District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.665/2021.
Date of Institution: 22.12.2021
Date of Order: 18.01.2023.
Ajay Kumar S/o Shri Ram Das R/o H.No. NK-105, Village Nawada Koh P.O. Pali, Delhi Police Society Tehsil & distt. Faridabad – 121004.
…….Complainant……..
Versus
1. TATA AIG General Insurance Company Ltd., Regd. B9 First floor, Jhariya Market, Sarai Khawaja Road, Faridabad- 121003 through its Incharge.
Also at: 15th floor, Tower A, Penisula Business Park, G.K.Marg, Lower Paral, Mumbai – 400 013, Maharashtra.
2. Axis Bank Ltd., (Loan Department), Basement & Ground Floor, HUDA shopping Centre, SCO 8, Sector-16, Faridabad, Haryana – 121002 through its Incharge.
3. Vishal, Executive Telecaller of Axis Bank Ltd., (Loan Department), Basement & Ground floor, HUDA Shopping Centre, SCO 8,Sector-16, Faridabad, Haryana – 121002.
…Opposite parties……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Dinesh Kumar, counsel for the complainant.
Sh. Sanjay Rawat, counsel for opposite party No.1.
Opposite parties Nos.2 & 3 ex-parte vide order dated 30.08.2022.
ORDER:
The facts in brief of the complaint are that the complainant had purchased a Car Boleno Sigma 1.2 CC bearing its Regn. No. HR-51-CC/4918 on 23.12.2020 and the said car was financed from the opposite party No.2. The complainant had received a telephonic call from the side of opposite party No.4, who had disclosed to his client that the complainant was the valuable customer of opposite party No.2 i.e. Axis Bank, hence, the bank had decided to provide the Group Insurance Mediclaim Policy for a sum of Rs.15,00,000/- in which accidental claim of Rs.10,00,000/- were except from the said policy amount and also disclosed to the complainant that complainant would pay only Rs.4,449/- as premium of the said policy through debit card and rest of the premium of the said policy would be bear by the opposite party NO.2 itself. On believing the words of opposite party NO.4 the complainant agreed for the same and paid the said amount from his debit card. After sometime the complainant received a policy bond of policy NO. 0238178373, which was valid from 31.12.2020 to 30.12.2021 which was issued by opposite party NO.1. When the renewal period of the said policy had come near then the customer care executive had called to the customer for renewal of the said policy. During discussion with the said executive had disclosed to the complainant that the said policy was a top up policy and if the complainant wants to get the benefits of the said policy then firstly he would take base policy after that he could take the benefits of the said policy. The
complainant had disclosed to the said executive that opposite party No.4 had not disclosed anything about this to him at the time of selling the above said policy. Upon which said executive had disclosed to the complainant that the said fact was clearly mentioned in the record of the said policy. Thereafter the complainant many times requested the opposite parties Nos.1 to 2 to correct the above said policy and issued the based policy to him but the opposite parties were not giving any heed to the requests of the complainant. The aforesaid act of opposite parties amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to:
a) opposite party No.1 to issue the base policy to the complainant.
b) pay an amount of Rs.50,00,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 51,000 /-as litigation expenses.
2. Opposite party No.1 put in appearance through counsel and filed written statement wherein Opposite party No.1 refuted claim of the complainant and submitted that the complainant had alleged mis-selling and deficiency of service against the agents under the subject policy. The opposite party company was not privy to any of the communication between the complainant and the agents. The complainant had failed to furnish any evidence in support of his allegations and cannot be taken simply on their word. It was further noteworthy that on the basis of the proposal form, the subject policy was issued to the complainant. The opposite party company had issued top up to the Medicare master policy on 31.12.2020 through the opposite party No.2 being their corporate agents. It was pertinent to note that the said policy was in the form of deductibles. In common parlance, the top up plans were very crucial as they provide with the
coverage after the customer had maxed out the claims against the regular health policy. In the present case, the policy was issued in the form of deductibles. It was apparent that a health insurance deductible was proportion of the medical/hospitatisation expenses which had to be paid out of pocket before an insurance claim had to be made. In the present case, the deductible amount for the said top up policy was amounting to Rs.2,00,000/- which was explicitly mentioned in the certificate of insurance availed by the complainant. Offering deductible on the top up policy was a common feature which provides threshold limit upon the insurer to pay the claim and the remaining cost should be entirely borne by the insured person. Opposite party No. 1 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. Notice issued to opposite parties Nos.2 & 3 on dated 1.8.2022 not received back either served or unserved. Tracking details filed in which it had been mentioned that “Item Delivery Confirmed”. Case called several times since morning but none appeared on behalf of opposite parties Nos.2 & 3. Therefore, opposite parties Nos.2 & 3 were proceeded against ex-parte vide order dated 30.08.2022,
4. The parties led evidence in support of their respective versions.
5. We have heard learned counsel for the parties and have gone through the record on the file.
6. In this case the complaint was filed by the complainant against opposite parties– TATA AIG General Insurance Company Limited with the prayer to: a) opposite party No.1 to issue the base policy to the complainant. b) pay an
amount of Rs.50,00,000/- as compensation for causing mental agony and harassment . c) pay Rs. 51,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.C-1 – Card,Ex.C-2 – Test report,. Ex.C-3 – Test, Ex.C-4 - report, Ex.C-5 – receipt No. 44688 dated 24.2.2022
On the other hand counsel for the opposite party No.1strongly
agitated and opposed. As per the evidence of the opposite party No.1 Ex.RW-1/A – affidavit of Shri GG Padmakar Tripathi Manager – legal of Tata AIG General Insurance Company Ltd., Ex.RW-1/1 –Enrolment form for Group Health, Ex.RW-1/2 – Terms & conditions of Group Medicare – Axis Bank, Ex.RW/1/3 - Group Medicare Certificate of insurance,
7. In this case, the complaint was filed by the complainant with the prayed to opposite party No.1 to issue the base policy to the complainant & pay an amount of Rs.50,00,000/- as compensation for causing mental agony and harassment.
8. In this case, the complainant had purchased a Car Boleno Sigma 1.2 CC bearing its Regn. No. HR-51-CC/4918 on 23.12.2020 and the said car was financed from the opposite party No.2. As per Annexure R-1 & 2, oopposite party issued a top up policy in respect of the group Medicare Policy baring 0238178373 in favour of the complainant The details of the said policy is mentioned hreiun below:
Policy No. | 0238178373 |
Certificate No. | 00924799 |
Policy Type | Group Medicare Policy – Top Up |
Name of Policy Holder | Mr. Anay Kumar |
Period | 31.12.2020 to 31.12.2021 31.12.2021 to 30.12.2022 |
Premium | Rs.4449/- |
Agent | Axis Bank |
Policy document disptached | Policy soft copy delivered to customer on 01.01.2021 on his registered email id. |
On the other
hand, counsel for the complainant argued that when the renewal period of the said policy had come near then the customer care executive had called to the customer for renewal of the said policy. During discussion with the said executive had disclosed to the complainant that the said policy was a top up policy and if the complainant wants to get the benefits of the said policy then firstly he would take base policy after that he could take the benefits of the said policy.
9. There is nothing on record to disbelieve and discredit the aforesaid ex-parte evidence of the complainant. Since opposite parties No. 2 &3 have not come present to contest the claim of the complainant, therefore, the allegations made in complaint by the complainant go unrebutted. From the aforesaid ex-parte evidence it is amply proved that opposite parties Nos.2 & 3 have rendered deficient services to the complainant.
10. After going through the evidence led by the parties, the Commission is of the opinion that when the opposite party No.1 had not issued the base policy to the complainant first, how opposite party issued the TOP-UP Policy to the complainant. Hence, the deficiency in service on the part of the opposite parties Nos.1 to 3 have been proved. Resultantly, the complaint is allowed.
11. Opposite party No.1 is directed to issue the Base policy to the complainant. Opposite parties Nos.1 to 3 are directed to pay Rs.50,000/- as compensation on account of mental tension, agony and harassment. Opposite parties Nos.1 to 3 are also directed to pay Rs.2200/- as litigation expenses to the complainant. Compliance of this order be made within 30 days from the date of receipt of copy of order. Copy of this order be given to the parties concerned free of costs and file be consigned to record room.
Announced on: 18.01.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
