Tamil Nadu

South Chennai

CC/599/2006

N.Krishnamurthy - Complainant(s)

Versus

City Bank its manager - Opp.Party(s)

M.Udhaya Kumar

08 Jan 2018

ORDER

                                                                                                                           Date of Filing  : 05.12.2006

                                                                          Date of Order : 08.01.2018

DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, CHENNA (SOUTH)

2^ND Floor, Frazer Bridge Road, V.O.C. Nagar, Park Town, Chennai-3

PRESENT: THIRU. M. MONY, B.Sc., L.L.B, M.L,                    : PRESIDENT

                 TMT. K. AMALA, M.A. L.L.B.                                :  MEMBER-I

             DR. T.PAUL RAJASEKARAN, M.A ,D.Min.PGDHRDI, AIII,BCS : MEMBER II

CC. NO.599/2006

MONDAY THE 8^th DAY OF JANUARY 2018

N. Krishnamurthy,

No.13, Club Road,

Chetpet,

Chennai.                                                     .. Complainant.

 

                                      ..Vs..

 

1.  M/s. City Bank by its Manager,

Club House Road,

Anna Salai,

Chennai 600 002.

 

2. The New India Insurance Company Ltd.,

Rep. by its Branch Manager,

No.260, old No.701-702 2^nd floor,

Annsalai, Chennai.                                    .. Opposite parties.

 

 

Counsel for complainant         :  M/s. M.Udhaya Kumar  

Counsel for opposite party-1  : M/s. R. Balaji

Counsel for opposite party-2  :  M/s. M.B.Gopalan

ORDER

THIRU. M. MONY, PRESIDENT

       This complaint has been filed by the complainant against the opposite parties under section  12 of the Consumer Protection Act 1986 seeking direction to pay a sum of  Rs.5,00,000/- towards refund of treatment expenses  and to pay cost of the complaint.

1. The averments of the complaint in brief are as follows:

          The complainant submit that  he is a credit card holder of the 1^st opposite party bank bearing No.4385879140647003.   Originally the complainant had the credit card Account No. 5425569279755003.  The 1^st opposite party unilaterally without having the comment of the complainant converted the credit card as  Visa Gold Card.  The complainant also availed good health Medi claim Insurance  policy of the 2^nd opposite party bearing No.CHENI-GH03-12-05671-A.   The Insurance policy amount will be debited automatically from the bank account.  The  General Manager of 2^nd opposite party also sent reminder for the renewal of Good Health Insurance Policy and Mr. Krishnamuthy informed the complainant that his Good Health Insurance Policy is automatically renewed; on 25.10.2004 and the premium also debited in the credit card account.   Similarly for the renewal of policy if the proposer  opts for non renewal of policy or for changes in the renewed policy he / she shall inform Citi bank by filling the application  form indicated and it reaches atleast 10 days prior to the date of communication to the policy.  Once the policy is renewed, no request for alteration of policy choice will be entertained.  The complainant has applied to the New India Assurance Co. Ltd., through Citi Bank for Insurance in respect of himself and family members and has paid premium through the 1^st opposite party.   But the opposite party has not sent any reminder letter for renewal of the policy for the year 2005-2006.  However the complainant remitted a sum of Rs.5000/- on 20.10.2005 towards renewal of Insurance policy. The earlier policy was lapsed on 30.11.2005.  The opposite parties has not sent fresh medi claim policy.    The complainant is entitled the benefit of automatic renewal of Medi claim policy as per the terms and conditions of the policy availed.     Further the complainant state  that on 4.5.2006 the complainant has developed sudden severe heart attack and was admitted in Apollo Hospital, Chennai and undergone Angiography, Angioplasty etc and discharged on 12.5.2006.  The complainant has expended a huge amount of Rs.3,50,000/-.   The complainant is entitled to reimbursement of the entire amount as per the terms and conditions of the policy but the complainant was compelled to pay the amount, since the opposite party neglected to renew the policy.     As such the act of the opposite parties amounts to deficiency in service which caused mental agony and hardship to the complainant. 

2. The brief averments in the written version filed by the 1^st opposite party is as follows:

The  1^st opposite party deny each and every allegations except those that are specifically admitted herein.   The 1^st opposite party submit that  the complainant had the credit card facility since 19.10.1995.  It was  upgraded on 26.4.2004 as Visa Gold.  The 1^st opposite party also sate that this opposite party deliberately closed the credit card and issued a new credit card is not correct.  The complainant is using the upgraded visa gold credit card.  Further the 1^st opposite party state that as a part of the credit card facility is that the complainant was enjoying the Good Health Mediclaim policy since December 1999  to November 2004.   Under this policy the role of the bank is confined to that of debiting the credit card account of the card Member providing the list of members for Inclusion into the facility with the 2^nd opposite party.  The 2^nd opposite party as an Insurer supposed to provide cover to the card members listed out by the bank.   Further the 1^st opposite party state that during the month of October 2005 the 2^nd opposite party received renewal form dated 14.10.2005 duly signed by the complainant requesting the 1^st opposite party not to renew the policy.  Hence the 1^st opposite party did not debit any premium for the year 2005-2006 from the card account and did not renew the policy.  Since the complainant opted non renewal of mediclaim policy  no renewal letters sent and as such the policy was treated as cancelled.  Hence there is no deficiency in service on the part of the opposite  parties and the complaint is liable to be dismissed.

3. The brief averments in the written version filed by the 2^nd  opposite party is as follows:

The  2^nd opposite party deny each and every allegations except those that are specifically admitted herein.   The 2^nd opposite party state that the complainant misconstrued the Good Health Mediclaim policy and making unsustainable claim.  The 1^st  & 2^nd opposite parties are the independent entitles  having distinct business.   For the benefit of the customer the bank negotiates for policy which are issued by 2^nd opposite party.  As an insurance company the 2^nd opposite party is functioning subject to applicable law and regulations.   Without the receipt of premium and without the receipt of instruction this opposite party cannot be assessed for any deficiency in service.  The 2^nd opposite party is an Insurer is not aware of the validity, subsistence, eligibility and continuation of card membership.  The scheme of auto renewal is always subject to the bank instructions to this opposite party.  In this case the 2^nd opposite party has not received any instruction from the 1^st opposite party for the renewal of policy.  The 1^st opposite party has confirmed by its letter dated 20.9.2006 filed by the complainant himself that they could not renew the policy in December 2005.  Though the complainant alleges the remittance of Rs.5000/- on 28.10.2005 and filed statements dated 25.11.2005 miserably failed to file the subsequent statements which would disclose that there was no debit for the medi claim policy.    Hence there is no deficiency in service on the part of the opposite  parties and the complaint is liable to be dismissed.

4.     In order to prove the averments of the complaint, the complainant has filed proof affidavit as his evidence and documents Ex.A1 to Ex.A.10. marked.  Proof affidavit of the opposite parties filed and Ex.B1 marked on the side of the opposite parties.

5.      The points for consideration is :

Whether the complainant is entitled to a sum of Rs.5,00,000/- towards compensation for the expenses incurred towards the treatment and for mental agony with cost as prayed for?

 

6.      ON POINT:

          Heard both sides.   Perused the records (viz) complaint, written version, proof affidavits and documents.    The learned counsel for the complainant contended that admittedly the complainant  is a credit card holder of the 1^st opposite party bank bearing No.4385879140647003.   Originally the complainant had the credit card Account No. 5425569279755003.  The 1^st opposite party unilaterally without the comment of the complainant converted the credit card as  Visa Gold Card. The complainant also availed good health Medi claim Insurance  policy of the 2^nd opposite party No. CHENI-GH03-12-05671-A.   The complainant  further contended that the Insurance policy amount will be debited automatically from his account for renewal always.   The  General Manager of the 2^nd opposite party also sent letter remaining the renewal of Good Health Insurance Policy and Mr. Krishnamuthy informed the complainant that his Good Health Insurance Policy is automatically renewed as per Ex.A2, on 25.10.2004 and the premium also debited in the credit card account.  The terms and conditions of Insurance policy Ex.A1 also reads “ the proposal authorities Citi Bank to debit Good Health Policy premium to this citi bank card account for good health policy benefit for self and / or family members / or employees.    The process are accepted  and cover is granted under this policy based on the advance payment of deposit premium to the company by Citi bank.    Similarly for renewal of policy if the proposer opts for non renewal of this or for changes in renewed policy he / she shall inform Citi bank by filling the application  form indicated and it reaches atleast 10 days prior to the date of communication to the policy.  Once the policy is renewed,  no request for alteration of policy choice will be entertained.  The complainant has applied to the New India Assurance Co. Ltd., through Citi Bank for Insurance in respect of himself and family members and has paid premium through the 1^st opposite party.  Further the complainant contended that the opposite party has not sent any reminder letter for renewal of the policy for the year 2005-2006.  However the complainant remitted a sum of Rs.5000/- on 20.10.2005 towards renewal of Insurance policy. The earlier policy was lapsed on 30.11.2005.  The opposite parties has not sent fresh medi claim policy which is against the terms and conditions of the policy availed which amounts to deficiency in service.  The complainant is entitled the benefit of automatic renewal of Medi claim policy as per the terms and conditions of the policy availed.   The complainant is having the credit card and the transactions are current.   The non performance of the Mandatory obligation on the part of the opposite party and violation of the terms and conditions of policy amounts to unfair trade practice.   Further the contention of complainant is that on 4.5.2006 the complainant has developed sudden severe heart attack and was admitted in Apollo Hospital, Chennai and undergone Angiography, Angioplasty etc and discharged on 12. 5.2006.  The complainant has expended a huge amount of Rs.3,50,000/- .  the complainant is entitled to reimbursement of the entire amount as per the terms and conditions of the policy but the complainant was compelled to pay the amount, since the opposite party neglected to renew the policy.

7.             The learned counsel for the 1^st opposite party contended that the complainant had the credit card facility since 19.10.1995.  It was  upgraded on 26.4.2004 as Visa Gold.  The contention of the complainant is that  the opposite party deliberately closed the credit card and issued a new credit card is not correct.  On the other hand the complainant is using the upgraded visa gold credit card  without any comments.  Further the contention of 1^st opposite party is that as a part of the credit card facility is that the complainant was enjoying the Good Health Mediclaim policy since December 1999  to November 2004.   Under this policy the role of the bank is confined to that of debiting the credit card account of the card Member providing the list of members for Inclusion into the facility with the 2^nd opposite party.  The 2^nd opposite party as an Insurer supposed to provide cover to the card members listed out by the bank.   Further the contention of the 1^st opposite party is that during the month of October 2005 the 2^nd opposite party received renewal form dated 14.10.2005 duly signed by the complainant requesting the 1^st opposite party, not to renew his policy as per Ex.B1.  Hence the 1^st opposite party did not debit any premium for the year 2005-2006 from the card account and did not renew the policy.  Since the complainant opted non renewal of mediclaim policy  no renewal letters sent and as such the policy was treated as cancelled.  Equally the principle of auto renewal of the policy is subject to the instructions by the bank to the Insurance company.  In this case the complainant submitted a letter requesting the bank not to renew the policy and the policy was duly cancelled.   The complainant suppressed the above said facts and filed the case.   Further the contention of the 1^st opposite party is that the allegation of payment of Rs.5000/- on 20.10.2005 into the credit card account towards the premium for mediclaim policy is not correct.  The 1^st opposite party pleaded and contended that for the  act  for non renewal of the policy or change in renewal policy the complainant has to inform the bank otherwise the renewal policy is automatic as per the scheme.   In this case the complainant opted for the non renewal of the policy.    Further the contention of the 1^st opposite party is that the denial of benefit on the policy on admission into hospital by the complainant  during the month of May 2006 for his illness is only out of his own will for that the opposite parties are not liable.

8.     The contention of the 2^nd opposite party is that the complainant misconstrued the Good Health Mediclaim policy and making claim is unsustainable.  The 1^st opposite party & 2^nd opposite parties are the independent entitles having distinct business.   For the benefit of the customer the bank negotiates for policy which are issued by 2^nd opposite party.  As an Insurer the 2^nd opposite party is functioning subject to the applicable law and regulations.   Without the receipt of premium and without the receipt of instruction this opposite party cannot be accused for any deficiency in service.  The 2^nd opposite party is an Insurer is not aware of the validity, subsistence, eligibility and continuation of card membership.  The scheme of auto renewal is always subject to the bank instructions to this opposite party.  In this case the 2^nd opposite party has not received any instructions from the 1^st opposite party for the renewal of policy.  The 1^st opposite party  has confirmed by its letter dated 20.9.2006 filed by the complainant himself that they could not renew the policy in the year 2005.  Though the complainant alleges the remittance of Rs.5000/- on 28.10.2005 and filed statements dated 25.11.2005 miserably failed to file the subsequent statements which would disclose that there was no debit for the medi claim policy.  Until hospitalization  after the lapse of renewal of policy on 1.12.2005 the complainant failed to raise any dispute against non renewal.   The compensation claimed is imaginary and unsustainable.   Considering the facts and circumstances of the case this Forum is of the considered view that the complainant after issuing Ex.B1 letter and after cancellation of the policy of insurance failed to initiate steps.  Therefore the complainant is not entitled to any relief sought for in the complaint and the point is answered accordingly.

        In the result the complaint is dismissed.  No cost.  

          Dictated  by the President to the Assistant, taken down, transcribed and computerized by her, corrected by the President and pronounced by us in the open Forum on this the 8^th day of January 2018. 

MEMBER –I                       MEMBER-II                              PRESIDNET.

COMPLAINANT’S SIDE DOCUMENTS:

Ex.A1-             - Copy of terms and conditions of the policy.

Ex.A2- Oct’2004  - Copy of letter from opposite party.

Ex.A3- 1.12.2004 - Copy of Good Health policy certificate.

Ex.A4-             - Copy of Insurance policy card.

Ex.A5- 25.11.2005- Copy of bank statement.

Ex.A6- 11.5.2006 - Copy of hospital bill.

Ex.A7- 15.5.2006 - Copy of letter sent by complainant.

Ex.A8- 7.8.2006  - Copy of legal notice.

Ex.A9- 20.9.2006 - Copy of reply sent by 1^st opp. party.

Ex.A10- 7.9.2006 - Copy of reply sent by 2^nd opp. party.

OPPOSITE  PARTIES SIDE DOCUMENTS:  

Ex.B1- 14.10.2005       - Copy of Non renewal instructions.

 

MEMBER –I                       MEMBER-II                              PRESIDNET.