BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,  MANGALORE

Dated this the 20^th April 2017

PRESENT

  SRI VISHWESHWARA BHAT D     : HON’BLE PRESIDENT

   SMT.LAVANYA M. RAI                   : HON’BLE MEMBER

ORDERS IN

C.C.No.49/2016

(Admitted on 30.1.2016)           

Mr. K. Shivaprasad Shetty,

Aged 61 years,

S/o Late Dr. Babu Shetty,

Y.R. Shetty compound,

Nanthoor junction, Post Kulshekar,

Mangalore 575005.

                                                                 ……… Complainant

(Advocate for Complainant by Sri. KSR)                                                                                                   

VERSUS

1. M/s United India Insurance co. Ltd,

Represented by its Divisional Manager,

Divisional Office, Ramabhavan Complex,

Kodialbail, Mangalore 575003.

2. Vijaya Bank,

Represented by the chief Manager,

City Mangalore Branch,

Sharavu Ganapathi Temple Road,

                        Mangalore 575001

                                                                                       …. Opposite Parties

 (Advocate for Opposite Party No.1. Sri.AKK)

 (Advocate for Opposite Party No.2. Sri. KBR)

ORDER DELIVERED BY HON’BLE MEMBER

SMT. LAVANYA M. RAI

1.  This complaint is filed under section 12 of the Consumer Protection Act alleging deficiency in service against the opposite party claiming certain reliefs.

The brief facts of the case are as under:

          The complainant is a credit card customer of the 2^nd Opposite Party for the last 30 years without any break.  The present credit card issued by 2^nd Opposite Party to the complainant is bearing No.5421761047001992 and valid till May 2018. In order to provide value added service to its credit card customers, the 2^nd Opposite Party introduced a special insurance scheme to its credit card customers in association with a general insurance company to provide health insurance, home-suraksha and personal accident cover.  Among the said three segments of insurance covers available under the scheme, heath insurance is a compulsory service and home suraksha and personal accident cover are optional services.  The annual premium is determined, depending on the number of segments in which the insurance cover is sought by the credit card holder. To enable its credit card holders desirous of getting admission to the insurance scheme, after completion of the documentation, the 2^nd Opposite Party debits the amount of annual premium to the credit card account of the credit card holder and remits the said premium to the 1^st Opposite Party.  Thereafter, every year, the policy will be renewed automatically.  For renewal of the insurance facility, every year, before the 30^th day of November.  After receiving the renewal premium, the 1^st Opposite Party issues certificate of insurance to the credit card holder of the  2^nd Opposite Party. The 1^st Opposite Party is providing the insurance cover to the credit card holders of the 2^nd Opposite Party under the said insurance scheme which is named as V Care u. The mediclaim insurance under the aforesaid v care u insurance policy provides cover to the insured and his family under two options.  Option No.1 Family size of 1+3 and option No.2 family size 1+5.  The annual premium will be determined on the basis of the option of the insured depending on the size of the family of the insured.  The complainant has opted for medicalim cover to his family size which is 1+3.  Therefore, policy of the complainant provided cover to the complainant, his wife, daughter and his dependant mother.  The current certificate of insurance is issued by the 1^st Opposite Party on 1.1.2015 bearing master policy No. VCIS 0529 072600/46/14/39/0002227 and the same is valid till 31.12.2015.  the 2^nd Opposite Party has paid to the 1^st Opposite Party, the premium for renewal of the policy of the complainant till 31.12.2016.  After receiving the annual insurance premium of Rs.17,208/ for renewal of the policy for the period from 1.1.2014 till 31.12.2014, the 1^st Opposite Party sent the certificate of insurance to the complainant in the month of January 2015.  But while going through the certificate of insurance, the complainant observed that the 1^st Opposite Party has deleted the name of the complainants mother padmavathi Shetty from the certificate of insurance.  The complainant represented the matter to the officials of both the Opposite Parties but the Opposite Parties started giving evasive answers and did not restore the name of the complainants’ mother in the certificate of insurance.  Therefore, the complainant wrote a letter dated 9.12.2014 to the 1^st Opposite Party requesting for restoring the name of his mother in the insurance certificate.  The 1^st Opposite Party did not respond to the said letter.  Insurance policy was again renewed for the period 1.1.2015 to 31.12.2015 and the 1^st Opposite Party issued the insurance certificate dated 1.1.2015 for the said period in the month of  January 2015 without restoring the name of the mother of the complainant in the policy.  Therefore, the complainant submitted another representation dated 25.4.2015 to the grievance cell of the 1^st Opposite Party situated at Bangalore, requesting for restoring the name of his mother in the insurance certificate.  However, the 1^st Opposite Party vide reply dated 19.5.2015, declined to restore the name of the complainants mother padmavathi shetti in the policy, stating that she is aged above 80 years and she cannot be provided with the health insurance cover.  Hence the above complaint filed by the complainant before this forum under section 12 of the C.P.Act 1986(here in after referred to as the Act) seeking direction from this Fora to the Opposite Parties to restore mediclaim cover to the complainant’s mother, to pay Rs. 10,000/ being damages towards mental agony and sufferings and such other reliefs.

 II. Version Notice served to the opposite parties by RPAD, inspite of receiving notice the Opposite Party No.1 filed version stating that the Opposite Party admits issue of Vijaya Bank Credit Card Holders Group Insurance, special contingency Master Insurance policy to the vijaya bank, Hampanakatta branch to the their credit card holders.  However, the claim, if any, under the said policy is subject to the terms, conditions and exclusion clauses the policy issued being the special contingency policy, the age limit of the persons to be insured under the policy shall be as per provision of the policy issued and provision of the policy, persons exceeding age limit of 80 years shall not be insured under the policy referred above, and this Opposite Party has intimated the complainant vide their letter dated 19.5.2015.  Opposite Party states that the premiums are being charged as per the IRDA guidelines for various polices issued by the insurance companies depending upon the age of the persons to be covered and previsions are made for removal of insured person from the policy, once they attain the age of 80 years.  As the mother of the complainant has attained the age of 80 years, her name is dropped and the policy was renewed with applicable premium at the relevant period and the complainant was made aware of all these aspects in black and white.

          Opposite Party No.2 version filed it is admitted that the Opposite Party No.1 is an insurance company carrying on general insurance business including health care insurance.  Further admitted that the complainant herein is a credit card customer of the Opposite Party No.2. After completion of the documentation the 2^nd Opposite Party debit the amount of annual premium to the credit card account of the credit card holder and remits the said premium to the 1^st Opposite Party.  It is further denied that every year before the 30^th day of November, the 2^nd Opposite Party debit amount towards the annual insurance premium for the succeeding year to the credit account of the respective credit card holders.  The 2^nd Opposite Party only after receiving intimation from the credit card holder pays the annual insurance premium to the 1^st Opposite Party.  The mediclaim insurance under the aforesaid V Care U insurance policy provides cover to the insured and his family.  As per the terms of the policy the Opposite Party no.2 is not responsible to settle the claim of the complainant.  The 2^nd Opposite Party only facilitates the scheme to its customer through 1^st Opposite Party and prays for dismiss the complaint.

III.     In support of the above complaint the complainant Mr. K.Shivaprasad Shetty, filed affidavit evidence as CW1 and answered the interrogatories served on him and produced documents got marked at Ex.C1 to C14. On behalf of the opposite party Mr. Rajan. P.M, (RW1) of opposite party also filed affidavit evidence.

IV.     In view of the above said facts, the points for arise for our consideration in the case are:

1. Whether the Complainant proved that the Opposite Party committed deficiency in service?
2. If so, whether the Complainant is entitled for any of the reliefs claimed?
3. What order?

        We have considered the arguments submitted by the complainant and Opposite Party and also considered the materials that was placed before the Fora and answered the points are as follows:

                     Point No. (i) : Partly Affirmative

                    Point No. (ii) : Partly Affirmative

                    Point No. (iii): As per the final order.

REASONS

V.   POINTS No. (i) and (ii): 

          The complainant is the credit card customer as per Ex.C3 of the Opposite Party No.2 since last 30 years without any break and taken policy as per Ex.C2, Ex.C4, Ex.C5 and Ex.C6 .  the Opposite Party No.1 deleted the name of the complainant’s mother from the certificate of insurance stating that she is aged about 80 years and she cannot be provided with the health insurance cover.  Hence complainant written letter as per Ex.C7, C8 and C10.  But not comply the same hence this complaint. On the other hand Opposite Party No.1 stating that, the claim if any, under the policy is subject to the terms and conditions and exclusion clauses the policy issued being the special contingency policy, the age limit of the persons to be issued and provision of the policy persons exceeding age limit of 80 years shall not be insured under the policy.  Opposite Party No.2 stated that as per the terms of the policy the Opposite Party No.2 is not responsible to settle the claim of the complainant.  Opposite Party No.2 only facilitates the scheme to its customers though 1^st Opposite Party.  After perusal of the entire records we also noted that the complainant filed memo on 20.3.2017 which reveals that Opposite Party No.1 has covered the name of the complainant’s mother while renewing the policy for the year commencing from 1.1.2017 to 31.12.2017 and certificate issued produced before the fora.  Now the complainant seeking direction from this fora that continuity benefit under the policy for the period left out and also as to protect the status of continuous membership. Now the points for consideration is that the Opposite Party No.1 has complied the relief no.1 sought in the complainant since the Opposite Party complied the relief no.1 once again granting continuity benefit does not arise and the prayer is also beyond the complaint.  It is true that the Opposite Party complied relief no.1 after filing the present complaint i.e. on 23.1.2016 and it is after lapse of year hence awarding damages for mental agony and sufferings for delay is meets ends of justice.  Therefore we are of the opinion that even though the Opposite Party No.1 is compiled the relief sought in the complaint the Opposite Party No.1 being insurance company and Opposite Party No.2 is provide value added service is liable to pay the compensation of Rs.5,000/ for commit deficiency in service and also pay the cost of litigation expenses of Rs.2,000/ is justified.  So that, the Opposite Party No.1 and 2 are equally liable to pay the compensation.  Hence answer to the points no.1 and 2 partly in the affirmative.

          In the result, accordingly we pass the following Order.

ORDER

                The complaint is partly allowed with cost.  Opposite Parties No.1 and 2 jointly and severally are directed to pay a sum of Rs.5,000/ as compensation and also pay a sum of Rs.2,000/ towards cost of the proceedings to the complainant.  Payment shall be made within 30 days from the date of the receipt of copy of the order.

            Copy of this order as per statutory requirements, be forwarded to the parties free of cost and file shall be consigned to record room.

(Page No.1 to 9 directly dictated by Member to the Stenographer typed by him, revised and pronounced in the open court on this the 20^th April 2017)

             MEMBER                                        PRESIDENT

      (LAVANYA M RAI)                    (VISHWESHWARA BHAT D) 

D.K. District Consumer Forum          D.K. District Consumer Forum

             Mangalore                                       Mangalore

ANNEXURE

Witnesses examined on behalf of the Complainant:

CW1  Mr. K.Shivaprasad Shetty,

Documents marked on behalf of the Complainant:

Ex.C1: copy of the insurance policy issued by National insurance Co.Ltd.

Ex.C2: Copy of the insurance policy issued by the 1^st Opposite Party, united India insurance co. ltd.

Ex.C3: Copy of the credit card no. 5421761047001992 of the complainant.

Ex.C4: 1.1.2013: Certificate of Insurance issued by Opposite Party No.1.

Ex.C5: 1.1.2014: Certificate of insurance issued by Opposite Party No.1

Ex.C6: 1.1.2015: Certificate of insurance issued by Opposite Party No.1

Ex.C7: 9.12.2014: copy of the letter of the complainant to Opposite Party No.1

Ex.C8: 25.4.2015: copy of the letter of the complainant to Opposite Party No.1.

Ex.C9: 19.5.2015: Letter of Opposite Party No.1 to the complainant.

Ex.C10: 1.6.2015: Letter of the complainant to Opposite Party No.2.

Ex.C11: 18.6.2015: Application of the complainant under RTI Act to Opposite Party No.2 copy

Ex.C12: 18.6.2015: Application of the complainant under RTI Act to  Opposite Party No.2 copy

Ex.C13: 24.7.2015: Reply letter of Opposite Party No.2 to the complainant.

Ex.C14: 2.8.2015: Reply letter of Opposite Party No.2 to the complainant.

Witnesses examined on behalf of the Opposite Parties:

RW1: Mr. Rajan. P.M,

Documents marked on behalf of the Opposite Parties:

Nil

Dated: 20.4.2017                                      MEMBER