Brief fact of this case is that, the Complainant purchased an Arogya Rakshya Policy (health insurance) vide Policy No.0105002018484100000299189 on payment of Rs.10,112/- for health coverage of himself along with other 3members of his family for coverage of 5,00,000/- on dt.23.03.2016and accordingly the insurance Company issued a policy bond. The complainant went on renewing the said policy for next 3 years i.e. up to 28.02.2019 for health coverage. The complainant could not able to renew the said policy from 28.02.2019 to 28.03.2020 due to undergone treatment for an accident after lapse of grace period of 30days.When the complainant approached the OP.No.1 on 20.04.2019 clearly stated by giving a mail that they are unable to recommended for continuity benefit of the policy as it lapses the grace period. Again on 26.04.2019 the complainant approached the OP.No.2 through mail with reason for non-renewal of policy in due time with two numbers of guideline of IRDA where it is clearly mentioned that even after over of grace period of 30 days policy can be renewed within 90days by certain conditions and insurance company to inform the complainant positively in advance i.e. before 3 months when policy premium is to enhance and the complainant’s policy premium in each year was enhancing, as such it is the duty of Ops insurance company to intimate the enhance premium prior to renewal date but in present case that has not been made by OP insurance company. Even after receipt of guideline the OP.No.2 on 11.05.2019 rejected the prayer of the complainant to renew the said policy within 90 days and further stated that renewal reminder has given by SMS on 06.02.2019 at 12.15pm to mobile No.9437084602 of complainant which was false. When the OP.No.2 clearly refused to renew the said policy as they did not found any merit for condonation of delay, despite guidelines of IRDA put the complainant to mental agony and financial loss which is nothing but deficiency of service as such the Ops are jointly & severally liable for the cost and compensation. Hence prayed that the Commission should be pleased to direct the Ops to renew the policy from 28.02.2019 to 28.03.2020 and direct the Ops to pay Rs.50,000/- towards mental agony and harassment and Rs.10,000/- towards cost of litigation and any other relief found fit and proper for interest of justice.
The complainant relies upon the following documents:
- Photocopy of Policy Bond.
- Photocopy of letter dt.20.04.2019 addressed to OP.1
- Photocopy of prescription,DHH,Keonjhar dt.28.02.2019..
- Photocopy letter dt.26.4.19 addressed to Op.No.2 with a copy to Op.No.1.
- E-mail dt.08.05.2019/09.05.19 & 10.05.19 of complainant addressed to Op.No.2.
- Guideline of IRDA dt.31.03.2009 and 25.01.2018.
- E-mail dt.11.5.19 of OP.No.2 regarding refusal of renewal request of complainant.
Under the above complain the case was admitted and notice issued to Ops.
OP No.1 admitted that the true fact is that the present complainant after expiry of 30 days of grace period the complainant approached this OP to renew his lapsed policy which is beyond the capacity of OP No.1. The said policy holder after date of expiry i.e 28.02.2019 and after lapse of grace period of 30days requested the OP.No.2 for renewal and the complainant has simply informed to this OP Bank on 20.04.2019 without submitting valid documents and due premium while the complainant is well aware of that any such renewal require submitting valid documents with deposit of the due premium amount and system will not accept after the expiry of grace period. This OP Bank has intimated and forwarded the complainant’s request to its Head office of OP.No.2 and its Head office also as such this OP has meticulously performed its duty to extend service. Since the branch can only renew policy if valid documents with due premium comes within the expire/grace period as it is a system generated mechanism and after intimation to Op. No.2 by Head office of this OP i.e insurance company intimated the complainant with a copy to this OP stating that “unless there is a valid reason that disabled the insured from renewing the policy that too within reasonable days of expiry of 30days grace period, approval of continuity benefit cannot be obtained” and turned down complainant’s request as Op.No.2 not found a valid reason in the above case. Regarding IRDA guide line and refusal of renewal of policy, it is OP.No.2 to reply and this OP has no role to play on this point.
The OP.No.1 relies upon the following documents:
- Letter dt.26.04.2019 of complainant.
- Letter of complainant forwarded to Head office.
- Letter of Op.No.2 addressed to complainant with a copy to this OP.
Op No.2submitted that the present case as laid is not maintainable under law and fact. There is no cause of action to file this case against the present OP No.2. The present case is bad for mis-joinder and non-joinder of party. The present case is having no merits hence liable to be dismissed. The most incredible fact is that due to the latches on the part of the present complainant, renewal as alleged could not be made, which is not at all intentional or deliberate. Hence, the present case does not any way turn out to be case of deficiency of service. The policy bearing No.0105002018484100000299189 which was valid up to 28.02.2019 as admitted by the complainant but due to the non-renewal of the same within the stipulated period as per the guidelines framed by IRDA inspite of reminder sent by the insurer in right time, the policy in question could not be renewed which was already intimated to the complainant. Thus, it is sufficient enough to make it clear that the insurer has performed its duty meticulously and the same no way turn out to be a cause of deficiency of service. It is evident from the complaint itself that the complainant had approached the insurer after the expiry of grace period for necessary renewal which was beyond the terms and conditions of IRDA but by misrepresenting the IRDA guidelines, the complainant was trying to patch-up his own latches. In fact the non-renewal of policy as alleged could not be made due to the fault of the complainant; hence it is expedient for the ends of justice that the case be dropped with costs, being devoid of any merit.
The OP.No.2 relies upon the following documents:
No enclosures.
On the above pleadings the following issues are framed to decide the case.
- Whether the case is maintainable?
- Whether any cause of action arises on this case?
- Whether Ops have made any deficiency of service?
- Whether the complainant is entitled to get any relief sought for?
- Whether the case is bad for mis-joinder & non-joinder of party?
FINDINGS
All the issues are interlinked each other.So they are discussed jointly to decide the case. It is admitted fact that Op No.2 was insurer pertaining to Arogya Rakshaya Policy bearing No.0105002018484100000299189 which was valid up to 28.2.2019. The complainant on 26.2.19 met with an accident for which he could not renew the said policy from 28.2.2019 to 28.2.2020. But one OPD prescription of DHH,Keonjhar filed by the complainant is not good ground as he was not an indoor patient at that time. As an outdoor patient the complainant had sufficient time to deposit the insurance premium within the grace period but the complainant failed to deposit the premium. As pr the IDRA guidelines filed by the complainant “Any change in the premium structure or terms of health insurance policies filed with IRDA shall be made only after such a change(s) is/are filed and accepted by the Authority. Thereafter, insurers shall intimate such revision(s) to all the policy holders such that the policy holders are so informed at least three months prior to the date of renewal of their cover. These revisions will only be accepted by IRDA for justified and compelling reasons or if they are to the benefit of policyholders”. In this case the complainant has prayed to renew the policy as per the guidelines but the complainant has not mentioned in this case regarding any change of premium structure or terms of health insurance policy as per IRDA guidelines. The OP No.2 had reminded the complainant by SMS for renewal of the policy but the complainant strongly denied it but no parties have filed any document regarding the SMS. This Commission has not found any deficiency of service by OP.No.2. So far as the OP No.1 is concerned the Indian Bank,Keonjhar Branch, this OP is a proforma party.Since the branch can only renew policy only if valid documents with due premium comes within the expire/grace period as it is a system generated mechanism and after intimation to Op.No.2 by Head office of this OP i.e insurance company intimated the complainant with a copy to this OP stating that“unless there is a valid reason that disabled the insured from renewing the policy that too within reasonable days of expiry of 30days grace period, approval of continuity benefit cannot be obtained”. In the above situation this Commission feels that the complainant has not properly intimated the matter to the Ops, so OP.No.1 has not made any deficiency of service from their side. OP No.1 has filed enclosures to defend his case. On the above circumstances the complaint filed by the petitioner has no merits so this case is not maintainable and there is no cause of action arises in this case. The complainant is not entitled to get any relief.
ORDER
The complaint case being devoid of merits is dismissed without any cost.
