By Smt. Beena. M,Member:-
This is a complaint filed under section 35 of the Consumer Protection Act 2019.
2. Facts of the case in brief: The Complainant is a diary-farmer and had been making a living from dairying for many years. The Complainant is a member of the Opposite Party society and used to sell milk to the society for the last 10 years. The 2nd Opposite Party had been collecting money as medi claim premium from the Complainant for the last 5 years. From time to time, medical claim policies were taken from the 3rd Opposite Party and renewed. Thus, on 24-06-2019, the 2nd Opposite Party received Rs.5,000/- from the Complainant for policy renewal. The above amount was paid by the Complainant in order to maintain the Mediclaim cover by paying the amount before the expiry of the previous year’s Mediclaim holiday and to keep the policy alive. The 2nd Opposite Party, who had received the amount from the Complainant paid it to the 3rd Opposite Party for renewal of the policy and had informed the Complainant that necessary steps had been taken for renewal. In the meantime, the Complainant was affected by Renal Stone disease and was admitted to the hospital on 05.07.2019 and underwent treatment till 12.07.2019 and incurred medical expenses of Rs.1,48,630/-. The Complainant through the 2nd Opposite Party has filed a claim application along with the bills, reports and supporting documents to the 3rd Opposite Party. But the claim was rejected by the 3rd Opposite Party. The claim for reimbursement under medi claim coverage was rejected on the ground that the hospitalization and treatment was occurred beyond the period covered under the policy. When the Complainant sought details of this, it was learned that before the expiry of the policy term, the 2nd Opposite Party had issued a post dated cheque to renew the policy, but it was dishonoured and later, the 2nd Opposite Party issued a demand draft to the 3rd Opposite Party to renew the policy and in the meantime the Complainant fell ill and the treatment expenses were paid by him. The 2nd Opposite Party received the premium from the Complainant for renewal of the policy even before the expiry of the policy. Therefore, the responsibility and liability to take steps to renew the policy in time lies with the 1st and 2nd Opposite Party. Due to non-receipt of reimbursement amount on time, the Complainant has suffered huge financial losses and mental agony. The act of the 3rd Opposite Party which attempted to avoid liability is unfair trade practice regardless of the fact that, to the best of the Complainant’s knowledge, there is a grace period of one month from the expiry of the existing policy. Hence, this complaint.
3. On admission of the complaint, the copy of the complaint was served to the Opposite Parties. The Opposite Parties appeared and filed version. The 1st and 2nd Opposite Party filed version jointly.
4. The contention of the 1st and 2nd Opposite Parties, in brief, are as follows:
The Opposite Parties admitted the statement that the Complainant is a member of the 1st Opposite Party society and has been supplying milk for some time now, the milk of the cows was supplied by the Complainant to this Opposite Party institution and the Mediclaim has been taken from the 3rd Opposite Party and is being renewed. But they denied the statement that the Complainant paid money in advance. The Opposite Parties also admitted that they had issued a cheque for renewal of the policy before the expiry of the policy but when it was dishonoured, the 1st Opposite Party renewed the policy by issuing a demand draft. The cheque was issued by the 1st Opposite Party towards payment of a large amount as premium for the above policy which is a group insurance policy. But due to a sudden situation, the funds required to encash the cheque were not available in the bank account of the Opposite Party. At that time was the 3rd Opposite Party had sent the cheque for collection. The 3rd Opposite Party, who is highly responsible and liable for the renewal of the policy, has deliberately not informed the 1st and 2nd Opposite Parties about the return of the cheque. Since last year 2016 Malabar Region Cooperative milk producers’ cooperative sangam Union LTD. had implemented an insurance scheme in relation to the insurance company and the members of the cooperative society had been included in the scheme and thus the Opposite Party used to renew the policy since 2016. The illness suffered by the Complainant is entitled to medical expenses under the policy. Therefore, 3rd Opposite Party is liable to pay the policy amount. There is a grace period of one month to get the policy benefit retroactively and the a 3rd Opposite Party has not considered it. The 1st and 2nd Opposite Party on 20.06.2019, Wayanad District co-operative Bank’s cheque of Rs.2,04,800/- was given to the 3rd Opposite Party for policy renewal. But the said cheque was given for collection by the 3rd Opposite Party only after it was kept in hand for two weeks. There is no deficiency in service on the part of 1st and 2nd Opposite Party.
5. Version filed by the 3rd Opposite Party Oriental Insurance Company in the above matter.
As per the complaint the Complainant was under treatment in Shiba hospital Calicut from 05.07.2019 to 12.07.2019. Whereas 3rd Opposite Party had issued a policy in the name of 2nd Opposite Party which is valid from 31.07.2019 to 30.07.2020. Therefore, at the time of the alleged treatment the Complainant has no coverage of policy and the 3rd Opposite Party is not liable to pay any amount to the Complainant. The Complainant himself found that at the time of the alleged treatment there was no policy coverage, since 2nd the Opposite Party has not properly renewed the policy due to some reason which is not under the control of 3rd Opposite Party. According to them, they is are unnecessary party to this proceedings and is put to hardship and loss. The service provided by 3rd Opposite Party is perfect and there are no latches or negligence on the part of them at any point of time. The allegation in the complaint that one month grace period is available in this policy after the policy period for treatment benefit etc are unknown to law and the same is not legally sustainable at all. Even if the Complainant is entitled to get any amount as treatment expenses and compensation the same should be paid by 2nd Opposite Party and 3rd Opposite Party is no way liable to pay any amount towards treatment or compensation. In fact they are entitled to get compensation from the Complainant for unnecessarily impleading 3rd Opposite Party to these proceedings. Therefore, the 3rd Opposite Party prayed to dismiss the complaint against them with compensatory costs.
6. Then the case was posted for evidence. The Complainant filed proof affidavit and examined as PW1, the documents produced were marked as Ext.A1 and A2. On the side of the 1st and 2nd Opposite Party, filed proof affidavit and the Secretary was examined as OPW1 and the document produced were marked as Ext.B1 to B6, witnesses were examined as OPW2 to OPW4.
7. The points for consideration are the following.
- Is there any deficiency in service or unfair trade practice or unfair trade practice on the part of Opposite Parties?
- If so, what cost and relief?
8. On perusal of proof affidavit & documents produced by both parties this Commission convinced that the 3rd Opposite Party has failed to exercise reasonable care. Ext.A1 shows that the 2nd Opposite Party deducted Rs.5,000/- as medi claim premium on 24.06.2019 from the price of milk. Ext.A2 is the rejection letter issued by the 3rd Opposite Party which shows that the claim of the Complainant was rejected on the ground that there was no valid insurance policy as on 05.07.2019 due to dishonor of the cheque submitted on 03.07.2019 whereas, the patient was admitted to the hospital on 05.07.2019. Further commencement of the policy was from 31.07.2019. Here the 1st and 2nd Opposite Party stated in their version that they had given the cheque to the 3rd Opposite Party before the renewal of the policy, i.e., on 20.06.2019. They produced postal receipt and voucher which was marked as Ext.B2, a perusal of receipt voucher No.395 dated 20.06.2019 shows that Rs.35/- received as postal charge. Ext.B3 series is the letter issued by the 2nd Opposite Party to the 3rd Opposite Party, it is clearly mentioned that the cheque dated 20.06.2019 enclosed with the letter for renewal of policy of the members of the 1st Opposite Party. So it is clear from these documents that the 1st and 2nd Opposite Parties had sent the cheque on 20.06.2019. At the time of chief examination of OPW4, he deposed that “tIcf¯n\I¯v Hcp registered article within District BsW¦n date of posting + one day and in other districts date of posting + 2 days BWv normal delivery norm”. Meaning thereby in the normal course any article sent by the registered post out of district is expected to be delivered within 3 days. According to the above deposition, the 3rd Opposite Party must have received the cheque on 23.06.2019. But in Ext.A2 the 3rd Opposite Party stated that the cheque was received by them on 03.07.2019. Here no documents have been produced by the 3rd Opposite Party to prove this statement. So it is clear that after receiving the cheque on 23.06.2019 the 3rd Opposite Party kept the cheque under custody without presenting it before the bank. As per Ext.A2, there was sufficient balance in the account from 24.06.2019 to 02.07.2019. The delay for renewal of the policy is caused only due to the delay of 3rd Opposite Party in presenting the cheque. The negligent act of 3rd Opposite Party only has caused delay of renewal of policy. Therefore, they are liable to pay the claim amount with compensation and cost. There is no deficiency in service seen on the part of 1st and 2nd Opposite Party.
In view of the above discussion, we partly allow the complaint and 3rd Opposite Party is directed to pay Rs.1,48,630/- (Rupees One Lakh Forty Eight Thousand and Six Thirty Only) along with interest @ 8% per annum from the date of filing the complaint till realization and to pay compensation to the tune of Rs.10,000/- (Rupees Ten Thousand Only) and also Rs.5,000/-(Rupees Five Thousand Only) as cost to the Complainant. The 3rd Opposite Party is directed to comply the Order within 30 days from the date of receipt of this Order.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 28th day of June 2024.
Date of Filing:-18.11.2020.
PRESIDENT : Sd/-
MEMBER : Sd/-
APPENDIX.
Witness for the Complainant:-
PW1. Saidu Muhammed. K. M. Agriculture.
Witness for the Opposite Parties:-
OPW1. Saji. P. J. Secretary, Kabanigiri KSS.
OPW2. Manoj. P. Courier Service(professional
Couriers).
OPW3. Aswathi. T. P. Branch Post Master.
OPW4. Ragish Ravi. Assistant Superintendent of
Posts, Kalpetta.
Exhibits for the Complainant:
A1. Milk Bill. Dt:24.06.2029.
A2. Copy of Notice. Dt:19.03.2020.
Exhibits for the Opposite Parties:-
B1. Copy of Bank Pass Book front page.
B2. Cash Voucher. Dt:20.06.2019.
B3(Series). Copy of Letter and list (6 Pages).
B4. Copy of Day Book. Dt:20.06.2019.
B5. Courier Receipt. Dt:15.07.2019.
B6. Copy of Day Book. Dt:15.07.2019.
PRESIDENT :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
ASSISTANT REGISTRAR
CDRC, WAYANAD.
Kv/-
