Delhi

New Delhi

CC/1076/2013

Amit Bhachawat - Complainant(s)

Versus

M/s. Royal Sundaram Alliance Insurance Co. Ltd - Opp.Party(s)

19 May 2016

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI),

 ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE,

 NEW DELHI-110001

 

 

Case No.C.C./1076/2013                                                                                                                   Dated:

In the matter of:

Mr. Amit Bhachawat

7D, 1^st Floor, NRI Colony,

GK-IV, New Delhi-110019

        ……..COMPLAINANT

 

VERSUS

Royal Sunderam Alliance Insurance Co. Ltd.,

1505-1506, 15^th Floor, Ambadeep Building,

14, K.G. Marg, New Delhi-110001

       

               .... OPPOSITE PARTY

 

PRESIDENT: S.K. SARVARIA

 

ORDER

 

The non-issuance of insurance policy by the OP insurance company despite payment of premium by the complainant for the period 15/12/2012 to 14/12/2013 has led the complainant to file the present complaint under section 12 of the Consumer Protection Act, 1986. The complaint is filed by the complainant alleging in brief that he is health insurance policy holder bearing number HJ 00006102000105, since 2005 and has been regular in paying premium every year before the due date.  On 14th, the day of December every year. The complainant paid the premium amount of Rs. 31,448 on 3/12/12 through his American Express credit card for the period 15/12/2012 to 14/12/2013. For the next year, the complainant did not receive any information regarding renewal of the said policy so on 29/11/2013, the complainant wrote an email seeking renewal notice from the OP insurance company. On 30/11/2013 OP insurance company sent email reply stating that the subject policy stood expired on December 14, 2012. As the renewal premium was not received and it was also stated that in case the premium has been paid towards renewal  of policy then the bank statement reflecting premium debit towards the OP insurance company be shared with the OP to assist further in this regard. Thereafter complainant on 2/12/2013 sent proof of payment of Rs. 31,448/– and asked the OP to send the renewal notice, but the OP has been dillydallying the same.

 

The apprehension of the complainant is that in case of any mishappening or unfortunate incident during the period 15/12/2012 to 14/12/201, the complainant and his parents would have been deprived of the fruits of the health insurance, in as much as the said health policy was not renewed despite receiving the premium by the OP. The complainant has prayed for the following reliefs against the OP insurance company:

(a)       direct the opposite party to refund the amount of Rs. 31,448/- (Thirty one   thousand four hundred and forty eight only) paid as premium, with interest @            24% p.a. from the date of payment till it’s realization; and

(b)       direct the opposite party to pay an amount of Rs. 2,00,000/- as compensation to   the complainant for harassment and mental agony; and

(c)        direct opposite party to pay to the complainant an amount of Rs. 50,000/- as litigation and miscellaneous expenses.

(d)       direct the opposite party to revive/renew the said health insurance policy without charging any premium for the current year i.e. period 15.12.13 to 14.12.14.

(e)       pass such other and further order(s) as this Hon’ble Commission may deem fit and proper in the facts and circumstances of the case.

 

The notice of the complaint was issued to the OP insurance company who was served and contested the complaint by filing reply admitting that the complainant had taken a Healthy Shield Gold Policy bearing number HJ 00006102000106 from the OP from 15/12/2012 to 14/12/2013 by paying a sum of Rs. 31,448 and the said policy covered complainant along with his father and mother. OP has alleged that the complainant was provided with the renewal notice before expiry of the policy and has denied that the renewal notice was not sent to the complainant. OP has submitted that the documents filed by the complainant on the mail correspondence are bogus and untenable and complainant intends to make unlawful gains from OP. OP submitted that the health policy issued to the complainant was valid at all times and therefore, there was no question of complainant's parent being deprived of the benefit under the policy. The OP has denied other facts stated in the complaint and has prayed for dismissal of the complaint with costs.

 

In the rejoinder the complainant has denied the averments made in the reply of the OP and has reaffirmed the facts stated in the complaint. In support of his case, the complainant has filed his affidavit in evidence. On behalf of OP the affidavit in evidence of  Mr G. Vinay Parkash an officer and authorised representative of the OP insurance company is filed. The OP has also filed written arguments.

 

We have heard the learned counsel for the parties and have gone through the written arguments filed on behalf of the OP, record of the case and relevant provisions of law.

 

During the course of arguments it is not disputed that the complainant has paid a sum of Rs. 31,448/– on 3/12/2012 towards the health insurance policy in question for its extension for the period 15/12/2012 to 14/12/2013. The complainant has proved the correspondence by email with the OP insurance company as Exhibit CW 1/2 and Exhibit CW 1/3. Although, OP has alleged this email correspondence as bogus documents, but we do not see any reason to disbelieve the same for the obvious reason that the insurance policy issued by OP to the complainant is proved by OP's witness as Ex- R i.

 

The basic facts that the complainant is a Health Insurance Policy Holder since 2005 and his renewing the health policy regularly with the OP Insurance Company is not disputed.  There is mismatch of policy number and according to the complainant he is holder of policy No.HJ00006102000105 since 2005 but according to the OP the policy No. of the complainant is HJ00006102000106.  Although no dispute is raised regarding the policy number by other of the parties and in my view of the policy number given by the complainant seems to be a typographical error and actual policy No. HJ00006102000106 as given by the OP seems correct as it matches with the copy of the Health Insurance Policy and also forwarding letter Exhibit CW-1/4. 

The e-mail exchanged between the parties show that the complainant by e-mail dated 29/11/2013 has knocked at the door of the OP for renewal of the policy and the reply of the OP in the e-mail dated 30/11/2013 it has informed the complainant that the policy in question stood expired on 14/12/2012 as the renewal premium was not received at their end.  Thereafter further e-mails were exchanged between the parties and complainant gave the details of premium paid by him for renewal of policy  for the period 15/12/12 to14/12/13 and thereafter the OP has sent the policy for the said period vide forwarding letter dated 4/12/13 Exhibit-CW-1/4 to the complainant, during pendency of this complaint.

  Arguments on behalf of OP emails relied upon are forged and fabricated documents does not hold any water for the simple reason that after these emails were exchanged between the parties, the OP ultimately issued the policy for the period 15/12/12 to 14/12/13 on 4/12/16 at the fag end of the duration of the said policy.  This shows the email exchanged between the parties is genuine.   The payment of Rs.31,448/- on 3/12/12 for renewal of the Health Insurance Policy in question through American Express Credit Card of the complainant for the policy duration 15/12/12/ to 14/12/13 is not disputed.  Therefore, when the premium amount was paid by complainant on 3/12/12 for renewal of Health Insurance Policy from 15/12/12 to 14/12/13, the reply by email on 30/11/13 of the OP that the policy in question stood expired on 14/12/12 as renewal premium was not received at their end and demand of particulars of premium paid by the complainant  towards renewal shows deficiency in service on the part of the OP Insurance Company.  More so, when the renewal of the policy for the period 15/12/12/ to 14/12/13 was sought by the complainant by making payment of premium well in time on 4/12/12 and the policy in question was renewed at the fag end of the policy duration i.e. 4/12/13.  Therefore, it is a clear cut case of deficiency in service on the part of OP Insurance Company and apprehension of the complainant shown in the complaint and expressed during the course of the arguments, had the complainant and/or his parents been confronted any mishappening or unfortunate incident during the period 15/12/12 to 14/12/13, the complainant and his parents would have been deprived of the fruits of the health insurance as same was not renewed on 14/12/13 and OP would have taken the plea that the policy stood expired on 14/12/12 due to renewal, are well-founded. Therefore, the complainant succeeds against the OP in this complaint and is entitled to refund of the amount besides compensation.  However, compensation of Rs.2 lakh claim and cost of litigation of Rs. 50,000/-seems to be quite higher side, keeping in view the amount of premium of policy deposited by the complainant for its renewal.

            In view of the above, we allow the complaint and direct the OP Insurance Company to refund the amount of Rs.31,448/-paid as premium by the complainant alongwith simple interest @10% p.a. from the date of deposit till the date of realization of the said amount.  In addition, for mental agony and harassment suffered by complainant, we direct the OP to making the payment of Rs. 25,000/- only which shall be inclusive of cost of litigation. In case of the said amount of Rs. 25,000/- is not paid by the OP within a period of one month of receipt of this order the same shall be recoverable by the complainant alongwith simple interest @10% p.a. from the date of this order  till recovery of the said amount.

Copy of the order be sent to each of the parties free of cost by registered post.  This order be sent to server (www.confonet.nic.in ).

File be consigned to record room.                  

Pronounced in open Forum on 19.05.2016.

 

 

 

 

(S K SARVARIA)

PRESIDENT

 

                                            (H M VYAS)

MEMBER