Kerala

Thiruvananthapuram

CC/13/100

Henry Thomas - Complainant(s)

Versus

Divisional Manager, New India Assurance Co. - Opp.Party(s)

C.S. Raj Mohan

30 Jun 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACADU

THIRUVANANTHAPURAM

 

PRESENT

            SRI.P.V.JAYARAJAN      : PRESIDENT

         SMT.PREETHA.G.NAIR   : MEMBER

                                         SRI.VIJU.V.R                 : MEMBER

CC.NO.100/2013 (Filed on : 08/03/2013)

ORDER DATED : 30/06/2022

 

COMPLAINANTS

1. Henry Thomas,

TC.4/74(1), Shrom,

Ambala Nagar, Kowdiar.P.O

Thiruvananthapuram District

 

2. Sarjaine Thomas,

TC 4/74(1), Shrom, Ambala Nagar,

Kowdiar.P.O, Thiruvananthapuram District

 

(By Adv.C.S.Rajmohan)

565.  

OPPOSITE PARTY

Divisional Manager,

New Indian Assurance Company Limited,

2^nd Floor, Kottarathil Building, Palayam,

Thiruvananthapuram

 

(Sreevaraham G Satheesh)

ORDER

SMT.PREETHA.G.NAIR  :MEMBER

 

          1.       The first complainant availed a family Medi claim policy from the opposite party in the year 2007. The family members covered under the policy were first complainant, his wife and his son (second complainant ) and daughter, the sum assured was one lakh eah. The first complainant was regularly remitting the premium without any default. The policy which was availed by the first complainant covers the entire family members. The first complainant received the policy copy for the tenure of 18/03/2012 to 17/03/2013, after remitting the prescribed premium. On perusal of the policy schedule, it was seen that the name of the second complainant was not included. The previous policy dated 18.03.2011 to 17.03.2012 all the four members were included. But without any reason in the policy schedule covering from 18.03.2012 to 17.03.2013 the name of the second complainant was not included. No information was given by the opposite party regarding the non-inclusion of the second complainant. The first complainant was regularly paying the premium annually and opposite party is bound to issue policy for the family members also. The first complainant availed the policy long back in order to protect the family from an unforeseen incident to be happened. The opposite party is liable to include the name of the second complainant or else issue a new policy in his favour to avoid the policy lapse from the date of exclusion. As the name of the second complainant was deleted by the opposite party without any intimation which caused much  damage to the second complainant. Non inclusion of the name of the second complainant amounts to deficiency in service and unfair trade practice. The right of the second complainant to raise a claim will be barred as opposite party arbitrarily thrown him out from the family policy schedule availed by the first complainant. The opposite party’s act amounts to unfair trade practice and deficiency in service. Hence this complaint.

          2.       The opposite party admitted that the first complainant availed a medical policy in the year 2007, in his name and covering his three family members including the second complainant. The said policy renewed on 18.03.2012 by the first complainant excluding the name of the second complainant, as he was married by that time and became a separate family. This was done as per the policy condition and the complainants were well aware of it. The opposite party informed to avail a separate policy for the second complainant if the second complainant wants to continue the coverage he has taken a separate policy. As per principle of insurance law, no coverage of insurance policies is available without retrospective effect. The complainant never opted to take any policy for the second complainant, no premium for the second complainant was paid by them. In the absence of any request for policy without payment of any premium the opposite party can never issue a policy in the name of the second complaint. The fact that the first complainant was advised to submit a separate proposal for the second complainant, he agreed to the same of the first complainant remitted premium for three members only excluding the second complainant. There is no deficiency in service from the part of opposite party.   

          Complainant filed chief affidavit and documents. Exts.P1 & P2 marked. Complainant was examined as PW1. Opposite party filed chief affidavit.Exts.D1 & D2 marked. Opposite party was examined as DW1. Both parties filed argument notes.

Issues

1. Whether there is any deficiency of service from the part of the opposite party?
2. Whether the complainants are entitled for the relief.

Issues 1 & 2

The first complainant availed the policy from opposite party around 13 years back and he was regularly remitting the premium without any default. According to the complainant without any reason is the policy schedule covering from 18.03.2013 the name of second complainant was excluded. At the time of cross examination PW1 deposed that first complainant  എൻറെ  അച്ഛനാണ്. അച്ഛൻ അഡ്വക്കേറ്റ് ആണ് . 36 വർഷമായി ഞാനും അഡ്വക്കേറ്റ് ആണ്.  He has further deposed that family coverage ഉള്ള Policy യിൽ ഏതെങ്കിലും ഒരാൾ പ്രത്യക family ആയി കഴിഞ്ഞാൽ family പോളിസിയിൽ  നിന്നും  നീക്കപെടും എന്നും പുതിയ policy എടുക്കണമെന്നും അറിയാമോ ? അറിയാം. പക്ഷേ നിർബന്ധം ഇല്ല  എന്നാണ് അറിഞ്ഞത് Hence from the deposition it is clear that the second complainant has the knowledge that he has to take separate policy after the marriage. The opposite parties had not given intimation to the complainant to exclude the second complainant from family policy. The complainants have not produced any evidence to prove that premium for the second complainant was paid. In Ext.P2 the policy from 18.03.2011 to 17.03.2012 premium paid was for an amount of Rs.8793/- for four members. In Ext.P1 the policy from 18.03.2012 to 17.03.2013 the premium paid was Rs.7267/- four three members. As per Ex.D2 in Cl. No.1 who can take this policy: “All the persons proposed for this insurance should be between the age of 18 years and 65 years. Children between the age of 3 months and 18 years are covered provided one or both parents are covered concurrently. Children between 18 years to 25 years can be covered provided they are financially, dependent on the parents and one or both parents are covered simultaneously”. In this case the second complainant has not produced and evidence to prove that he is financially dependent on the parents.

                    In view of the above discussions we find that complainant miserably failed to prove his case.

                    In the result, complaint dismissed. No order as to costs.

                   A copy of this order as per the statutory requirements be forwarded to the parties free of charge and thereafter the file be consigned to the record room.

  Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the Open Commission, this the 30^th day of June 2022.

 

                                                                                         

                                                                                         Sd/-

                   P.V.JAYARAJAN     : PRESIDENT

                                                                                           Sd/-

         PREETHA.G.NAIR : MEMBER

                                                                                              Sd/-

VIJU.V.R                 : MEMBER

 

 

 

                                                                                               

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Be/

 

 

INDEX

CC.NO.100/2013

List of witness for the complainant

PW1                      - Sarjaine Thomas

 

Exhibits for the complainant

Ext.P1                   - Copy of medi claim policy schedule from 18.03.2012

   to 17.03.2013

 

Ext.P2                   - Copy of medi claim policy schedule from 18.03.2011 to    

                              17.03.2012

 

List of witness for the opposite party

DW1                     - Sankara Narayan

Exhibits for the opposite party

 

Ext.D1                  - Copy of Medi Claim Policy 2007

 

Ext.D2                  - Copy of New India Medi claim Policy

 

Court Exhibits      - NIL

 

 

                                                                                              Sd/-

                                                                                       PRESIDENT