IMPORTANT POINT
Insurance amount is not payable where there is no outstanding amount in complainant’s Credit Card account.

Mrs. M. Shreesha, Member—Aggrieved by the order in C.C. No. 827/2005 on the file of District Forum-1, Hyderabad, opposite parties 1 and 2 preferred this appeal.

2. The brief facts as set out in the complainant is a policy holder under Citibank Credit Shield Plus of opposite party for risk coverage credit card benefit i.e. for Rs.5,00,000 under which if any accident occurs the policy holder shall get all the benefits covered by the Citi Bank Credit Shield Plus Credit Card Term Insurance Policy according to which insurance cover is available to the eligible credit card members of Citi Bank N.A. and the card holder is entitled to claim upto Rs.5,00,000 in the event of death, total and permanent disability or upon diagnosis of a covered critical illness or surgery amount. Insurance cover also provides for minimum amount to be paid in the event of the card holders total and temporary disability. The complainant met with an accident on 10.11.2004 at Guntur Highway and he got fracture to his right arm and was operated in KIMS Hospital at Hyderabad and he got permanent disability and also lost his job and is not in a position to work in the office. The complainant approached for insurance benefits under Credit Shield Plus and also submitted medical bills. The opposite party has not paid claim amount but contrary to that claimed abnormal credit card expenditure which is not availed by the complainant and demanded abnormal amount of Rs. 1,24,300.52 and Rs.16,594 against the credit cards without giving statement of accounts. The opposite party sent legal notice dated 14.5.2005 for which the complainant also give reply notice dated 26.5.2005. Even after giving the reply notice, the opposite party wanted the complainant to pay credit card amount without producing any statement of account and without paying the entitled insurance claim amount though the premium amount is paid without any default till the complainant met with an accident in the month of November, 2004. Hence the complaint seeking direction to the opposite party to pay Rs.9,16,125 in total i.e. Rs.5,00,000 towards insurance claim amount, Rs.41,125 towards medical claim, Rs.2,25,000 towards loss of payment @ Rs.25,000 p.m., Rs.1,00,000 towards compensation and Rs.50,000 towards deficiency of service alongwith interest @ 24% p.a. from the date of filing till realization and also award incidental charges, legal expenses.

3. Opposite parties 1 and 2 filed counter stating that the complainant has been enjoying the credit card facility since May 2002 and he has been holding two credit cards. Opposite parties submit that the complainant has registered for Citibank Credit Shield Plus Policy for medical insurance and as per the terms and conditions of the contract, monthly instalment due to be paid by the insured member to the policy holder as stated in the last billing statement issued just prior to the date of loss for Total Temporary Disability Claim subject to a maximum of 5% of Rs.5,00,000 or the credit limit for each individual insured participating card in respect of each insured member whichever is lower. Hence the opposite parties considered minimum amount due to be paid in the billing cycle just prior to the date of loss and in this case the amount is zero and the same is mentioned in the terms and conditions. The complainant was informed that since the amount payable under the coverage was ‘nil’ he was required to pay the medical charges in his card account. The complainant has not paid the amounts due in spite of repeated requests and demands in violation of the terms and conditions agreed by him while availing the credit cards. The opposite parties submit that there is no deficiency in service on their behalf and prayed for dismissal of the complaint with costs.

4. The District Forum based on the evidence adduced i.e. Exs. A1 to A1 and B1 and B2 allowed the complaint in part directing the opposite parties 1 and 2 with joint and several liability to pay a sum of R