BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 26th day of August, 2009

Present:

SRI.LAIJU RAMAKRISHNAN PRESIDENT

SMT.SHEELA JACOB MEMBER

SMT.BINDU SOMAN MEMBER

C.C No.78/2009

Between

Complainant : Philip Zacharias,

Vellackal House,

Kuninji P.O,

Thodupuzha – 685 583,

Idukki District.

And

Opposite Party : The Branch Manager,

National Insurance Company Limited,

Pulimoottil Shopping Arcade,

P.BNo.21, Thodupuzha – 685584.

(By Adv: Thomas Sebastian)

O R D E R

SMT.BINDU SOMAN(MEMBER)

Complaint is filed against deficiency in service.
 

Complainant availed a mediclaim policy from the opposite party. He is a regular customer of opposite party for the past 4 years. Complainant has renewed his policy in time, but in 2008 he cannot renew his policy in time. After two days he renewed the policy. Opposite party received the premium amount, but they have not yet issued the renewed policy certificate. Opposite party stated that after the decision from Head Office, the policy certificate will be issued immediately. Complainant approached opposite party for policy certificate, but not given. During this time he was in hospital. He cannot claim his medical bill without the policy certificate. Complainant approached opposite party's office at Thodupuzha many times, at last he sent a Registered letter to the opposite party on 18.11.2008 claiming his premium amount and cancellation of policy. Opposite party issued complainant's renewal policy on 06.12.2008 after 7 months time. Policy renewal date is 07.05.2008. Opposite party served a letter to complainant stating that it was renewed only on 21.08.2008. So this complaint is very much desperate and filed a complaint before this Forum.
 

2. Opposite party filed written version. In the written version of opposite party, their first argument is that this complaint is not maintainable. Opposite party submitted that two days delay in renewal can be allowed only after the consultation with Divisional Office. So in order to condone the delay in renewing the policy the matter was referred to Divisional Office, Thripunithara. As per sanction, the opposite party issued fresh policy as No.570801/48/08/8500000277 for a period of 7.05.2008 to 6.05.2009. The opposite party issued letter to renew the policy. But the complainant did not turn up and issued letter demanding the cancellation of policy on 18.11.2008, and return of premium. So the policy was cancelled. As per policy condition 5.8, if the policy cancelled after six months of the commencement of the risk period, the rate of premium to be charged in full annual rate. Here the policy is cancelled on 18.11.2008, after 6 months from the commencement of the risk period. Hence the company is not liable to refund any premium. The allegation that the complainant did not get the medical bill amount for the treatment in the hospital during the policy period is not correct. The complainant had not made any claim to the opposite party during the period "7.05.2008 to 18.11.2008". Complainant is not entitled to get any premium returned because it was cancelled after six months of commencement of risk. So there is no deficiency on the part of opposite party.
 

3. The point for consideration is whether there is any deficiency in service on the part of the opposite parties, and if so, for what relief the complainant is entitled to?
 

4. The evidence consists of the oral testimony of PW1 and marked Ext.P1 to P4. PW1 was cross examined by opposite parties counsel and marked Exts.R1 to R3. No oral evidence on the part of opposite party.
 

5. The POINT:- Ext.P1 is the hospital bill of the complainant. Ext.P2 is the premium receipt of complainant. Ext.P3 is the letter from Insurance company. Ext.P4 is the letter send by complainant to opposite party. Ext.R1 is the Policy Certificate. Ext.R2 is the premium receipt copy. Ext.R3 is a letter of the complainant. After discharging from Hospital complainant approached opposite party for claim, but refused. Opposite party issued policy certificate only after 7 months. Opposite party in their written version stated about the condition and rules regarding insurance. Insurance is a contract of almost good faith. Complainant is a regular customer of opposite party. He had a good relation with opposite party. No previous dispute or any type of misdealings is not reported, so it is understood that this is the only event of complainant made two days delay for renewing his policy. After repeated requests, opposite party served policy certificate to complainant after 7 months. The act of opposite party made the complainant to think about the cancellation of the policy. Complainant is very well aware of the benefits of medi-claim policy. Because of the delay in issuing the policy certificate the complainant was not able to claim for his hospital expenses. So it is a gross deficiency in the part of the opposite party to make such a long delay. It is the right of the complainant to cancel the policy because he did not get good service from the opposite party. So we think it is proper to give back the premium amount to the complainant.

Hence the petition is allowed. Opposite party is directed to return the premium amount with 12% interest from the date of receipt of premium and opposite party is also directed to pay Rs.1,000/- as cost of this petition.

Pronounced in the Open Forum on this the 26th day of August, 2009
 

Sd/-

SMT.BINDU SOMAN(MEMBER)
 

Sd/-

I agree SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
 

Sd/-

I agree SMT.SHEELA JACOB(MEMBER)

APPENDIX

Depositions :

On the side of Complainant :

PW1 - Philip Zacharias

On the side of Opposite Party :

Nil

Exhibits:

On the side of Complainant:

Ext.P1 - Medical Bill issued from Holy Family Hospital, Muthalakkodam

Ext.P2 - Photocopy of Premium Receipt

Ext.P3 - Photocopy of opposite party's letter dated 5.12.2008

Ext.P4 - Photocopy of complainant's letter dated 31.01.2009 addressed to the opposite party

On the side of Opposite Parties:

Ext.R1 - Policy Schedule

Ext.R2 - Premium Receipt

Ext.R3 - Complainant's letter dated 14.08.2008 addressed to the opposite party