Delhi

East Delhi

CC/129/2017

MADHUSUDHAN GARG - Complainant(s)

Versus

N.I.C. - Opp.Party(s)

06 Sep 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

C.C. NO. 129/17

 

Shri Madhu Sudan Garg

H. No. E-1138/A, Hari Om Gali

Near Alka Public School, Babarpur,

Shahadara, Delhi- 110032

….Complainant

Vs.    

 

1. National Insurance Company Ltd.

Branch XXVII Eleventh Floor,

Scope Minar North Tower, Core 2,

Laxmi Nagar District Center,

Shahdara, Delhi- 110092

 

 

2. Bank of Baroda

Vishvas Nagar,

Delhi- 110032

Through its Branch Manager

1.  

 

Date of Institution: 29.03.2017

Judgement Reserved on: 06.09.2019

Judgement Passed on: 16.09.2019

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By: Harpreet Kaur Charya (Member)

 

JUDGEMENT

The facts necessary for disposal of the present complaint are that the complainant had initially filed complaint where he had impleaded National Insurance Co. Ltd. as OP-1, M/s Raksha TPA Pvt. Ltd. as OP-2 and Bank of Baroda as OP-3. Subsequently, OP-2 was dropped from the array of parties and thereafter amended memo of parties was filed.

The complainant and his family were under cover of mediclaim, continuously for last 8 years. The complainant was maintaining SB account no. 32010100002638 with OP-2, Bank of Baroda who use to collect the premium for the mediclaim policy and forward the same to OP-1, the insurance company. It has been stated that the policy document was issued after 2 to 3 months upon receipt of premium by OP-1.

Mediclaim policy no. 361701501510000598 was issued by OP-1 for the period from 29.12.2015 to 28.12.2016. The premium of Rs. 4,845/- for the renewal of said policy was debited from the complainant’s account on 19.12.2016 by OP-2.

On 18.02.2017, the wife of the complainant Smt. Pankaj Garg was admitted in Shri Ram Singh Hospital. Cashless claim was denied on the pretext that the mediclaim policy had not been renewed as the premium had not been received by OP-1. Thereafter, claim for reimbursement was filed, which was also rejected on the same ground by OP-1.

The complainant enquired from OP-2, where he came to know that OP-2 had already issued a DD bearing no. 584997 of Rs. 4,845/- dated 19.12.2016 in favour of OP-1 for renewal of mediclaim policy. It has been stated by the complainant that as per communication between OP-1 and OP-2 which is of date 29.12.2016, OP-2 was informed regarding mentioning of wrong policy number for the purpose of renewal which was ignored by them,  therefore both OP-1 and OP-2 negligent. The complainant has also stated that as per mail dated 29.12.2016 the name of the complainant was mentioned but even then OP-1 did not renew the policy despite getting the premium. Therefore, the non-renewal of policy amounts of deficiency in services on the part of OP-1 and at the same time, since, OP-2 was negligent and failed to rectify the error of mentioning the wrong policy number, he was also liable for deficiency in services.

Despite communication neither the claim of the complainant was settled nor any satisfactory reply was given by OPs. Complainant also requested for issuance of new mediclaim policy vide mail dated 26.02.2017 and reimbursement, which also remained unanswered. OP-2 refused to refund the premium amount of Rs. 4,845/- deducted on account of renewal of mediclaim policy in dispute.  

Stating that both OP-1 and OP-2 have acted in gross negligent manner, which amounts to deficiency in services, the complainant has filed the present complaint with prayer for directions to OPs to pay Rs. 31,259/- alongwith        interest @ 24% per annum; to refund Rs. 4,845/- alongwith interest @24% per annum and Rs. 2,00,000/- as compensation on account of mental agony and harassment.

The complainant has annexed copy of Aadhar card, copy of mediclaim policy no. 36170150151000598, copy of e-mail dated 29.12.2016, copy of letter dated 20.02.2017, copy of discharge summary dated 22.02.2017, copy of invoice and receipts issued by Shri Ram Singh Hospital dated 22.02.2017 and copy of pass book of the complainant’s account with OP-2 with the complaint. 

Written Statement was filed on behalf of OP-1, the insurance company where they have taken several pleas in their defence such as there was no privity of contract between the complainant and OP-1 at the time of treatment of the complainant’s wife, hence, the complainant was not consumer qua them. It was submitted that the complainant and OP-2 had failed to get the policy renewed in time and even within the grace period therefore they were not liable to pay the claim. It was submitted that M/s Raksha TPA Co. Ltd. had asked the Hospital vide letter dated 20.02.2017 for furnishing the renewed policy to enable them to process the claim of the complainant. It was admitted that OP-2 had sent a request for renewal of policy bearing number 3617015015100000660 w.e.f. 28.12.2016 but there was error in the policy number which was brought to the knowledge of OP-2 through email, but OP-2 failed to furnish the correct policy number despite request which was admitted by OP-2 vide letter dated 12.10.2017 stating that “inadvertently the policy number mentioned on it was wrong. Perhaps, your office had sent a mail regarding this error which could not be attended at our end due to unprecedented rush of demonetization”. It was further submitted that the policy was issued for the period from 01.03.2017 to 20.02.2017 vide policy no. 361701501610007523”. Rest of the contents of the complaint have been denied with prayer for dismissal of complaint with heavy cost.

OP-1 has annexed copy of letter dated 12.10.2017 as Annexure R1/1 and copy of policy as Annexure R1/2 (Colly.) with the reply.

OP-2, Bank of Baroda have also filed Written Statement, where they have stated that the complaint was bad for misjoinder of answering parties as the claim pertained to the mediclaim policy issued by OP-1. It was submitted that the role of OP-2 was merely confined with respect to receiving of policy premium and forwarding the same to OP-1 and it was only upon receipt of premium OP-1 issued policy. In case there was any query or doubt regarding the premium/ policy OP-1 was under obligation to intimate OP-2 immediately.  It was also submitted that in the present case policy bearing no. 3617015015100000660 was to be renewed w.e.f. 28.12.2016 for which banker’s cheque no. 584997 dated 19.12.2016 was issued to OP-1 and subsequent to which no intimation was sent to them regarding the policy in dispute. They have submitted that it was only upon the receipt of Notice of the present complaint they came to know that the policy of the complainant was not renewed. The factum of any intimation by OP-1 was denied and was stated that OP-1 had correspondence details/ telephone number of the complainant and could have intimated the complainant and it was the callous attitude on the part of OP-1, the banker’s cheque could not be cancelled and the proceeds could not be credited to the complainant’s account.  

On 22.09.2017 a meeting was held by the officials of OP-2 with OP-1 to resolve the complainant’s issue but nothing had been done by OP-1. They have denied that there was any negligence on their part, and have submitted that               OP-1 was solely responsible for the negligence, if any. (They have also denied rest of the contents of complaint.  

Rejoinder to Written Statement of OP-1 was filed by the complainant where he has denied the submissions made on behalf of OP-1 and reiterated the contents of the complaint. It has been submitted that policy bearing                         no. 361701501610007523 was issued from 01.03.2017 deliberately excluding the period in which the claim of the complainant was made.

In Rejoinder to Written Statement of OP-2, the complainant has stated that OP-2 was duly informed about the non-renewal of the mediclaim policy, but they failed to resolve the issue. Rest of the contents of the Written Statement have been denied and those of the complaint have been reiterated.

Evidence by way of affidavit was filed by complainant, where he has deposed on oath the contents of his complaint. He has got exhibited the copy of Aadhar Card as Ex.CW1/1.  He has stated that he had been subscribing for mediclaim policy for himself and family continuously for last 9 years. He has relied on policy for the period from 29.12.2015 to 28.12.2016, which is Ex.CW1/2. The copy of passbook from where the premium was debited has been exhibited as Ex.CW1/3. Medical Bills alongwith discharge summary are Ex.CW1/4 (Colly.). Letter dated 20.02.2017 and email dated 29.12.2016 are Ex.CW1/5 and Ex.CW1/6 respectively. He has deposed that an email dated 26.02.2017 was sent to OP with request for issuance of new mediclaim policy for the next term and reimbursement of the amount spent on the treatment of his wife, the said email is Ex.CW1/7.

OP-1 have got examined Shri Raghunath Panwar, Administrative Officer, who has re-affirmed the contents of their reply on oath and has got the copy of the renewed policy as Ex.R-1/2 (Colly) and copy of letter dated 12.10.2017 as Ex.R-1/1. He has stated that the policy of the complainant could not be renewed as there may be other insured persons having similar name, therefore, the correct policy number was mandatorily required for renewal of policy.

OP-2 have got examined Shri Ajay Kumar, Chief Manager, Authorized Signatory duly authorized by power of attorney dated 11.07.2017, Ex.OP1/1.  He has reiterated that they had never received any intimation from OP-1, with respect to the error in policy number. Emails dated 16.01.2018 sent by OP-2 to OP-1 are Ex.OP1/2.  He has further stated that even if the email as alleged by OP-1 was sent, the same could have been missed due to demonetization drive as they were handling large number of public.

We have heard the argument of Ld. Counsel of Complainant, Ld. Counsel for OP-1 and Ld. Counsel for OP-2. We have also perused the material placed on record. The dispute is with respect to the non-payment of claim of                       Rs. 31,259/-, which was rejected by OP-1 stating that there was no policy cover as on the date of admission/ treatment. It is an admitted fact by all the parties that the premium for the renewal of the mediclaim policy for period28.12.2016 to 27.12.2017 was to be deducted from the account of the complainant and then be forwarded by OP-2 to OP-1.

The said premium of Rs. 4,845/- was duly deducted from the account of complainant on 19.12.2016 for which a DD was prepared and forwarded to            OP-1. If we look at Ex.R-1/1 which is letter written by OP-2 to OP-1 for revalidation of policy of complainant w.e.f. 28.12.2016, where they have mentioned in point no. 2 “inadvertently the policy number mentioned on it was wrong, perhaps your office had sent a mail regarding this error which could not be attended at our end due to unprecedented rush of demonetization”. Further an email dated 29.12.2016 which is from DRO-II/ NIC to Bank of Baroda, Vishwas Nagar, where the subject is “Jeevan Sharma required correct policy number against DD number 584997 dated 19.12.2016 A/c Mr. Madhusudan Garg”. It reads:

Dear Sir,

           Please provide correct policy number for the said DD account as policy number you written 361700501510000660, which is in the name of Hema Sinha instead of Mr. Madhusudan Garg.

           Thus, it is clear that it was OP-2, Bank of Baroda, who had written the wrong policy number against the premium deducted from the account of complainant. The excuse for negligence by OP-2 that due to demonetization they could not share the correct policy number of the complainant does not absolve them from their negligence, the complainant cannot be made to suffer for the negligence of the staff of OP-2.

           The callous attitude/ negligence of the staff of OP-2 is also obvious from Ex.CW1/5, which is letter dated 20.02.2017, which was issued by ‘Raksha TPA’ to ‘Shri Ram Singh Hospital and Heart Institute’, where they have asked for the renewed policy. The said letter bears an endorsement by some official of OP-2, where they have endorsed “payment has been made by DD no. 584997 dt. 19.12.2016” and the said endorsement has been signed with the date 20.12.2016. This again shows the negligence in the working of the staff of OP-2. When the letter is of 2017, then how can the official of OP-2 endorse it with date of year 2016, this is a serious matter.

           During the course of argument the counsel for complainant has stated that the premium of Rs. 4,845/- that had been deducted from the account of complainant on 19.12.2016 has been credited by OP-2 on 16.01.2018. The complainant in his complaint has prayed for interest on the said amount. To decide upon that if we look at Ex.OP1/2, which are mails exchanged between OP-1 and OP-2 with respect to cancellation of BC no. 584997 dated 19.12.2016 in connection with health policy of Mr. Madhusudan Garg. From this communication it is not clear as to who was in possession of the demand draft for fixation of liability to pay interest but it is clear that the complainant was deprived of enjoyment of the amount deducted on account of premium. Therefore, we direct OP-1 and OP-2 jointly and severally liable to pay                   interest @6% per annum from 19.12.2016 to 16.01.2018.

           OP-1 cannot be held liable of deficiency in service as they had intimated OP-2 regarding the error in policy number vide email dated 29.12.2016. Further, the complainant had requested for renewal of policy on 26.02.2017 and thereafter policy was renewed from 01.03.2017. So, OP-1 cannot be held liable to pay the claim amount as neither complainant nor his family had mediclaim cover.

           Hence,in the facts and circumstance of the present complaint, we hold only OP-2 is deficient in services. Therefore, we direct OP-2 to pay Rs. 31,259/- incurred by complainant on medical treatment expenses alongwith interest @9% from the date of filing of complaint till realization.

We further award compensation on account of mental agony and harassment of Rs. 15,000/- as the conduct of OP-2 in not rectifying the error committed by them and rendering complainant without any mediclaim cover for the period 28.12.2016 to 28.02.2017.

Copy of the order be supplied to the parties as per rules.

           File be consigned to Record Room.

 

 (HARPREET KAUR CHARYA)                                                                      (SUKHDEV SINGH)

                           Member                                                                                                   President