Punjab

Ludhiana

CC/15/521

Kunal Kumar Sofat - Complainant(s)

Versus

National Ins.Co.ltd - Opp.Party(s)

compl.in person

30 Nov 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA

 

Consumer Complaint No.521 of 02.09.2015

Date of Decision        :   30.11.2016

 

Kunal Kumar Sofat s/o Sh.Sat Pal Sofat, 57 Friends Colony, Pakhowal Road, village Daad, Ludhiana. 

….. Complainant

Versus 

National Insurance Company Limited, through its Branch Manager, SCO No.38, Feroze Gandhi Market, Ludhiana.

..…Opposite party

 

(Complaint U/s 12 of the Consumer Protection Act, 1986)

 

 

QUORUM:

SH.G.K.DHIR, PRESIDENT

MRS. VINOD BALA, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant                     :         In person

For OP                          :         Sh.D.S.Rampal, Advocate

 

PER G.K DHIR, PRESIDENT

 

1.                          Complainant purchased many insurance policies from OP. These policies included two car insurance policies, mediclaim policy, accident policy, two wheeler policy and house hold insurance policy. Out of those insurance policies, six were around five years old and complainant got claim in those policies during last 5 years as per detail given below:-

Name of policy                     Number of time claim got        Policy Number

a)Car Insurance (Ecco)            One Time                 404502/31/13/6100005465

b)Car Insurance(Indica)           Three Times                       404502/31/13/6100005884

c)Two wheeler Insurance         One Time                 404502/31/13/6200006376

d)Accident Insurance               Zero Time                 404502/48/13/8500001126

e)Household Insurance            Four Times               404502/4813/360001125

                                                in three years

On 2.9.2015, the complainant received letter from the Branch Manager of insurance company for supplying information to the complainant that his above stated policies will be cancelled within 7 days from the date of letter, meaning thereby as if all the policies of the complainant will be cancelled on 3.9.2014. Complainant sent two request letters to Mr.Namdhari CRM(Chief Regional Manager) of National Insurance Company and got the positive reply from the Divisional Manager office to the effect that the policies will not be cancelled. Complainant appreciated the Branch Manager of this positive act through letter dated 10.9.2015, but later on got knowledge as if his insurance policies cancelled by the insurer. Due to cancellation of the insurance policies, complainant faced financial loss, risk and harassment. Even the complainant lost no claim bonus in policy of the car, personal insurance and mediclaim policy etc. Due to cancellation of mediclaim policy, continuity of  the mediclaim came to an end resulting in failure to avail the benefit of that policy. On account of cancellation of accident insurance policy, risk guard of family protection of the complainant became no active. On one side, the Central Government tried    to make accidental insurance of every citizen of India compulsary, but on other side, the National Insurance Company senior officials are settling their personal scores with the complainant by cancelling the accident insurance policy. On account of cancellation of these policies, the complainant claims to have faced loss of money, particularly when the insurance company had not returned back the government taxes and other charges charged by it at the time of purchase of the policies by the complainant. Those sittings in the seat are showing their power by cancelling the policies. Besides, the complainant claims that he had been updating the C.B.I.Chandigarh branch against the senior officials of the insurance company and that is why, policies has been cancelled for harassing him(complainant). Complainant want to restart the cancelled policies for remaining period and even he seeks refund of the total cost of the policies. Refund of amount of Rs.21,500/- along with compensation of Rs.1,75,000/- sought.

2.                Op filed written reply by pleading interalia as if the complaint in the present form is not maintainable; complaint is false and frivolous; complaint is bad for non-joinder and mis-joinder of necessary parties because the Divisional Office no.4, Kesar Ganj Chowk, Ludhiana, the governing office has not been impleaded as party; complainant has not approached this Forum with clean hands and that OP has been illegally dragged in litigation. Besides, it is claimed that intricate question of law and facts are involved, which cannot be adjudicated in the summary proceedings and as such, Civil Court alone is competent to decide the complaint. Complaint also alleged to be not verified. Policies of the claimant rightly cancelled by the OP as complainant has claimed number of claim in those policies and he is not proved to be a good customer. Proportionate refund of premium of all the policies was paid to the complainant after cancellation of the policies and as such, the complainant is estopped by his act and conduct from filing this complaint. It is claimed that the complainant is manipulating the claims and that is why, he lodged claim many times. Purchase of the policies by the complainant and cancellation thereof not denied. OP has right to cancel the policies as per the terms and conditions of the insurance policies. OP after cancellation of the policies, has refunded the proportionate premium with regard to the remaining period of those policies. Due services rendered by OP. It is denied that the complainant lost no claim bonus and there is break in continuity of mediclaim policy. The general act and conduct of complainant forced OP to cancel the policies of the complainant. Complainant is unnecessarily harassing the officials of OP by way of filing false applications and raising number of claims in certain policies. It is claimed that the complainant is manipulating the claims. Complainant is at liberty to get insured any vehicle from any other insurance company and he is also at liberty to take any fresh medical claim policy, if he is so interested. Accidental policy was taken for the first time by the complainant and as such, he has not lost anything in respect of any claim bonus or other benefit. It is denied that the senior officials of OP are settling personal scores with the complainant by cancelling the insurance policies. Complainant had been informed qua refund of proportionate premium and cancellation of the policies and as such, complainant not entitled to any relief.

3.                Complainant to prove his case tendered in evidence his affidavit Ex.CA along with documents Ex.CW1 to Ex.CW9 and thereafter, closed the evidence.

4.                On the other hand, counsel for the OP tendered in evidence affidavit Ex.RA of Sh.Bikker Singh, Branch Manager along with documents Ex.R1 to Ex.R37 and thereafter, closed the evidence.

5.                Synopsis of written arguments submitted by the complainant, but not by Op. Oral arguments of complainant and counsel for OP heard and records gone through minutely. 

6.                Though, complainant has mentioned the details of five insurance policies in para no.3 of his complaint, but in fact, six policies cancelled by OP is the contention of counsel for OP. After going through record certainly, it is made out that six policies of the complainant had been cancelled by the OP. Detail of those policies worked out from the produced documents by OP are as under:-

Sr. No.	Number of policy with name(if any)	Validity period	Cover note concern
i)	404502/31/13/6100005465 Maruti Eco Car insurance Policy	14.02.2014 to midnight of 13.02.2015	Ex.R1(hereinafter in short referred to as Policy No.1)
ii)	404502/31/13/6100005884 Insurance of Package Private car bearing registration No.DL-09-CG-7574	10.03.2014 to midnight of 09.03.2015	Ex.R3(hereinafter in short referred to as Policy No.2)
iii)	404502/31/13/6200006376 Policy regarding Motorcycle/Scooter i.e.Enfield Bullet 350 Std Classic bearing registration No.DL-09-SN-3098	29.03.2014 to midnight of 28.03.2015	Ex.R5(hereinafter in short referred to as Policy No.3)
iv)	404502/48/13/3600001125 Householders insurance policy	21.02.2014 to midnight of 20.02.2015	Ex.R7(hereinafter in short referred to as Policy No.4)
v)	404502/48/13/8500001126 Accident Insurance Policy	Record not produced and cover note not available.	Reference made in Ex.R22 and Ex.R24 (hereinafter in short referred to as Policy No.5)
vi)	404502/42/14/8100000217	Not mentioned in complaint and record not produced	Reference made in Ex.R28 (hereinafter in short referred to as Policy No.6)

 

7.                Discussion on above referred six policies held heading wise by referring policy no.1, 2 etc as under:-

POLICY NO.1:-

8.                Ex.R1, Ex.R2, Ex.R9, Ex.R11 to Ex.R13 and Ex.R17 are the documents pertaining to this policy of Maruti Eco car. Ex.R1 is the insurance cover note, whereas Ex.R2 is the terms and conditions providing for cancellation of insurance policy. GR.24 of these conditions incorporated in Ex.R2 provides that a policy can be cancelled by the insurer by sending to the insured seven days notice of cancellation by recorded delivery to the insured’s last known address and the insurer will refund to the insured the pro-rata premium for the balance period of the policy. Further, as per this GR.24, policy can be cancelled at the option of the insured with 7 days notice of cancellation and the insurer will be entitled to retain premium on short period scale of rates for the period, for which, the cover has been in existence prior to the cancellation of the policy. The balance premium, if any, will be refundable to the insured. However, refund of the premium will be subject to, there being no claim under the policy. So, cancellation of the policy Ex.R1 permissible as per terms and conditions of the policy on the option or at the instance of insurer and also of the insured. In case, the insurer cancels this policy, then             it has to issue 7 days notice in writing of cancellation and even will have to refund the pro-rata premium for the balance period of the policy. However, refund of such premium not essential, if the claim under the policy has already been received on any occasion by the insured.

9.                Notice for cancellation of this policy Ex.R9 issued through registered post on 26.8.2014 by mentioning the address of the complainant as is given in the cover note Ex.R1 itself and as such, due notice delivered to the complainant at the last known address. Receipt of this notice by the complainant not denied because in para no.4 of the complaint itself, he(complainant) has admitted having received  letter from the Branch Manager on 2.9.2015 containing information qua the cancellation of the policy. Seven days notice was required to be issued for cancellation and the same has been done by sending Ex.R9=Ex.R13 and as such, cancellation of the policy Ex.R1 is in accordance with the terms and conditions of the policy.

10.              Claim of Rs.10,325/- paid on this policy on 4.8.2014 through disbursement voucher Ex.R11 and the same fact reflected in duplicate schedule Ex.R12 also, where reference of cancellation made as per India Motor Tariff. Reference of such payment also made in Ex.CW2. As claim under this policy was received once and as such, in view of clause GR.24 contained in Ex.R2, premium amount under policy has not been refunded on proportionate/pro-rata basis as per above quoted terms and conditions of the policy. So, cancellation of the policy in question being in accordance with the terms and conditions of the policy is quite legal.

POLICY NO.2:-

11.              Relevant documents in this respect are Ex.R3, Ex.R4, Ex.R9=Ex.R13=Ex.R17, Ex.R15, Ex.R16 and Ex.R35 to Ex.R37. Rule Gr.24 contained in Ex.R4 is the same as is quoted above while holding discussion on Policy No.1. For cancelling policy Ex.R3, 7 days notice in writing issued on 26.8.2014 as disclosed by contents of Ex.R9=Ex.R13=Ex.R17.

12.              Claim of this policy paid for an amount of Rs.70,000/- is a fact reflected by documents Ex.R15 and Ex.R16. That payment made on basis of reports Ex.R35 and Ex.R36 and payment of same made in pursuance of the orders passed in complaint as revealed by copy of order passed in Execution No.45 of 13.02.2015 placed on record as Ex.R37. Reference of receipt of Rs.70,000/- under this policy even made in Ex.CW2.  So, once the claim under this policy has been received by the complainant , cancellation of policy in question after issue of seven              days notice in writing is in accordance with the terms and conditions contained in GR.24 referred above. So, no illegality committed by OP in cancellation of this policy also.

POLICY NO.3:-

13.              Relevant documents in this respect are Ex.R5, Ex.R6, Ex.R9=Ex.R13=Ex.R17 and Ex.R19 to Ex.R21. Ex.R5 is the insurance cover note, whereas, Ex.R6 contains the general terms and conditions contained in GR.24, reference of which made in detail while holding discussion of policy No.1. Before cancellation of this policy, notice Ex.R9=EX.R13=Ex.R17 was issued and as such, the policy cancelled after serving requisite notice. Ex.R19 to Ex.R21 are the documents produced to show as if claim under this policy of amount of Rs.6350/- was received by the complainant through disbursement voucher Ex.R19 dated 27.10.2014. Reference of receipt of this claim also made in Ex.CW2 and as such, in view of receipt of claim once by the complainant under this policy, there was no necessity for OP to refund the proportionate balance premium to complainant. Being so, cancellation of this policy in question even is as per the terms and conditions of the policy contained in Ex.R6.

POLICY NO.4-

14.              Relevant documents in this respect are Ex.R7, Ex.R8, Ex.R25 to Ex.R27 and Ex.R31 to Ex.R33. Ex.R7 is the policy cover note, whereas Ex.R8 is the terms and conditions of the policy in question. As per clause 4 of general conditions contained in Ex.R8, the company may at any time after issue of 7 days notice in writing, cancel the policy, in which case, company shall return to the insured a proportion of the last premium corresponding to the unexpired period of insurance. Ex.R25 is the notice issued on 26.8.2014 for cancellation of this policy w.e.f. 3.9.2014. The factum regarding receipt of this notice not denied in the complaint or in the evidence of complainant on affidavit and as such, virtually cancellation of this policy took place after issue of 7 days notice in writing at the address of complainant given in policy cover note Ex.R7 itself. After cancellation of this policy, the proportionate premium for the unexpired period along with the service tax took place by refunding of Rs.2688/- to the complainant is a fact borne from the contents of Ex.R26 (disbursement voucher). So, termination/cancellation of this policy is also in accordance with clause 4 of general conditions contained in Ex.R8.

POLICY NO.5:-

15.              Relevant documents qua this policy are Ex.R22 to Ex.R24. Ex.R22 is the notice issued for cancellation of this policy on 26.8.2014. Cancellation of policy stipulated after expiry of 30 days period i.e. w.e.f. 26.9.2014 as per contents of Ex.R22. Ex.R23 contains the terms and conditions of this policy. As per clause 5.9 of Ex.R23, company not be bound to give notice for renewal, but the           company may at any time cancel the policy by sending the insured 30 days notice by registered letter at the insured last known address and in such event, the company shall refund to the insured a Pro-rata premium for unexpired period of insurance. However, company will remain liable for any claim, which arose prior to the date of cancellation. In view of this term contained in clause 5.9 of Ex.R23, the company by sending registered notice Ex.R22 to the complainant at the last known address has rightly cancelled the policy as per clause 5.9 of the terms and conditions. However, liability of company will remain for any claim, which arose prior to the date of cancellation i.e. 26.9.2014.

16.              Pro-rata refund for the unexpired period along with service tax took place through disbursement voucher Ex.R24 because refund of Rs.2342/- in all done through bank account of the complainant. So, cancellation of this policy is also in accordance with terms and conditions of the policy itself.

POLICY NO.6:-

17.              Relevant documents qua this policy are Ex.R28 to Ex.R30. For cancellation of this policy, registered notice Ex.R28 dated 26.8.2014 was sent to the complainant at his address by informing that after expiry of 7 days period, the policy will cease to be operational w.e.f.3.9.2014. Clause 6 of the terms and conditions of policy contained in Ex.R30 provides that the company may at any time by notice in writing, determine this policy, provided that the company shall in that case return to the insured, the last paid premium less a pro-rata part thereof    for the portion of the current insurance period, which shall have expired. Such notice shall be deemed to be sufficiently given if posted and addressed to the insured at the address last registered in the company’s books and shall be deemed to have been received by the insured at the time, when the same would be delivered in the ordinary course of post or the policy may be cancelled at any time by the insured by a notice in writing under a Certificate of posting or a registered A.D. In this case, after serving 7 days notice through registered post Ex.R28, the policy stood cancelled w.e.f.3.9.2014 because registered notice sent at the address of the complainant, qua which there is no denial by the complainant. Refund of premium with service tax of amount of Rs.790/- took place through disbursement voucher Ex.R29 and as such, cancellation of this policy took place as per the terms and conditions of the policy.

18.              The terms and conditions of the contract of insurance is binding on the parties and nothing can be added or subtracted thereto by the Forum or by the parties. In holding this view, we are fortified by law laid down in cases of Ind Swift Limited vs. New India Assurance Co.ltd and others-IV(2012)CPJ-148(N.C.); Usha Sharma and others vs. New India Assurance Co.Ltd and others-I(2012)CPJ-488(N.C.); United India Insurance co.Ltd. vs. Harchand Rai Chandan Lal-IV(2004)CPJ-15(S.C.) and Deokar Exports Private Limited vs. New India Assurance Co.Ltd-I(2009)CPJ-6(S.C.). In view of the above cited legal position and by keeping in view the terms and conditions of the policies in question, it is obvious that the policies in question cancelled legally as per the terms and conditions of the policy either by paying the premium or serving requisite notice. However, where the pro-rata premium for unexpired period not refunded, there such pro-rata refund of premium was not required because of receipt of the claim earlier by the complainant. Factum of receipt of claim on household fire policy and motor claim etc., proved by letter Ex.CW2 produced by the complainant.

19.              Complainant vehemently contends that Op have claimed that complainant has not proved to be a good consumer and that is why proportionate refund of premium of all the policies on cancellation done. It is vehemently contended by complainant that he has received claims on the basis of orders of this Forum in two cases as revealed by copy of orders Ex.R31, Ex.R32, Ex.R34 and Ex.R37 as well as report of surveyor Ex.R35 and as such, allegations of complainant not proved to be a good consumer are false. Even if plea regarding complainant not being a good consumer may have been taken, but despite that cancellation of the policies is in accordance with terms and conditions of the policies and as such, cancellation cannot be termed as malafide. Certainly, the complainant has got the claims through consumer complaints or through execution, but that question is not determining factor as to whether the cancellation of policies legally justified or not because if the cancellation had taken place in accordance with terms and conditions of the policies, then deficiency in service or adoption of unfair trade practice cannot be inferred. As cancellation of all the six policies took place as per the terms and conditions of the policies and as such, there is no deficiency in service or unfair trade practice on the part of Ops. Being so, complaint merits dismissal.

20.              Therefore, as a sequel of the above discussion, the complaint dismissed with no order as to costs. Copies of order be supplied to the parties free of costs as per rules.

21.                        File be indexed and consigned to record room.

 

                                      (Vinod Bala)                                (G.K.Dhir)

                               Member                                       President

Announced in Open Forum

Dated:30.11.2016

Gobind Sharma.