<br /> IN THE DISTRICT CONSUMERS’ DISPUTES REDRESSAL FORUM AT MYSORE<br /> <br /> PRESENT: 1. Shri.A.T.Munnoli<br /> B.A., L.L.B (Spl.) - President <br /> <br /> 2. Smt.Y.V.Uma Shenoi<br /> M.Sc., B.Ed., - Member<br /> 3. Shri. Shivakumar.J.<br /> B.A., L.L.B., - Member<br /> <br /> CC 182/09 DATED 13.08.2009<br /> ORDER<br /> <br /> Complainant Vimal Chand Jain, <br /> S/o Late Aviraj Jain, No.905/171, S.J.Hostel Road, Vidyaranyapuram, Mysore-08.<br /> (By Sri.Sridhar Chakke, Advocate)<br /> Vs. <br /> Opposite Parties 1. P.Suresh Babu, Divisional Manager, M/s The New India Assurance Company Ltd., No.2951, 2nd Floor, JLB Road, Chamundipuram, Mysore-04.<br /> 2. The Regional Manager,<br /> M/s The New India Assurance Company Ltd., No.2-B, Unity Building Annex, Mission Road, Bangalore-27.<br /> (By Sri.Jaganath Suresh Kumar, Advocate for O.P.1)<br /> <br /> Nature of complaint : Deficiency in service<br /> Date of filing of complaint : 21.05.2009<br /> Date of appearance of O.P. : 16.06.2009<br /> Date of order : 13.08.2009<br /> Duration of Proceeding : 1 MONTH 28 DAYS<br /> <br /> <br /> PRESIDENT <br /> <br /> <br /> <br /> MEMBER<br /> <br /> <br /> MEMBER<br /> <br /> Sri. A.T.Munnoli,<br /> President<br /> <br /> 1. Under Section 12 of the Consumer Protection Act, the complainant has filed the complaint seeking a direction to the first opposite party to renew the Medi claim policy by receiving the policy premium amount of Rs.3,000/- and further direct the opposite party to pay damages of Rs.50,000/- and a sum of Rs.50,000/- towards Consumer Welfare Fund for Unfair Trade Practice and to grant litigation expenses of Rs.5,000/-.<br /> <br /> 2. It is alleged in the complaint that, complainant is a Senior Citizen. He is policy holder of Medi claim with the opposite party for long period. The last policy of the complainant with the opposite party is valid from 25.09.2007 to 24.09.2008. On earlier occasions, whenever the complainant underwent medical treatments, the opposite party honoured the policies of the complainant without raising any dispute, queries or repudiation of the claims made.<br /> <br /> 3. On 23.01.2008, during the validity of the policy, complainant had made claim and that was not honoured by the opposite party on untenable excuses. On 20.03.2008, complainant made written communication, bringing that fact to the notice of the opposite parties and it was rejected arbitrarily. The complainant registered a complaint against the opposite parties before Insurance Regulatory and Development Authority at Hyderabad. A sum of Rs.15,284/- was claimed by the complainant. Subsequently, the opposite parties settled the said amount.<br /> <br /> 4. Before completion of the period, the complainant communicated the opposite parties for renewal of the policy along with Demand Draft for a sum of Rs.3,000/- on 13.09.2008. The opposite parties failed to renew the policy. They sent communications on 11.09.2008 and 16.09.2008 refusing to renew the policy. The opposite parties compelled the complainant to obtain policy for himself, as well as for his family members. It was highly an Unfair Trade Practice on the part of the opposite parties.<br /> <br /> 5. Contrary to the earlier communication, on 31.10.2008, the opposite parties communicated the complainant that they never refused for the renewal of the policy and it is self explanatory and high handedness on the part of the opposite parties.<br /> <br /> 6. After repeated communications by the complainant for renewal of the policy, the opposite parties demanded from the complainant Rs.7,236/- along with proposal form. In the earlier communications, the opposite parties stated that they were unable to renew the policy in individual, but all the family members of the complainant have to take Medi claim policy. This attitude, demand and compulsion of the opposite parties is an absolute Unfair Trade Practice. Failure on the part of the opposite parties to renew the policy as it existed, is the negligence on their part in rendering service to the complainant. Further, it is alleged that the complainant has subjected to great mental agony due to the act of the opposite parties. Hence, it is prayed to award the damages and also to direct the first opposite party to renew the policy.<br /> <br /> 7. In pursuance of the notice, the first opposite party appeared through counsel and filed version. Wherein, it is admitted that the complainant is the Medi claim policy holder as claimed. However, it is contended that the liability of the opposite party is strictly in terms, conditions, exclusions and endorsements contained in the policy. It is renewal policy and the complainant was getting it renewed. He had made mediclaim through policies and that has been paid. It is further contended that M/s Medi Assist India Pvt. Ltd., is a third party administrator, who is independent, constituted and empowered to deal with all Health Insurance Services under Insurance Regulatory and Development Authority. Any person taking a mediclaim policy from the opposite party, for renewal have to send all the documents to the third administrator. They scrutinize and decide the claim. It is known to the complainant. In fact, the opposite party persuaded the third party and got the claim of the complainant settled. Unnecessary, the complainant had made representation to IRDA and also to the Grievance Cell against the opposite party.<br /> <br /> 8. It is stated that complainant has suppressed the facts and correspondence between the parties. The opposite party has explained to the complainant as to why enhanced premium for renewal was claimed. The letters written by the opposite party has been mislead or misunderstood by the complainant. The opposite parties are in insurance business. They settled claims of the policy holders. They need money not only to settle the claims in future, but also to survive in business. The request to take policy for other family members cannot be construed or termed as Unfair Trade Practice. The opposite party never refused to renew the policy of the complainant. The opposite party had requested the complainant to pay premium of Rs.7,236/- for renewal. Without paying it, the complainant is trying to dictate the opposite party for renewal of the policy for the sum, he is willing to pay. It is unreasonable and opposed to law. As per clause 6 of the policy, the opposite parties have discretion to revise the premium rate. The renewal is not automatic. The opposite party can charge enhanced premium by loading on the previous claim experiences. The complainant is a diabetic for many years. He made claims for his treatment and that was settled. The opposite parties have set of guidelines to follow at the time of renewal. The enhanced premium cannot be termed as unreasonable and unjust or amounts to Unfair Trade Practice. The notice of the complainant has been replied. There is no deficiency in service, as alleged. There is no cause of action. All other allegations are denied. Therefore, it is prayed to dismiss the complaint.<br /> <br /> 9. The complainant has filed his affidavit, in which the facts alleged in the complaint are sworn to. For him certain documents with lists are produced. On the other hand, for the first opposite party, the Divisional Manager has sworn to the affidavit, in which the facts mentioned in the version are stated. For the opposite party, certain documents with list are produced. Further, for the opposite party written arguments are filed. Also, we have heard both the sides and perused the material on record.<br /> <br /> 10. Now the points arises for consideration are as under:-<br /> 1. Whether the complainant has proved deficiency in service on the part of the first opposite party in not renewing the mediclaim policy and that he is entitled for a direction for renewal of the policy, as prayed?<br /> 2. What order?<br /> <br /> 11. Our findings are as under:-<br /> Point no.1 : Affirmative.<br /> Point no.2 : As per the order.<br /> <br /> REASONS<br /> <br /> 12. Point no. 1:- So far, concerned to the fact that complainant had mediclaim valid policy for the period claimed and in time he approached the opposite party for renewal along with the D.D. for Rs.3,000/-, there is no dispute. The complainant alleges inspite of it, the opposite party did not renew the policy. On the other hand, the opposite party denied the allegation that they refused to renew the policy. However, they content that as per clause 6 of the policy, renewal is not automatic and the opposite party requested the complainant to pay premium of Rs.7,236/- for renewal, but that has not been paid.<br /> <br /> 13. Office copy of the letter sent by the complainant to the opposite party for renewal of the policy is on record. That is not in dispute. In this letter, amongst other facts, it is mentioned that complainant is sending D.D. for Rs.3,000/- and the previous policy premium was Rs.2,303/- and further it is stated if any difference, the opposite party may call on the complainant so that he can visit the opposite party and settle the claim. To this letter, the opposite party wrote to the complainant on 16.09.2008 stating that they were loosing heavily on the policy and they have loaded the premium by 50% and also co-sharing of the claiming amount for the first Rs.25,000/- apart from all exclusions with a condition that all family members should also take a mediclaim policy. Such, reply was sent by the opposite party to the complainant, but they have not admittedly renewed the policy. Thereafter, on 31.10.2008, it is stated by the opposite party that they have never refused to renew the policy and they asked the complainant certain details. This letter was written after lapse of the policy, which was valid up to 24.09.2008. Thereafter, at last on several communications by the complainant, the opposite party on 18.02.2009 wrote to the complainant requesting to remit Rs.7,236/- along with proposal form.<br /> <br /> 14. From the facts noted above, during validity period of the policy complainant requesting the opposite party to renew the policy and had sent D.D. For Rs.3,000/-. By the letter dated 31.10.2008, the opposite party informing the complainant that they have loaded the premium by 50% and co-sharing of the claim amount for the first Rs.25,000/- and also with a condition that all family members should take mediclaim policy. In the policy in question, there is no term or condition that the policy can be renewed only in case the policy holder takes policy for all the family members etc., Thereby, it indicates that the opposite party is compelling the complainant to take mediclaim policy or policies for all the family members of the complainant. The contention of the complainant in this regard that such act of the opposite party is Unfair or unjust under the circumstances, has to be believed.<br /> <br /> 15. As regards, the contention of the opposite party that as per clause 6 renewal is not automatic, complainant is not claiming that the opposite party ought to renew the policy automatically. During validity period the complainant applied for renewal with opposite party. Loading of the premium by 50% even though there is such a condition in the policy on what basis that has been done and what are the Rules, Regulations or Guidelines, is not placed on record by the opposite party. The fact that the premium for the policy for the earlier period was Rs.2,303/- is not at all disputed. Even though, the earlier premium was Rs.2,303/- along with the letter for renewal, complainant sent D.D. for Rs.3,000/-, much more amount then the premium. Not only that in the letter, the complainant requested the opposite party to call upon if there is any difference, so that he can approach the opposite party and settle the claim. But, that has not been done by the complainant. At last, as noted here before, only on 18.02.2009 opposite party called upon the complainant to remit Rs.7,236/-, which is several times more than the earlier premium. It is the contention of the complainant that the demand made by the opposite party is arbitrary. As noted here before, the opposite party has not placed any Rules, Regulations, Circulars or other material to establish that on what basis such amount was demanded by them from the complainant. Hence, the contention of the complainant that the said demand made by the opposite party is arbitrary, has to be believed.<br /> <br /> 16. In United India Insurance Company Ltd., Vs. Sh.Satish Aggarwal, The National Consumer Disputes Redressal Commission in paragraph 12 has observed that “in view of the meaning or word ‘Renewal’ and without any express word to the contrary, we have no hesitation in accepting the finding written by both the Forum that terms were the same as well as it will come into effect from the expiry of the original term, as has been explained in the Strove Judicial Dictionary.” Hence, the opposite party is bound to renew the mediclaim policy of the complainant. Accordingly, we are of the opinion that the complainant is entitled for renewal of the policy as prayed. Accordingly our finding in affirmative.<br /> <br /> 17. Point No. 2:- Considering the discussion made above and conclusion arrived at, we pass the following order:- <br /> <br /> ORDER<br /> <br /> 1. The Complaint is partly allowed.<br /> 2. The first opposite party is hereby directed to renew the mediclaim policy of the complainant within a week from the date of order.<br /> 3. The first opposite party is hereby directed to pay cost of the proceedings amounting to Rs.2,000/-. <br /> 4. Give a copy of this order to each party according to Rules.<br /> <br /> (Dictated to the Stenographer, transcribed by her, transcript revised by us and then pronounced in the open Forum on this the day 13th August 2009)<br /> <br /> <br /> <br /> (A.T.Munnoli) <br /> President <br /> <br /> <br /> <br /> (Y.V.Uma Shenoi)<br /> Member<br /> <br /> <br /> <br /> (Shivakumar.J.)<br /> Member<br /> <br />