Delhi

East Delhi

CC/764/2014

PRAKASH - Complainant(s)

Versus

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

-

28 Apr 2017

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.  764/14

 

1. Shri Prakash Chandra Gupta

S/o Shri Kailash Chand Gupta

H. No. 245, Ramkrishna Apts.

Patparganj, I.P. Extension

Delhi – 110 092                                                           …….Complainant

Vs.

1. Oriental Insurance Company Ltd.

DO 13 23/23 B EMCA House, Ansari Road

Darya Ganj, New Delhi – 110 002

Through its Development Manager

 

2. M/s. Vipul Medcorp TPA Private Ltd.

515, Udyog Vihar, Phase – V

Gurgaon – 122 016

 

3. Oriental Bank of Commerce

I.P. Extensiion, Patparganj, Delhi – 110 092

Through its Branch Manager                                              ….Opponents

 

Date of Institution: 10.09.2014

Judgment Reserved on: 28.04.2017

Judgment Passed on: 01.05.2017

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari  (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By : Sh. Sukhdev Singh (President)

 

JUDGEMENT

          This complaint has been filed by Shri Prakash Chandra Gupta against Oriental Insurance Company Ltd. (OP-1), M/s. Vipul Medcorp TPA Pvt. Ltd. (OP-2) and Oriental Bank of Commerce (OP-3) under Section 12 of the Consumer Protection Act, 1986. 

2.       The facts in brief are that the complainant was issued a mediclaim policy no. 271600/48/2014/21 for the period 03.04.2013 to 02.04.2014 from M/s. Oriental Insurance Company Ltd. (OP-1).  The complainant issued a cheque no. 030626 dated 01.04.2014 for Rs. 23,139/- in favour of OP-1, drawn on OP-3 bank towards premium of the said policy for renewal of policy.  OP-1 issued receipt dated 02.04.14 acknowledging the receipt of the cheque dated 01.04.2014.  OP-1 renewed the said policy vide policy no. 271600/48/2015/20 dated 02.04.2014 for the period w.e.f. 03.04.2014 to 02.04.2015.

          It is stated that Cheque no. 030626 dated 01.04.2014 for          Rs. 23,139/- in favour of OP-1 was wrongly dishonored by OP-3 bank on the ground of post dated as the said cheque was not post dated.  The complainant deposited the premium of Rs. 23,273/- in cash with OP-1 on 07.04.2014 and OP-1 issued receipt dated 07.04.2014.  Accordingly, OP-1 again renewed the policy vide policy                       no. 271600/48/2015/91 dated 07.04.2014 for the period 07.04.2014 to 06.04.2015 after condoning the delay and considering the fact that the cheque was wrongly dishonored by OP-3.  The same was mentioned on the policy dated 07.04.2014.

          The wife of the complainant Smt. Meena Gupta met with an accident and admitted in Shanti Mukund Hospital.  She was discharged from the hospital on 06.04.2014.  OP-1 and OP-2 refused to entertain the claim of the complainant of Rs. 52,896/- on the ground that the policy stands cancelled in view of the dishonor of the cheque of the premium amount.

          It is further stated that the complainant visited the office of OP-1 in the mid of April 2014 and met with the Development Manager of OP-1 who asked the complainant to submit his claim.  Accordingly, the complainant submitted his claim in the mid of April 2014 alognwith relevant documents as demanded by OP-1. 

Thereafter complainant received a letter dated 02.05.2014 from OP-2 in which they have stated that why the complainant did not submit the claim within time.  The complainant sent the communication explaining the reasons of submitting the claim late.  The complainant again received a letter dated 20.05.2014 from OP-2, wherein it was informed that the claim would be processed, but the claim of the complainant has not been settled till date.  Due to the negligence and deficiencies on the part of OPs, the complainant has prayed for refund of Rs. 52,896/- spend by the complainant on the treatment of his wife alongwith interest @ 24% p.a. and Rs. 2,00,000/- on account of compensation.

3.       In reply, Oriental Bank of Commerce (OP-3) have stated that the complaint is not maintainable as the relief has been sought from OP-1 and OP-2.  It is further stated that the cheque no. 030626 of               Rs. 23,139/- was returned as “instrumental post dated” as the cheque was presented on 04.04.2014 and the date mentioned on the cheque was 07.04.2014.

          OP-1, in their reply, have stated that they renewed the policy vide policy no. 271600/48/2015/20 for the period 03.04.2014 to 02.04.2015, subject to realization of cheque no. 030626 dated 01.04.2014.  When the said cheque was dishonored due to reason “instrument post dated”, they have cancelled the policy no. 271600/48/2015/20 for the period 03.04.2014 to 02.04.2015.  They renewed a fresh policy                      no. 271600/48/2015/20 for the period from 07.04.2014 to 06.04.2015 after depositing the premium in cash by the complainant on 07.04.2014. 

They have further stated that it was clearly mentioned in the policy “That in case of dishonor of premium cheque the company shall not be liable under the policy and the policy shall be void abinito (from inception)”. 

It is stated that the complainant was not covered under the policy on 05.04.2014 as the policy was cancelled due to dishonor of cheque of premium; the complainant did not give the intimation of hospitalization within 48 hours and submit the claim documents within 7 days of discharge as per terms and condition of the policy.  Other facts have also been denied.

No WS was filed by OP-2.

4.       The complainant has filed rejoinder to the WS of OP-1 and 3, wherein he has controverted the pleas taken in the WS and reasserted his pleas.

5.       In support of its complaint, the complainant has examined himself on affidavit.  He has narrated the facts which have been stated in the complaint.  He has also got exhibited documents such as copy of mediclaim policy no. 271600/48/2014/21 for the period 03.04.2013 to 02.04.2014 (Ex.CW1/1), receipt of the cheque dated 01.04.2014 (Ex.CW1/2), copy of receipt dated 02.04.2014 (Ex.CW1/3), copy of policy valid w.e.f. 03.04.2014 to 02.04.2015 (Ex.CW1/4), copy of letter dated 14.08.2014 (Ex.CW1/5), copy of pass book (Ex.CW1/6), receipt dated 07.04.2014  issued by OP-1 (Ex.CW1/7), copy of policy             no. 271600/48/2015/91 renewed for the period from 07.04.2014 to 06.04.2015 (Ex.CW1/8), copy of discharge summary and medical bills (Ex.CW1/9) (colly), copy of letter dated 08.04.2014 (Ex.CW1/10), copy of letter dated 02.05.2014 (Ex.CW1/11), copy of communication sent by the complainant (Ex.CW1/12), copy of letter dated 19.05.2014 (Ex.CW1/13), copy of letter dated 20.05.2014 (Ex.CW1/14) and copy of letter dated 01.06.2014 (Ex.CW1/15).

          In defence, OP-3 has examined Shri Manpal Singh, Manager of OP on affidavit.  He has also narrated the facts which have been stated in the WS.  He has also got exhibited copy of letter dated 14.08.2014 (Ex.R3W1/1).

          OP-1 has examined Shri Satish Kumar Sharma, Manager of OP on affidavit.  He has also narrated the facts which have been stated in the WS. 

6.       We have heard Ld. Counsel for parties and have perused the material placed on record.  It has been argued on behalf of the complainant that dishonor of cheque did not affect the policy as before dishonor of chdque, the complainant have deposited the premium by way of cash.  He has further argued that the policy was in operation before the date of accident as it was renewed by condoning the delay from 03.04.2014 and the premium was paid in cash on 07.04.2014 before the date of cancellation i.e. 08.04.2014. 

          On the other hand, Ld. Counsel for OP-1 have argued that condonation of delay was only for the purpose of Exclusion Clause. 

To appreciate the arguments of Ld. Counsel for the parties, a look has to be made to the evidence and the documents placed on record by both the parties.

          Firstly, the testimony of complainant Shri Prakash Chandra Gupta is taken up.  From his testimony, it is evident that mediclaim policy no. 271600/48/2014/21 was issued for the period 03.04.2013 to 02.04.2014 as pe policy (ex.CW1/1).  For renewal of this policy cheque (Ex.CW1/2) of dated 01.04.2014 was issued against receipt (Ex.CW1/3), which is of dated 02.04.2014.  This policy has been renewed from 03.04.2014 to 02.04.2015 as per policy (Ex.CW1/4).  Cheque issued as stated have been dishonored and complainant deposited the amount of Rs. 23,273/- on 07.04.2014 vide receipt (Ex.CW1/7).  This policy has again been renewed w.e.f. 07.04.2014 to 06.04.2015 vide policy (Ex.CW1/8).

          Shri Satish Kumar Sharma, Manager of Oriental Insurance Company (OP-1) has not differed on the question of issuance of policy and its renewal.  This witness has further stated that claim of the complainant was not covered as the policy was cancelled due to dishonor of cheque.

          The question that arises for consideration is as to whether on the date of accident, the complainant was covered under the policy, issued by OP.  Document (Ex.CW1/1) is a policy, which was for the period 03.04.2013 to 02.04.2014.  This policy has been renewed vide           Ex. CW1/4 w.e.f. 03.04.2014 to 02.04.2015.  Again this mediclaim policy has been renewed from 07.04.2014 to 06.04.2015, which is Ex. CW1/8.  The plea of counsel for OP-1 have been that the period of insurance as stated in this policy has been 07.04.2014 to 06.04.2015 and it does not cover the date of accident i.e. 05.04.2014 as it does not commence from 03.04.2014. 

          The simple argument which has been advanced on behalf of   OP-1 has been that the earlier policy, which was operative from 03.04.2014 to 02.04.2015 was not in operation due to dishonor of cheque.  Though, the policy which was in operation from 03.04.2014 to 02.04.2015 was cancelled on the ground of dishonor of cheque, but the fact remains that the complainant have deposited the cash on 07.04.2014 and the delay in renewal has been condoned by the Oriental Insurance Company Ltd. 

          To quote from Ex.CW1/8, which is a policy effective from 07.04.2014 to 06.04.2015, it has been stated in the policy itself “Delay in renewal due to bank fault condoned by DM”.  Thus, from this, it is evident that the delay in renewal of the policy has been condoned.  When the delay has been condoned, the policy remains effective from 03.04.2014 to 06.04.2015 instead of 07.04.2014 to 06.04.2015.  That being so, it covers the date of accident which is 05.04.2014.  Thus, the plea of Ld. Counsel for OP that condonation of delay was only for the purpose of Exclusion Clause does not hold good.  When the policy was renewed condoning the delay, it relates back to the earlier policy which was expiring on 02.04.2014.  The fact that the commencement of policy relates back and the period of commencement starts from 03.04.2014 and expires on 02.04.2015, certainly, the period of accident which is of dated 05.04.2014 was covered under the policy. 

When the accident was covered under the policy, the rejection of claim by the insurance company on the ground that the complainant was not covered under the policy as the policy was cancelled due to dishonor of cheque, does not arise.  Thus, there has been deficiency on the part of OP.  when there has been deficiency on the part of OP, certainly, the complainant is entitled for the amount spent by him on the treatment of his wife amounting to Rs. 52,896/-.  Not only that, due to cancellation of policy, the complainant could not recover the amount which led to mental pain and agony.

In view of the above, it is ordered that M/s. Oriental Insurance Co. Ltd. (OP) shall pay an amount of Rs. 52,896/- alongwith 6% interest from the date of filing of complaint.  We further award an amount of    Rs. 20,000/- compensation on account of mental torture and harassment with Rs. 10,000/- towards litigation expanses.  The order be complied within a period of 45 days.  If not complied, then total amount of Rs. 82,896/-shall also carry interest @ 6% p.a. from the date of order till realization.

There is no liability of OP-2 and OP-3.               

                    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