Case No. : 287/2022
Date : 20.03.2023
Present : Sh. Mrinal Sharma Counsel for Complainant
Arguments heard on admission. The case of the Complainant in nutshell is that he had been taking Insurance Mediclaim Policy from the OPs from 28.06.2017 and then he got it renewed from 28.06.2017 to 27.06.2018 and he used to get it renewed on the call made by OP1 for the purpose of renewal of the Insurance Mediclaim Policy. Similarly, he got a call from OP and got the Insurance Policy renewed from 28.06.2018 to 27.06.2019 and also from 28.06.2019 to 27.06.2020. However, after 27.06.2020 or even prior to that date, the Complainant did not get any call from OP’s office for the purpose of renewal of the insurance policy and when complainant approached the OPs for the purpose of renewal of the Insurance Mediclaim Policy, the OP arbitrarily refused to renew the said policy, and the attitude of OP has compelled the complainant to file the present complaint inter alia on the ground that the insurance company has refused to renew the policy of the persons who have attained the age of 60 years and complainant came to know that in the month of January, 2020 the OP2 had introduced/ incorporated a new clause which states that from January, 2020 onwards the OP2 will not be renewing mediclaim insurance of any person above the age of 60 years.
It is submitted that this clause was never informed to the complainant in the year 2017 when he got the first medical policy from OP and even otherwise OP has no right for not renewing the policy in terms of their agreement and as per guidelines of IRDA, the OP cannot refuse to renew the insurance policy. Not only this, it is further stated that the complainant became unwell and had to remain hospitalized for various periods and has to spent a lot of amount on its treatment and if the OP would have granted/renewed the Policy, the amount spent on hospitalization would have been reimbursed by the OP which is to the extent of Rs.1,80,000/- and as such she has filed present complaint thereby praying that OP be directed to pay Rs.1,80,000/- along with interest which she has borne on her treatment, a compensation of Rs.25,00,000/- and litigation charges of Rs.2,00,000/-.
The Commission has enquired from Ld. Counsel for the Complainant as to how the Complainant is a consumer as she has not paid any premium for obtaining any Insurance Mediclaim Policy or if it be put in other words, the OP has not demanded the premium from the complainant for the renewal of its policy nor the complainant has paid any premium, then how the complainant would fall within the definition of Consumer under Section 2 of the Consumer defines consumer as follows:-
7) "consumer" means any person who-
(i) buys any goods for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly paid or partly promised, or under any system of deferred payment, when such use is made with the approval of such person, but does not include a person who obtains such goods for resale or for any commercial purpose, or.........
7) (ii) hires or avails of any service for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment and includes any beneficiary of such service other than the person who hires or avails of the services for consideration paid or promised, or partly paid and partly promised, or under any system of deferred payment, when such services are availed of with the approval of the first mentioned person, but does not include a person who avails of such service for any commercial purpose.
Keeping in view the above facts, it has nowhere come on record that OP has ever promised to insure the complainant as is being alleged. It is not a case of the complainant even that she was assured to give insurance policy after the age of 60 years and that assurance was for consideration or that assurance has not been fulfilled. Once no consideration has passed or promised to pay as per the pleadings, the complainant would not fall within the definition of Consumer.
Consequently, her contention that she spent huge amount on her treatment for the period in question when she was not having any policy is of no consequence and is not relevant as she has not been able to establish that she is a ‘consumer’ under CPA-2019.
Therefore, since Complainant is not a ‘consumer’ within the definition of Section 2(7) of Consumer Protection Act 2019 and as such the complainant is not maintainable and the same is hereby dismissed.
