BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.175 of 2020
Date of Instt. 19.06.2020
Date of Decision: 05.07.2024
Bachan Singh, aged 62 years, son of Sh. Sham Singh, resident of H. No.16, Madhuban Colony, Basti Bawa Khel, Jalandhar.
..........Complainant
Versus
1. Reliance General Insurance Co. Ltd., through it's The Managing Director/Principal Officer Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway, Santacruz (East), Mumbai-400055.
2. The Manager/Principal Officer, Reliance General Insurance Co. Ltd., 1st Floor, SCO-2, Puda Complex, Ladowali Road, Jalandhar- 144007.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Sh. Jaswant Singh Dhillon (Member)
Present: Sh. M. S. Jass, Adv. Counsel for the Complainant.
Sh. V. K. Gupta, Adv. Counsel for OPs.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the complainant alongwith his wife namely Swaran Kaur went to Germany on tourist Visa in the month of June 2018 to meet his elder son namely Didar singh and for the said purpose got insured him and purchased insurance policy i.e. Reliance Travel Care Policy, Policy No.20022182833000144 for the period from 00.00 Hrs on 21st June 2018 to 18th September 2018. During his visit to Germany the complainant suffered from infection on his right hand due to insect bite and for the same the complainant got him medically treated from Klinikum Frankfurt hospital at Germany under the above said policy. Hand of the complainant was operated three times i.e. on 18-07-2018, 24.07.2018 and 31.07.2018 and for the said medical treatment my client spent an amount of 7,785.77 EURO. In the month of July 2018 the value of one EURO was equal to Rs.80/- of Indian Currency. The complainant submitted his claim documents with OP No.2 alongwith all Original Medical Bills and other documents in the month of July 2018 but till today OPs has not settled the claim of complainant. The complainant as well as his sons namely Didar Singh and Tejinder Singh, many time approached OPs personally, though letters and e-mails, for the settlement of claim and payment of amount spent on medical treatment of complainant but OPs lingered on the matter on one pretext or the other. The complainant is an old aged person and in this old age faced undue harassment from OPs since July 2018, due to their delay tactics. The complainant also got served a legal notice dated 10-01-2020 to OPs through his counsel and same was received by the OPs, but no response and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to settle the claim of complainant and make a payment of a sum of 7,785.77 EURO i.e. Rs. 6,23,000/- (as per International Market rate in the month of July 2018 i.e. One Euro Rs. 80/-) alongwith interest @18% p.a. from July 2018 till the date of realization of amount and also to make payment of Rs.50,000/- as damages and Rs.10,000/- as litigation expenses to the complainant.
2. Notice of the complaint was given to the OP, who filed reply and contested the complaint by taking preliminary objections that the present complaint is frivolous, vexatious and devoid of merits and hence, the same is liable to be dismissed with heavy cost. It is further averred that the complainant has not approached this Forum with clean hands. The complainant has suppressed various material facts in the present complaint. Hence, the present complaint is liable to be dismissed on this ground only. It is further averred that there is no deficiency in service or negligence or unfair-trade practice on the part of answering OP which brings the present case adjudicable before this Forum under Consumer Protection Act. It is submitted that all the claims and benefits which are covered under the policy are to be paid by the insurance company as per terms and conditions of the insurance policy. It is submitted that in case any material information is withheld by the insured at the time of taking insurance policy which is material for assessing the risk or to issuance of insurance policy, then the insurance company has the right to ask further documents for verification/decide any claim or even to cancel the insurance policy on the basis of misrepresentation of material facts. Apart from this in case any disease/claim is not covered under the policy or is not payable as per terms and conditions of the insurance policy then the insurance company is not bound to pay the claim. It is submitted that the complainant has purchased online travel insurance policy from the answering opposite party, after going through all the terms and conditions of insurance policy available on the website of answering OP, complainant has decided to obtain the insurance policy from answering OP, and at the time of insurance policy be complete set of terms and conditions were again supplied to the complainant. It is submitted that at the time of taking the insurance policy and filing online information complainant has informed the answering OP that complainant is not suffering any pre-existing disease/injury or pre-existing health condition and on the basis of information provided by the insured/complainant answering OP issued the insurance policy bearing number 2002211828330001444. It is further averred that the present complaint is not maintainable under any provision of law and it is liable to be dismissed with heavy cost. It is submitted that the present complaint is filed by the complainant by concealing the actual and true material facts to the answering respondent company. It is submitted that at the time of taking of insurance policy complainant has not disclosed his pre-existing health conditions and has specifically stated that he is not suffering from any pre-existing disease and is not under medication, however during the processing of the claim when the answering OP requested for previous treatment history and documents presented for the first time. Thereafter complainant has provided his past consultation papers dated 30/11/2017 & 14/12/2017 from Care Max Super specialty Hospital, Jalandhar. It is further averred that the OP requested the complainant to provide the documents but the same has not been provided by the complainant despite the repeated requests vide different letters by OP. The prescription slips, letters and emails provided by the complainant. Since these information is not provided as such OP was unable to proceed further with the claim and same is closed on account of non-furnishing of required information. It is further averred that present complaint is pre-mature since the claim of the complainant is not repudiated and is closed on account of non- submission of documents and same will be processed once the required information is provided. Hence present complaint is liable to be dismissed being pre-mature. On merits, it is admitted that
3. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
4. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
5. We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.
6. It is admitted and proved fact that the complainant purchased Reliance Travel Care Policy, which was valid from 21.06.2018 to 18.09.2018, which is evident from Ex.C-2. The complainant has alleged that during his visit to Germany, he suffered from infection on his right hand due to insect bite and for the same the complainant got himself medically treated from Klinikum Frankfurt Hospital at Germany and spent an amount of 7785.77 EURO (Rs.6,23,000/- approximately), which is evident from Ex.C-7. The complainant has submitted his claim documents with OP No.2 alongwith all original medical bills and other documents Ex.C-4 to Ex.C-6, Ex.C-8 and Ex.C-9, but the OPs have not settled the claim of the complainant. Copies of the emails, acknowledgment of complainant, legal notice and receipts are Ex.C-11 to Ex.C-16.
7. The contention of the OPs is that at the time of taking of insurance policy, complainant has not disclosed his pre-existing health conditions and stated that he is not suffering from any pre-existing disease and is not under medication, however during the processing of the claim when the OP requested for previous treatment history and documents, the complainant provided the said documents. The OP demanded indication from complainant’s treating doctor/s in India for T.Digoxin 0.25 mg, T. Tide Plus (20) & T. Strocit Plus, but the same has not been provided by the complainant despite the repeated requests vide different letters by OP vide Ex.OP-4 to Ex.OP-7 and the claim of the complainant was closed on account of non-furnishing of required information. If we go through the case file very minutely, it is clear that the complainant has already submitted the bills and other required documents to the OP for settling the claim. In rejoinder the complainant has also stated that he provided each and every information, which was asked by the agent of the OPs at the time of taking policy in question. In such circumstances, the OPs are directed to settle the insurance claim raised by the complainant on the basis of documents already submitted by the complainant within 15 days from the date of receipt of order, failing which the OPs will be liable to pay compensation of Rs.20,000/- to the complainant. Even then if any document is required by the OPs, the same can be demanded from the complainant and the complainant is directed to furnish those documents, they are in possession, to the OP within 10 days from the date of receipt of demand by the OP. With regard to the document required by the OP i.e. indications from complainant’s treating doctor/s in India, for his being on, T. Digoxin 0.25mg, T. Tide Plus (20) & T. Strocit Plus, if the document is not in possession of the complainant and he is unable to provide the same, the OP can get it verified or get the indications from the concerned doctor of their own. It is further ordered that if the complainant is not satisfied with the settlement of the claim made by the OPs, then he is at liberty to file a fresh complaint. Thus, the complaint of the complainant is disposed of. This complaint could not be decided within stipulated time frame due to rush of work.
8. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
05.07.2024 Member Member President
