STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
U.T., CHANDIGARH
First Appeal No. | : | 68 of 2013 |
Date of Institution | : | 19.02.2013 |
Date of Decision | : | 07.05.2013 |
Sh. Atul Nahar S/o Sh. N .K. Nahar, #3137, Sector 40-D, Chandigarh.
……Appellant/Complainant.
Versus
[1] The Manager, TATA AIG General Insurance Co. Ltd., SCO No. 232-234, Sector 34-A, Chandigarh.
[2] TATA AIG General Insurance Co. Ltd., Simran Centre, 2nd Floor, 30-H Parsi Panchayat Road, Andheri (E) Mumbai – 400069.
[3] TATA AIG General Insurance Co. Ltd., Regd. Office: Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, G.K. Marg, Lower Parel, Mumbai – 400013.
....Respondents/Opposite Parties.
Appeal under Section 15 of the Consumer Protection Act, 1986.
BEFORE: JUSTICE SHAM SUNDER (RETD.), PRESIDENT.
MRS. NEENA SANDHU, MEMBER.
Argued by: Sh. G. D. Gupta, Advocate for the appellant.
Sh. Rajneesh Malhotra, Advocate for respondents No.1 to 3.
PER MRS. NEENA SANDHU, MEMBER.
This appeal is directed against the order dated 03.12.2012, rendered by the District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (hereinafter to be called as the District Forum only), vide which it disposed of the complaint of the complainant (now appellant), with the following directions:-
“11. Keeping in view the foregoing, we dispose off the present complaint. The Complainant is at liberty to approach the Opposite Parties for payment of the hospitalization benefit under the MRP Policy bearing No.MRP 25000051982 in terms of hospitalization beyond one day if he can prove the hospitalization. The Complainant may also file his claim under the HCP Policy bearing No. HCP 250000013636 and take payment as per the willingness shown by the Opposite Parties to make payment in terms of the reply filed. No costs.”
2. The facts, in brief, are that the complainant had obtained two Policies from Opposite Parties No. 2 and 3, vide Insurance Policy No.MRP 25000051982 known as TATA AIG Maha Raksha Personal Injury Policy, effective from 10.6.2008 to 09.06.2009 (hereinafter to be referred to as “MRP Policy”) and Policy bearing No. HCP 250000013636 valid from 28.06.2008 to 27.06.2009 (hereinafter to be referred to as “HCP Policy”). It was stated that both the policies covered personal accident cover, injuries and hospitalization, besides reimbursement of medical expenses. It was further stated by the complainant that no policy terms and conditions of either of the policies were supplied to him. It was further stated that the complainant got the HCP Policy renewed for another year but due to an unfortunate event, he had a sudden accidental fall, while playing cricket in the College ground and suffered a fracture of the right knee joint, for which treatment was given to him at Dr. Bhatia’s Bone and Joint Care Clinic, Sector 37-D, Chandigarh. It was further stated that the complainant remained confined to bed from 13.9.2008 to 10.11.2008. It was further stated that the complainant submitted his claim form alongwith detailed medical expenses bill for Rs.7,575/-, duly verified by the treating Orthopedician to the Opposite Parties, on 6.2.2009. It was further stated that as per MRP Policy, the complainant was entitled to a claim of Rs.18,000/- + domiciliary hospitalization @ Rs.1,500/- per day for 58 days, for which he remained confined to bed i.e. Rs.1,12,575/-. It was further stated that the complainant was also eligible for accidental benefit for injuries @ Rs.4,000/- per day, as In-Hospital Indemnity for accident + Rs.15,000/- as accident Medical Expenses Reimbursement and other compensatory allowance under the HCP Policy. It was further stated that no amount of compensation was paid by the Opposite Parties, despite the fact that, the premium had been charged from him. It was further stated that the complainant lodged his claim with Opposite Party No.3, and provided all desired documents, to Opposite Party No.2. It was further stated that the Opposite Parties, paid a sum of Rs.3,500/- only, after a lot of reminders. It was further stated that the aforesaid act of the Opposite Parties, amounted to deficiency in service. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), directing the Opposite Parties, to pay an amount of Rs.1,12,575/- being the sum insured under the policy (Annexure C/2), Rs.19,500/- for injury on daily basis under Policy (Annexure C/1), Rs.15,000/- on account of medicines, attendance expenditure and special diet, Rs.5,000/- spent as transportation charges, Rs.10,000/- as interest @9% per annum for delayed payment, Rs.50,000/- towards compensation for harassment and mental agony, and Rs.25,000/- as cost of litigation, was filed.
3. The Opposite Parties, in their written version, took up some preliminary objection, that an amount of Rs.3,500/- had already been paid to the complainant as full and final settlement under MRP Policy. It was stated that the MRP Policy did not provide cover for expenditure incurred towards medical expenses. It was further stated that as per terms of HCP Policy, under which no claim had reportedly been filed by the insured, the Opposite Parties, were willing to pay a sum of Rs.11,150/- towards In-Hospital Indemnity and accidental medical expenses. It was further stated that the MRP Policy was valid from 10.6.2008 to 9.6.2009 and provided for payment under Plan 3 Level 1 (maximum permissible claim) as given in the schedule of the insurance policy. It was further stated that the complainant had placed, on record, previous MRP Policy Schedule under Plan 3 with Level 4 benefits. It was further stated that initially the complainant had applied for Plan 3 Level 4 Policy, but lateron he called the call centre of the Opposite Parties, on 9.7.2008 and requested for downgrading of the policy, resulting in reduction of premium payable, and reduction in insurance policy from Level 4 to Level 1. It was further stated that as per the request of the complainant, the MRP Policy was accordingly down graded to Plan 3 with Level 1 benefits. It was further stated that the HCP Policy was, however, valid for Level 3 payment (maximum permissible claim), but no claim under this Policy was ever registered by the complainant. It was further stated that the Opposite Parties, were willing to release the amount due under this policy to the complainant, subject to fulfillment of the requirements of claim. It was further stated that the terms and conditions of the Policy were sent to the complainant, along with the insurance policy. It was further stated that no prudent man would get the insurance policy renewed, if the terms and conditions were not being supplied. It was further stated that after the unfortunate accident, the complainant submitted his bill, which was processed, as per the terms and conditions of the policy and Rs.3,500/- were paid. It was further stated that the insured had suffered fracture, in the right knee, and was hospitalized for one day. It was further stated that the other amounts claimed by the claimant under the policy, were not covered and hence, were not payable. It was further stated that the amount payable, as per the terms and conditions of MRP Policy (Level 1) were in hospital indemnity for sickness with benefit of Rs.500/- per day and 25% of principal sum insured of Rs.12,000/- for Coverage under Fractures Dislocation & Burns. It was further stated that the amount payable under the HCP Policy was Rs.11,150/- which had not still been claimed by the complainant. It was further stated that the amount claimed by the complainant, in this complaint, was not payable, except the amount of Rs.11,150/- due under HCP Policy as per terms and conditions of the Policy for which, no claim was made. It was further stated that there was, thus, neither any deficiency, in rendering service, on the part of Opposite Parties, nor they indulged into unfair trade practice. The remaining allegations, contained in the complaint were denied.
4. The parties led evidence, in support of their case.
5. After hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, disposed of the complaint, vide the impugned order, as sated above.
6. Feeling aggrieved, the appellant/complainant, has filed the instant appeal.
7. We have heard the Counsel for the parties, and, have gone through the evidence and record of the case, carefully.
8. At this stage, it is pertinent to mention here that, alongwith the appeal, the applicant/appellant/complainant, moved an application for condonation of delay of 30 days in filing the same (appeal). The grounds, set up, in the application, by the applicant/appellant, are to the effect, that after the receipt of certified copy of the impugned order on 19.2.2012 and, subsequently, on 22.12.2012, the Counsel discussed the same with the appellant/complainant, for filing an appeal. Because of vacations, on 23.12.2012, the Counsel left for Puri (Orissa) to attend a conference of Adhivakta Parishad and returned to Chandigarh on 31.12.2012. It was further stated that the Counsel misplaced the certified copy of the judgment, while shifting his office from District Courts, Sector 17, Chandigarh to New District Courts Complex, Sector 43, Chandigarh, as a result whereof, the appeal could not be drafted and filed within time. It was further stated that after tracing the files, the judgment was traced on 14.02.2013, the grounds of appeal were drafted and eight sets were prepared, which were got signed and attested. It was further stated that since as 17.02.2013 and 18.02.2013, were the holidays on account of Saturday and Sunday, the appeal was filed on 19.02.2013, without any further delay. It was further stated that the delay aforesaid, in filing the appeal, was on account of the circumstances, beyond the control of the Counsel. It was further stated that the delay, in filing the appeal, was neither intentional, nor deliberate. Accordingly, the prayer for condoning the aforesaid delay was made.
9. In reply to the aforesaid application, filed by the respondents/Opposite Parties, it was stated that the reasons given by the applicant/appellant, for condonation of delay of 30 days are not sustainable, in the eye of law. It was further stated that the non-availability of the Counsel and misplacement of the certified copy of the order, could not be considered to be sufficient grounds for condonation of delay. It was further stated that the applicant/appellant failed to explain each day’s delay. Accordingly, a prayer for dismissal of the appeal, on the ground of delay itself, was made.
10. The applicant/appellant, has also filed another application under Order 1 Rule 10 C.P.C, for impleading M/s. Hongkong Shanghai Banking Corporation Limited, Umang Plot No.1406-A/28, Mindspace, Malad (West), Mumbai-400064, as a party, to the complaint, on the ground, that during the course of trial of the complaint before the District Forum, it was noticed that the said Corporation had active role in debiting and crediting the insurance premium to Opposite Parties No.1 and 2, as they were having business relationship and common interest in the sale of insurance policies, in question. It was further stated that the said HSBC Bank had also submitted a fake and fabricated bank statement maneuvering the entry of refund of premium of Rs.6,024/-, while allegedly downsizing the insurance policy. It was further stated that the said statement was not in the proper Performa of debit and credit with narration as was required under the Banking Regulations.
11. In reply, to this application, the respondents/ Opposite Parties, stated that M/s. Hongkong Shanghai Banking Corporation Limited has no role to play in the present dispute, as the applicant/appellant has only made the payment of the policy through M/s. Hongkong Shanghai Banking Corporation Limited. It was further stated that the premium, in excess, was returned to the applicant/appellant through this very HSBC Bank, on downgrading the Policy, and the amount was duly credited to the account of the applicant/appellant. It was further stated that the applicant/appellant had himself filed an application for summoning HSBC Bank alongwith his statement of account, to which, no objection was given by the respondents/Opposite Parties, and, as such, the representative of HSBC Bank, placed, on record, the account statement of the applicant/appellant. It was further stated that the applicant/appellant has leveled allegations of fraud and fabrication, which cannot be adjudicated under the summary proceedings of the Consumer Fora, the appeal as well as the application, filed by the applicant/appellant, be dismissed at the outset.
12. We have heard the Counsel for the parties, on the aforesaid application, as also, in the main appeal, and have gone through the evidence, and record of the case, carefully.
13. First coming to the application for condonation of delay of 30 days, in filing the appeal, the Counsel Sh. Gaurav Gupta, Advocate, who drafted the appeal and filed the same, has filed his own affidavit, in support of his contention that after receipt of the certified copy of the impugned order on 19.12.2012, he had gone to Puri (Orisa) on 23.12.2012, for attending a conference of Adhivakta Parishad and returned to Chandigarh on 31.12.2012. He has also testified in his affidavit, that he misplaced the certified copy of the order impugned, while shifting his office from District Court Complex, Sector 17, Chandigarh, to new District Courts Complex, Sector 43, Chandigarh. In our view, the litigant, should not suffer, for the fault of his/her Counsel, which has happened in the present case. In these circumstances, for the reasons, explained in the application for condonation of delay, which is duly supported by an affidavit of Sh. Gaurav Gupta, Advocate, Counsel for the applicant/appellant, and finding sufficient cause, the delay of 30 days, in filing the appeal, is condoned.
14. Now, coming to the next application, under Order 1 Rule 10 C.P.C., for impleading M/s. Hongkong Shanghai Banking Corporation Limited, Umang Plot No.1406-A/28, Mindspace, Malad (West), Mumbai-400064, as a party, to the complaint, it is pertinent to mention here that in the complaint, filed before the District Forum, the applicant/appellant/complainant neither raised any allegation against M/s. Hongkong Shanghai Banking Corporation Limited, nor he made any reference of it. Moreover, from perusal of zimini order dated 06.11.2012 of the file of the District Forum, it is clear that the representative of M/s. Hongkong Shanghai Banking Corporation Limited, appeared and placed, on record, a copy of the letter dated 31.10.2012 alongwith transaction details of the applicant/appellant for the period from 18.06.2008 to 17.07.2008, which are at Pages 249 to 255 of the District Forum’s file. It is surprising that the applicant/appellant did not move any application, before the District Forum, to implead M/s. Hongkong Shanghai Banking Corporation Limited, as a necessary party, to the complaint. It was for the applicant/appellant, to move such an application, at that point of time, before the District Forum, and, not at this appellate stage. Accordingly, the application, is dismissed.
15. Now, coming to the merits of appeal, admittedly, the complainant purchased Insurance Policy No.MRP 25000051982, effective from 10.6.2008 to 09.06.2009 and paid a premium of Rs.9,134/- for a sum assured (Rs.18,000/- being cash for every injury and Rs.22,500/- for internal injury) and monetary benefit as per Level-4 (Annexure C-1). As per learned counsel for respondents/Opposite Parties, no doubt, the appellant/complainant, purchased the MRP Policy Schedule under Plan 3 with Level 4 benefits. The appellant/complainant got it changed by calling at the Call Centre of the Opposite Parties, on 09.07.2008. The Counsel for the respondents/Opposite Parties further submitted that as per the request of the appellant/complainant, the said MRP Policy was downgraded to Plan 3 Level 1 benefits (Policy Schedule Annexure A-1). From the perusal of the new Policy Schedule (Annexure A-1), it is apparent that the annual premium was Rs.3,110/- and as per the details provided by the HSBC Bank vide Statement of Account at Page 251 of the District Forum’s file, an amount of Rs.6,024/- was refunded to the appellant/complainant, by the Opposite Parties, being the excess premium charged, on account of previous policy. Neither, the factum of making request for changing the Plan, under MRP Policy, was denied by the appellant/complainant nor was any replication, filed by him, to the written statement filed by respondents/Opposite Parties, before the District Forum, to refute the said plea. Admittedly, the appellant/complainant filed claim of Rs.7,575/- vide Personal Accident Claim Form (Annexure C/12) and the Opposite Parties, rightly paid a sum of Rs.3,500/- to him, for 01 day hospitalization, under Plan 3 Level 1 of the downgraded MRP Policy, as is apparent from letter dated 30.06.2009 (Annexure C-19).
16. As regards the benefit, under the HCP Policy bearing No.HCP 250000013636, since no claim was filed by the appellant/complainant with the respondents/Opposite Parties, hence, he had no locus-standi to file the complaint qua the said policy, against the Opposite Parties, and the District Forum, rightly granted liberty to the appellant/complainant, to file claim under HCP Policy, if he so desired.
17. No other point, was urged, by the Counsel for the parties.
18. The impugned order, therefore, does not suffer from any illegality and perversity, warranting the interference of this Commission.
19. For the reasons recorded above, the appeal filed by the appellant/complainant, is dismissed with no orders as to costs. The impugned order, rendered by the District Forum, is upheld.
20. Certified Copies of this order be sent to the parties, free of charge.
21. The file be consigned to Record Room, after completion.
Pronounced.
7th May 2013.
Sd/-
[JUSTICE SHAM SUNDER (RETD.)]
PRESIDENT
Sd/-
[NEENA SANDHU]
MEMBER
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STATE COMMISSION
(First Appeal No.68 of 2013)
Argued by: Sh. G. D. Gupta, Advocate for the appellant.
Sh. Rajneesh Malhotra, Advocate for respondents No.1 to 3.
Dated the 7th day of May, 2013.
ORDER
Vide our detailed order of the even date, recorded separately, this appeal filed by the appellant/complainant, has been dismissed, with no orders as to costs.
(NEENA SANDHU) MEMBER | (JUSTICE SHAM SUNDER(RETD.)) PRESIDENT | |
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