Order-21.
Date-24/06/2016.
The instant case relates to an application u/s.12 of the C.P. Act, 1986.
The case of the complainant, in short, is that Late Kailash Chandra Sureka being the husband of the complainant No.1 and the father of the complainant no.2 had been holding a CITI Bank Credit Card having No.4564 0701 5521 4375. Late Kailash Chandra Sureka also availed of Good Health Insurance Policy through OP2 for the period 01-01-2014 to 31-12-2014. The beneficiaries of the said policy were Late Kailash Chandra Sureka himself and his wife Smt. Rani Devi Sureka, complainant No.1 in this case. The policy holder was to pay an annual premium of Rs.23,984/- as per terms of the policy and Late Kailash Chandra Sureka and Rani Devi Sureka were insured for a maximum amount of Rs.3 Lakh and Rs.3 lakh i.e. Rs.6 lakh during the period of subsistence of the said policy. The aforesaid amount of premium was automatically deducted from the credit card of Late Kailash Chandra Sureka and the policy was consequently renewed year to year. The diseased submitted the duly filled in form as usual practice on 9th December, 2014 for renewal of the policy for the period 01-01-2015 t0-31-12-2015 for deduction of the annual income of Rs.23,984/- from his credit card. The OP1 vide letter dated 12-01-2015 requested the deceased to forward the complete set of KYC documents on 28-01-2015 Late Kaisakh Chandra Sureka issued a letter to the OP2 with copy of OP1 stating that payment was to be collected by the OP1 directly during the said bank credit card. The renewed policy, however, had not been received even after lapse of almost one month. OP1 also issued a letter dated 29-01-2015 acknowledging the receipt of the letter dated 28-01-2015 and stated that OP1 was in the process of reviewing the same. unfortunately, the renewed policy was not received by the said Kailash Chandra Sureka who ultimately expired on 20-02-2015 due to cardiac arrest. The legal heirs of Late Kailash Chandra Sureka at several occasions demanded the claims as per the policy upon the death of Late Kailash Chandra Sureka but to no good. The complainant also gave legal notice dated 21-08-20-15 to the OPs demanding a sum of Rs.4,18,700/-. The aforesaid amount was in respect of the medical expenses incurred due to hospitalization and treatment of the said deceased but till date no reply has been received by the Advocate of the complainant. hence, this case.
OP 1 appeared in this case and contested the case contending, inter alia, that the case is not maintainable in law and there is no deficiency in service on the part of the OP1. It is stated that in December, 2014 OP1 had forwarded the papers for renewal of the policy when it was found that there was a mis-match in the date of birth of the deceased card holder the card of the deceased card holder was not debited as such. In January, 2015 the deceased card holder forwarded the KYC documents the OP thereafter, came to know about the death of Late Kailash Chandra Sureka, the date of death has February 20, 2015 and the card was locked. No claim was ever made during the time when the deceased card holder was hospitalized. The present complaint is afterthought. No claim can be awarded to the complainant for the period when the policy was not renewed. No hospitalization bill has been submitted till death either to the answering OP or before this Ld. Forum. It is also alleged that the coverage sum of rs.3 lakh only which for hospitalization as per the terms and condition of the policy issued by the OP2. It is also alleged that the claim has to be examined by the OP2 or its third party agency. OP1 submits that the allegation levelled against them is baseless. This OP submits that there being no deficiency of service on the part of the OP1. Complainant should be dismissed with cost.
OP2 New India Assurance Company Ltd. also made appearance in this case and has contested the case contending, inter alia, that the complainant has no cause of action against this OP who is dealing with insurance business within the purview of the Insurance Act, 1938 and rules framed therein. It is submitted that the petition of complaint is defective, incomplete and suppressive of material facts. It is submitted that this insurance company approached the CITI bank with a proposal to select executing customer of said bank to avail various0 group insurance policy of the New India
Assurance Company Ltd. CITI Bank availed various group insurance policy from this OP for credit card holders and accordingly a master policy named as Good Health Policy is issued every month in the CITI Bank as principal insured. Accordingly Mr. Kailash Chandra Sureka since deceased and his wife Rani Devi Sureka was enrolled in the Good Health Polcy in the month for January, 2000. According to the insurance certificate it has been provided that renewal is automatic only if the premium due is paid by the CITI Bank to this OP before the due date on behalf of the card holder as per his card, her application form. In the instant matter the premium as due was not paid by the CITI Bank for the status of the card was blocked by the CITI Bank as apparent from the letter dated 30-03-2016 issued by the CITI Bank to Late Kailash Chandra Sureka and also by the letter of CITI Bank dated 10-04-2015. In this said letter it has been, inter alia, intimated that commencing from January, 2015 trill March, 2015 no transaction has been made and the card was in block position. This OP has no liability under the said policy in absence of any valid insurance contract between the OP and the complainant. This OP accordingly has prayed for dismissal of the purported claim in limine.
Points for Decision
Whether the complainants are entitled to get claim as prayed for.
Decision with Reasons
The factual matrix of the instant subject matter, as we find from the documents on record, that New India Assurance Company Ltd. has through their corporate agent namely M/s. CITI Corp. Finance India Pvt. Ltd. (CFIL) approached the CITI Bank with a proposal to enroll the existing customer of CITI Bank to avail of various credit insurance policies of New India Assurance Company Ltd. CITI Bank as we find availed various Group Insurance Policies from New India Assurance Company Ltd. for its Credit Card Holders and accordingly, the master policy named as good health policy is issued forthwith to CITI Bank as principal insured.
Accordingly, the card member in the subject matter being Mr. Kailash Chandra Sureka and his wife Rani Devi Sureka were registered as member of the Good Health Policy in the month of January, 2000. From the documents on record we find that Late Kailash Chandra Sureka was holding good Good Health Insurance Policy for the last 14-15 years together with his wife Smt. Rani Devi Sureka.
We also find that on 28-01-2015 Late Kailash Chandra Sureka issued a letter addressed to the OP2 with copy to OP1 specifically mentioning for renewal of the said policy after duly filled in form and intimating that the payment was to be collected by the OP2 directly through CITI bank credit card. OP2, however, did not fulfill the part of its responsibility. We also find that the said deceased vide his letter dated 27-01-2015 provided all the documents, the complete sheet of KYC Documents as required by the OP2. The said deceased submitted the duly filled in form dated 09-01-2014 for renewal of the policy for the period 01-01-2015 to 31-12-2015 for deduction of the annual premium of Rs.23,984/- from the credit card of the deceased. But curiously enough the renewed policy had not been received by the deceased. OP2 also issued a letter dated 29-01-2015 wherein OP1 had categorically acknowledged the receipt of the letter dated 28-01-2015 and had mentioned that the OP1 was in the process of reviewing the same. Said Late Kailash Chandra Sureka ultimately expired on 20-02-2015 due to cardiac arrest. It appears that the premium of the insurance policy was not paid by the OP1 to OP2 for the reason best known to them.
It is argued from the side of the OP1 that the card was dormant and, as such the insurance premium could not be deducted from the debit card of the deceased. It appears from the documents on record that the OP has categorically stated that the card was blocked on 16-03-2015 in any event the amount of premium is required to be deducted by December, 2015, therefore, the card being blocked during any period subsequent thereby does not matter. Even as late as on 29th July, 2015, the OP1 had mentioned that the OP1 were in the process of reviewing the grievance of the deceased. The statement of account filed from the side of the complainant goes to show that the card was not dormant and transactions were made vide the card during the period 12-12-2014to 11-01-2015. So, the question is has the card could be dormant as alleged from the side of the OP1? We find that due to non-sending of the amount by OP1 resulting in cancellation of the mediclaim policy, the complainants were put to unnecessary mental agony, harassment and, of course, we think that it is a deficiency of service at the instance of the Bank.
We think that Bank has committed deficiency in service in not sending the amount of premium to OP2 resulting in the support of the insurance policy. Moreover, we find that the complainant is a holder of Good Health Policy for the last 15 years. We find that the deceased never made any direct payment throughout the tenure of the last 15 years to the insurance company but through the concerned Bank being OP1. We think that OP1 is liable for deficiency in service.
Hence,
Ordered
That the instant complaint be and the same is allowed on contest against OP1 and dismissed against OP2. OP1 is directed to make payment of the insured amount of Rs.3 lakh along with interest at the rate of9 percent p.a. from the date of passing this order to the complainant along with litigation cost of Rs.5,000/- and compensation to the tune of Rs.50,000/-, 50 percent of which to be deposited to the account of this Forum within 30 days from the date of passing this order, in default, the complainant will be at liberty to put the decree into execution and in that case OP will be liable to pay the penalty at the rate ofRs.100/- per diem to be deposited to this Forum account after the expiry of the stipulated time till full and final payment.
