BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

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Vikas Mohan, C/o LIC of India, SCO No.7, Sector 7, Madhya Marg, Chandigarh.

….…Complainant

                                      V E R S U S

LIC of India, Divisional Office, Chandigarh, Jeevan Parkash Building, Sector 17, Chandigarh.

                                                ..…Opposite Party

CORAM:     SH.JAGROOP SINGH MAHAL            PRESIDENT

                   SH. RAJINDER SINGH GILL                 MEMBER

Argued by:  Complainant in person.

Sh.Rakesh Verma, Adv. for OP.

PER SHRI RAJINDER SINGH GILL, MEMBER

                   Briefly stated, the complainant and his parents were covered under the Medical Re-imbursement and Hospitalization Scheme provided by OP Corporation to the complainant being its employee from 22.1.2009 and the premium thereof was automatically deducting from his salary.  On 21.5.2009, the father of the complainant was treated for angiography and angioplasty at PGI, Chandigarh on which the complainant had to spent a sum of Rs.1,42,000/- inclusive of medicines.  Since, his father as a dependent was covered under said scheme, so he applied to OP for reimbursement of said mediclaim.   It is averred that the OP Corporation in the meantime suddenly stopped deducting the premiums for the said policy from salary account of complainant after March, 2009.  The matter was taken up with OP, who vide letter dated 7.8.2009 clarified that the dependent parents of the employee with earned income not exceeding Rs.2550/- per month were allowed inclusion into the scheme as on 1.5.2006 if opted for coverage before 30.4.2006 and if option is not exercised, they cannot join the scheme at a later date.  In response to this, the complainant explained to the OP Corporation that his father was getting pension of Rs.1255/- per month and since he retired on 31.12.2007, so his parents were not dependent on him before 30.4.2006.  However, inspite of all this, nothing concrete was done by the OP Corporation to reimburse the medical claim sought by the complainant.  Hence, this complaint alleging the above act of OP as gross deficiency in service due to which the complainant had to suffer a lot.

2]                    OP filed reply stating therein that complainant had not submitted any medical claim bills for his father to branch office and moreover, the father of the complainant was not covered under the group mediclaim scheme, which came into effect from 1.1.1998.  However, it is admitted that there is a group mediclaim scheme for LIC Employees covered with New India Assurance Company Limited.  It is submitted that as per the provisions of said scheme, the dependant parents of the employees with earned income not exceeding Rs.2550/- per month were allowed inclusion into the scheme as on 1.5.2006 if opted for coverage before 30.4.2006 (Ann.R-3), if option is not exercised then they cannot join the scheme at a later  date, which was duly informed to the complainant vide Ann.R-3.  It is also submitted that at the time of scrutiny, it was found that the complainant’s parents were not covered under the said scheme, so the medicalim premium was refunded to him on 25.3.2009 vide An.R-6, well before the commencement of risk which was to commence only from 1.4.2009.  Pleading no deficiency in service and denying rest of the allegation, it is prayed that the complaint be dismissed.

3]                Parties led evidence in support of their contentions.

4]                We have heard the complainant and ld.Counsel for the OP and have also perused the record. 

5]                The perusal of the record reveals that as per the provisions of scheme in question, the dependant parents of the employees with earned income not exceeding Rs.2550/- per month were allowed inclusion into the scheme as on 1.5.2006 if opted for coverage before 30.4.2006 and if the option is not exercised then they cannot join the scheme at a later date.  Admittedly, the complainant sought coverage of his parents under the said scheme in Jan. 2009.  He has not given any such option before 30.4.2006 as required under the provisions of the scheme.   The plea of the complainant is that since his father was in service and retired only on 31.12.2007, so he could not join/covered them under the said scheme before that date i.e. 31.12.2007.  We are of view that this plea is of no help to the complainant because the inclusion into the said scheme was available only upto 1.5.2006 if opted for coverage before 30.4.2006 and not beyond that date, whatever was the reason and moreover, he could have joined them after the renewal of the said scheme on 1.4.2009 but he did not. 

6]                 It is not disputed that the risk under the said scheme was to commence only from 1.4.2009 whereas the refund of the premium was given to the complainant on 25.3.2009 (Ann.R-6) i.e. well before the commencement of the risk and by doing so the OP made the position clear to the complainant.  Therefore, in our opinion the said act of OP was legal and justified.  According to the complainant, he applied for the above said scheme on 22.01.2009, to get medical cover for his parents who were fully dependent on him and his office had accepted the request and deducted the premium from his salary from the month of March, 2009.  It may be mentioned that the scheme had already came to an end on 30.04.2006 and no application was invited by the OP to cover fresh cases under the said scheme. Even if the complainant applied on 22.01.2009 or his employer deducted the premium, that would not make any binding contract between the parties because the same would be contrary to the scheme floated by the OP in view of which no fresh members could be inducted after 30.04.2006.  The deposit of premium contrary to the provisions of the scheme would not create a binding contract between the parties.  The mere fact that earlier his father was in service or he was enjoying good health would not be a sufficient ground to bypass the provisions of the scheme or to create a new contract which was never intended to be created by the OP.  In any case it was a unilateral decision of the complainant and his employer who deducted the premium which would not bind the OP. Otherwise also the risk under the said scheme for the next year was to commence on 01.04.2009, however when the OP came to know of the deduction of the premium through which the policy was sought to be enforced for the benefit of the father of the complainant, they refunded the amount to the complainant on 25.03.2009, well before the commencement of the scheme and therefore no subsisting contract came into existence.

7]                In view of above discussion, we are of the opinion that the complaint is meritless.  The same is accordingly dismissed.

                Certified copies of this order be sent to the parties free of charge.  The file be consigned.