Chandigarh

DF-I

CC/1081/2019

Mr. Dev Dutt Gandhi - Complainant(s)

Versus

Reliance General Insurance Co. Ltd. - Opp.Party(s)

Amarbir Singh Dhaliwal & Gurtej Partap Singh Sandhu

01 Nov 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

                                     

Consumer Complaint No.	:	CC/1081/2019
Date of Institution	:	25/11/2019
Date of Decision	:	01/11/2022

 

Mr. Dev Dutt Gandhi (since deceased) through his legal heir and wife Mrs.Anupama Gandhi w/o late Mr. Dev Dutt Gandhi, r/o House No.5724, Duplex Phase III, Modern Housing Complex, Manimajra, Chandigarh 160101.

… Complainant

V E R S U S

Reliance General Insurance Company Ltd. in 2^nd Floor, SCO 147-148, Madhya Marg, Sector 9C, Chandigarh Pin 160009 through its Managing Director/Director/Authorised Signatory.

… Opposite Party

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER

                                                                       

ARGUED BY	:	Sh. J.P. Nahar, Counsel for complainant
	:	Sh. Arun Kumar, Counsel for OP

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Mr. Dev Dutt Gandhi, complainant against the opposite party (hereinafter referred to as the OP). The brief facts of the case are as under :-

1. It transpires from the allegations as projected in the consumer complaint that in the month of April 2018, complainant planned a US trip from 10.6.2018 to 9.7.2018 and accordingly had purchased return air tickets (Annexure C-1).  At that time, complainant had also purchased travel insurance from OP which was valid w.e.f. 10.6.2018 to 9.7.2018. The said insurance policy covered the complainant from various medical expenses, accidental, coverage trip cancellation including entire interruptions and various other coverages.  It was informed to the complainant at the time of purchasing the insurance policy that if due to any reason he is required to cancel his return air tickets and purchase new tickets, then the OP shall be liable to pay 600 US dollar to the complainant for the purchase of new air tickets. Due to the serious illness of his mother, who was admitted in the hospital, complainant was compelled to cut short his trip and returned to India and for that purpose he had purchased new air tickets for departure on 26.6.2018 and reached India on 27.6.2018 and the new air ticket is Annexure C-2 which also shows that the complainant had purchased the said tickets for 1076 US dollar i.e. INR 76223.84.  After arrival in India, complainant lodged his claim as per the insurance policy, but, the OP did not respond to the same. On this, the complainant sent an email (Annexure C-5) to the OP, but in response to that, OP had informed the complainant vide letter dated 14.11.2018 that his claim has been repudiated on the ground that relationship of the mother is not included in the definition of family.  As the complainant had paid huge amount of premium to the OP for purchasing the policy and as per terms and conditions of the policy, the trip cancellation and interruption was covered upto 600 US dollars, OP is liable to pay the said amount to the complainant.  It is alleged that since the OP had not allowed the said claim of the complainant, there is clear case of deficiency in service on its part.  The OP was requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.
2. OP resisted the consumer complaint and filed its written statement, inter alia, taking preliminary objections of maintainability, cause of action and also that the complainant has set up a false complaint against the OP.  On merits, admitted that the trip of the complainant was insured at the relevant time, but, denied that the claim of the complainant was wrongly repudiated by the OP.  It is alleged that in fact, as per the terms and conditions of the policy, certain categories of relatives are covered under the definition of family and since mother is not covered under the said policy, claim of the complainant was rightly repudiated by the OP.  The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
3. In rejoinder, complainant re-asserted his claim put forth in consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.

2. In order to prove their case, parties have tendered/proved their evidence by way of affidavits and supporting documents.
3. 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 on the part of OP?
2. Whether the complainant is entitled for the claim as prayed for?

Point No.(i) & (ii)

4. Both these points are interconnected, hence are taken together to avoid repetition of facts and evidence.
5. Admittedly, the complainant had purchased the Reliance Travel Care Policy (Annexure C-2) from the OP w.e.f. 10.6.2018 to 9.7.2018 for travelling to US during the said period, as is also evident from the travel ticket (Annexure C-1) and policy is Annexure C-2 as well as Ex.OP-2.  It is further an admitted case of the parties that the complainant had cut short his trip due to illness of his mother, who remained admitted in the hospital w.e.f 19.6.2018 to 22.6.2018 and 26.6.2018 to 3.7.2018, as is also evident from Annexure C-3.  It is further an admitted case of the parties that the complainant after purchasing new tickets (Annexure C-4) had departed from US on 26.6.2018 and reached India on 27.6.2018 and had purchased the said ticket for 1076 US dollar. The case of the complainant is that as the cancellation of the trip was covered under the policy (Annexure C-2) and as per the terms and conditions of the policy, OP had undertaken to pay 600 US dollars to the complainant on cancellation of the trip, and since the genuine claim of the complainant has not been allowed by the OP, complainant has successfully proved that there is deficiency in service on the part of the OP and the complainant is entitled for the reliefs, as prayed for.  On the other hand, defence of the OP is that since the illness of the mother has not been covered under the policy (Ex.OP-2), the claim of the complainant was rightly repudiated by the OP and the complaint of the complainant 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 any deficiency in service on the part of OP by denying the genuine claim of the complainant, as is the case of the complainant, or if the claim of the complainant was rightly repudiated by the OP, being not covered under the policy (Annexure C-2/Ex.OP-2).
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 an admitted case of the parties that the foreign trip of the complainant was covered w.e.f. 10.6.2018 to 9.7.2018 by the OP vide the Policy (Annexure C-2/ Ex.OP-2) and also that the complainant had cancelled the trip before his actual day of departure from US and reached India on 27.6.2018 due to illness of his mother, case is reduced to a narrow compass as it is to be determined if the serious illness of the mother of the complainant, which has caused the cancellation of the trip of the complainant in the midway, is covered under the policy (Annexure C-2/Ex.OP-2)
2. The learned counsel for the complainant has contended with vehemence that as the complainant was informed by the OP at the time of issuance of the policy (Annexure C-2) that cancellation of the trip for whatever may be the reason, is covered under the policy and since the policy has covered the cancellation of the trip upto the extent of 600 US dollars, complainant is entitled for the said amount alongwith compensation as prayed for.  On the other hand, learned counsel for the OP has contended with vehemence that as mother does not come under the definition of family of complainant for the purpose of claim of the policy holder, rather unforeseen illness, injury or death of the insured/insured person’s family member i.e. his lawful spouse below the age of 60 years and maximum of two dependent children are covered, claim of the complainant was rightly repudiated by the OP and the consumer complaint of the complainant be dismissed with costs.
3. Thus, one thing is very clear from the facts as set up in the consumer complaint, defence of the OP and the contention of the learned counsel for the parties that the entire case is revolving around the terms and conditions of the policy. The relevant clauses of policy i.e. “family” and trip cancellation and interruption clause are reproduced as under :-

“Family” means the Insured, his/her lawful spouse below the age of 60 years and maximum of two (2) dependent children (including stepchildren and adopted children) below the age of 21 years.”

“Benefit 13 – Trip Cancellation and Interruption

What it covers.

The Company shall compensate the Insured/Insured Person if a trip is cancelled or interrupted due to any of the following reasons :

1.       Unforeseen illness, injury, or death of the Insured/Insured Person’s family member.  Injury or illness must be so disabling as to reasonably cause a trip to be cancelled or interrupted.

xxx                       xxx                       xxx”

From the aforesaid terms and conditions of the policy, one thing is further clear that the unforeseen illness of the mother, as is the case of the complainant, is not covered under the trip cancellation since mother is not covered under the definition of family.

4. The learned counsel for the complainant has contended with vehemence that as the OP has only supplied two pages policy (Annexure C-2) to the complainant and the remaining part of the policy (Ex. OP-2) was never supplied to the complainant, the terms and conditions and the wording of the policy (Ex.OP-2) is not binding upon the complainant and the OP cannot be allowed to take benefit of Ex.OP-2.  In support of his arguments, learned counsel for the complainant has relied upon the judgment of Hon’ble Apex Court in case United India Insurance Co. Ltd. Vs. M.K.J. Corporation, Appeal (Civil) 6075-6076 of 1995 decided on 21.8.1996 in which it was held as under :-

          “It is a fundamental principle of Insurance Law that utmost good faith must be observed by the contracting parties.  Good faith forbids either party from concealing (non-disclosure) what he privately knows, to draw the other into a bargain, from his ignorance of the fact and his believing the contrary.  Just as the insured has a duty to disclose, “similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured.”

 

5. On the other hand, learned counsel for the OP has contended with vehemence that as even Annexure C-2 has clearly referred in its last part at page 2 that alongwith the policy schedule, policy terms and conditions and annexure are also attached, it is clear that complete Ex.OP-2 was also supplied to the complainant at the time of issuance of Annexure C-2 and the complainant now cannot come up with a new plea when the same was never taken up by him in the consumer complaint about the non supply of complete policy.  There is force in the contention of the learned counsel for the OP as the consumer complaint does not reveal any word about non-supply of the terms and conditions of the policy to the complainant, rather when the OP has taken a specific defence that all the documents were supplied to the complainant, including Ex.OP-2, complainant has denied the said fact in his rejoinder by stating computer generated documents do not bear the signature of the complainant or any other authorized person.  Not only this, when even Annexure C-2 has categorically contained a note on its foot that the policy terms and conditions and annexures are also attached with the policy schedule (Annexure C-2) and the policy holder was asked to ensure that he has received, read and understood all these documents and if the policy holder has not received any of these, he was asked to mail/write to the company at the given email address as well as toll free contact number, the aforesaid Ex.OP-2 is deemed to have been received by the complainant, especially since nothing has come on record that the complainant ever approached the OP for the non-supply of the terms and conditions or the annexures attached with the policy either through email or through toll free contact number. 
6. As it is an admitted case of the complainant that due to the serious illness of his mother, he had to cancel the trip as a result of which he rescheduled his return journey to India by purchasing new ticket (Annexure C-4), it is safe to hold that the claim of the complainant was rightly repudiated by the OP vide repudiation letter (Ex.OP-3) as mother is not included in the definition of family as per policy.

8. In view of the foregoing discussion, it is safe to hold that complainant has failed to prove any deficiency in service on the part of OP and he is not entitled for the prayed reliefs. Accordingly, the present consumer complaint, being devoid of any merit, is hereby dismissed, leaving parties to bear their own costs.
9. Certified copies of this order be sent to the parties free of charge. The file be consigned.

Announced 01/11/2022 hg			Sd/- [Pawanjit Singh] President
			Sd/- [Surjeet Kaur] Member