| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA CC.No.365 of 07-09-2015 Decided on 08-02-2017 Mittar Sain Singla S/o Gopi Ram R/o H.No.B-28/41, Janta Colony, Rampura Phul, Tehsil Phul, District Bathinda C/o Singla Tea Industries Near Railway Crossing, Rampura Phul, Tehsil Phul, District Bathinda. ........Complainant Versus 1.Oriental Bank of Commerce, Rampura Phul, Tehsil Phul, District Bathinda. 2.The Oriental Insurance Company Ltd., Branch Office, Rampura Phul, Tehsil Phul, District Bathinda, through its Manager. .......Opposite parties Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Sh.M.P Singh Pahwa, President. Sh.Jarnail Singh, Member. Present:- For the complainant: Sh.Ritesh Singla, Advocate. For opposite party No.1: Sh.Rajneesh Rampal, Advocate. For opposite party No.2: Sh.Sunder Gupta, Advocate. ORDER M.P Singh Pahwa, President The complainant Mittar Sain Singla (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986 against opposite parties Oriental Bank of Commerce and Other (here-in-after referred to as opposite parties). Briefly stated, the case of the complainant is that he is permanent resident of Rampura, District Bathinda. He is holding an account No.06422191049318 with opposite party No.1. On 22.4.2015, he visited the office of opposite party No.1. The concerned manager of opposite party No.1 as well as insurance adviser of opposite party No.2 induced the complainant to purchase medi-claim policy of opposite party No.2 for himself and his family members. It was revealed by opposite parties that in case of any health problem, the complainant and his family members will be entitled to reimbursement of the amount spent for the treatment. Considering the scheme beneficial, the complainant agreed to purchase the policy. Opposite parties assured him to provide the best services. Accordingly, officials of opposite parties obtained the signatures of the complainant on various blank printed forms on 22.4.2015, including proposal form, for issuance of medi-claim policy in the name of the complainant and his wife Sushila Devi. He purchased the policy for Rs.5 lakhs and he was required to deposit the premium of Rs.6830/- with opposite party No.2. He got prepared a demand draft No.612992 dated 22.4.2015 drawn on OBC, Rampura Phul and handed over the same to opposite parties. Opposite parties also assured the complainant that the policy has started w.e.f. 22.4.2015 on account of payment of the premium amount and he shall receive the policy within a few days, but he has not received any policy till date. It is alleged that on 11.5.2015, the wife of the complainant namely Sushila Devi, who is also life assured under the policy, met with an accident and sustained multiple grievous injuries at Sri Nagar. She was got admitted in SKIMS Medical College & Hospital, Bemina, Sri Nagar. The complainant spent Rs.10,000/- for providing first aid to his wife in the hospital and thereafter he, after hiring Ambulance, took his wife to Chandigarh by spending Rs.7000/- and got her admitted in Sri Guru Harkrishan Sahib & Eye Hospital Trust, Sohana, Mohali on 11.5.2015 itself vide IP No.15/4552, MRD No.1565562. Sushila Devi remained admitted in the hospital up to 16.5.2015 and she was operated and treated for the injuries on her person and discharged on 16.5.2015. After 16.5.2015, the complainant visited the hospital alongwith his wife for follow-up treatment as outdoor patient and he has also been purchasing the medicines from Mehraj Medicos, Rampura Phul. He has already spent approximately Rs.76,435/- for the treatment of his wife. It is further alleged that the intimation regarding the accident of the wife of the complainant was given to opposite parties telephonically and complainant also intimated opposite party No.1 about the accident of his wife in writing on 23.5.2015 as required by opposite party No.1. He lodged the medical claim with opposite parties, but on 27.5.2015, opposite party No.1 repudiated the lawful claim of the complainant on the ground that the policy was issued to him on 20.5.2015 while his wife met with an accident on 11.5.2015. He again sent letter to opposite party No.1 on 1.6.2015 and requested it that the policy was purchased on 22.4.2015 and demand draft was also issued on 22.4.2015, which was got encashed by opposite parties in the month of April 2015 itself. In case of any delay in issuance of the policy i.e. one month from the date of purchase of policy, opposite parties are themselves responsible for the same and they cannot take shelter of the fact that the policy was issued on 20.5.2015, but opposite parties did not pay any heed to his request and again repudiated his claim vide letter dated 10.6.2015. It is further alleged that opposite parties have concocted a false story only to escape from their liabilities of making payment of the insurance claim. On this backdrops of fact, the complainant has alleged deficiency in service on the part of opposite parties and has prayed for directions to opposite parties to reimburse the medical claim of Rs.76,435/- and also claimed Rs.50,000/- as compensation and Rs.55,000/- as cost of litigation. Hence, this complaint. Upon notice, opposite parties appeared through their respective counsel and contested the complaint by filing their separate written version. In its separate written version, opposite party No.1 has raised the legal objections that there is neither deficiency in service nor unfair trade practice on its part. Sushila Devi wife of the complainant, who allegedly met with an accident, she herself is assured with the policy. The complainant has no locus-standi or cause-of-action to file this complaint. The complaint is not maintainable and complainant has not come with clean hands and has suppressed the material facts from this Forum. He is estopped from filing this complaint by his own acts, conduct and acquiescence. The complaint is bad for non-joinder of necessary parties i.e. Third Party Administrator under the policy. The intricate question of law and facts are involved in this case and parties have to lead evidence by examining the witnesses and cross-examination of the witnesses is necessary. The matter cannot be decided in summary procedure. The complainant may approach the civil court, if advised. The complaint is false, frivolous and vexatious and it has been filed to cause undue harassment and botheration to opposite party No.1. It is liable to dismissed with penalty. On merits, it is denied that opposite party No.1 induced the complainant to purchase medi-claim policy from opposite party No.2 for himself and his family members. The complainant himself requested the manager of opposite party No.1 that he wants to purchase medi-claim policy for himself and his wife. It is admitted that he got prepared a demand draft No.612992 dated 22.4.2015 in the name of opposite party No.2 being the premium amount of insurance policy. It is further mentioned that the liability to pay the claim, if any under policy is subject to terms and conditions enshrined in the policy. It is admitted that the proposal form was filled up and information provided by the complainant and his signatures were obtained on the proposal form on 23.4.2015 It is further mentioned that the demand draft got issued by the complainant alongwith proposal form was sent to opposite party No.2. The medi-claim policy No.233200/48/2016/478 insuring the complainant and his wife Sushila Devi for the period from 18.5.2015 to 17.5.2016 has been issued. It is denied that opposite party No.1 assured the complainant the insurance policy has commenced w.e.f. 22.4.2015. There is process of issuing the policy at the end of opposite party No.2. Opposite party No.2 sent the medi-claim policy and policy documents in due process. It is pleaded that as per complainant, his wife Sushila Devi met with an accident on 11.5.2015. The medi-claim policy became effective from 18.5.2015 and on that date, the complainant and his wife were not insured with opposite party No.2. Moreover it is for opposite party No.2 to decide the payment of claim, if any, relating to the assured persons as per terms and conditions of the policy, but since the complainant and his wife were not insured, as such, they were not entitled to claim any amount. All other averments of the complainant are controverted. In the end, opposite party No.1 prayed for dismissal of complaint. In its separate written version, opposite party No.2 has also raised the legal objections regarding non-joinder of necessary party i.e. Medi Assist. There is no privity of contract between the complainant and opposite party No.2 to indemnify the insured as wife of the complainant has allegedly met with an accident on 11.5.2015 and Oriental Bank Mediclaim Policy Schedule was issued on 18.5.2015 and it was effective from 18.5.2015 to 17.5.2016. The wife of the complainant received injuries on 11.5.2015 and she was discharged on 16.5.2015 i.e. before the commencement of the policy. As such, opposite party No.2 is not liable to pay any compensation to the complainant. It is further mentioned that opposite party No.2 received the premium from opposite party No.1 on 18.5.2015 alongwith list of other persons seeking mediclaim policies alongwith covering letter dated 15.5.2015 and mediclaim policy was issued on the same day i.e. on 18.5.2015. The negligence, if any, for depositing the proposal form alongwith premium is on the part of opposite party No.1. The complaint against opposite party No.2 deserves dismissal. Opposite party No.2 has also raised legal objections regarding concealment of true facts, locus-standi or cause-of-action and that the complaint is false, frivolous and vexatious. On merits, opposite party No.2 has reiterated its stand as taken in the legal objections and detailed above and prayed for dismissal of complaint. Parties were asked to produce evidence. In support of his claim, the complainant has tendered into evidence photocopy of proposal form, (Ex.C1); photocopy of bank passbook, (Ex.C2); photocopy of medical record, (Ex.C3); photocopy of test advise, (Ex.C4); photocopies of reports, (Ex.C5 to Ex.C7); photocopy of discharge summary, (Ex.C8); photocopies of bills/receipts/cash memos, (Ex.C9 to Ex.C17) photocopies of letters, (Ex.C18 to Ex.C21); his affidavit dated 10.2.2016, (Ex.C22) and closed the evidence. To rebut the claim of the complainant, opposite party No.1 has tendered into evidence affidavit of Deepak Kumar dated 12.4.2016, (Ex.OP1/1) and closed the evidence. Opposite party No.2 has tendered into evidence affidavit of Roop Lal dated 5.5.2016, (Ex.OP2/1); photocopy of policy, (Ex.OP2/2); photocopy of letter, (Ex.OP2/3); photocopy of terms and conditions, (Ex.OP2/4) and submitted written arguments. We have heard learned counsel for parties and gone through the file as well as written arguments submitted by opposite party No.2. Counsel for complainant has reiterated his stand as taken in the complaint and detailed above. It is further submitted by learned counsel for complainant that the material facts are not in dispute. It is not disputed that the complainant purchased mediclaim policy of opposite party No.2. On 22.4.2015, the premium of Rs.6830/- was paid to opposite party No.2 through opposite party No.1 vide bank draft dated 22.4.2015. This fact stands proved from the proposal form, (Ex.C1) and passbook, (Ex.C2). Opposite party No.1 was to forward this draft alongwith other documents to opposite party No.2 immediately and thereafter opposite party No.2 was to issue the policy. Opposite party No.2 has produced on record letter, (Ex.OP2/3), which proves that the application of the complainant alongwith other applications was received in the office of opposite party No.2 on 15.5.2015. This fact sufficiently proves that opposite party No.1 has caused deficiency in service by unnecessary delay in submitting form to opposite party No.2. It is also not disputed that the wife of the complainant met with an accident on 11.5.2015. In case, the policy was issued by opposite party No.1 w.e.f. 22.4.2015, the claim of the complainant regarding this accident was to be covered and fully reimbursed. Opposite party No.2 has repudiated the claim mainly for the reason that the accident has taken-place on 11.5.2015 and policy was issued w.e.f. 18.5.2015. The complainant was not at fault for any manner. He has spent Rs.76,435/- for the treatment of his wife Sushila Devi. She was also covered under this policy. Therefore, the complainant is entitled for reimbursement from opposite party No.1 as well as opposite party No.2. It is also submitted by learned counsel for complainant that opposite party No.1 was working as agent of opposite party No.2. Therefore, in case of deficiency in service on the part of opposite party No.1, opposite party No.2 is also equally liable being principal. Opposite party No.2 cannot escape from its liability only by pleading that it has received the proposal form and other documents on 20.5.2015 whereas the complainant has submitted the documents on 22.4.2015. Therefore, complaint be accepted and claimed relief be granted. On the other hand, learned counsel for opposite party No.1 has submitted that the complainant has not brought true facts before this Forum. The claim of the complainant is based on 'Oriental Bank Mediclaim Policy'. The complainant has not brought on record policy documents. Opposite party No.2 has produced the same as Ex.OP2/2. Salient features of this policy reveal that it was a group mediclaim policy. Opposite party No.1 was to submit the applications in group and not individually. Ex.OP2/3, is the letter by which the mediclaim proposal forms were forwarded to opposite party No.2 for further process. As per this letter, total 16 proposal forms were submitted, which were from 22.4.2015 to 14.5.2015. This Forum can also take judicial notice of the fact that in such type of group policies, it takes time to collect the applications of different applicants and then to submit the same to the concerned quarter. Keeping in view this factual position, no deficiency in service can be attributed to opposite party No.1. It is further submitted by learned counsel for opposite party No.1 that the complainant has purchased the policy, which was to cover for one year. The policy documents, (Ex.OP2/2) reveals the cover period from 18.5.2015 to 17.5.2016. In this way, the complainant has availed the protection for full one year. He has not suffered any loss. It is further submitted by learned counsel for opposite party No.1 that even if the wife of the complainant met with an accident and spent some amount for treatment, opposite party No.1 cannot be held liable for whole treatment. At the most, opposite party No.1 can be liable only for the some delay in submitting the application of the complainant to opposite party No.2. Therefore, the complaint is liable to be dismissed. Learned counsel for opposite party No.2 has submitted that the insurance policy is a contract, but no binding contract come into existence before issuance of the policy. Letter, (Ex.OP2/3) proves that the application of the complainant alongwith premium amount was received in the office of opposite party No.2 vide letter dated 15.5.2015 and policy was effective from 18.5.2015. The claim of the complainant for accident and treatment is between 11.5.2015 to 16.5.2015. Therefore, this claim is not covered under the policy. As such, opposite party No.2 is not deficient in service in any way. The complaint against opposite party No.2 is liable to be dismissed. To support these submissions, learned counsel for opposite party No.2 has cited some following cases law:- (i) 1984 AIR (SC) 1014 Life Insurance Corporation of India Vs. Raja Vasireddy Komalavalli Kamba and others; (ii) 2003 (2) RCR (Civil) 278 United India Insurance company Ltd. Vs. Lehru and Ors.; (iii) 2016 (1) CLT 550 New India Assurance Co. Ltd. Vs. Ashok Kumar Yadav. We have given careful consideration to these rival submissions and gone through the case law cited by learned counsel for opposite party No.2. Some facts are not in dispute. It is not disputed that the complainant has opted to purchase 'Oriental Bank Mediclaim Policy'. He submitted the proposal form alongwith bank draft of Rs.6830/- (Premium) on 22.4.2015. The policy was to be issued by opposite party No.2 after receipt of proposal form as well as premium amount. Opposite party No.1 has forwarded the proposal form of the complainant alongwith other proposal forms vide letter dated 15.5.2015. Therefore, there is clear cut delay in submission of proposal form as well as premium amount by opposite party No.1 to opposite party No.2. This fact itself proves deficiency in service on the part of opposite party No.1. Regarding deficiency in service on the part of opposite party No.2. As discussed above, opposite party No.1 has submitted the proposal form as well as premium amount on 15.5.2015 and opposite party No.2 has issued the policy effective from 18.5.2015 to 17.5.2016. There was no delay on the part of opposite party No.2 in issuing the policy in question. The claim of the complainant is regarding accident occurred on 11.5.2015 and treatment was taken till 16.5.2015. This period was not covered under the policy. Therefore, opposite party No.2 cannot held liable for any claim. Now, question is regarding compensation for which the complainant can be held entitled to. The purpose of the complainant was to purchase the policy covering the period for one year. The policy is on file as Ex.OP2/2. It is for the period of one year commencing from 18.5.2015 to 17.5.2016. Opposite party No.1 was deficient only in submitting the proposal form and premium amount to opposite party No.2. Therefore, opposite party No.1 can be held liable only for this delay in submitting these documents i.e. after about 22 days. Keeping in view the facts of the case, the complainant is held entitled to compensation amounting to Rs.30,000/- from opposite party No.1. For the reasons recorded above, the complaint is partly accepted with Rs.5000/- as cost against opposite party No.1 and dismissed qua opposite party No.2. The complainant is entitled to Rs.30,000/- as compensation from opposite party No.1. The compliance of this order be made within 45 days from the date of receipt of copy of this order. In case of non-compliance within the stipulated period, the interest @12% per annum will yield on the amount of Rs.30,000/- till realization. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record. Announced:- 08-02-2017 (M.P Singh Pahwa) President (Jarnail Singh) Member
| |
