Smt.Sudesh Kumari, complainant has filed the present complaint against the titled opposite parties U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short, the C.P.Act.) in which she has prayed that the opposite parties be directed to make payment of insured amount along with interest @18% P.A. from the date of  her treatment  till its realization. Opposite parties be further directed to pay Rs.50,000/- as compensation for causing mental agony, physical harassment and deficiency in service on the part of the opposite parties along with Rs.3,000/- as litigation expenses, in the interest of justice.   

2.       The case of the complainant in brief is that in October 2015 she had gone abroad i.e. Australia.  Before leaving India for abroad, she got herself insured for the period 22.10.2011 to 19.01.2012 and paid premium of Rs. 6045/- to the opposite party no.1 and 2 through opposite party no.3. She further got the insurance policy extended from 19.01.2012 to 17.04.2012 and she again paid another premium of Rs.6045/- to the opposite party No.1 and 2 through opposite party No. 3. While living abroad, she fell ill and she undergone treatment and spent about 252 dollars on her treatment. As per the terms and conditions of the policy she is entitled to refund of the amount spent by her on her treatment during existence of policy. Therefore, she submitted her claim for reimbursement to the opposite party No.1 and 2 through the opposite party No.3, but the opposite parties  are putting the matter pending with one or the other excuse and till date  neither the amount has been reimbursed to her, nor the opposite parties  are giving anything in writing to her. Despite the fact, that she had been approaching the opposite party No. 2 time and again, but all in vain. Thus, there is deficiency in service on the part of the opposite parties. Hence, the present complaint was preferred with the prayed relief as herein above.

3.       Upon notice, the opposite parties No.1&2 appeared and filed their joint written reply through their counsel by taking the preliminary objections that the   complainant has no locus standi and cause of action to file the present complaint. The complainant has not come to the court with clean hands and as such not entitled for any discretionary relief. There is no deficiency in services on the part of the opp. parties and the complaint of the complainant is premature. The matter of fact is that the complainant failed to provide all the relevant documents demanded by the opp. parties, due to which the claim of the complainant has been closed after giving several opportunities to the complainant. The matter of fact is that the claim has been filed by the complainant. The letter dated 14.02.2012, 29.02.2012, 15.03.2012 and 29.03.2012 has been sent to the complainant but the complainant failed to fulfill the requisite documents. The documents required has been duly tick marked in the letter dated 29.03.2012 which is pending from the complainant side. The original claim form duly filled and signed by the insured along with mentioning the total claimed amount, copy of Passport, Visa with exist and entry stamp/boarding pass. The original bills and payment receipts, original Pharmacy for an amount of AUD 89.85 has been demanded from the complainant, but the complainant failed to provide the above said documents. So, it is the complainant who is at fault and failed to fulfill his part of obligation.  Due to non-providing of relevant documents the claim of the complainant has been closed as No claim. So, it is the complainant who is at fault and failed to fulfill his part of obligation and as such the claim has rightly been not paid. The complaint of the complainant is not within limitation. The complainant failed to file the present complaint within the period of 2 years from the date when the claim has been made ‘No Claim’. On merits, it was wrong and denied that the complainant fell ill at Abroad and spent 252 Dollars.  Many letters have been sent to the complainant but inspite of that the complainant failed to complete the requisite formalities, so it is the complainant who is at fault and there is no deficiency in services on the part of the opposite parties. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.        Upon notice, the opposite parties No.3 appeared and filed its written reply through its counsel by taking the preliminary objection that the   complaint is highly time barred and liable to be dismissed. On merits, it was admitted that premium of the insurance deposited in the account of opposite parties no.1 and 2 through the answering opposite party.  The complainant never gave any intimation to the opposite party no.3 about the illness and treatment so the complainant has not filed any prescription of the Doctor without which nothing can be ascertained.  The complainant did not approach the opposite party no.3 about his grievances nor he gave any document of the same as alleged. If at all any amount is recoverable on the basis of Insurance Policy that is only from the opposite parties no.1 & 2, so the question of request for refund of amount does not arise. The complainant is not entitled to recover any amount from the opposite party no.3 and lastly prayed that the complaint may be dismissed with costs.

5.       Complainant tendered into evidence her own affidavit Ex.C1, alongwith other documents Ex.C2 to Ex.C5 and closed the evidence. 

6.       Counsel for the opposite parties no.1 &2 tendered into evidence affidavit of Sh.Amit Chawla Ex.OP1, alongwith other documents Ex.OP2 to Ex.OP28 and closed the evidence.

7.       Counsel for the opposite party no.3 tendered into evidence affidavit of Sh.Rakesh Kumar Manager UAE Ex.OP-3/1 and closed the evidence.

8       We have examined all the documents/evidence produced on record and have also duly considered and perused the arguments duly put forth by the learned counsels for both the sides, while adjudicating the present complaint. We find that the present complaint pertains to the non-settlement of medical- treatment claim filed by the complainant pertaining to the medical-aid received by her during her stay in Australia, while being there on tourist visa. The OP insurers have not contested the issuance of the Med-claim Policy nor the complainant’s ailment or its treatment etc but have simply stated that the claim in question could not be settled on account of non-submission of the requisite documents by the complainant in spite of the repeated reminders and thus the impugned claim had to be closed. However, the OP insurers have not produced the alleged ‘repudiation’ letter or its ‘receipt’ by the complainant or even its ‘dispatch’ from its own office and thus it shall be judicially presumed that the impugned claim has not been finally repudiated/ settled. Moreover, the complainant has alleged in the last line of para ‘4’ of his complaint that the OP insurers had verbally advised him of the alleged ‘repudiation’ only a week before his filing of the present complaint and the OPs have not contested/ repelled the same. And, thus it also negates the OP’s pleading of ‘limitation’ in the last line of para ‘4’ of the written reply and also repeated by the OP3 in his separate written reply. Further, the complainant has duly produced the Doctor’s prescription (Ex.C3) and the Medicines Bill (Ex.C4) as duly received and produced here as Ex.OP6 to Ex.OP16. We also observe that the delayed settlement has prompted as an outcome of ‘unfair trade practice’ coupled with ‘deficiency in service’ and that surely holds the OP insurers liable to an adverse award under the Act.

9.       In the light of the all above, while partly allowing the present complaint we hold the titled OP insurers as guilty of unfair trade practice/deficiency in service and thus ORDER them to pay to the complainant the full proceeds of the impugned insurance claim besides to pay her Rs.5,000/- as cost and compensation within 30 days of the receipt of the copy of these orders otherwise the aggregate awarded amount shall attract interest @ 9% P.A. from the date of the complaint till actually paid.

10.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

                 (Naveen Puri)

                                                                                     President.

ANNOUNCED:                                                   (Jagdeep Kaur)

October 09,2015.                                                           Member               

*MK*