ORDER

BY SRI.H.R.SRINIVAS, PRESIDENT.

This is the Complaint filed by the Complainant U/S Section 12 of Consumer Protection Act 1986, against the Opposite Party (herein referred in short as O.P) alleging the deficiency in service in not including the health condition of his son in the insurance policy and not issuing the insurance policy with the said health condition of his son though received the premium, and further not refunding the amount received as premium inspite of request and hence for issuing of the insurance policy by incorporating the illness of his son and or in the alternative to refund the amount of Rs.29,807/- paid to OP and also for compensation of Rs.50,000/- for causing torture and harassment physically and mentally and misrepresenting the facts.

2.      The brief facts of the complaint are that;

The complainant’s son one Aravind I K.Chari, was suffering from “schizoaffective disorder” which has been certified by the Nimhans, Bangalore. He contacted one Ramesh of IDBI insurance requesting him that his son is suffering from the said disease and there is an order by the IRDI in this regard to include the said disease in the insurance policy.  He introduced one Santosh an employee of OP and after lot of discussion, and informing him the existing disease of his son, he agreed to provide insurance by mentioning the existing illness of his son and a sum of Rs.29,806/- was paid towards two years premium. The said amount was credited to the account and the proposals were cancelled.  When the same was enquired Mr.Santosh informed that it is due to technical fault, whereas the under writers had given approval for the proposal.

3.      It is contended that again on February 20^th, of 2020, he obtained the Aadhar Card, pan card and live photo as everything has been digitalized.  He also informed the advantages of the policy and again informed that the under writers have approved the policy in respect of the existing illness.  All the formalities were completed.  When the policy was issued, there was no mention of pre-existing disease of his son which was contrary to the assurance given by Santosh.  The same was returned to the insurance company and several correspondences were made and the company requested to provide some irrelevant details.  Again on 1^st July 2020 he made a request to the OP for issuing a revised policy which they did not do it.  Santosh was not available for the call.  Inspite of requesting the OP to send a revised policy it has not done so and even it has not refunded the insurance premium paid. Hence there is deficiency in service and prayed the commission to allow the complaint by awarding compensation.

4.      Upon the service of notice, OP appeared before the Commission through its advocate, whereas did not file the version in time as prescribed under the provisions of Consumer Protection Act and hence its right to file the version was forfeited.

5.      In order to prove the case, complainant examined himself and got five documents marked. Arguments Heard. The following points arise for our consideration:-

1) Whether the complainant has proved deficiency in service on the part of the Opposite Party?

2) Whether the complainant is entitled to the relief prayed for in the complaint?

6.     Our answers to the above points are:-

POINT NO.1:            In the Affirmative

POINT NO.2:            Partly in the affirmative.

                                For the following.

REASONS

7.     POINT No.1:-

   Perused the complaint, affidavit evidence and the documents produced by the complainant.  OP has not at all filed its defence and not refuted the allegations made by the complainant against it, though it put its appearance through its advocate. Further the complainant has produced the correspondences made with the OP, wherein it had requested the OP to issue new policy after returning the one issued at the earliest, wherein there was no mention of mental illness of his son Aravind I.K.Chari.  

        8.     It is stated in the complaint that one Santosh had assured him that the illness of the son of the complaint would be mentioned in the policy and the same will be covered in the insurance that would be provided to the complainant, whereas the complainant has not been provided with the insurance policy mentioning the illness of Aravind I.K.Chari.

        9.     It is the prerogative of the insurance company to accept the proposal or not basing on the guidelines issued by IRDI and also on the recommendations of the under writers.  Hence this Commission cannot direct OP to issue health insurance in respect of the illness which the son of the complainant is suffering.  Only this commission can order the OP to refund the amount received towards the premium in case OP is not in a position to issue the policy.

        10.   The SMS has been sent to the mobile phone of the complainant whereas it is mentioned as “Rs.29,807/- spent on your SBI card ending with 5391 at Religare Health Insurance on 20.02.2020 if the transaction was not done by you call 186050030000.  On 23^rd February 2020 complainant has sent a message to Religare Company stating that “the policy document has not been received on email.  I will be grateful if policy is sent on email and whatsapp. Thanks”.  Again on 6^th June 2020 complainant has sent a message to Santosh of Religare, stating that “he has sent the policy to the head quarters since it is not mentioned the existing illness of his son.”

        11.   When this is taken into consideration it is clear that the complainant has paid Rs.29,807/- towards purchase of the policy and after return of the policy also, OP did not issued another policy incorporating the pre-existing illness of his son.  Hence not refunding the amount and when failed/rejected to issue policy, amounts to deficiency in service and hence we answer point No.1 partly in the affirmative.

12.   POINT NO.2

        As pointed above, that the Commission has no authority to direct the OP to issue the policy in a particular manner as it is governed by the guidelines of the IRDAI and also on the recommendations of the under writers, the complainant is only entitled for refund of the premium amount which he has paid to OP, i.e., Rs.29,807/- along with interest at 12% p.a., from 20.02.2020 till payment of the amount.

        13.   Further the act of OP in not refunding the amount and also not issuing the insurance policy put the complainant who is a senior citizen to mental agony, mental worry and also mental strain besides suffering financial loss. Hence we are of the opinion that if the OP is directed to pay a sum of Rs.5,000/- towards damages and Rs.5,000/- towards litigation expenses would be just, proper and reasonable under the circumstance.  Hence we answer point No.2 partly in the affirmative and pass the following;

ORDER

1. Complaint is allowed in part with cost.
2. OP is directed to refund the premium amount paid i.e., Rs.29,807/- along with interest at 12% p.a., from 20.02.2020 till payment of the amount to the complainant.
3. OP is further directed to pay Rs.5,000/- towards damages and Rs.5,000/- towards litigation expenses to the complainant.
4. The OP is further directed comply the above order within 30 days from the date of receipt of this order and submit the compliance report to this forum within 15 days thereafter.
5. Send a copy of this order to both parties free of cost.

Note:You are hereby directed to take back the extra copies of the Complaints/version, documents and records filed by you within one month from the date of receipt of this order failing which the same will be weeded out/destroyed.

(Dictated to the Stenographer over the computer, typed by him, corrected and then pronounced by us in the Open Forum on this 12^TH  DAY OF OCTOBER 2021)

MEMBER                                PRESIDENT

ANNEXURES

1. Witness examined on behalf of the Complainant/s by way of affidavit:

Copies of Documents produced on behalf of Complainant/s:

Ex P1: Correspondence with OP insurance company

Ex P2: Copy of the medical certificate and prescription

Ex. P3: Email correspondences

Ex P4: Copies of the policy document

Ex P5: Whatsapp chat

2. Witness examined on behalf of the Opposite party/s by way of affidavit:

• NIL -

Copies of Documents produced on behalf of Opposite Party/s

• NIL -

MEMBER                                        PRESIDENT