Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 516.
Instituted on : 22.09.2016.
Decided on : 24.07.2018.
Sh.Om Parkash Ruhil s/o Sh. Chhotu Ram R/o H.No.99, Vikas Nagar, Rohtak, Distt. Rohtak.
………..Complainant.
Vs.
- The Managing Director, United India Insurance Company Ltd., 24, Whites Road, Chennai-600 014.
- The Distt. Manager, The United India Insurance Company Ltd., Rohtak, Distt. Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.RAJBIR SINGH DAHIYA, PRESIDENT.
SH. VED PAL, MEMBER.
Present: Sh.B.S.Goyat, Advocate for the complainant.
Sh.Gulshan Chawla, Advocate for opposite parties.
ORDER
RAJBIR SINGH DAHIYA, PRESIDENT:
1. Brief facts of the case are that complainant got a travel health insurance from the opposite parties during the journey of Australia bearing policy No.0216002615990792222 from 01.11.2015 to 08.04.2016. That during the journey complainant fall ill and paid $500AUD for his treatment. That complainant is legally entitled to reimburse the above said amount being insured person and the complainant duly submitted the claim form alongwith all the necessary documents to the opposite party company within stipulated time. That the complainant got only Rs.1840/- insptie of $500 i.e. Indian currency approximate of Rs.25000/-. That opposite parties illegally disclaim the treatment amount of the complainant for which the complainant is legally entitled to get the amount of $500 AUD i.e. Rs.25000/- approximately. That the act of opposite parties is illegal and amounts to deficiency in service. Hence, this complaint and the complainant has prayed for directing the opposite parties to make the payment of $500 AUD for his treatment i.e. Rs.25000/- approximately alongwith Rs.20000/- on account of harassment to the complainant.
2. After registration of complaint, notice was issued to the opposite parties. Opposite parties in their reply has submitted that complainant filed the claim in the office of opposite parties stating the factum that he had spent an amount of AUD 501.23. It was further alleged/detailed that the complainant spent total amount on treatment of 2 different diseases i.e. Conjunctivitis an amount of AUD 80.38 and Gastro esophageal reflux an amount of AUD 419.85. That both the treatment are different and having no concern with each other. That as per the terms and conditions of the policy the claim amount qua the conjunctivitis was not payable being less than the deductable amount and an amount of USD 27.86 which is equivalent to Rs.1840/- was rightly paid to the insured by the company. It is denied that the complainant is entitled for an amount of Rs.23160/- or any other amount. It is prayed that complaint may kindly be dismissed with costs.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C16 and closed his evidence. On the other hand ld. counsel for the OPs tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R13 and closed his evidence.
4. We have heard learned counsel for the parties and have gone through material of the case very carefully.
5. The complainant was paid only Rs.1480/- by the OPs and giving a reasoning in para no.1 & 2 of the reply on merits by the OPs. After going through the averments put forth by the parties of the insurance company we conclude that the complainant is entitled to claim of Rs.23500/-(converted from AUD currency) after the standard deduction of Rs.4700/- (converted from AUD currency) which comes to Rs.18800/- and after deduction of Rs.1840/- which has already paid by the OPs. The net amount comes to Rs.16960/-(Rupees sixteen thousand nine hundred sixty only) which sum is awarded favouring the complainant and against the OPs alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 22.09.2016 till its realization and OPs shall also pay Rs.3500/-(Rupees three thousand five hundred only) as litigation expenses to the complainant within one month from the date of decision.
6. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
24.07.2018.
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Rajbir Singh Dahiya, President
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Ved Pal Hooda, Member.
