as compensation and Rs.1000/ as cost of proceedings. Order to be complied within one month from the date of receipt of order and failing which the complainant is entitled to get the whole amount with 9% interest from the date of order till realisation.
Pronounced in the open court on the 29th day of January 2011
Sd/-
Smt.Seena H,
President
Sd/- Smt.Preetha.G.Nair
Member
Sd/-
Smt.Bhanumathi.A.K Member
APPENDIX
Witnesses examined on the side of the complainant
Nil
Witnesses examined on the side of the Opposite parties
Nil
Exhibits marked on the side of the complainant
Ext.A.1. Copy of the policy dated 19th August 2009
Ext.A2 - Copy of the passport
Ext.A3.- Xeroxcopy of claim Form
Ext.A4.- Copy of the medical bill issued by the Newharm Family Dental Care Centre, London
Ext.A5 - Copy of the letter sent by the complainant to the 3rd opposite party dated 29/9/2009.
Ext.A6 - Closing letter issued from the 3rd opposite party.
Ext.A7 - Copy of letter regarding claim settlement issued by 3rd opposite party.
Exhibits marked on the side of the opposite party
Nil
Cost Allowed
Rs.1000/ allowed as cost of proceedings.
