Haryana

Kurukshetra

CC/425/2020

Vinod Kumar S/o Shri Nanak Chand - Complainant(s)

Versus

Care Health Insurance - Opp.Party(s)

Jai Pal Singh

26 Jul 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION KURUKSHETRA.

 

Consumer Complaint No.425 of 2020

Date of instt.: 11.12.2020

                                                                        Date of Decision:26.07.2021.

 

Vinod Kumar aged 35 years, son of Shri Nanak Chand resident of house No.118/19, village Sunderpur, Post office Palwal, near SD Girls Senior Secondary School, Sunderpur, Tehsil Thanesar, District Kurukshetra.

                                                                        …….Complainant.                                        Versus

 

Care Health Insurance Company Limited, Unit No.604-607, 6^th Floor, Tower C, Unitech Cyber Park, Sector -39, Gurugram – 122001 (Haryana).

 

                                                                 ….…Opposite party.

 

Complaint under Section 35 of Consumer Protection Act.

 

Before       Smt. Neelam Kashyap, President.    

                   Ms. Neelam, Member.       

                   Shri Issam Singh Sagwal, Member.

 

Present:     Sh. Jai Pal Singh  Advocate for the complainant.             

Sh.Rajesh Kaushik Advocate for OP.

ORDER     

                    This is a complaint under Section 35 of the Consumer Protection Act, 1986 moved by complainant Vinod Kumar against Care Health Insurance Co.-the opposite party.

2.             The brief facts of the complaint are that the complainant had obtained   the Care Health Insurance Policy from the OP for the year 2019-2020 ( 15.9.2019 to 14.9.2020) for the sum of Rs.5.00 lacs. It is further submitted that  in  September 2020, the complainant received phone call from the officials of OP regarding renewal of the said policy but the complainant refused to get the policy renewed but despite refusal OPs debited the  amount of Rs.,14,491/- from the Credit Card of Sunil Kumar, a friend of the complainant and issued the policy No.14812187 in the name of the complainant forcibly and illegally. On asking OPs agreed to cancel the policy and refund the amount subject to return of original policy documents and cancellation request. Accordingly, the complainant wrote letter dated 24.10.2020 informing them that the company has issued the policy from 15.9.2020 illegally and debited the amount of Rs.14,491/-  whereas  it was made clear to the OP that the complainant does not want to continue with the said policy and demanded the amount back but the OPs failed to return the amount of the complainant which amounts to deficiency in services on the part of the OP. Thus, alleging deficiency in services on the part of the OP, the complainant has filed the present complaint and prayed that the OPs be directed to refund the amount of Rs.14,491/- to the complainant alongwith compensation for the mental harassment and agony caused to him and the litigation expenses.

3.             Upon notice, OP appeared and filed written statement disputing the claim of the complainant. It is submitted that the complainant had approached the respondent-company for purchasing a health insurance policy. The said request of the complainant was duly complied and requisite policy vide No.14812187 was issued providing health coverage to the complainant, her spouse and daughter with effect from 15.09.2019 to 14.09.2020 for a sum assured Rs.5,00,000/- subject to policy terms and conditions. The complainant paid a premium amount of Rs.13,828/- against the said policy. The copy of the policy certificate for the year 2019-2020  has been issued. That prior to renewal of the policy representative of the OP called the complainant five times to take the consent for renewal  ( 25 Aug. 4 Sept. 7 Sept.11 Sept). However, the call was not picked up/disconnected/and busy. Since, there was auto renewal marked on this policy. The policy was registered through CCSI for auto renewal at the time of first sourcing. Hence, the policy got renewed  w.e.f. 15.09.2020 till 14.09.2021. Vide mail dated 25.09.2020, the complainant had mailed regarding the cancellation of the policy and refund for premium account. Accordingly, the OP vide its mail dated 25.09.2020 asked the reasons for cancellation as per company terms and conditions.  OP communicated that once the complete documents are received by us, in original, your policy would be cancelled and premium amount post deductions, if any would be refunded to you within ten working days. However, on not receiving any OP from the complainant to the above mail, the cancellation was not initiated.  Company again called the complainant on 6^th of Nov. However, the same was disconnected . However, in this case, the policy was renewed yearly on 15.9.2020 and the complainant approached for cancellation on 25.09.2020 (within a month) hence, as  per norms of the company, the OP can only initiate 75% of the premium amount as refund as the same is in accordance with the policy terms and conditions. Thus, it is submitted that there is no deficiency in services on the part of the OP and prayed for dismissal of the complaint.

4.             The complainant in support of his case has filed affidavit Ex.CW1/A and tendered documents Ex.C-1 to Ex.C-4 and closed his evidence.

5.             On the other hand, OP in support of its case has filed affidavit Ex.RW1/A and tendered documents Ex.R-1 to Ex.R-7 and closed its evidence.

6.             We have heard the learned counsel for the parties and gone through the material available on the case file.

7.             The learned counsel for the complainant has argued that  the complainant  had obtained   the  Care Health Insurance Policy from the OP for the year 2019-2020 ( 15.9.2019 to 14.9.2020) for the sum of Rs.5.00 lacs. It is further argued that  in  September 2020, the complainant received phone call from the officials of OP regarding renewal of the said policy but the complainant refused to get the policy renewed but despite refusal OPs debited the  amount of Rs.,14,491/- from the Credit Card of Sunil Kumar, a friend of the complainant and issued the policy No.14812187 in the name of the complainant forcibly and illegally. On asking OPs agreed to cancel the policy and refund the amount subject to return of original policy documents and cancellation request. Accordingly, the complainant wrote letter dated 24.10.2020 informing them that the company has issued the policy from 15.9.2020 illegally and debited the amount of Rs.14,491/-  whereas  it was made clear to the OP that the complainant does not want to continue with the said policy and demanded the amount back but the OPs failed to return the amount of the complainant which amounts to deficiency in services on the part of the OP.

8.             On the other hand, while reiterating the submissions made in the written statement, the learned counsel for the OP has argued that the complainant had approached the respondent-company for purchasing a health insurance policy. The said request of the complainant was duly complied and requisite policy vide No.14812187 was issued providing health coverage to the complainant, her spouse and daughter with effect from 15.09.2019 to 14.09.2020 for a sum assured Rs.5,00,000/- subject to policy terms and conditions. The complainant paid a premium amount of Rs.13,828/- against the said policy. The copy of the policy certificate for the year 2019-2020  has been issued. That prior to renewal of the policy representative of the OP called the complainant five times to take the consent for renewal  ( 25 Aug. 4 Sept. 7 Sept.11 Sept). However, the call was not picked up/disconnected/and busy. Since, there was auto renewal marked on this policy.  It is further argued that the  policy was registered through CCSI for auto renewal at the time of first sourcing. Hence, the policy got renewed  w.e.f. 15.09.2020 till 14.09.2021. Vide mail dated 25.09.2020, the complainant had mailed regarding the cancellation of the policy and refund for premium account. Accordingly, the OP vide its mail dated 25.09.2020 asked the reasons for cancellation as per company terms and conditions.  OP communicated that once the complete documents are received by us, in original, your policy would be cancelled and premium amount post deductions, if any would be refunded to you within ten working days. However, on not receiving any OP from the complainant to the above mail, the cancellation was not initiated.  Company again called the complainant on 6^th of Nov. However, the same was disconnected . However, in this case, the policy was renewed yearly on 15.9.2020 and the complainant approached for cancellation on 25.09.2020 (within a month) hence, as  per norms of the company, the OP can only initiate 75% of the premium amount as refund as the same is in accordance with the policy terms and conditions.

9.             In this case, the OP-company has renewed the insurance policy of the complainant without his consent or permission and has  debited the amount of Rs.14,491/- from the complainant. The complainant moved application Ex.C-1 to the OP company requesting to refund the amount of Rs.14,491/- to the complainant and the said application was received by the OP on 27.08.2020  as per tracking record Ex.C-2 but even the OP company has failed to refund the amount of Rs.14,491/- to the complainant.  The  OP instead of refunding the amount to the complainant wrote E-mail Ex.C-3 to the complainant and in return the complainant again requested to refund the amount of Rs.14491/- which has been received by the OP company on 30.10.2020 but even the OP did not bother to refund the amount to the complainant.

                The OP in the written statement has submitted that as per terms and conditions of the policy, the complainant is entitled to refund of 75% of the premium amount i.e. 75% of Rs.14,491/-  because he has applied for refund of the premium amount within one month but till date the OP has not even refunded the 75% of the premium amount to the complainant. The  complainant had applied for  cancellation of the policy and refund of the premium amount within one month and the present complaint has been filed by the complainant on  11.12.2000, therefore, the complainant is entitled to 75% of Rs.14,491/- from the OP but the OP has failed to refund the said amount to the complainant  and such an act on the part of OP company amounts to grave deficiency in services on the part of the OP. Thus, the complainant is entitled to refund of 75% of  Rs.14491/- alongwith compensation for the mental harassment caused to him and for the litigation expenses.

10.            In view of our above mentioned findings, we accept the present complaint and direct OP to  refund 75%  of Rs.14,491/- to the complainant. The OP is further directed to pay the sum of Rs.10,000/- as compensation  to the complainant for the mental agony and pain cause to him  and Rs.5000/- as   litigation expenses. The OP is   further directed to make the compliance of this order within a period of thirty days from the date of preparation of certified copy of this order, failing which, the complainant will be at liberty to initiate proceedings under Section 72/75 of the Act against the OPs. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the record-room, after due compliance.

Announced in open Commission:

Dt.: 26.07.2021                                                   (Neelam Kashyap)

                                                                                 President.

 

 

(Issam Singh Sagwal),         (Neelam)       

Member                               Member.