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BEFORE THE DISTRICT CONSUMER DISPUTE REDRESSAL FORUM,

GURGAON

C.C. NO. ______ OF 2019

IN THE MATTER OF:

OMAR SIDDIQUI …COMPLAINANT

VERSUS

MAKE MY TRIP INDIA PVT LTD

…OPPOSITE PARTIES

COMPLAINT UNDER SECTION 12 OF THE CONSUMER PROTECTION

ACT, 1986.

MOST RESPECTFULLY SHEWETH:

1. That the Complainant Mr. Omar Siddiqui is a peace loving and law
abiding citizen of India and a resident of House No. K1-19B, Phase – I,
New Palam Vihar, Gurugram, Haryana – 122017.

2. That the complainant is a frequent traveller. He had visited many states

throughout India, not only India, but the rest of the world. That it is
widely promoted that opponent party is a region leader in the travel
booking industry providing the best services and, on that basis, the
complainant had booked a room through a mobile app called MMT(of
the opposite party) that provided the best services. Complainant had
availed services on vacation or holiday.

3. That the complainant had opposite party are an online service provider
dealing in online travel services including booking and selling of flight
tickets, domestic and international holiday packages, hotel reservations,
and rail and bus tickets. That the complainant had booked a hotel room
bearing booking ID NH7000330622120 through the mobile App/ website
of opposite party for a period of 2 days i.e. 14 th September, 2019 to 16th
September, 2019 at Marquis Beach Resort, Candolim, Bardez, Goa for
Rs. 14,016 as consideration. A true copy of the relevant booking marked
as Annexure A-1.
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4. That on 10th September, 2019 the complainant opted for cancellation of

the abovementioned booking on severe medical conditions which
prevailed at the time with his wife who was accompanying the
complainant and complainant had submitted appropriate medical
documents and reports which clearly indicated his wife/ co-occupant was
unable to travel and the booking for the hotel room was redundant for
them. A true copy of medical reports marked as Annexure A-2.

5. That the complainant timely notified the opposite party about the
cancellation of the hotel room booking and was in accordance with the
policies of opposite party regarding cancellation of bookings. A true copy
of booking cancellation intimation marked as Annexure A-3.

6. That the opponent had not taken conscience of factors which lead to
cancellation of booking and refused to refund any amount which was
generated towards the booking of the hotel room. That the cancellation of
booking of hotel by complainant was due to Force Majeure and was not
intentional and the opponent provided with all the required medical
documents in order to address the genuine problem faced which
ultimately leaves no option with the complainant except to cancel the
booking.

7. That a complaint is within the limitation prescribed under sec 24A of The
Consumer Protection Act,1986 and this will be appear from
acknowledgment and admission contained in interalia in annexures to
this complaint. That the cause of action accrued/arose to the complainant
and against the opposite party on --/--/---- when the hotel room had
booked by complainant.

8. That the cause of action had accrued/arose when the complainant had
given all the personal details and had made payment on the website/
mobile App of opposite party. That the cause of action had accrued/arose
when complainant had sent notice and legally entitled to recover the
amount of Rs 14,016.

9. That the complainant’s claim is not barred by law of Limitation.

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10. That the insurance policy was duly ported and the documents including
all her previous reports/ claims were submitted to the Opposite Party
No.2 & Opposite Party No.1 which clearly showed that the Complainant
had Diabetes for the last 7 years or more. True Copy of the discharge
summary of earlier record which shows Diabetes/conditions is annexed
herewith as ANNEXURE -A3.

11. That the Opposite No.2 was provided with the previous Claims along
with the Policy Form and he was required to submit the same to the
Opposite Party No.2 for purpose of the conclusion of porting the
respective Policy. The Opposite Party No.2 is an agent of the Opposite
Party No.1 and any acts performed by the agent shall hold the Principal
as Vicariously liable. The definition of “Agent” & “Principal” as per the
Indian Contract Act, 1872 is given as below.

Section 182. ‘Agent’ and ‘principal’ defined.—An ‘agent’ is a person

employed to do any act for another, or to represent another in dealings
with third person. The person for whom such act is done, or who is so
represented, is called the ‘principal’. —An ‘agent’ is a person employed
to do any act for another, or to represent another in dealings with third
person. The person for whom such act is done, or who is so represented,
is called the ‘principal’."

12. That in December, the Complainant suddenly fell ill and the level in her
oxygen fell low, due to which she was immediately hospitalised in the
ICU of the Venkateshwara Hospital, Dwarka. That the complainant was
on the Ventilator in the ICU for a total of 4 days. When the family
members of the complainant applied for claim from the Opposite Party
No.1, it was to their utter dismay and shock when they were informed
that the complainant’s claim had been rejected due to Non- Disclosure as
she did not disclose that she had diabetes. True Copy of the Claim filed
by the Complainant’s family members dated 02.01.2019 is annexed
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herewith as ANNEXURE-A4. True Copy of the Claim Denial Letter

dated 09.01.2019 issued by the Opposite Party No. 1 to the Complainant
is annexed herewith as ANNEXURE -A5.

13. That thereafter on 28.12.2018, the Complainant was discharged from the
Hospital and had paid around Rs. 6,51,005/- (Rupees Six Lakh ,Fifty One
Thousand & Five Only) towards the Patient Bill issued by the
Venkateshwara Hospital, Dwarka. This is exclusive of the Payments
made against the Pharmacy Expenditures which amounts to approx Rs.
9283/- (Rupees Nine Thousand Two Hundred & Eighty Three Only).
True Copy of the Patient Bill Summary issued by Venkateshwara
Hospital, Dwarka is annexed herewith as ANNEXURE -A6. True copy
of the Pharmacy Bills are annexed herewith as ANNEXURE -A7.

14. That it was incumbent upon the Opposite Party No. 1 to take/ retrieve
relevant information from the original service provider at time of porting
the Insurance policy and any failure at the end of the Opposite Party No.1
& Opposite Party No.2 to do the needful cannot give them the right of
denying the lawful right of the insured.

15. That the Definition of Pre-existing Condition/Disease as given in the

Policy is given as below-:

Pre-existing Disease means any condition, ailment or Injury or related

condition(s) for which the Insured Person had signs or symptoms, and/or
were diagnosed, and/or received Medical Advice/treatment within 48
months prior to the first Policy issued by the insure.

16. That the Insurer/ Complainant had her policy ported effective from
12.01.2017. And the last treatments of the Insurer/ Complainant with
respect to Diabetes/Conditions as provided under already attached
Annexure -A3, dates to 29.03.2014. Hence as per the definition of Pre-
existing Disease as given above, the various conditions/ ailments on the
basis of which the Opposite Parties had rejected her claim cannot fall
under the scope of Pre-existing Disease since the same were more than
48 months prior to time of Policy Issuance.
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17. That the Opposite Parties rejected the Claim of the Complainant on the
basis that the conditions of Diabetes & Hypertension fall under the scope
of Pre-existing Diseases. That the same is bad in law as per the findings
of the Hon’ble Delhi State Consumer Disputes Redressal Commission,
New Delhi in case of Life Insurance Corporation of India vs Sudha
Jain 2007(2) CLT 423 has drawn conclusions in para 9 of the order and
the relevant clause in 9(iii) is given as follows-:

“9(iii) Malaise of hypertension, diabetes occasional pain, cold,

headache, arthritis and the like in the body are normal wear and tear of
modern day life which is full of tension at the place of work, in and out of
the house and are controllable on day to day basis by standard
medication and cannot be used as concealment of pre-existing disease
for repudiation of the insurance claim unless an insured in the near
proximity of taking the policy is hospitalised or operated upon for the
treatment of these diseases or any other disease.”

18. That the definition of Portability as given in the policy is given as

below:-

Portability means transfer by an individual health insurance

policyholder (including family cover) of the credit gained for pre-existing
conditions and time bound exclusions if he/she chooses to switch from
one insured to another.

19. That when a policy holder ports a policy, the policy holder will get all the
benefits of the previous policy. And as per the previous claims submitted
by the Complainant to both the Opposite Parties.

20. That all the documents pertaining to the policy holder were provided to
the Opposite Party No.1 and it was their duty to observe that the
complainant had diabetes. The Opposite Party No.1 should have rejected
it at the outset and not later. The acceptance of the policy being given
implies acceptance and knowledge of all facts relating to patient.

21. That the Insurance proforma, which has been only basis of rejection of
the complainant’s claim, was in fact filled by the Opposite Party No.2,
agent of Opposite Party No.1. It is evident from the fact that the
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signatures of the Complainant were in the Hindi Language, whereas the

entire Insurance Proforma was written in English. Since there is no
source of authority disclosed by the Opposite Party No.2 to fill the form
nor any disclosure made of the fact that the relevant terms and conditions
of the proforma were explained in the Hindi Language to the
Complainant, thus Any wrong disclosures in the proforma are the ones
made by the Opposite Party No.2 without any authority from the
Complainant whatsoever.

22. That the as per the Law laid down by the Hon'ble Supreme Court in
case P. Vankat Naidu Vs. Life Insurance Corporation of India & Anr.
IV (2011) CPJ 6 (SC) 6 , that the Opposite Parties must provide cogent
evidence to prove the allegation of suppressing information of pre-
existing illnesses on part of the Complainant, is held as per Para 6 & 7 as
follows:

6. “We have heard learned counsel for the parties and carefully perused
the record. In our view, the finding recorded by the District Forum and
the State Commission that the respondents had failed to prove that the
deceased has suppressed information relating to his illness was based on
correct appreciation of the oral and documentary evidence produced by
the parties and the National Commission committed serious illegality by
upsetting the said findings on a wholly unfounded assumption that the
deceased has suppressed information relating to hospitalization and
treatment.

7. Since the respondents had come out with the case that the deceased
did not disclose correct facts relating to his illness, it was for them to
produce cogent evidence to prove the allegation. However, as found by
the District Forum and the State Commission, the respondents did not
produce any tangible evidence to prove that the deceased had withheld
information about his hospitalization and treatment. Therefore, the
National Commission was not justified in interfering with the concurrent
finding recorded by the District Forum and the State Commission by
making a wild guesswork that the deceased had suppressed the facts
relating to his illness."

23. It is further submitted that the very purpose behind the contract of
insurance is to provide indemnity to insured. If such a connotation is
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accepted, the purpose of obtaining insurance will be defeated. That

accordingly the the Hon'ble Punjab & Haryana High Court expressed its
anguish and observed in case New India Assurance Company Limited
Versus Smt. Usha Yadav & others 2008(3) R.C.R. (Civil) 111 as
follows-:

"It seems that the Insurance Companies are only interested in earning
the premiums, which are rather too stiff now a days, but are not keen and
are found to be evasive to discharge their liability. In large number of
cases, the Insurance Companies make the effected people to fight for
getting their genuine claims. The insurance Companies in such cases
rely upon clauses of the agreements, which a person is generally made to
sign on dotted lines at the time of obtaining policy. This is, thus, pressed
into service to either repudiate the claim or to reject the same. The
Insurance Companies normally build their case on such clauses of the
policy, but would adopt methods which would not be governed by the
strict conditions contained in the policy."

24. That as per Regulation 6(4) of the The Insurance Regulatory and
Development Authority of India (Protection of Policyholders’ Interests)
Regulations, 2017 which is as follows:-

Where for any reason, the proposal and other connected papers are not
filled in by the prospect, the insurer or the distribution channel shall
explain the contents of the form, and a certificate shall be incorporated
at the end of the proposal form from the prospect that the contents of the
proposal form and connected documents have been fully explained to
him and he has fully understood the significance of the proposed
contract.

That in the present matter the Opposite Party No.2 had filled in all the
details in the policy Form. Since in his doing so, the opposite parties
were obligated to provide to the Insured/ Complainant a certificate that
that the contents of the proposal form and connected documents have
been fully explained to the Insured/ Complainant and that she has fully
understood the significance of the proposed contract. But the opposite
parties failed to fulfil the above mentioned obligation in view of their
ulterior motives to Dupe the Insurer/ Complainant/ Consumer.
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25. The complainant incurred total sum of Rs. 6,60,288/- (Rupees Six Lakh
Sixty Thousand Five Two Hundred and Eighty Eight only) in treatment
which the Opposite Party No.1 is bound to pay in terms of the contract of
Insurance.

26. That the complainant is a consumer and insurance policy was issued to
the complainant by the Opposite party from its office situated within the
territorial jurisdiction of this Hon’ble Forum. Therefore this Hon’ble
Forum has jurisdiction to adjudicate the dispute between the parties.

27. That the cause of action to file the present complaint arose on above
mentioned dated and lastly arose on 09.01.2019 when the Opposite party
No.1 repudiated the legitimate claim of the complainant.

28. That the present complaint is within the period of limitation.

29. That there is no other matter pending before any court or authority
between the parties with respect to the same cause of action.

30. It is submitted that the contract of insurance was executed within the
territorial jurisdiction of this Hon’ble Court and Payments of premium
were also made from territorial jurisdiction of this Hon’ble Court
therefore this Hon’ble Court has jurisdiction to decide the dispute
between the parties.

PRAYER

IN VIEW OF THE ABOVE IT IS THEREFORE MOST

RESPECTFULLY PRAYED THAT:

a. That the Opposite Party may kindly be directed to pay a sum of Rupees
6,60,288/- (Rupees Six Lakh Sixty Thousand Five Two Hundred and
Eighty Eight only) along with interest @ 18% p a from the date of
payment i.e. ________ till its realization.

b. The Opposite party may kindly be directed to pay a sum of Rupees

1,00,000/- (Rupees One Lac only) as compensation to the Complainant
for wrongfully repudiating the claim of the Complainant and causing
mental, social and economic and financial loss etc.

c. Cost of the proceedings be granted in favour of the Complainant.

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d. Pass any other /further orders as this Hon’ble Forum may deem fit and
proper in the fact and circumstances of the case.

AND FOR THIS ACT OF KINDNESS THE COMPLAINANT HEREIN

AS FOR DUTY BOUND SHALL EVER PRAY.

COMPLAINANT

VERIFICATION:

I, ___________________ do hereby verify at Gurgaon on this the ____ day of

______ 2019, that Para ____ to ____ are true and correct to my knowledge as
derived from the records, that of para ___ to ____ are believed to be correct on
information and legal advice received. Last para is prayer to this Hon’ble Court.

COMPLAINANT

Gurgaon
Date:

Counsel for the Complainant

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BEFORE THE DISTRICT CONSUMER DISPUTE REDRESSAL FORUM,

GURGAON

C.C. NO. ______ OF 2019

IN THE MATTER OF:

ANJUM SIDDIQUI …COMPLAINANT

VERSUS
RELIGARE HEALTH INSURANCE COMPANY LIMITED & Anr.

…OPPOSITE PARTIES

AFFIDAVIT
I, ________________, wife of aged about __
years, resident of ________________________________, Gurugram
do hereby solemnly affirm and declare as under:-

1. That I am the Complainant in the present case and conversant with the
facts of the case and hence competent to swear the present affidavit.

2. That the content of the complaint have been drafted by my counsel as per
my instructions and the contents of the same have been duly read out and
explained to me in my vernaculars and I hereby state that the facts stated
therein are all true and correct to my knowledge. The contents of
complaint may kindly be read as part and parcel of the present affidavit as
the contents of the same have not been reproduced herein for the sake of
brevity.

Deponent

Verification:

Verified that the content of the above complaint are true and correct to my
knowledge, no part of it is false and nothing material has been concealed
therefrom. Verified at Gurugram on __ of _________, 2019.

Deponent