Chandigarh

DF-I

CC/828/2019

Mrs. Gurmeet Walia - Complainant(s)

Versus

Tata AIG General Insurance Co. Ltd. - Opp.Party(s)

Pankaj Maini

27 Feb 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                    

Consumer Complaint No.	:	CC/828/2019
Date of Institution	:	14/08/2019
Date of Decision	:	27/02/2023

 

Gurmeet Walia W/o Sh. Harjit Singh Walia aged 75 years, resident of House No.2490, Sector 40-C, Chandigarh.

… Complainant

V E R S U S

1. Tata AIG General Insurance Co. Ltd., through its Manager (Claims), Tata AIG General Insurance Co. Ltd., A-501, 5^th Floor, Building No.4, Infinity Park, Gen. A.K. Vidya Marg, Dindoshl, Malad (E), Mumbai.
2. Tata AIG General Insurance Co. Ltd., through its Branch Manager, SCO No.232/234, 2^nd Floor, Sector 34-A, Chandigarh 160022.
3. Sh.Gaurav Dutta, Agent of Tata AIG General Insurance Co. Ltd., C/o Branch Manager, SCO No.232/234, 2^nd Floor, Sector 34-A, Chandigarh 160022.

… Opposite Parties

CORAM :	PAWANJIT SINGH	PRESIDENT
	SURESH KUMAR SARDANA	MEMBER

 

                                                

ARGUED BY	:	Sh.Pankaj Maini, Counsel for Complainant.
	:	Sh.Sahil Abhi, Counsel for OP No.1 & 2.
	:	OP No.3 ex-parte.

 

Per Suresh Kumar Sardana, Member

1.      Averments are that the complainant had purchased the travel insurance from the OPs under the Insurance Plan of Travel Guard Senior. The policy was issued to the complainant on 13.03.2018, the OPs have taken the premium of Rs.34,576/- from the complainant (Annexure A-2). The policy issued by the OPs is valid for 120 days from the date the complainant went abroad. According to the policy the period under which the complainant has to undergo the visit is w.e.f. 28.03.2018 to 25.07.2018. The complainant got the problem in her spinal cord and got the treatment from Aurora Healthcare and she was taken to the hospital on 06.11.2018. The complainant was diagnosed with left low back pain, unspecified chronicity with sciatica presence unspecified. The treatment was granted to the complainant, the hospital charged $583 from the complainant. The complainant son cleared the outstanding bill regarding the treatment of the complainant and the hospital was given the receipt to the complainant there is no outstanding amount towards the complainant. The son of the complainant has been pursuing the claim with the OPs and the OPs have started pursuing the claim of the complainant. The OPs vide email dated 02.06.2019 demanded the payment receipt for US $583. Whereas, the son of the complainant has clearly stated that he has paid the bill through cash and does not have the receipt. He has submitted all the documents with the OP No.3 and requested for processing of the claim. Alleging that the aforesaid act amount to deficiency in service and unfair trade practice on the part of OPs, complainant filed the instant complaint.    

2.      OP No.1 & 2 contested the consumer complaint, filed their written reply and stated that the complainant has failed to lead reasonable and cogent evidence to prove the maintainability of the complaint and deficiency on the part of the OP’s as the complainant had not produced the receipt of payment of $583 from the hospital rather the complainant in reply to the emails of the OP’s had clearly stated that he got no receipt with him. On the other hand the OP’s has led reasonable and cogent evidence to the effect that there is no deficiency in service on their part and the claim has rightly been closed. It is also submitted that premium is a consideration for the contract of insurance i.e., for obtaining the insurance and cannot be returned back. Terms and conditions of the policy is exhibited as Ex.R-1. Pleading that there is no deficiency in service or unfair trade practice on their part, OP No.1 & 2 prayed for dismissal of the consumer complaint.
3.      Notice of the complaint was sent to OP No.3 seeking its version of the case. However, nobody appeared on behalf of OP No.3 despite following proper procedure, therefore it was proceeded ex-parte on 31.10.2019.

2.     Parties led evidence by way of affidavits and documents.
3.     We have heard the learned counsel for the parties and gone through the record of the case.
4.     It is an admitted fact that the complainant was having proper insurance cover, during the period of her sickness. The ground for not passing of claim by the OPs is that no relevant receipt of the amount from the hospital was not submitted by the complainant to the OPs. It is observed that during the pendency of complaint, the complainant submitted the receipt to the OPs and OPs were willing to pay an amount of Rs.15,079/- (US $ 220.65 * Rs.68.34/-), which is not acceptable to the complainant and desired reimbursement of entire amount as per receipt.
5.     On perusal of complaint and the receipt for amount incurred towards treatment, it is observed that the complainant paid US $583 towards treatment. On perusal of policy it is observed that there is a clear mention of US $100/- as a deductible amount. Hence, in our view an amount of Rs.33,008.22/- (US $583-US $100= US $483*68.34), is payable to the complainant. By not paying the said legitimate amount the OPs are found to be deficient in providing service and has caused mental harassment to the complainant and needs to be duly compensated.
6.     In view of the above discussion, the present consumer complaint succeeds and the same is accordingly partly allowed. OP No.1 & 2 are directed as under :-

1. to pay an amount of ₹33,008.22/- to the complainant alongwith interest @ 9% per annum from the date of filing of this complaint till realization.
2. to pay an amount of ₹7,000/- to the complainant as compensation for causing mental agony and harassment to her;
3. to pay ₹5,000/- to the complainant as costs of litigation.

7.     Since no deficiency in service or unfair trade practice has been proved or alleged against Opposite Party No.3, therefore, the consumer complaint qua it stands dismissed with no order as to costs.
8.     This order be complied with by the OP No.1 & 2 within thirty days from the date of receipt of its certified copy, failing which, they 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.
9.     Certified copies of this order be sent to the parties free of charge. The file be consigned.

			Sd/-
27/02/2023			[Pawanjit Singh]
Ls			President
			Sd/-
			[Suresh Kumar Sardana]
			Member