BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.218 of 2021
Date of Instt. 16.06.2021
Date of Decision: 30.06.2022
Atinderjit Singh Syali aged about 65 years s/o Late Sh. Harbhajan Singh Syali R/o 93, Block-B, Royal Estate, Nangal Krar Khan, Kukarpind, Jalandhar, Punjab.
..........Complainant
Versus
1. Bajaj Allianz General Insurance Co. Ltd., Bajaj Allianz House, Airport Road, Yerawada, Pune, Maharastra, through its General Manager.
2. Bajaj Allianz General Insurance Co. Ltd., 2nd Floor, Satnam Complex, BMC Chowk, GT Road, Jalandhar, through its Manager/Authorized Signatory.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Sh. Jaswant Singh Dhillon (Member)
Present: Sh. O. P. Kangniwal, Adv. Counsel for the Complainant.
Sh. R. K. Sharma, Adv. Counsel for OPs No.1 and 2.
Order
Dr. Harveen Bhardwaj(President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the complainant had purchased mediclaim insurance policy from the OP No.2 and thereafter regularly remained paying the premium in the shape of its consideration for the hired services. Consequence to which, after fulfilling all the requisite formalities for the purpose including payment of requisite premium i.e. basic premium to the tune of Rs.8865/- alongwith GST @ 15% total amounting to Rs.10,195/-. Consequence to which, the mediclaim insurance policy was issued by the OP No.2. At the time of issuance of above said mediclaim insurance policy in the month of June, 2017 OP No.2 allotted Master Policy No.OG-17-9999-9960-00000004, and customer ID:96336091 to the complainant. One thing more worthwhile to clarify that at the time of issuance of mediclaim insurance policy, the complainant also mentioned the name of his wife namely Jasvir Kaur as nominee in the above said mediclaim insurance policy i.e. the name which also finds reference in the respective booklets of mediclaim insurance policy of since from year June, 2017 till the year 2020-21 also. In the beginning, as well as, subsequent thereto, it was also assured by the OP No.2 through its authorized agent and otherwise also, that keeping intact the master policy number, as well as customer ID number, have been allotted to complainant, the same mediclaim insurance policy will remain in continuation till complainant’s death, provided the complainant regularly pay the premium etc. Subsequent to that, in continuation to the same master policy number, as well as, consumer ID detailed above, the complainant having similar benefits of mediclaim insurance policy for which the complainant was entitled in the mediclaim insurance policy referred above, was renewed/extended by Op No.2 for the year 2018-19, after receiving the requisite amount of premium amounting to Rs.10,461/- as well as after observing all the requisite formalities. At this time some more amounts in the shape of premium are to be paid, specially because, at this year the GST was enhanced from 15% to 18%. Then again the said policy was renewed for the year 2019-20 after receiving the requisite of premium amounting to Rs.10,461/- with GST @ 18%. This medical insurance policy is to expire on 19th June of 2020. The complainant intended to keep it continue in future also. The complainant visited the office of OP NO.2 personally and requested for continuation of mediclaim insurance policy, keeping intact same master policy number, as well as consumer ID, detailed above. But the OP No.2 put off the matter with one lame excuse or the other. Rather indirectly/cunningly tried to induce the complainant to get new mediclaim insurance policy, instead of its renewal/extension. Perhaps because of the reason that in the above said mediclaim insurance policy, there is a stipulation that in case the complainant keeps continue such mediclaim insurance policy with the OPs for at least three years. Under such circumstances, the complainant and his/her nominee become legally entitled for any type of medical benefits, expected to be occurred in their future life, a is also clarified from the booklet of mediclaim insurance policy itself. The complainant made a written representation under register cover on 01.06.2020 to OP No.2 and its zerox copy was also sent to the office of OP No.1, expecting the OPs to give due consideration to the genuine request and renew/extend the mediclaim insurance policy of the complainant for the year 2020-2021 also, keeping intact same master policy number, as well as, consumer ID, detailed above, as it was assured in the year 2017. Here it is worthwhile to mention that alongwith this written representation dated 01.06.2020, the complainant also enclosed a cheque bearing no.459245 of Rs.10,461/- to be encashed from State Bank of India, NRI Branch, Jalandhar in the shape of premium. Because inspite of above said all, the mediclaim insurance policy with the same master policy number and customer ID number, referred above was not being renewed with the name of the complainant retrospectively. Thus, the complainant was forced to file a complaint under Consumer Protection Act as amended upto date on 17.06.2020. However, after appearing before the Consumer Commission, Jalandhar through their counsel, the OPs disclosed in their written statement that the mediclaim insurance policy with the name of the complainant and his wife have already stands/renewed on 16.06.2020 from the period of 20.06.2020 to 19.06.2021, with the original Master Policy No.OG-17-9999-9960-00000004 and customer ID 96336091 to the complainant. Resultantly, the complaint was dismissed as withdrawn from the respective Tribunal on 02.02.2021. Now again because the OPs were indirectly showing their intention not to renew the mediclaim insurance policy retrospectively. Therefore, the complainant sent a legal notice dated 13.05.2021m, but all in vain and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to renew/extend the mediclaim insurance policy from 19th June, 2021 onwards under the same master policy no.OG-17-9999-9960-00000004, customer ID:96336091, issued to complainant at the time of issuance of Mediclaim insurance policy for the year 2017-18 and the OPs also be directed to provide all types of the medical facilities/benefits to the complainant as well as his nominee i.e. Jasvir Kaur, in case of any physical or medical problem/necessity, during the subsistence and continuation of mediclaim insurance policy referred to above. Further the OPs be directed to pay a compensation of Rs.3,00,000/- alongwith interest in lieu if illegal and arbitrarily direct/indirect repudiation of Mediclaim insurance policy, keeping intact the master insurance policy number and customer ID referred above, allotted to complainant at the time when initially the mediclaim insurance policy was issued to the complainant for the year 2017-18. Further, the Opposite Parties be directed to pay Rs.2,00,000/- for mental and physical harassment to the complainant and further Opposite Parties be directed to pay Rs.60,000/- as litigation expenses.
2. Notice of the complaint was given to the OPs, who filed reply and contested the complaint by taking preliminary objections that the complaint is not maintainable against the Bajaj Allianz General Insurance Co. Ltd./OP as the same is without any cause of action , as such the complaint is liable to be dismissed with special cost. It is further averred that earlier the insurance policies were issued/renewed to the Atinderjit Singh Syali with Master Policy No.OG-17-9999-9960-00000004 with Customer ID No. 96336091 under Group Policy, the complainant being customer of Bajaj Finance Ltd (BFL) having specific Child Certificate Number for a particular year and the last renewed policy was for the period 20-06-2020 to 19-06-2021 vide Child Certificate No. OG - 21-1202-6021-00000106. The insurance policy is not automatically renewed but the same is renewed on the request of the insured and payment of premium thereof. No assurance was given to the complainant by the Opposite Party that the keeping the intact the Master Policy number as well as Customer ID number, policy shall remain in continuation till complainant's Death, provided the complainant regularly pay the premium rather the complainant was apprised off the fact that the such policies with the Master Policy No. OG-17-9999-9960-00000004 shall be renewed from time to time on payment of renewal premium till there is tie up between the Bajaj Allianz General Insurance Co. Ltd and Bajaj Finance Ltd. (BFL). The complainant has concealed the material information from this Hon'ble Commission about the renewal notice dated 01-04-2021 served upon the complainant (more than two months prior to date for renewal of policy). As the policy was/were issued/renewed in the name of 21 complainant being customer of Bajaj Finance Ltd. (BFL) and on expiration of tie up between the Bajaj Allianz General Insurance Co. Ltd. and Bajaj Finance Ltd. (BFL), it was not possible to renew the policy with Master Policy No.Master Policy No.OG-17-9999-9960-00000004, as such renewal notice dated 01.04.2021 was served upon the complainant stating there in that the your (complainant) policy bearing No. OG-21 1202-6021-00000106 will be replaced with another Group Health Plan call " Family Health Care (FHC) and that the said policy due for renewal from 19 -06-2021 will be renewed with Family Health Care Policy Premium and that suitable credit of continuity/waiting periods for all the previous policy years would be extended in the revised policy, provided the policy has been maintained and renewed without a break. That if the complainant wants to continue under same premium amount, the complainant must contact the Bajaj Finserv Ltd being the prime customer, to know about their latest tie ups with other insuring agencies. The complainant cannot take advantage of his own wrong as despite notice dated 01 -04-2021, the complainant did not get the policy issued under the Family Health Care Plan, as such the complaint is liable to be dismissed. On merits, the factum with regard to issuance of insurance policy to the complainant as well as renewal of the same is admitted, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
3. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
4. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
5. We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.
6. The case of the complainant is that he took mediclaim insurance policy from the OP No.2 in the month of June, 2017 on the payment of requisite premium. The OP No.2 allotted master policy to the complainant in the month of June, 2017. The name of the wife of the complainant was also mentioned in the policy as a nominee and the mediclaim insurance was extended from year 2017 till 2020-21 on the payment of requisite premium. The complainant sent legal notice alongwith cheque of Rs.10,461/- to extend/renew the mediclaim policy from 19 June, 2021 onwards keeping intact the same master policy number and customer ID, but the OPs are not extending/renewing the policy, due to this fact, the complainant has suffered mental tension and harassment and request has been made to allow the complaint.
7. The contention of the OPs is that the insurance policies were renewed to the complainant with Master Policy No.OG-17-9999-9960-00000004 with Customer ID No. 96336091 under Group Policy. The complainant was the customer of Bajaj Finance Ltd. having specific Child Certificate Number for a particular year and the last renewed policy was for the period 20-06-2020 to 19-06-2021. It has been alleged by the complainant that as the policy issued by the Bajaj Finance Ltd. was renewed upto June, 2021 and on the expiration of tie up between the Bajaj Allianz General Insurance Co. Ltd. and Bajaj Finance Ltd., it was not possible to renew the policy with master policy no.OG-17-9999-9960-00000004, therefore the notice dated 01.04.2021 was served upon the complainant informing him that his policy will be replaced with another Group Health Plan call ‘Family Health Care and the said policy was due for renewal from 19.06.2021. This fact has been concealed by the complainant as he has not disclosed about the receipt of notice dated 01.04.2021 issued by the OP, therefore the complainant has no right of compensation and no cause of action against the OP. Request has been made to dismiss the complaint.
8. The issuance of policy and the purchase of the mediclaim insurance policy having Policy No.OG-17-9999-9960-00000004 with Customer ID No. 96336091 has been admitted by the OP and has been proved by the complainant as Ex.C-1 to Ex.C-5 and Ex.C-5/1 is the letter by the Bajaj Allianz General Insurance written to the complainant alongwith the cover note of mediclaim insurance policy. The complainant has proved on record the application/representation to the Manager Bajaj General Insurance Company to renew his mediclaim insurance policy from 20th June, 2019 to 20th June, 2020. Ex.C-6 has been proved the copy of complaint which was filed by the complainant against the OP before the Consumer Disputes Redressal Forum for the renewal of his policy from June, 2019 to June, 2020. The written statement was filed by the OP before the Consumer Commission and the same has been proved as Ex.C-7, in which the OP has admitted that the policy has already been renewed and the renewed policy has been sent to the complainant also. On account of admission of the OPs in their written statement, the said consumer complaint was withdrawn by the complainant. Ex.C-8 has been proved as the legal notice issued by the complainant to the OP for the renewal of his policy from 19 June, 2021 onwards and Ex.C-9 to Ex.C-11 has been proved the postal receipts, Ex.C-12 is the cheque of Rs.10,461/- dated 13.05.2021 sent alongwith the notice as a premium for the renewal of the policy from June, 2021 onwards.
9. To rebut the case of the complainant, the OP has proved on record the transcript of proposal for mediclaim insurance policy schedule Ex.O-1, which was valid from 20 June, 2019 to 19 June, 2020. Similarly, the period of insurance from 20 June, 2020 to 19 June 2021 has been proved as Ex.O-2. Ex.O-3 is the letter allegedly written by the OP to the complainant on 01.04.2021.
10. As discussed above, the purchase of policy by the complainant has not been denied. It is not denied that the policy was taken by the complainant from Bajaj Finance Ltd. earlier. The OP has alleged that earlier there was a tie up between Bajaj Finance Ltd. and Bajaj Allianz General Insurance Co. Ltd. and now due to the expiry of the above said tie up, the complainant was asked to get the policy renewed with the family health care premium to which complainant has denied. Perusal of Ex.O-3 shows that the letter was written to the complainant on 01.04.2021, in which it has been mentioned that the Policy No.OG-21-1202-6021-00000106 will now be replaced with another Group health plan called ‘Family Health Care (FHC) (UNI:BAJHLIP21182V022021). In the entire letter, it has not been mentioned that the changes in the policy is being made because of the expiry of tie up between Bajaj Finance Ltd. and Bajaj Allianz General Insurance Co. Ltd. It has simply been mentioned that they have made certain changes with respect to terms of renewal. This fact was not brought to the notice of the complainant at any time by the OP. Till 2021, the policy issued by the OP was covering Bajaj Finance Ltd. Customers, but suddenly without any notice or any information, the policy customers cannot be made to suffer all of his sudden. If there was an expiry of tie up between the two, this fact could have well been brought to the notice of the complainant. The complainant has sent a legal notice also to which the OPs have not replied mentioning this fact of expiry of tie up between the parties. The OP cannot withdraw the benefits all of sudden from the customers, who pay the handsome premium for the insurance policy, therefore there is a deficiency in service and there is unfair trade practice on the part of the OPs and as such, the complainant is entitled for the relief as claimed.
11. In the light of above detailed discussion, the complaint of the complainant is partly allowed. The complainant was allotted the Master Policy No.OG-17-9999-9960-00000004 and the OPs are directed to renew/extend the mediclaim insurance policy from 19.06.2021 to 18.06.2023 with all the medical facilities and benefits to the complainant as were there under the master policy number allotted to the complainant under this policy and customer ID and his nominee on the receipt of necessary premium as per rules. Further, the OPs are directed to pay a compensation of Rs.10,000/- to complainant for causing mental tension and harassment to the complainant and Rs.5000/- as litigation expenses. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
12. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
30.06.2022 Member Member President
