Chandigarh

StateCommission

A/24/2023

RAVINDER ARORA - Complainant(s)

Versus

UNITED INDIA INSURANCE COMPANY LIMITED - Opp.Party(s)

Complainant(in Prsn)

28 Apr 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

 

Appeal No.	:	24 of 2023
Date of Institution	:	13.02.2023
Date of Decision	:	28.04.2023

 

 

 

 

 

Ravinder Arora, Advocate, aged 60 years S/o Late Sh. Gobind Ram Arora, Resident of Flat No.34, Bollywood Height-2, Peer Mushalla, Zirakpur-160104.

….Appellant/Complainant.

 

Versus

1]     United India Insurance Company Ltd., Divisional Office II, SCO 177-178, Sector 8-C, Chandigarh through its Divisional Manager Sh. Ajay Sharma.

2]     United India Insurance Company Ltd., SCO 855, 1^st Floor, Mani Majra, Chandigarh through its Branch Manager Sh. Mangal.

3]     United India Insurance Company Ltd., SCO 122-123, Sector 17, Chandigarh through its Regional Manager Sh. N. K. Sidhu. 

...Respondents/Opposite parties.

 BEFORE:   JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

               MR. RAJESH K. ARYA, MEMBER

 

ARGUED BY :-   

 

Sh. Ravinder Arora, appellant in person.

Sh. Satpal Dhamija, Advocate for the respondents.

PER  RAJESH  K. ARYA, MEMBER

                This appeal has been filed by the complainant (appellant  herein) seeking enhancement of compensation awarded by the District Consumer Disputes Redressal Commission-II, U.T., Chandigarh (in short ‘District Commission’), vide order dated 16.12.2022 in consumer complaint bearing No.167 of 2022. The District Commission awarded following relief:-

“9]    Taking into consideration the above discussions and findings, we are of the opinion that the OPs not only remained deficient in their service but they also resorted to unfair trade practice. Therefore, the present complaint is allowed against OPs with direction to pay an amount of Rs.30,000/- to the complainant. The OPs are also directed to pay an amount of Rs.15,000/- to the complainant towards compensation for causing harassment & agony due to their deficient services, alongwith litigation cost of Rs.7,000/-.

        This order shall be complied with by the OPs within a period of 45 days from the date of receipt of copy of this order, failing which it shall be liable to pay additional cost of Rs.10000/- apart from above relief.”

2]             Briefly stated the facts as culled from the impugned order are narrated thus:-

“Concisely put, the complainant obtained Individual Personal Accident Policy from  OP (Ann.C-1) valid from 18.2.2021 to 17.2.2022 having sum insured of Rs.3 lacs. Unfortunately, the complainant, during the policy period, on 31.5.2021 suffered injury on his foot and diagnosed with bimalleolar right ankle fracture. The complainant visited ‘Ojas’ Hospital, Panchkula on 1.6.2021 for surgery but could not be admitted as his report of Covid-19 was positive. After getting negative report of Covid-19, the complainant was admitted in Ojas Hospital, Panchkula, where he remained admitted from 15.6.2021 to 18.6.2021 and surgery of ORIF-LATMALLELOUS PLATING was conducted on him (Ann.C-5).  It is stated that the complainant after surgery keep on visiting the hospital for follow up treatment and remained on wheel chair throughout till complete recovery.  It is also stated that after having 17 weeks rest as advised by doctors, the complainant on 26.9.2021 lodged claim with OP Insurance Company. However, the OP Insurance Company rejected the claim lodged by complainant on the ground that there is delay in lodging/intimating the claim vide email dated 28.10.2021 (Ann.C-7).  It is submitted that the complainant explained all the position and situation to the OPs by sending detailed email dated 28.10.2021 for settling the claim.  It is submitted that the complainant also furnished all requisite documents to the Investigator appointed by the OP Company in the matter, but still the claim has not been paid.  It is stated that the OPs vide email dated 25.1.2022 asked the complainant to file affidavit to the effect that whether he attended any of the court matter or did not attend at all any court matter (Ann.C-11) whereas it is not the condition mentioned in the policy.  It is also stated that the OPs with malafide intention are not clearing the claim of the complainant.  Hence, this complaint has been preferred alleging the said act of OPs as deficiency in service and unfair trade practice.

2]       The OPs have filed reply and while admitting the factual matrix of the case, stated that upon intimation of the claim, the answering OP deputed Investigator Mr.Harsh Vardhan Mehta to investigate the matter, who sought clarification from complainant vide several letters, but the complainant instead of reply preferred present complaint. It is stated that the claim is still pending for final decision. It is also stated that in view of the investigation report, it cannot be observed that the complainant was not in a position to do any professional work as alleged. It is submitted that the medical record provided by complainant does not suggest anywhere that he was advised for complete bed rest and in the absence of any documentary proof, regarding complete bed rest, it cannot be presumed that complainant was not in a position to do any work. Denying all other allegations and pleading no deficiency in service, the OPs have prayed for dismissal of the complaint.”

3]             The enhancement has been sought by the appellant on the ground that the District Commission has erred in holding that there is no evidence on record with regard to the fact that the appellant was advised 17 weeks rest. It has been stated that in view of Clause 1(f) of the Insurance Policy, Exhibit C-1, the District Commission should have allowed the claim for Rs.5,000/- per week instead of Rs.3,000/- per week. It has further been stated that the District Commission also erred in awarding meager amount of compensation for mental pain and agony, litigation expenses etc. and it has also not granted interest on the awarded amount, which should have been 18%.

4]             On the other hand, on behalf of the respondents, it has been stated that since the medical record provided by complainant does not suggest anywhere that he was advised for complete bed rest, therefore, it could not be presumed that complainant was not in a position to do any work. It has been stated that no ground is made out for enhancement in the relief awarded by the District Commission and the appeal is liable to be dismissed.

5]             After hearing the appellant in person, Ld. Counsel for the respondents and going through the material available on record, impugned order and the written arguments very carefully, we are of the considered view that the compensation awarded by the District Commission to the appellant on account of mental pain and agony, litigation expenses etc. is meager and the same needs to be enhanced for the reasons to be recorded hereinafter. It is no doubt true that the appellant suffered injury on his foot on 31.05.2021 and when he was diagnosed with bimalleolar right ankle fracture, his surgery was delayed as he could not be admitted in ‘Ojas’ Hospital, Panchkula as his report of Covid-19 was positive. Thereafter, when tested negative for Covid-19, he was admitted in the said Hospital, Panchkula, where he remained admitted from 15.6.2021 to 18.6.2021 and surgery was conducted on him. He also kept on visiting the hospital for follow up treatment and remained on wheel chair throughout till complete recovery. No doubt, the appellant definitely suffered immense mental agony and harassment during the course of his illness. We may  state here that the Fora constituted under the Consumer Protection Act are quasi judicial bodies, required to observe the principles of natural justice and to award relief of a specific nature and to award wherever appropriate, compensation to consumers. In Surendra Kumar Tyagi Vs. Jagat Nursing Home and Hospital and Another, IV (2010) CPJ 199 (N.C.), the principle of law, laid down, by the National Consumer Disputes Redressal Commission, New Delhi, was to the effect that the compensation should be commensurate with loss and injury, suffered by the complainant. The compensation is required to be fair, just and not unreasonable and arbitrary. Here in the instant case, looking at the sufferance of the appellant on account of mental agony and physical harassment due to deficient services of the respondents, the compensation awarded by the District Commission on this account needs to be enhanced being meager. The same needs to be enhanced adequately.

6]             So far as the contention raised on behalf of the appellant that the appellant was advised 17 weeks rest and the District Commission should have allowed the claim for Rs.5,000/- per week instead of Rs.3,000/- per week, we do not find any force in this contention as the District Commission after due appreciation of facts and documentary evidence on record, rightly observed from the Discharge Summary (Annexure C-5) that the appellant who suffered from Hypertension & Type-2 Diabetic Mellitus had undergone surgery for his fractured foot and before being operated for his fractured foot, he had to remain quarantined for 17 days as a Covid positive case. The District Commission rightly raised a presumption that the appellant had suffered immense physical pain not only due to fractured foot but also after the surgery being performed.  It also further rightly observed that in the case of the appellant, a diabetic person, it is known fact that recovery in such kind of patients is slow and such people are required to be very particular throughout their recovery phase in order to avoid any gangrene being developed. Thus, the non-payment of the due claim for the disputed period definitely amounted to deficiency in service as well as unfair trade practice on the part of the respondents, as rightly held by the District Commission. Further, per record, there was no justification qua his claim for 17 weeks and the District Commission rightly held the entitlement of the appellant for the claim for 10 weeks, which it quantified @1% of the capital sum insured, as per Clause-1(f) of the policy (Annexure C-1), which came to be Rs.30,000/- (10 weeks X Rs.3000/- per week). Thus, the appellant has failed to make out any ground for enhancement on this account.

7]             So far as the contention raised that the District Commission did not award any interest, it may be stated here that the District Commission has awarded additional cost of Rs.10,000/- in case the respondents failed to comply with the order within the period of 45 days from the date of receipt of copy of order. Thus, we feel that this claim of the appellant has been taken care of by the District Commission in terms of additional cost.

8]             For the reasons recorded above, the appeal is partly allowed and the impugned order dated 16.12.2022 passed by District Commission-II, U.T., Chandigarh is modified in the manner that the respondents/opposite parties are, jointly and severally, directed :-

1. to pay an amount of Rs.30,000/- to the appellant/complainant.
2. to pay an amount of Rs.25,000/- (instead of Rs.15,000/-) to the appellant/complainant towards compensation for causing harassment & agony due to their deficient services.
3. To pay litigation cost of Rs.7,000/- to the appellant/complainant.

        This order shall be complied with by the respondents/opposite parties within a period of 45 days from the date of receipt of copy of this order, failing which they shall be liable to pay additional cost of Rs.10,000/- apart from above relief.

9]             Certified copies of this order be sent to the parties free of charge.

10]           File be consigned to Record Room after completion.

Pronounced.

28.04.2023.

(RAJ SHEKHAR ATTRI)

PRESIDENT

 

 

 

(RAJESH K. ARYA)

MEMBER

 

Ad