PRESIDENT, DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

Consumer Complaint No.- 68/2024

Present-Dr. Ramakanta Satapathy, President,

  Sri. SadanandaTripathy, Member

Jayanta Kumar Swain, aged about 54 years.

S/O- Mr.Bhramarbar Swain

R/O-SCR-A/2, Housing Board Colony, Modipara, Ps-Town,

Dist-Sambalpur-768002, Odisha.                                                       ……….......Complainant.

Vrs.

1. Managing Director, Bajaj Allianz General Insurance Company Ltd. Regd. Office-Bajaj Allianz House, Airport Road, Yerwada

Pune-411006, Maharastra.

2. The Branch Head, Bajaj Allianz General Insurance Company Ltd.

2^nd floor, Veer SurendraSai Marg, Near Hotel Nikki,

Sambalpur-768001,Odisha.                         .…....……….Opp. Parties

Counsels:-

1. For the Complainant         :- Self
2. For the O.P.s                       :- Sri. B.K.Purohit, Adv.

Date of Filing:23.02.2024,  Date of Hearing :22.07.2024  Date of Judgement : 27.08.2024

Presented by Sri SadanandaTripathy, Member.

1. The case of the Complainant is that the Complainant had purchased a Mediclaim Insurance policy for his family from 14^th December, 2017 to 14.02.2024 paying premium regularly each year. The Complainant received some phone calls from customer care of BAGICL as reminders for renewal of the policy, in first week of January, 2024. The customer care of BAGICAL sent a link to renew the policy in due date. But when the Complainant opened the link for renew purpose, He found that the premium amount has been changed & hiked as compared to last year i.e INR 28,772.00. The customer surprised & asked the customer care during the telephonic call about the changes, but the answer was unsatisfactory. The Complainant sent a mail on dtd. 05.02.2024, to know about facts & asked for sending the IRDAI approval copy of premium revision, but the company was unable to provide the same. In general Terms & Conditions of the company bond in page 13 & subject Matter is “possibility of revision of Terms of the policy including the premium rate is under. “That, the company with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured person shall be notified three months before changes or effected”. The BAGICAL has failed to serve revision of premium notice in prior times to the Complainant. That the Complainant has received a reply through mail on dtd. 06.02.2024 which is not satisfactory based on the T & C of the company. Within the six years of service company has increased three times of the premium, whereas the company replied that the premium has increased after three years. If the IRDAI has given freedom to company to increase the premium, reference to IRDAI circular released in 2019, consolidated health Insurance regulations 2016 with amendments, why the company has written in terms & conditions. From the above activities of OPs show unlawful & unreasonable acts of the OPs & the Complainant is going to face severe financial loss & mental agony. “The company, with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured person shall be notified three months before the changes are affected”.
2. The Written Version of the O.P No. 1 is that the OP No. 1 i.e MD has been unnecessarily arrayed as Responded/OP because there is no privity of contract between the Complainant and Respondent no. 1. The Respondent no. 1 neither a proper nor a necessary party to the complaint. This Insurance Company is distinct from its shareholders and its Directors. There is no contract between the Complainant and Respondent No. 1 (MD). Therefore, filing a case against Respondent No. 1 is not based on any contract nor there is any such liability on Respondent No. 1(MD). Consequently, there is no cause of action against Respondent No. 1 since there is no cause of action against Respondent No. 1, the name of a Respondent no. 1 is liable to be deleted from the array of parties in complaint.

The Version of the OP No. 2 is that Insurance Policy is a contract and both the parties are under obligations to obey/fulfill all the terms and conditions of the same in the strict sense of the words written therein. As the terms and conditions of the Policy are sacrosanct, the claim arrived is also processed within the precincts of the Policy only. It is well settled law that when the voluminous evidence and complicated questions are involved in the Consumer Complaint, the better course is to direct the Complainant to approach the Civil Court to get the grievance resolved by leading cogent oral and documentary evidence. There are no latches and omissions or deficiency in rendering services on the part of this Insurance Company, therefore, the present complaint is not maintainable. The question involved does not come under the purviews of section 2(1)(g) and 2 (1)(0) of the consumer Protection Act, 1986. Since there is no deficiency in service on the part of opponent Insurance Company, the dispute involved can only decided by Civil Court or by Arbitrator and it does not come under the purview of this Hon’ble Commission.

3. From the Written Statements of the both the parties, it is observed that In general Terms & Conditions of the company bond in page 13 & subject Matter is “possibility of revision of Terms of the policy including the premium rate is that “the company with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured person shall be notified three months before changes or affected”. The BAGICAL has failed to serve revision of premium notice in prior times to the Complainant. Hence deficiency in service found against the OP.

The O.P.No.1 and O.P.No.2 are not separate entities. O.P.No.2 working under the O.P.No.1 and for any lapses the O.P.No.1 is equally liable.

ORDER

The case is disposed of on contest. The O.Ps are directed to pay Rs. 50,000/- towards financial loss, mental agony and harassment as compensation and further Rs. 5,000/- towards cost & litigation expenses to the Complainant within 30 days from the date of order, failing which the amount will further carry with 9% interest per annum till realization to the complainant.

Order pronounced in the open Court today on 27^th day of Aug, 2024.

Free copies of this order to the parties are supplied.