Delhi

North East

RBT/CC/157/2022

CHARANPREET SINGH - Complainant(s)

Versus

MR.JASMEET JASSI - Opp.Party(s)

03 Aug 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

RBT/Complaint Case No.157/22

 

 

In the matter of:

 

	Shri Charnpreet Singh S/o Tejinder Pal Singh R/o 386, Indra Vihar, Near BBM Depot No. 2 Delhi 110009	Complainant
	Versus
1.           2.               3.	Mr. Jasmeet Jassi, (Agent of Star Health & Allied Insurance Co. Ltd.) B-4A, Vijay Nagar, Delhi 110009   Through its Manager Star Health And Allied Insurance Company Ltd., C-8, Third Floor, New Krishna Park, Near Janakpuri west Metro Station New Delhi 110018   Through its Manager Cigna TTK 32-B, 3rd Floor, Rajindra Nagar, Pusa Road, Near Karol Bagh Metro Station New Delhi 110005	Opposite Parties

 

DATE OF INSTITUTION:         JUDGMENT RESERVED ON:                         DATE OF ORDER  :

17.01.2018 28.04.2023 03.08.2023

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

ORDER

Surinder Kumar Sharma, President

The Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that Complainant had purchased a mediclaim policy from Opposite Party No. 2 on 26.10.2013. The policy was valid till 25.10.2017. Thereafter, Opposite Party No. 2 demanded Rs. 11,677.00/- for mediclaim insurance for the year 2017-18. Complainant stated that previous premium was Rs. 8,665.00/-.  Thereafter, the Complainant argued with Opposite Party No. 2 for hike of premium but official of Opposite Party No. 2 denied for any help. Thereafter, Complainant search on internet for best premium of policy and then approached the Opposite Party No. 3 for portability of mediclaim policy. Complainant paid Rs. 8,762.00/- to the Opposite Party No. 3 for the mediclaim policy for a sum insured of Rs. 5,50,000.00/-. After that on 09.11.2017 Complainant received an email regarding previous claim settlement history of 2015-16. Thereafter, on 12.11.2017 Complainant sent an email to Opposite Party that “I am not carry any paper regarding it. What will I do?” After that Complainant was shocked when the official of Opposite Party No. 3 rejected the mediclaim policy and said that “We regret to inform you that we are unable to process your proposal for insurance in view of your non fulfilment of the requirement raised by us.” After that Complainant sent emails to Opposite Party No. 2 and Opposite Party No. 3 on 16.11.2017 requesting to provide medical history of his wife but they avoided the matter. Then on 20.11.2017, Complainant received a mediclaim history from Connaught Place branch office. Thereafter, Complainant sent all PDF file of medical history to Opposite Party No. 3 through email on 20.11.2017. Thereafter, Complainant again sent an email on 22.11.2017 regarding the status of mediclaim policy but there was no proper response from Opposite Party No. 3. After that Complainant received a letter from Opposite Party No. 3 on 23.11.2017 for full and final settlement and also agreed to reversed Rs. 50,000/- in Complainant card within 7-10 days. After that Complainant approached IRDA and the official of IRDA suggested to Complainant to first take a mediclaim policy from Opposite Party No. 2 for continuity of policy. Complainant stated that Opposite Parties have failed to provide proper service and claim amount for which they were duty bound and did not given the policy to the Complainant for himself and his family. Complainant has prayed to cancel the registration of Opposite Party No. 3 for not providing the proper service and for compensation of Rs. 5,00,000/- on account of mental harassment and litigation expenses.
2. None has appeared on behalf of the Opposite Party No. 1 and Opposite Party No. 3 to contest the case despite service of notice. Therefore, Opposite Party No. 1 and Opposite Party No. 3 were proceeded against ex-parte vide order dated 20.07.2018 and 06.04.2018 respectively.

Case of the Opposite Party No. 2

3. Opposite Party No. 2 contested the case and filed its written statement. It is stated that there is no cause of action against Opposite Party No. 2 to file the complaint. It is stated there is no deficiency in service on the part of Opposite Party No. 2. The Opposite Party No. 2 has denied the allegations of the Complainant. It is admitted that the Complainant has purchased insurance policies form it from 31.10.2013 to 23.11.2018. it is stated that the premium of the policy was enhanced as the Complainant has chosen the wider scope of the family health with Optima cover, across board, with additional features etc. It is stated that enhanced features/scope of cover were in terms of:

• Health Checkup
• Recharge available in absolute amounts for all sum insured options of Rs. 3 lakhs and above.
• All Day Care Procedures covered
• Bonus allowed for first claim free renewal is 25 % and for all subsequent claim free renewals is additional 10 %. Maximum bonus allowed is 100%.
• Room Rent benefits
• Sum insured options of Rs. 20 lakhs and 25 lakhs are now available
• The following covers are now offered under the proposed revision

1. Emergency Domestic Medical Evacuation
2. Compassionate Travel
3. Repatriation of Mortal remains
4. Treatment in Preferred Network Hospital
5. Shared accommodation
6. AYUSH Treatments
7. Second Medical Opinion
8. Assisted Reproduction Treatment
9. Additional Sum Insured for Road Traffic Accident (RTA)

4. Hence, there is a hike in the premium. It has prayed for the dismissal of the complaint.

Rejoinder to the written statement of Opposite Party No. 2

5. The Complainant filed rejoinder to the written statement of Opposite Party No. 2 wherein the Complainant has denied the pleas raised by the Opposite Party No. 2 and has reiterated the assertions made in the complaint.

Evidence of the Complainant

6. The Complainant in support of his case filed his affidavit wherein he has supported the assertions made in the complaint.

 

Evidence of the Opposite Party No. 2

7. To support its case Opposite Party No. 2 has filed affidavit of Shri Rajiv Jain, Chief Manager of Opposite Party No. 2, wherein, he has supported the case of the Opposite Party No. 2 as mentioned in the written statement.

Arguments & Conclusion

8. We have heard the Complainant and Ld. Counsel for Opposite Party No. 2.  We have also perused the file and written arguments filed by the Complainant and Opposite Party No. 2.
9. The case of the Complainant is that he was purchasing a mediclaim policy from Opposite Party No. 2 from 31.10.2013 to 30.10.2017. His case is that then for further renewal of policy after 30.10.2017 the Opposite Party No. 2 demanded enhanced rate of premium. Then the Complainant search for other insurance policy and approached Opposite Party No. 3 for fresh policy and he also paid premium of Rs. 8,762/- to Opposite Party No. 3 through a cheque. The Opposite Party No. 3 demanded some information/documents and the same were sent by the Complainant through PDF on email. The case of Opposite Party No. 2 is that for further renewal of policy after 30.10.2017 the Complainant has opted for more facilities in respect of the mediclaim policy and for this reason enhanced premium was demanded. The Complainant has not rebutted this fact by leading any evidence. The Opposite Party No. 3 did not contest the case. From the material on record it is prove that the Complainant has paid premium of  Rs. 8,762/- to the Opposite Party No. 3 and also supplied the information/documents demanded by Opposite Party No. 3. Despite that the Opposite Party No. 3 did not give any mediclaim policy to the Complainant. There is no deficiency in service on the part of Opposite Party No. 2 as per available material on record.
10. In view of the above discussion, complaint is allowed against Opposite Party  No. 3. The Opposite Party No. 3 shall pay an amount of Rs. 8,762/- to the Complainant along with interest @ 6 % p.a. from the date of filing the complaint till recovery. Opposite Party No. 3 shall also pay an amount of Rs. 25,000/- on account of mental harassment and litigation expense along with interest  @ 6 % p.a. from the date of this order till recovery.
11. Order announced on 03.08.2023.

Copy of this order be given to the parties free of cost

File be consigned to Record Room.

(Anil Kumar Bamba)		(Surinder Kumar Sharma)
(Member)		(President)