BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM,
ERNAKULAM.
Date of filing : 14/02/2011
Date of Order : 31/05/2012
Present :-
Shri. A. Rajesh, President.
Shri. Paul Gomez, Member.
Smt. C.K. Lekhamma, Member.
C.C. No. 86/2011
Between
K.A. Jacob, | :: | Complainant |
Koduvathara House, Cheranellore. P.O., Ernakulam – 682 034. |
| (By Adv. Tom Joseph, Court Road, Muvattupuzha – 686 661) |
And
M/s. Reliance General Insurance Co. Ltd., | :: | Opposite Party |
X1/3599, 4th Floor, Elizabeth Alexander Memorial Building, Opp. Rainbow Arch Bridge, Marine Drive, Shanmugham Road, Kochi – 682 031. |
| (By Adv. Saji Isaac. K.J., 311, H.B. Flats, Panampilly Nagar, Cochin - 36) |
O R D E R
C.K. Lekhamma, Member.
1. The case of the complaint are as follows :
The complainant has been a Family Health Wise Policy holder of the opposite party for the last 3 years. While so, the complainant was asked to remit Rs. 8,644/- after allowing 15% NC towards the premium for renewal fell on 23-09-2010 as against the previous year premium amount Rs. 1,571/-. That is, 4 to 5 time than the previous year premium amount. The complainant had remitted the demanded premium under protest, since he will lose the no claim discount and the first thirty days exclusions, 1st year and 2nd year exclusions which he had earned during the last three years. The further enhancement of the premium is without any specific reasons amounts to unfair trade practice. The complainant is entitled for the refund of premium amount excessively collected from him than the previous year's premium amount along with interest and costs of the proceedings. Hence this complaint.
2. The version of the opposite party is as follows :
The opposite party contended that due to the inflation they are constrained to increase the premium keeping in view the interest of the consumer. Unless the opposite party increases the premium, to cope with the inflation, the opposite party will not be able to cater to the coverage issued to the customers as all the costs including medical costs have increased 4 to 5 times. In raising the premium rates for the Health Insurance products, the opposite party has taken various factors under consideration and has complied with all the provisions and guidelines of Insurance Regulatory Development Authority. The rates applicable to both existing and new customers are duly approved by the Insurance Regulatory Development Authority. The increase in premium chart was made after taking into consideration the health claims inflation rate, increase in incidences of illness and hospitalisation, increase in cost of Health Care, rate prevailing in the present Indian insurance market etc. There is no deficiency in service on the part of the opposite party. The complainant is not entitled to get any of the relief prayed for and is not entitled to any cost.
3. The complainant and the opposite party represented through counsel. The complainant adduced only documentary evidence. Exts. A1 and X1 were marked. Neither oral nor documentary evidence was adduced by the opposite party. Head the counsel for both sides.
4. The only point for determination is whether the complainant is entitled to get refund of the excess premium amount collected by the opposite party or not?
The case of the complainant is with regard to the enhancement of the premium and the subsequent collection additional amount by the opposite party without any specific reason. The opposite party contended that the premium was increased due to the inflation for that the opposite party has complied with all the provisions and guidelines of Insurance Regulatory Development Authority (IRDA). During the proceedings at the instance of the complainant, the opposite party has produced a copy of the letter dated 23-03-2010 issued by the IRDA along with a copy of the premium chart, which was marked as Ext. X1. The opposite party contended that as per the said sanction letter issued by the IRDA, the opposite party increased the premium. On a perusal of the said document in which it is mentioned that,
“Please be informed that the Authority has noted filing of revision of the product Reliance Health Wise Policy under F & U procedures and subject to the following, have no further comments to offer at the moment :
You may file the sales literature of the said product in accordance with IRDA (Insurance Advertisement and Disclosure) Regulations, 2000 & also file the final version of the product with all the revisions as agreed for our records.
The performance of the product shall be monitored periodically and the Board of the company shall be responsible for sustenance of the product at the rates offered by your company.
You may submit the performance of the product after Actuarial review on annual basis.”
Therefore, we cannot consider Ext. X1 as an approval from the IRDA. The premium chart in Ext. X1 was prepared by the opposite party and then hence. Not produced any approval from the IRDA as claimed by the opposite party. In the absence of any convincing evidence, we are of the considered view that the complainant is entitled to get refund of the excess premium amount collected by the opposite party from the complainant on 23-09-2010.
5. Accordingly, we partly allow the complaint and direct that the opposite party shall refund the excess amount collected from the complainant on 23-09-2010 towards the premium of the complainant's policy to him.
The order shall be complied with, within a period of one month from the date of receipt of a copy of this order, failing which the said amount shall carry interest @ 12% p.a. till realisation.
Pronounced in open Forum on this the 31st day of May 2012.
Forwarded/By order, Sd/- C.K. Lekhamma, Member. Sd/- A. Rajesh, President.
Sd/- Paul Gomez, Member.
Senior Superintendent.
A P P E N D I X
Complainant's Exhibits :-
Exhibit A1 | :: | Copy of the Policy Schedule |
“ X1 | :: | Copy of th approval from the IRDA dt. 23-03-2010 |
Opposite party's Exhibits :: Nil
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