Haryana

Panchkula

CC/82/2016

KRITIKA SHARMA. - Complainant(s)

Versus

ORIENTAL INSURANCE COMPANY LTD . - Opp.Party(s)

BHAVNA JOSHI.

12 Aug 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,  PANCHKULA.

                                                         

Consumer Complaint No	:	82 of 2016
Date of Institution	:	11.04.2016
Date of Decision	:	12.08.2016

Kritika Sharma D/o Sh.Sanjeev Sharma, R/o House No.28, First Floor, Shiwalik Enclave, NAC Manimajra, Chandigarh.

 

                                                                                      ….Complainant

Versus

1.       Oriental Insurance Company Ltd., through its Directors, Registered office address:- A25/27, Asaf Ali Road, New Delhi-110019.

2.       Branch Office:- SCO 325, IInd Floor, Sector-9, Panchkula-134109 through its Branch Manager..

                                                                         ...Opposite Parties

 

COMPLAINT UNDER SEC. 12 OF THE CONSUMER PROTECTION ACT, 1986.

 

Before:                Mr. Dharam Pal, President.

              Mrs.Anita Kapoor, Member.

              Mr.S.P.Attri, Member.

 

For the Parties:     Ms.Bhawna Joshi, Advocate, for the complainant. 

Mr.Ram Avtar, Adv., for the Ops.

 

ORDER

(Dharam Pal, President)

 

1. The complainant has filed this complaint under Section 12 of the Consumer Protection Act, 1986 against the Ops with the averments that on 20.04.2015, she obtained for Overseas Mediclaim Business and Holiday Policy from the Op No.2 vide policy No.231202/48/2016/65 (Annexure C-1) which was valid from 20.05.2015 till midnight of 05.07.2015 and she paid Rs.1,194/- as insurance premium. On 20.05.2015, the complainant travelled in Swiss International Airlines LX 147 from Delhi at 01:15 to Zurich at 6:20 (scheduled arrival time) and from Zurich at 07:20 to Amsterdam at 9:00 (scheduled arrival time) on LX 724. But the luggage of the complainant bearing baggage Tag LX 215082 did not reach Amsterdam in time which was delayed by over 12 hours and the delay was intimated to the Airlines. The complainant had to attend Summer classes at Den Haag on the same day and her luggage was contained all her study material, clothes and other belongings. The complainant also informed her father about non delivery of her baggage who contacted the airlines and made a complaint to the authorities (Annexure C-3). After delay of 2100 hours at Den Haag, the complainant received her baggage. On returning to India, the complainant sent her claim form alongwith requisite documents to M/s Heritage Health Services Pvt. Ltd., Unit 28, Ground Floor, TV Industrial Estate (Behind Glaxo), Hind Cycle Road, Worli, Mumbai-400025 but the same was returned with remarks “addressee left”. Thereafter, the  complainant sent the documents at second address i.e. Heritage Elite Auto House, 54, Andheri East, Kurl Road, Chakala Road, Mumbai-400099 and the same was returned with remarks “addressee left”. The complainant also sent a legal notice dated 04.02.2016 (Annexure C-5) to the Ops requesting to process the claim raised by her but to no avail. This act of the opposite parties amounts to deficiency in service on their part. Hence, this complaint.
2. The Ops appeared before this Forum and filed written statement by taking some preliminary objections and submitted that the present complaint is not maintainable as no communication received as yet from heritage health TPA Pvt. Ltd. and the insurance company has also not accepted or rejected the claim. It is submitted that the claim could only be processed when the claim file was complete in all respect containing all documents to enable Health Heritage Pvt. Ltd., to apply its mind to accept or reject the claim. It is submitted that Heritage Health Pvt. Ltd. had written letters dated 21.03.2016 and 05.05.2016 for proof of purchases be provided for all items due to delivery of baggage after delay of more than 12 hours from the scheduled arrival time at the destination but the complainant had not submitted the purchase bills of necessary items. It is submitted that the Op No.2 has issued overseas mediclaim business and holiday policy No.231202/48/2016/65 subject to terms and conditions and exclusion clause. It is submitted that it was the duty of the complainant to cooperate the Ops for submitting the mandatory documents i.e. original purchase bills/vouchers of necessary items purchased due to non delivery of baggage for processing the claim but the complainant did not supply the same inspite of letters written to her on 21.03.2016 and 05.05.2016 by Heritage Pvt. Health Service Pvt. Ltd. It is submitted that the complainant should have approached the Ops telephonically but she did not try for the same. Thus, there is no deficiency in service and unfair trade practice on the part of OPs and prayed for dismissal of the complaint with costs.
3. The counsel for the complainant has tendered into evidence affidavit Annexure C-A alongwith documents Annexure C-1 to C-5 and closed the evidence. Counsel for the OPs has tendered into evidence affidavit Annexure R-A alongwith documents Annexure R-1 to C-3 and closed the evidence.
4. We have heard learned counsel for the parties and have perused the record available on case file and also considered the written arguments submitted by the counsel for the Ops.
5. Purchasing of policy by the complainant from the Ops is not disputed. It is also not in dispute that she had travelled in Swiss International Airlines LX147 from Delhi to Zurich and from Zurich to Amsterdam.  The grievance of the complainant is that her baggage containing her belongings including course material and clothes did not reach Amsterdam, as per policy schedule causing inconvenience to her. It is also established on the case file that the baggage was delivered to her after delay of 12.00 hours at Den Hagg.  Both the parties are bound by the policy schedule but in the present case, the Ops have not provided the terms and conditions of the insurance policy at the time of purchase. Though the same has been placed on file but it does not bear the signatures of the complainant, therefore, it can be easily presumed that the terms and conditions have been concealed by the Ops and when the claim has been lodged then the same are being disclosed in order to avoid claim. In the policy schedule Annexure A-1 it has been mentioned that Delay in checked in Baggage-Over 12 hours (outbound Flights) covers $100 with $12 deductable  but in the terms and conditions it has been mentioned as under:

 

Section D-Delay of checked baggage: This insurance will pay up the limit of cover shown in the schedule for necessary emergency purchase of replacement items in the event that insured person suffers a delay of more than 12 hours from the scheduled arrival time at the destination for delivery of baggage  that has been checked by an International Airline for an international outbound flight from the Republic of India.

1. A non-Delivery certificate must be obtained immediately from the airline which must be submitted to Coris in the event of a claim hereunder.
2. Proof of purchase must be provided for all items reimbursed under this section.
3. Any payment under Section D shall be offset against any claim ultimately payable under Section C.

 

 The act and conduct of the OPs-insurance company is depreciable  and it cannot be supposed that same are meant to only earn profit because it being in a dominant position often acts in an unreasonable manner and after having accepted the value of a particular insured good disown that very figure on one pretext or the other when they are called upon to pay compensation. This take it or leave it attitude is clearly unwarranted not only as being bad in law but ethically indefensible because the insurance company always treat the report of the surveyor as per its own wishes. Perusal of the case file reveals that the complaint regarding loss of baggage was lodged on 20.05.2015 at 1.04 pm but till today the grievance of the complainant has not been removed. Though the baggage has been delivered but the same was not delivered as per schedule of the policy. As per Sub Clauses 5 of the Regulation No.9 the claim was to be decided/repudiated within 30 days from the date of report. On this point reliance can be taken from National Insurance Company Limited Vs. Rajesh Kumar Kalia 2013 (2) CLT 417 (PB). 

6. The Ops have come with the plea that no communication has yet been received from Heritage Health TPA Private Limited whether the claim has been rejected or accepted. The complainant is not supposed to run after insurance company after lodging the claim because it was the duty of the insurance company to redress the grievance of the insured upto his/her satisfaction but in the present case neither the Ops nor Heritage Health TPA Private Limited have honoured the genuine claim because it appears that they are trying to avoid the claim on one ground or the other by writing letters dated 21.03.2016 and 05.05.2016 (Annexure R-2 & Annexure R-3). It is strange that the Ops have received the premium from the complainant and when she lodged claim regarding delaying in delivery of baggage they are trying to shift the burden on Heritage Health TPA Private Limited.
7.  In view of the above, the complaint of the complainant deserves to be succeeded and the same is hereby allowed. The OPs is directed as under:-

1. To pay $ 100 with deductible $ 12 as per covers mentioned in policy schedule Annexure R1.

(ii)     To Pay Rs.10,000/- for compensation as mental agony and physical harassment and cost of litigation.

 

Let the order be complied with within 30 days from the date of receipt of the certified copy of this order failing which the item No.1 will carry interest @ 9 % per annum till its realization. A copy of this order be communicated to both the parties free of costs and file be consigned to the record room after due compliance.

 

 

Announced

12.08.2016           S.P.ATTRI        ANITA KAPOOR       DHARAM PAL

                             MEMBER         MEMBER                  PRESIDENT

 

Note: Each and every page of this order has been duly signed by me.

 

    

                                 

                                                          DHARAM PAL

                                                          PRESIDENT