National Consumer Disputes Redressal
Unit Trust Of India vs Smt Swaran Lath Jain on 4 August, 2010
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI Revision Petition No. 2549 of 2006 (from the order dated 09.06.2006 in Appeal No. 244 of 2003 of the State Consumer Disputes Redressal Commission, Himachal Pradesh, Shimla ) Unit Trust of India Flat No. 401 and 402 Mukesh Apartments Fingask Estate, Shimla 171003 UTI Investor Services Limited 174 and 175 Rajendra Bhavan Rajendra Place New Delhi ........ Petitioners Vs. Smt Swaran Latha Jain Shri Krishan Kumar Jain Both resident of Jain Niwas, Jain Mohalla Nadaun, Tehsil Nadaun District Hamirpur ..... Respondents BEFORE: HONBLE MR. JUSTICE ASHOK BHAN PRESIDENT HONBLE MRS VINEETA RAI MEMBER For the Petitioner Mr Dharam Dev, Advocate For the Respondent Mr Vishal Mahajan, Advocate Mr Vinod Sharma, Advocate Pronounced on 4th August, 2010 ORDER
PER VINEETA RAI, MEMBER This revision petition has been filed under Section 21 (B) of the CP Act, 1986 by Unit Trust of India (Petitioner in this case) against the impugned orders of the State Consumer Disputes Redressal Commission, Himachal Pradesh and earlier by District Forum Hamirpur, HP in complaint No. 263 of 2001.
Brief facts of the case according to the Petitioner are that the Petitioner launched a Scheme in 1993 under Senior Citizens Unit Plan (hereinafter referred to as SCUP). As per the provisions of this Scheme, launched in collaboration with New India Assurance Co. Ltd., those members joining SCUP after completion of 58 years of age alongwith their spouse would be eligible for medical insurance cover of Rs.2,50,000/-, after two years of joining the Scheme and the limit will be increased to Rs.5.00 lakh (after adjusting claims made, if any, earlier) six years after joining the SCUP scheme. However, the above limit is restricted to Rs.1,50,000/- per illness per spouse. Under the said scheme members would also be provided with an Identity Card and log-book to record the amounts claimed. Respondent No.1 joined SCUP as a member on 31.05.1997 and she & her spouse, Respondent No. 2 became eligible for medical cover as provided under the Scheme after two years i.e. from 31.05.1999. A duplicate identity card and log-book was also issued as the Respondent No. 1 stated that the original had not been received by her. On 26.06.1999 Respondent No. 2 was admitted in hospital for heart surgery for which an expenditure of Rs.2,65,500/- was shown as having been incurred and medical bills and claims were submitted on 25.05.2001 for settlement. The request though received late, was settled in terms of Clause 17 of the provisions of the Scheme to the extent of Rs.1,50,000/-. Since the claim for Rs.2,65,500/- was not maintainable under the provisions of the SCUP Scheme.
The Respondents in their revision while confirming membership under the scheme after payment of Rs.33,000/- have contended that for want of log-book and Identity Card they had to spend Rs.2,56,500/- on Respondent No. 2 surgery and treatment and despite submitting the claims with the required documentary proof, the Petitioner reimbursed only an amount of Rs. 1,50,000/-.
Aggrieved by this action, Respondents filed a complaint before the District Forum on the grounds of deficiency in service and un-fair trade practice and prayed that the Petitioner be directed to make the payment of Rs.2,56,500/- with interest @ 12% per annum from the date of operation i.e. 26.09.1999 till payment of the amount as well as damages to the tune of Rs.10,000/- for mental tension caused due to the acts of the Petitioner.
The District Forum vide its order dated 06.05.2003 allowed the complaint inter-alia on the grounds that the Petitioner failed to place on record any evidence that the Respondents were informed at the time of joining the Scheme that only Rs.1,50,000/- would be paid per patient per illness and the only information given to them was that they were given medical cover for Rs.2.50,000/- and this was therefore, their entitlement.
District Forum therefore, ordered that the Petitioner should pay the Respondent Rs.1.00 lakh and interest at the rate of 9% per annum from the date of filing of the complaint and Rs.500/- as cost of litigation.
Aggrieved by this order, the petitioner filed an appeal under Section 12 of the CP Act before the State Commission. The State Commission dismissed the appeal on 09.06.2006 on the following grounds :
We have heard the arguments of learned Counsel for the appellants as well as have carefully perused the record of the case. We have not found any such document which shows that there was any such agreement between the parties, from which it can be ascertained that the respondents ever agreed to the condition that claim limit per spouse per illness will be Rs.1,50,000/-. Even the plan where under Respondents were insured in not placed on record before the Forum blow by the appellants. Further there is not an iota of evidence to show that the respondents were ever made aware of the terms of the plan pertaining to the limit of amount per spouse per illness. Moreover, if we accept the version of the appellants Counsel, we do not find any rationale behind such clause if at all it existed. Why the respondent should not get Rs.2,50,000/- when they are insured for the said amount, particularly when the policy is operational is a question, which could not be answered satisfactorily by the Counsel for the appellants in a manner which could convince us. A person gets a policy of insurance with an idea that the same will help him in case of need. But if the insurers like the appellants are allowed to behave in an arbitrary manner while settling the claim, then people will suffer at their hands.
The State Commission thus upheld the order of the District Forum regarding relief provided to the Respondents.
Aggrieved by this order, the petitioner has filed the present revision petition.
We have heard the learned Counsel for both the parties on 28th July 2010 and also examined the relevant documents filed by the parties before the lower fora as well as written submissions made before this Commission. Copy of UTI SCUP scheme is on record which clearly states that there will be a limit of Rs.1,50,000/- for any one illness. Furthermore the entire scheme was notified in the Gazette of India dated 28.08.1993 and here also, it is clearly stated in Clause 5 that the amount of medical cover under this scheme shall be limited to a maximum of Rs.1,50,000/- per illness. Form A which is UTIs SCUP Membership certificate and part of the Gazette notification also specifically states that there will be a maximum limit of Rs.1,50,000/- per illness per spouse.
In view of the above facts, State Commission have erred in concluding that the concerned Insurance plan was not available on record and there was no iota of evidence to show that the Respondents were made aware of the terms of the Plan pertaining to the monetary limit permissible per spouse per illness. This fact is clearly stated in the Membership Certificate given to each member. In any case once a Scheme is widely publicized through a notification in the Gazette of India those joining it as members cannot take the plea of ignorance of its terms and conditions. They are thereafter bound by the terms and conditions of the scheme and cannot therefore seek relief beyond the maximum claim limit per person/ per illness stipulated in the scheme.
In view of these facts, we conclude that there was no deficiency in service on the part of the Petitioner and allow the revision petition. The impugned order of the State Commission is accordingly set aside with no order as to cost.
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[ Ashok Bhan., J ] President Sd/-
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[ Vineeta Rai ] Member Satish