Order-15.
Date-18/07/2017.
Shri Kamal De, President.
This is an application u/s.12 of the C.P. Act, 1986.
Complainant’s case in short, is that an agent of the OP Insurance Company rang the complainant and approached the complainant for taking insurance policies under the OP Insurance Company. The complainant being convinced by the words of the said agent of the OP took an insurance policy namely SARV-Suraksha Policy bearing Policy No.51044089. The complainant also took another policy namely Health-Suraksha Policy, Silver Plan vide policy No.5104088 in the year 2012. It is stated that the said health Insurance Policy involved a coverage of Rs.2 lakhs and premium amount was of Rs.9,006/-, policy type Family Floater. The premium amount for other policy was Rs.787/- covering an insurance amount of Rs.10 lakhs. It is stated by the complainant that complainant paid the amount as per instruction of OP Company through online facility. The company also provided a Toll Free No.18002700700. It is stated that the complainant was unable to pay the premium amount for the year 2015 to 2016 due to non-working of online facilities and the complainant immediately contacted with the OP’s office through Toll Free No.18002700700 but the said Toll Free No. was found all time busy. The complainant, however, was able to make contact on another date on making several attempts and the complainant was informed that the collecting agent will go to the house of the complainant to collect the premium but nobody came to the complainant’s house for collection of premium amount. The complainant, thereafter, again contacted with OP over Toll Free Number and a staff of the OP over phone directed the complainant to pay the premium amount to their owner’s office at Kolkata. But the OP’s staff failed to render proper address of the said office. The complainant, thereafter, on making query with an agent went to the office of OP1 and requested OP staff to accept the premium amount but he said office refused to accept the same due to delay. The complainant also told the OP that she is ready to pay the charge of delay payment but the OPs refused to accept such premium. The complainants submits that there is no fault on the part of the complainant and she is always ready to pay her premium amount but due to deficiency in service on the part of OPs on online facilities the complainant could not pay premium amount in time. It is alleged that the denial of acceptance of the premium amount is illegal. The complainant has prayed for direction upon the OPs to accept the premium amount and to continue the policies or to refund the premium amount paid till date with interest along with other reliefs as per prayer in the petition of complaint.
OPs have contested the case in filing written version contending, inter alia, that the complainant has no cause of action against the OPs and the case is filed suppressing material fact. It is stated that the validity period of last policy of insurance was till 12-01-2015, date on which renewed policy would have started if the renewal had been made but the present complaint petition has been filed after two years from the aforesaid date and the present complaint is barred as such by limitation. It is further stated that the complainant was also provided with two policies of insurance under the name and style of Health Suraksha Policy and SARV Suraksha Advantage Policy. Both the policies were taken through HDFC Bank Ltd. who acted as agent in those policies. The complainant has alleged refusal or liability to renew the policies through the online mode that no proof in respect of such refusal has been filed from the side of the complainant. The complainant has stated that on being instructed by HDFC Bank Ltd. she tried to renew the policies through online mode but neither the bank has been made a party in this case nor any documentary proof has submitted by the complainant. It is alleged that the complainant never approached the OPs for renewal of aforesaid policies as well as never tried to renew the said policy through online mode. It is alleged that the complainant failed to renew her policies to enjoy the continuous benefit and since there was a break in period which was beyond the allowed time limit the complainant is trying to make out a case just to enjoy the facility of a continuous policy. It is also stated that the local address of the OPs was well-known to the complainant and yet the complainant never approached the Kolkata Regional Office of the OPs for manual renewal of the same. It is stated that the complainant has made out a story of approaching their corporate office at Mumbai and in fact, no such request for continuous renewal of those policies was ever lodged by the complainant with the OPs. It is stated that there is no deficiency in service on the part of the OPs. It is stated that the case is frivolous suppressive of material fact and is liable to be dismissed with cost.
Point for Decision
- Whether the OPs are deficient in rendering service to the complainant?
- Whether the complainant is entitled to get the relief as prayed for?
Decision with Reasons
We have perused the documents on record, Xerox copy of renewal notice of Health Insurance Policy Reference No.HN26122011001169, Xerox copy of welcome letter dated 24-01-2014 of the OP addressed to the complainant, Xerox copy of Health Suraksha Policy, Silver Plan, Xerox copy of SARV-Suraksha Policy, Silver Plan, Xerox copy of SARV-Suraksha Policy, SARV Suraksha Advantage, Xerox copy of letter dated 24-01-2014 for the purpose of Section 18D of Income Tax, Xerox copy of Health Card and other documents on record.
The point for dispute as we find is with regard to the insurance policy under the name and style SARV-Suraksha Policy, SARV-Suraksha Advantage valid from 13-01-2014, 00.01 hours to 12-01-2015 midnight and also Health Suraksha Policy. The dispute arises regarding both the policies which were supposed to be renewed before 12-01-2015, the date on which the renewed policy would have started if the renewal has been made. We find that the present complaint petition has been filed after two years from the aforesaid date and that too no prayer for condonation of delay along with petition of complaint. We find that the OP provided two insurance policies under the name and style of Health Suraksa Policy and also SARV Suraksha Advantage Policy. We find that both the policies were taken through HDFC Bank Ltd. who acted as agent in those policies which is evident from the policies of insurance itself. But HDFC Bank is not made a party in this case. Moreover we find that the name of the agent has not also been disclosed by the complainant in the petition of complaint for the reason best known to the complainant.
We find that the complainant has not made out any case of any kind of discrepancy in the terms and condition of the policy. We also find that there is provision of auto debit of the premium amount from the bank account of the insured which has not also happened in this case. The number furnished by the complainant being 18002700700 is a Toll Free Number, in case of any discrepancy in respect of details of the policy scheduled and terms of the policy. It is not a number for online deposit for premium amount. We also think that the complainant ought to have contacted with HDFC Bank being agent for deposit of premium but the complainant has not also done so. The only allegation of the complainant is failure and or refusal to renew the policy through online mode but no proof in support of such refusal and/or failure has been substantiated by any documentary evidence. The complainant has not even filed the print out of concerned web page towards proof of non-allowance of online renewal of concerned date by the website of OPs. We think that the burden of proof lies upon the complainant to prove her case. But complainant would not be able to establish her case.
From the condition of the policy it appears that if the premium is not realized the policy shall be void from inception. Moreover, from the terms and conditions of the policies it also appears that all premiums for renewal of the policy must be received by the insurance company before the end of the policy period. A grace period of 30 days for renewing the policy is available under the policies. Any disease/condition contracted during the grace period will not be covered and will be treated as pre-existing condition. We do not believe that the complainant could not be able to pay the premium amount within a tenure of two years for the deficiency of service on the part of OP. Moreover, she turned up before this Forum after the lapse of limitation period of two years as stipulated in C.P. Act and that too without any petition of prayer for condonation of delay. The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risk covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitation or terms of the policy expressly set out therein. (AIR 1999 Supreme Court 3252 relied upon.)
We find that the complainant did not even approach the Regional Office of the OPs for manual renewal of the same. It is also apparent that the legal address of the OPs is well available in the website of the company. We are afraid we cannot pass any order for continuation of the policies. We also find that the refund of the premium amount is not possible because the complainant enjoyed the privilege of the policy, if any, during period covered under the policies. Considering the facts and circumstances and having regard to the Evidences and materials on record, we find no merit in the petition filed by the complainant.
Consequently, the case merits no success.
Hence,
Ordered
That the instant case be and the same is dismissed on contest against the OPs.
No order as to cost.
