District Consumer Disputes Redressal Commission, Hooghly

PETITIONER

VS.

OPPOSITE PARTY

Complaint Case No.CC/11/2019

(Date of Filing:-17.01.2019)

1. Sri Dipak De residing at

31, R.N. Neogi Lane P.O. & P.S.:- Bhadreswar, Dist. Hooghly, Pin:- 712124

Versus

1. The Branch Manager, Bank of India,  P.O. & P.S. Bhadreswar

Dist. Hooghly Pin:- 712124

2. The Branch Manager, National Insurance Company Limited, Chandannagar Division, 147/128, G.T. Road, Baghbazar

P.O. & P.S. Chandannagar, District:- Hooghly, Pin:- 712136.

3. The Deputy Zonal Manager, Bank of India, Howrah Zonal Office 4^th floor,

5, BTM Sarani, Brabourne Road, Kolkata-700001

………….Opposite Parties

Before:-

MR. DEBASISH BANDYOPADHYAY, PRESIDENT

MR. DEBASIS BHATTACHARYA, MEMBER

MRS. BABITA CHOUDHURY, MEMBER

Dtd. 23.02.2024

Final Order/Judgment

DEBASIS BHATTACHARYA:- PRESIDING MEMBER

 The instant consumer case filed under section 12 of the Consumer Protection Act 1986 originates from the grievances of the complainant arising out of alleged breach of contract by the OPs in the matter of renewal and continuation of a Health Insurance Policy.

To depict the case as presented in the complaint petition, after truncating the unnecessary details, the complainant, reportedly a customer of OP1 and 3 Bank, entered into the scheme of BOI National Swastha Bima Policy which was effective from 09.01.2018. The said scheme was marketed by OP1 and OP3 Bank being the corporate agent of the OP2 Insurance Company. The yearly premium of the said policy was Rs.7434/- and the complainant claims to have been quite regular in the matter of payment of the yearly premiums.

However, one fine morning the Complainant was informed that the tie-up between the Bank and the Insurance Company was severed and the Complainant was advised to make contact with OP Insurance Company. However, eventually the Complainant had to accept a new policy with enhanced premium under the compelling circumstances. He claims to have deposited the enhanced premium of Rs.30,153/- which was substantially higher than the previous one.

Now the Complainant expresses his grievances over the issue that at the time of entering into the policy there was no such clause in the terms and conditions of the policy that at some subsequent point of time the complainant might have to pay higher premium for continuation of the policy.

A complaint in this regard was lodged with the OP 1 on 04.01.2019 but in turn no communication was made by the said OP to the Complainant.

Hence the instant consumer complaint came up.

The complainant along with his petition has annexed copies of supporting documents viz. terms and conditions of the original policy i.e. BOI Swastha Bima Policy, premium certificates and policy schedules in respect of the periods 25.11.2009 to 24.11.2010, 25.11.2010 to 24.11.2011, 09.01.17 to 08.01.2018, 09.01.18 to 08.01.2019, 09.01.2019 to 08.01.2020, 09.01.2021 to 08.01.2022, communication made to the Branch Manager, Bank of India, Bhadreswar Branch expressing his grievances and petitions made to the OP bank under RTI Act.

The complainant filed the complaint petition seeking direction upon the opposite parties to make arrangements so that the complainant can revert back to the original BOI Swastha Bima Policy with the premium of Rs.7434/- fixed at the time of entering into the policy and to pay back the enhanced premium already paid by the Complainant with 12% interest from the date of severing the tie up.

Besides, the Complainant has also made prayers in his complaint petition to impose direction upon the opposite parties to pay compensation of Rs.19,00,000/- for causing harassment and mental agony. And pay further Rs.50,000/- towards litigation cost.

Evidence on affidavit and brief notes of arguments filed by the Complainant are almost replicas of the Complaint petition.

The OP Bank and the OP Insurance Company in the instant case are the service providers. Thus the complainant is apparently a consumer in terms of the relevant provision of the Consumer Protection Act 1986 and OP 1 and 2 are resident/having their office address within the district of Hooghly. The claim preferred by the complainant does not exceed the limit of Rs.20,00,000/-. Thus this Commission has territorial as well as pecuniary jurisdiction to proceed in the instant case.

Defence case:-

The opposite parties no.1 to 3 belonging to the same organization i.e. Bank of India and opposite party 2, i.e. National Insurance Company contested the case by filing elaborate rebuttals in their representations viz. written versions, evidence on affidavit and brief notes of argument denying therein the allegations leveled against them. OP 2 prayed for treating their written version as evidence on affidavit.

However the content of the written versions of all the OPs have been reiterated in the respective evidence on affidavit and brief notes of argument.

The content of the representations of the OP Bank and of the OP Insurance Company are almost identical.

Both the OP bank and OP Insurance Company in their representations put stress on the following issues.

1. No unfair trade practice had occurred on the part of the Respondent Insurance company as the tie-up in the matter of BOI National Swastha Bima Policy had been withdrawn after due approval of the Insurance regulatory and Development Authority of India and adhering to the guidelines as laid down by IRDA in case of withdrawal of any Health Insurance policy.
2. After the withdrawal of the tie up, the respective policy holders had been communicated three months prior to the expiry of their respective policies, intimating the same and also providing an option to the policyholders to migrate to alternative products offered by the Insurance Company.
3. The Complainant’s allegation that he was compelled to deposit the enhanced premium amount instead of the earlier premium is retaliated by the OPs by the counter argument that it was the Complainant himself who opted for the new policy. The Complainant might have chosen to discontinue the policy and as a matter of fact any insured at any point of time could have exercised the option of discontinuing the policy held by him/her.
4. In the instant case the Complainant chose to exercise the option of availing the new policy under the title ‘National Parivar Mediclaim Policy’ which had been offered by the OP Insurance Company as an alternative product for migration. Thus the Complainant before availing the new policy was quite aware of the premium amount.

The OP insurance Company to substantiate their arguments has annexed copies of the relevant IRDA guideline, the relevant Insurance Company Circular and the consequent notice sent to concerned customer.

The OP bank has stated in their brief notes of argument that the bank being the corporate agent of the Insurance Company had no liability or say whatsoever in the said act of severing the tie-up by the Insurance Company.

The OP Bank and the OP Insurance Company claim to have intimated the issue regardintg severing of the tie-up through their respective website as well as through display in the notice board.

Decision with reasons:-Materials on records are perused.

The bank apparently was the corporate agent of the OP Insurance Company for marketing the particular Health Insurance Policy    and the tie-up was made accordingly. But it was nowhere stipulated that the tie-up would continue for infinite period and the parties involved would never be able to come out of the tie-up. In the corporate interest both sides were at liberty to come out of the tie-up at any point of time when a particular product becomes unsustainable. But by no stipulation the Insurance Company was under the compulsion to stick to the earlier premium applicable to the BOI National Swastha Bima Policy. In the instant case the process of withdrawal of the particular product followed the norms mandated by the Regulator IRDAI and the policyholder was at liberty to opt for the discontinuation of the policy when the withdrawal of tie-up came within his knowledge. But he himself opted for the migration to the new policy offered by the OP Insurance Company and accordingly he also paid the enhanced premium.

It transpires on perusal of the relevant documents that the tie-up was withdrawn in accordance of the regulations of IRDAI which is a statutory body under the jurisdiction of Ministry of Finance, Government of India and while withdrawing the tie-up all necessary formalities were observed so far as the existing policy holders of BOI National Swastha Bima Policy were concerned.

Now, as the Complainant himself opted for migration to the fresh policy offered by the OP Insurance Company, the present claim of the Complainant becomes barred by the principle of estoppel.

The Commission is not supposed to direct the OP Insurance Company to restore the tie-up with Bank of India, the previous policies arising out of the tie-up and to revert back to the premium applicable to the previous policy in respect of all the policyholders of the said policy.                     

  Now, in view of the discussion made hereinabove and considering the facts and circumstances of the case, this commission is of the view that any sort of breach of contract, deficiency of service or unfair trade practice on the part of the OP Bank or the OP Insurance Company cannot be established.

Hence, it is

ORDERED

that the complaint case no.11/2019 be and the same is dismissed on contest. However there is no order as to costs.

Let a plain copy of this order be supplied free of cost to the parties/their Ld. Advocates/Agents on record by hand under proper acknowledgements/sent by ordinary post for information and necessary action.