Chandigarh

DF-I

CC/65/2019

Satyendra Jeet Singh - Complainant(s)

Versus

SOTC Travel Ltd., - Opp.Party(s)

Ajiteshwar Singh Adv.

22 Sep 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                                               

Consumer Complaint No.	:	CC/65/2019
Date of Institution	:	08/02/2019
Date of Decision	:	22/09/2022

 

1. Satyendra Jeet Singh, aged approximately 62 years, son of Mr. Rawel Singh, resident of House No.725, Sector 11-B, Chandigarh.
2. Swarnjit Kaur, aged approximately 56 years, wife of Mr. Satyendra Jeet Singh, resident of House No.725, Sector 11-B, Chandigarh.

… Complainants

V E R S U S

1. SOTC Travel Ltd. through its Managing Director, having its registered office at 324, Dr. D.N. Road, Fort, Mumbai, Maharashtra 400001.
2. Go Digit General Insurance Ltd., through its Managing Director, having its registered office at Smartwork Business Center, 1^st Floor, Nyati Unitree Westwing, Samrat Ashok Road, Yeawada, Pune, Maharashtra 411006.

… Opposite Parties

 

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

                                                                                                

 

ARGUED BY	:	Sh. Ajiteshwar Singh, Counsel for complainants
	:	Ms. Suksham Aggarwal, Counsel for OP-1 (through VC)
	:	Sh. Sumer Singh Brar, Counsel for OP-2

 

Per Pawanjit Singh, President

1. The instant consumer complaint has been instituted by the complainants against the opposite parties (hereinafter referred to as OPs). The brief facts of the case are as under :-

1. It transpires from the averments, as projected in the consumer complaint, that on 11.9.2018 both the complainants, being husband and wife, made requisite booking/reservation with the OPs for proposed tour package of 6 nights/7 days to Singapore and Malaysia from 14.10.2018 to 20.10.2018 and made the payment of ₹40,000/- as booking amount in favour of OP-1. On 17.9.2018, personnel of OP-1 introduced himself to the complainants and provided the requisite documents for completing visa formalities which were completed and acknowledged by OP-1. Thereafter the complainants further proceeded to transfer the balance amount of ₹1,35,850/- to the account of OP-1 on 27.9.2018. In this manner, total consideration amount to the tune of ₹1,75,850/- was paid by the complainants to OP-1. Other formalities were also asked to be carried out by the personnel of OP-1 from the complainants to enable the latter to carry foreign currency with them and also to fill the declaration form and finally on 10.10.2018 through email OP-1 had provided to the complainants “final hand-over’ by virtue of which, tickets, tour briefing sheet and tour confirmation vouchers were issued. Travel insurance was also issued by OP-2/ insurer as intimated by OP-1. A bare perusal of the documents provided by OP-2/insurer would show that as far as complainant No.1 was concerned, certificate bearing No.D001752048 was issued to him whereas certificate bearing No.D001724988 was issued to complainant No.2 after charging amounts of ₹2,585/- and ₹613/- respectively from them, out of the total consideration paid qua the tour package. The aforesaid certificates specified the sum insured/limits/ extent to which the complainants were covered under various heads.  Not only this, under the head of trip abandonment as also cancellation, limit of coverage was stated to be USD 1,500 for complainant No.1 while for complainant No.2 it was USD 1,000/-. During the first week of October, 2018 i.e. on 4.10.2018, complainant No.1 fell ill on account of which he was required to consult the physician i.e. Dr. V.K. Harjai at Fortis Medi-centre, Sector 11, Chandigarh and at that time he was diagnosed with viral fever and advised bed rest.  Complainant No.1 was recovering from the aforesaid viral fever, but, after about one week, his illness relapsed on account of which he was again required to visit his physician and as the earlier physician was not available, therefore, he consulted another physician i.e. Dr. S.K. Chawla who diagnosed that the viral fever had relapsed on account of which complainant No.1 suffered from high grade fever and accordingly he was again advised complete rest for minimum of 5 days. Both the aforesaid medical consultants had also issued certificate qua the treatment of complainant No.1. Due to the aforesaid ill health of complainant No.1, complainants were compelled to cancel their proposed trip and accordingly OPs were informed. Thereafter complainants raised their claim before OP-2, but, despite of their repeated requests, it rejected their claim.  OPs were also requested through legal notice, but, with no result. Hence, the present consumer complaint.
2. OPs resisted the consumer complaint by filing their separate written replies. OP-1 in its written reply took the preliminary objections of maintainability and cause of action.  On merits, OP-1 has come up with the defence that it has nothing to do with the claim of the complainants as the trip was insured by OP-2 and that it had only arranged the trip. Averred that the consumer complaint of the complainants is not maintainable against the answering OP and prayer has been made for dismissal of the same qua OP-1.
3. OP-2 in its written reply took preliminary objections of suppression of facts, maintainability and non-disclosure of material facts. On merits, admitted that the trip of the complainants was insured by the answering OP, but denied that the claim of the complainants was wrongly rejected. It is alleged that in fact the complainants had not disclosed to the OP about the illness of complainant No.1, immediately after he had undergone medical treatment and also that since the complainant No.1 was never hospitalized during the treatment rather he was alleged to be treated as an outpatient, therefore, the claim of the complainants is not covered under the terms of the policy and was rightly repudiated by the answering OP. It is further alleged that complainant No.1 had not disclosed material facts pertaining to his earlier diseases before getting the trip insured.  Prayer has been made that the consumer complaint of the complainants be dismissed with exemplary costs. The defence of OP-2 is supported by its affidavit.
4. The complainants filed separate rejoinders in which they have re-asserted their claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed and the amount as claimed, be ordered to be paid by the OPs to the complainants.

2. In order to prove their case, parties have led their evidence by way of affidavits and by tendering documents. Complainants have tendered their separate affidavits alongwith Ex.C-1 to Ex.C-21. On the other hand, OP-2 has tendered affidavit of its Network Manager. Since, OP-1 failed to file its evidence despite grant of numerous opportunities, therefore, vide order dated 4.12.2019 of this Commission, evidence of OP-1 was closed.
3. Most of the documents i.e. correspondence inter se parties through emails are not required to be discussed at length as it is an admitted case of the parties that the complainants have lodged their claim before OP-2 which was ultimately repudiated by it.
4. We have heard the learned counsel for the parties and also gone through the file carefully, including the written arguments.  For the reasons to be recorded hereinafter, following points are formulated for discussion and proper adjudication :-

1. Whether there is deficiency in service and unfair trade practice on the part of OP-2?
2. Whether the complainants are entitled for claim as prayed for?
3. Whether the consumer complaint of the complainants is not maintainable?
4. Relief.

Point No.1

5. Admittedly, both the complainants selected a tour package of 6 nights/7 days to Singapore and Malaysia through OP-1 and the proposed trip was from 14.10.2018 to 20.10.2018. It is further admitted case of the parties that an amount of ₹1,75,850/- was paid by the complainants to OP-1 for the said trip.  It is further an admitted case of parties that the said trip was got insured by the complainants from OP-2 as is also evident from copy of insurance policy (Ex.C-18). It is further an admitted case of the parties that the said trip was got cancelled by the complainants on the medical ground of complainant No.1.  The case of the complainants is that as the said trip was insured with OP-2, to whom the complainants had also paid the premium and the insurance policy (Ex.C-20) and the insurance certificates (Ex.C-6 and C-7) were issued by OP-2 and further that complainant No.1 suffered from viral fever just before the said trip and remained under treatment and further since OP-2 has repudiated the claim of the complainant without any reason, the complainants are entitled for compensation and costs as prayed for. On the other hand, defence of OP-2 is that since complainant No.1 was never hospitalized and as per the terms and conditions of the insurance policy, the claim is only allowed in case the insured is hospitalized, the claim of the claimants was rightly rejected and the consumer complaint of the complainants be dismissed with costs.
6. In the backdrop of the foregoing admitted and disputed facts on record, it is to be determined if there is deficiency in service on the part of OP-2, as is the case of the complainants, or if the consumer complaint is not maintainable, as is the defence of OP-2, especially when the complainants have not claimed any relief against OP-1.
7. Close scrutiny of the entire evidence on record of the case file, coupled with the rival contentions of the learned counsel for the parties, are discussed as under :-

1. At the very outset it may be observed that when it is admitted case of the parties that both the complainants got a foreign trip booked through OP-1 qua which they had paid an amount of ₹1,75,850/- and the said trip was insured with OP-2, the case is reduced to a narrow compass as it is to be determined if there is deficiency in service on the part of OP-2 and the complainants are entitled for the relief as claimed for or if the consumer complaint is liable to be dismissed.
2. The learned counsel for the complainants contended that since there is no condition in the terms of the insurance policy that the insured is only entitled for insurance claim in case he is hospitalized, OP-2 has wrongly rejected the claim of the complainants. On other hand, learned counsel for OP-2 contested with vehemence that insured is only entitled for claim in case he is hospitalized after his illness and further when it is the admitted case of the complainants that complainant No.1 was never hospitalized, claim of the complainants was rightly repudiated and the consumer complaint be dismissed with costs. There is no force in the contention of the learned counsel for OP-2 as perusal of insurance policy (Ex.C-18) in its internal page 23 clearly provides that in case of cancellation of trip, OP-1 will pay the cost that each insured person has paid……… and also that the insured person or any of his immediate family or travelling companion are injured or fall ill or is/or are quarantined leading to emergency hospitalization or death. The relevant para of the policy is reproduced as under :-

“Coverage

If you need to cancel your trip before the onset of the trip, we will pay the costs that each insured person has paid and cannot get back or which legally must be paid for their own personal travel and accommodation including excursions and planned event(s) up to the limits shown on your policy schedule for any of the following reasons.

1. You or any of your immediate family or travelling companion are injured or fall ill or is/are quarantined leading to emergency hospitalization or death

     xxx                        xxx               xxx”

                   Thus, one thing is clear from the aforesaid term that it was never required that the claim will only be cleared in case the person is hospitalized especially when the aforesaid term says that in case of the insured person or any of his immediate family or travelling companion are injured or fall ill or is/are quarantined leading to emergency hospitalization making further clear that in case a person is quarantined leading to his emergency hospitalization or death, the claim will also be allowed. 

3. Not only this, even the medical declaration available at internal page 21 of the insurance policy (Ex.C-18) also endorses this fact about the illness of a person who even has not been hospitalized is entitled to raise claim and the relevant para to this effect is reproduced as under :-

“Medical Declaration

Applicable to each insured person

Here’s another list of important info. This one mostly states that you need to be honest with us about the medical conditions you have before starting your trip, and about the health of those travelling with you. It also says that if you have any doubts about medical issues (or need to make a medical decision) while you’re travelling, you need to call us immediately. It would be ideal if you could read the details as prevention is always better than cure.

If, between booking a trip and the departure date or the renewal date (whichever is sooner), you or your immediate family or traveling companion or anyone upon whose good health your trip depends are referred to a Consultant/Specialist or attends Accident & Emergency department of a hospital or are admitted to a hospital, your policy will cover you for cancellation of your trip. Please note however, that if you still wish to travel you must call the Customer Services Team immediately and they will advise you if your insurance policy will cover you for claims relating to this condition.

If you or anyone upon whose good health your trip depends, is referred to a Consultant/Specialist, attends Accident & Emergency department of a hospital or is admitted to a hospital, after you have booked your trip but prior to paying any final balance due for your trip, you must call the Customer Services helpline number immediately. We will advise you if you will be covered for claims relating to this condition.

Please note, if you do not do this, it will affect your claim if you have to cancel your trip.”

4. The prescription slips/medical certificates(Ex.C-9 & C-10) issued by the Medical Officer from whom complainant No.1 got treatment, further prove that he remained under treatment for viral fever and he was advised complete rest and not to travel, further proving that cancellation of the trip was beyond the control of the complainants.
5. As the aforesaid evidence of the complainants is unrebutted by OP-2, it is clear that there is deficiency in service on the part of OP-2.

8. In view of the foregoing discussion it is safe to hold that there was deficiency in service on the part of OP-2 who has repudiated the claim of the complainants.

Point No.2

9. The certificates (Ex.C-6 and C-7) issued by OP-2 have clearly mentioned the limits/sum insured as well as the deductions to be made in case of cancellation of the trip.  In the case of complainant No.1, the sum insured has been mentioned as USD 1500 with deduction of USD 75 and in case of complainant No.2 the sum has been shown as USD 1,000 with deduction of USD 100, in case of trip cancellation. Thus, after deduction of aforesaid USD 175, both the complainants are entitled to USD 2,325 from OP-2 which is the insurer in the present consumer complaint.
10. In view of the foregoing discussion it is safe to hold that both the complainants are entitled to USD 2325. The aforesaid point is decided accordingly.

Point No.3.

11. As it has already been discussed above in the discussion on point No.1 & 2 that complainants are entitled for the insured amount alongwith compensation, it is unsafe to hold that the consumer complaint of the complainants is not maintainable. The aforesaid point is decided accordingly.

Relief

12. In the light of the aforesaid discussion, the present consumer complaint succeeds and the same is accordingly partly allowed against OP-2 and OP-2 is directed as under :-

1. to pay ₹1,66,179.38 (being equivalent of USD 2325 in Indian currency pegged/fixed @₹71.48 on the date of filing the present consumer complaint) alongwith interest @ 9% per annum from the date of filing of the consumer complaint i.e. 8.2.2019 till realization of the same.
2. to pay an amount of ₹20,000/- to the complainants as compensation for causing mental agony and harassment to them;
3. to pay ₹10,000/- to the complainants as costs of litigation.

13. This order be complied with by OP-2 within thirty days from the date of receipt of its certified copy, failing which, it shall make the payment of the amounts mentioned at Sr.No.(i) & (ii) above, with interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.
14. Since no deficiency in service or any unfair trade practice has been proved against OP-1, therefore, the consumer complaint qua it stands dismissed with no order as to costs.
15. Certified copies of this order be sent to the parties free of charge. The file be consigned.

	Sd/	Sd/-	Sd/-
22/09/2022	[Suresh Kumar Sardana]	[Pawanjit Singh]	[Surjeet Kaur]
hg	Member	President	Member