Complaint Petition CC-354-2022

Admission Hearing on 30/11/2022.

Before the Learned District Consumer Dispute Redressed Commission, North 24 Parganas

C.C. №354 Of 2022

In the matter of:
Complaint under Sections 34 (1), 34
(2) (d), 35, 36 and 39 of the
Consumer Protection Act, 2019

AND

In the matter of:

Ratul Aich

………………Complainant

Versus

HDFC ERGO General Insurance Company Limited
1st Floor, HDFC House,
Backbay Reclamation,
H. T. Parekh Marg, Churchgate, Mumbai — 400020.

………………Respondent

Most Respectfully Sheweth:

1. That the Complainant is a law abiding citizen of India residing at the address mentioned in the cause title of the complaint petition. (Attached the Photostat copy of the Adhaar Card of the Complainant as “Annexure-A”)
2. That the Complainant states that the complainant being a loyal customer for the respondent’s concern, that the complainant’s HDFC ERGO Health Insurance yearly health check-up claim of Rs. 2,000/- was repudiated and reimbursement Claim was denied-RR-FC21–12734614, that the complainant has downgraded his policy from 10 lakhs 2019–2020 to 5 lakhs in 2020–2021. Rs. 2,000/- is allocated for individual 10 lakhs policy every year and Rs. 1,500/- is allocated for individual 5 lakhs policy every 2 years, that the complainant has been given a written confirmation to utilize Rs. 2,000/- between 2020–2021 after renewing the policy in 2020, the health checkup has been taken and claimed by him during the same period of 2020–2021, that the respondent concern agreed to reimburse Rs. 2,000/- twice on the complainant’s email but the respondent concern didn’t, the respondent concern have first agreed on 17/11/2020 and then again on 04/12/2021, the respondent’s reason to reject the complainant’s claim is that it is not mentioned in the 5 lakhs current policy terms and conditions, that the complainant contends that false information was provided by the HDFC ERGO team to sell the renewed health policy (2020–2021), the company’s underwriting guidelines must be followed by the company’s designated representative prior to approval and the company cannot escape citing terms and conditions after providing the approval in writing, this is a violation of business ethics and clearly looks like the respondent concern are attempting to exhaust the Ombudsman system and tactfully discourage the insurance holder to drop small claims with 2 months long escalations email chains.
3. That the Complainant states that the complainant suffered mental and monetary harassment.
   Copy of the payment details is attached and annexed herewith as “Annexure B”.
4. That the Complainant states that being deprived of the facilitated service the complainant intimated the respondent’s concern on several occasions by way of telephonic conversations and emails in respect of the above mentioned issue. However, the respondent concern have acted like flogging of a dead horse in order to provide resolution which is extremely unprofessional in nature.
5. That the Complainant states that due to the respondent’s aforementioned malafide act and conduct the complainant got duped of his hard-earned money which is hindering the complainant in an erroneous way and he has been facing tremendous agony and due to the same the complainant has not been able to live his life in own accord.
6. That the Complainant states that being deprived of the proper and facilitated procurement he again and again intimated the respondent by way of the telephonic conversation and by way of electronic mail conversation in order to solve the said issue, however the executive of the respondents have acted like flogging of a dead horse in lieu of providing the proper services to the complainant and in lieu of providing the constructive reply to him till date.
7. That the Complainant states that the above mentioned dispute clearly states that there was negligence on the respondent and the said respondent company is running an Unfair Trade Practice in order to dupe the hard earned money of the complainant wherein respondents have intentionally provided the de novo dreadful and deceitful service to the complainant and has not provided the proper and facilitated services towards him which has caused his unnecessary noetic agony and stress.
8. That the Respondents have miserably failed in providing right and proper service despite the Complainant has paid the full amount to the respondent authority and thereby causing deficiency in service
9. That the instant Complaint is filed within the prescribed time period in terms of the provisions of the Consumer Protection Act, 2019.
10. That the cause of Action of the instant complaint arose on, the date 29/06/2022 upon non-performance of the Respondents of their obligations despite Notice of the Learned Advocate.
    (Attached the legal notice copy of Ld. Advocate dated 29/06/2022 as “Annexure-C”).
11. That the Complainant makes payment of the requisite Court Fees.
12. That the Complaint is made bona fide and for ends of justice.
13. That there is no suit pending nor has been decided on the same subject matter between the parties by ant competent court of law other than the described one.
14. That the instant Complaint is within the jurisdiction of this Learned Forum.
    In the aforesaid circumstances therefore, it is humbly prayed on behalf of the Complainant that Your Honor may be pleased to-
    i. Direct the Respondents to duly look into this matter with foremost importance to take necessary steps to render the proper service to the complainant and provide to the complainant with reimbursement of Rs. 2,000/- immediately.
    ii. Direct the Respondents to provide Rs.50, 000/- as a compensation to the Complainant for the deficiency in service and mental harassment and agony.
    iii. Direct the Respondents to pay the costs of litigation;
    And such other/further order/orders as Your Honour may deem fit and proper in the interest of justice, equity and good conscience.

And for this act of kindness, your Complainant as in duty bound, shall ever pray.

Verification, address, and affidavit have been removed from the complaint petition’s online version.

First in the series is, How effective is complaining to the Insurance Ombudsman and the Insurance Regulatory and Development Authority of India (IRDAI)? (Link)

Next in the series is Quasi Judicial Patients, & Victims of Insurance Companies Institutional Exploitation. (Link)