BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

AT PORVORIM –GOA

Coram : Ms. Bela N. Naik, President

     Mr. Auroliano De Oliveira, Member

                        Ms. Rejitha Rajan, Member

                            Consumer Complaint No. 56/2020

Mr. Vijay Kapoor(Senior Citizen)

          E-13 Navelcar Elite City

Bainguinim 403402                                             .……..Complainant

Versus

1. National Insurance Company Ltd.,

Through it’s Ms. Tajinder Mukherjee Chairman & M.D

3 Middleton Street,

Kolkata 700 071

2. National Insurance Co. Ltd.

Ms. Sujata Thakar, (ex) Branch Manager,

Govinda Building,

MG Road,

Panjim 403 001

3. National Insurance Company Ltd.

Dr. Domingo Souza Road

Mr. Avnekar, Divisional Manager,

Near Municipal Gardens,

Panjim 403001

4. Bank of India Ltd.,

Through it’s Managing Director,

Star House,

Bandra Kurla Complex,

Bandra East,

Mumbai 400 051

5. Bank of India Ltd.,

Through it’s Branch Manager

Rue De Ormuz

Panjim 403 001……………(Opposite Parties)

Date of Complaint :03-11-2020

Date of Judgement/Order : 27-02-2023

             Counsel for the Parties :

             For the Complainant : Complainant Mr. Vijay Kapoor in person.

             Opposite Parties: Adv. Mr. Amey Kakodakar for OP-3

 Adv. P.Vaze for OP-4 and OP-5.

 Opposite Party-2 - Absent

 Opposite Party-1 - Exparte

JUDGEMENT

(Per Ms. Rejitha Rajan, Member)

By this Judgement and Order, we shall finally dispose off the Complaint bearing No. 56/2020 dated 03-11-2020 filed by the Complainant alleging deficiency in services and unfair trade practice by the Opposite Party-1, Opposite Party-2, Opposite Party-3, Opposite Party-4 and Opposite Party-5 (for short the OP-1, OP-2, OP-3, OP-4 and OP-5) herein under Section 35 of the Consumer Protection Act, 2019.

The brief facts of the case of the Complainant is that :

1. That this Consumer case bearing No. 56/2020 arises out of the complaint filed by him i.e. Mr. Vijay Kapoor, the Complainant before the District Consumer Dispute Redressal Commission (“District Commission”, for short) upon purchase of a Medical Insurance Policy namely “BOI National Swasthya Bima Policy” availed under a medical insurance scheme from the Opposite Parties i.e. Bank and the Insurance Company. The Parties shall hereinafter be referred to as per their status in the said Complaint.

2. The Complainant states that the Opposite Party No.1, 2 and 3 referred as “insurers/insurance company” together with Opposite Party No. 4 and 5 referred as “bank” jointly floated a medical insurance scheme named as “BOI National Swasthya Bima Policy” referred to as “the policy/medical policy” exclusively for the customers of the Bank.  The Complainant also stated to inform that the Complainant had filed a CC 20/2020 against the insurers and others, whose scope and cause of action or prayers is entirely different and is pending disposal.

3. The Complainant states that he had an ongoing medical insurance policy of the maximum cover amount of Rs. 5.0 lakhs, the last of which was from 04-06-2018 to 03-06-2019 for a premium amount of Rs. 9,293 and which was renewable till age 80 and governed by the more  micro-level terms for claims (Copy of Medical Policy (Annexure 1 Pg. 6)and Macro-level Brochure/advertisement(Annexure 2 Pg. 7), micro-level terms for claims (Annexure 3, Pg. 8-9(verso) annexed with the Complaint). The Complainant states that he had this medical insurance with the Opposite Parties for the past ten years and out of which the first 5 or 6 years were incidence/claim free. That since around 2016, he had four surgery related hospitalizations and about another 4 related to heart-lung-prostrate-pressure complex.

4. That as the Complainant visited to renew the policy for 2019-2020, he was informed by the Opposite Parties that they would not renew the said medical policy on account of discontinuance of the said medical scheme (Copy annexed as Annexure 4 Pg. 10). That complainant found this amount to be wrongful, unilateral and arbitrary repudiation of the agreement/contract terms by the Opposite Parties especially as at his age in the 70’s most insurers would not give medical policy to new individuals above the age of 65 years and that the few that would provide such cover would do so at a huge cost of 7-10x plus cost-sharing (a copy of digitally produced cost of cover annexed with complaint at Annexure 5 (Colly, Pg. 11-12). And that he (the complainant) would be left in the lurch without any medical cover which otherwise happens to be a part of right to life under the constitution. That he (the Complainant) made efforts to resolve the matter of this repudiation of contract/agreement terms by the Opposite Parties as such those efforts failed as the complainant was informed by the Opposite Parties that they had terminated the scheme because they were running into losses and handed a withdrawal intimation letter without any date or identifiable authority or letter reference No. (Copy annexed as Annexure 6 Pg.13-14 with the Complaint). That the Opposite Parties had neither put up such an information on their respective web-sites nor was properly informed to him, (the complainant) of the continuation of the medical scheme via e-mail or SMS or by Notice in their offices/premises as they should have done with reasons thereof  for the consumer(s) with a proper and justifiable opportunity in terms of natural justice. That he (the complainant) had sent the Opposite Parties a notice (Copy annexed as Annexure 7 (Colly) Pg. No. 15-18 with the Complaint) but no redress came forth from the Opposite Parties.

5. The Complainant states that the Opposite Parties under such circumstances of the Complainant wrongfully mis-sold to him their “National Mediclaim Policy” which is referred as “new policy” (Copy annexed as Annexure 8 at Pg. 19 with the Complaint) for a much higher premium of Rs. 28,027 which is 3x (three times) more than Rs. 9,293/- premium of the withdrawn medical policy. That the said new policy was sold under the misrepresentation that it was same or even similar to the said wrongfully withdrawn medical policy. That infact the mis-sold alternate “National Mediclaim Policy” is not at all same or similar to it (Copy annexed as Annexure 8 at Pg. 20) as it is riddled with all kinds of restrictions and co-payments whereas the original wrongfully withdrawn policy was altogether and completely free from any restrictions or co-payments.

That it is also submitted by him (the complainant) about similarities, the cost and implications of the new policy versus the wrongfully withdrawn policy :

1. Joining age : generally not available for new persons beyond the age of 65 years.
2. Premium (somewhat similar) : 9.5K versus 65K (similar) : about 100K
3. Coverage : (somewhat similar) : none versus sub-sector limits/restrictions.
4. Pre-existing Conditions : (Somewhat similar) : None versus 1 to 4 years
5. Other : None versus several “other” conditionalities.

6. It was submitted by the Complainant that when compared on basis of similarities; he (the complainant) due to his advanced age would generally be not able to get medical insurance to start with. That he (Complainant) can get an insurer who will provide a similar medical cover but it would cost him within or around 100+k per annum as opposed to the Rs. 9k paid for the wrongfully withdrawn scheme of the Opposite Parties. It was submitted by the complainant that if one adds an approximate of 7% per annum increase in premiums, the actual premium cost would work out to some 110k versus 10k or a difference of some 10x or Rs. 100k per year and in addition to it the cost of much unwarranted harassment, mental tension and trauma.

7. It was submitted by the Complainant that the Opposite Parties especially being public servants are in gross negligent dereliction of their duty towards the public, deficiency in service and have exercised Unfair Trade Practice. That being public servants, they are being paid from public funds/state enterprise and are liable both in their official as well as in their private capacities for their negligent/dereliction acts/omissions of Deficiency in service and Unfair Trade Practice. Thus, the consequential costs/expenses including legal costs and leave of absence etc. of their (Opposite Parties) such negligent acts /omissions ought not to be inflicted upon the insured (complainant) and or the general public and or the exchequer (state enterprise) but should be squarely latched onto the Opposite Parties themselves.

8. That the reliefs prayed by the complainant are a) to either reinstate same or no-conditionality medical insurance together with costs, expenses and compensations at the same annual premium of <10k or payout @120k from age 71-80 = 10 years =Rs. 12.0 lakhs together with costs, expenses and compensations or a lump-sum of Rs. 20 lacs towards uninsured medical events till the end of life. b) discovery and production of documents/details of all persons aged 65 years or more that were denied such medical insurance in North and South Goa and application of balance from the Rs. 1.0 crore compensation to such persons c) costs for legal assistance/representation of Rs. 40,000/- d) cost of Rs. 10,000/- for secretarial work/typing/Xeroxing/scanning/printing, notary, travel, miscellaneous expenses. e) Rs. 2.0 lakhs for mental, physical and financial trauma. f) punitive costs of Rs. 4.0 Lakhs. g) if fit, permission to refer matter u/chapter III of Consumer Protection Act, 2019 to Central Consumer Protection Authority. h) any other relief

9. Thus, the Complainant approached this District Commission with the grievances of deficiency in services and Unfair Trade Practice on the part of the Opposite Parties(OP-1,OP-2,OP-3, OP-4 and OP-5).

10. Upon perusal of the Complaint, documents annexed, the arguments advanced on admission of the Complaint, the Opposite Parties (OP-1,OP-2,OP-3, OP-4 and OP-5) were duly notified vide the issuance of the notice(s) by Regd. AD along with the copy of Complaint and list of documents annexed/relied by the Complainant.  An opportunity for filing of Written Version to contest the case was provided to all the Opposite Parties. The OP-3 filed their written version, and that OP-4 and OP-5 also filed their written version collectively.  The Opposite Party No. 1 was served on 09-12-2020 and was given an opportunity to file written version within the stipulated period under Consumer Protection Act, 2019, however it is observed that the Opposite Party failed to appear before the Honourable District Commission. As the Opposite Party remained absent, the opportunity granted to Opposite Party No.1 to file written Version was closed and thus case proceeded against the Opposite Party ex parte vide Order dated 08-02-2021. The Complainant filed an application to delete Opposite Party No. 2 and an application to replace Annexure 3 pages 8-9(verso) with it’s correct version as Annexure 3a pages 8a-9a(verso) – Copy annexed as EA3. The Application to replace Annexure 3 Page 8-9 (verso) with it’s correct version as Annexure 3a pages 8a-9a(verso) was granted/allowed vide Order dated 30-09-2021). Subsequently, Complainant withdraws the Application dated 16/02/2021 to delete OP-2 (Respondent No.2) and as the Complainant sought liberty to file proper application, thus the order passed on Application dated 16-02-2021 is dismissed as withdrawn with liberty to file proper Application. Then Complainant filed an application dated 25-10-2021 by e-mail along with additional application to delete Opposite Party No. 2, however there is no Order seen to that effect. Application was filed by Opposite Party No. 3 seeking leave to file additional written version and filed additional written version dated 28-03-2022 on 29-03-2022. Complainant filed amended copy of the complaint deleting the Opposite Party No. 2. Complainant filed the Affidavit-in evidence and subsequently OP-3, OP-4, OP-5 filed their Affidavit-in-Evidence. Complainant and OP-3 filed the written arguments. The Complainant filed a Rejoinder/Rebuttal to the OP-3 written Arguments and thereafter the OP-3 and 4 filed their written arguments.

11. That the Opposite Party-1 has not appeared or contested the complaint and was accordingly marked ex parte. The Opposite Party-2 never appeared and was marked absent.

12. The Opposite Party No. 3 has stated that the contents of the complaint are garbled and difficult to comprehend. There is no deficiency of service from the Opposite Parties i.e. National Insurance Company or Bank of India which entitles the complainant to file the present complaint or to any of the reliefs claimed by the Complainant in the Complaint. That the grievance of the Complainant is that the “BOI National Swasthya Bima Policy” has been discontinued by the Opposite Party and therefore the Complainant could not obtain the renewal of the said “BOI National Swasthya Bima Policy” after the lapse of the BOI National Swasthya Bima Policy No. 270907501810000067 previously taken by the Complainant and thus had to take another Medical Insurance Policy.

13. The Opposite Party No. 3 submits that the Complainant infact does not disclose any cause of action in the said complaint to seek the reliefs claimed and as such that in fact, no cause of action arises to the Complainant to seek reliefs claimed by or under the said policy. Moreover, the Complaint does not disclose any deficiency in service by the Opposite Party No. 3 and further reiterates that there is no deficiency of service by or under the said Policy committed by the Opposite Party No. 3 or otherwise suffered by the Complainant. It is further submitted that as per Section 2(11) of the Consumer Protection Act, 2019 the “Deficiency means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service and includes – (i) any act of negligence or omission or commission by such person which causes loss or injury to the consumer; and (ii) deliberate withholding of relevant information by such person to the consumer”. That the discontinuance/withdrawal of the BOI National Swasthya Bima Policy by the Opposite Party does not result in nor amounts to the deficiency of the service as defined in Section 2(11) of the Consumer Protection Act, 2019 and that in the circumstances, the Complaint itself is not maintainable and deserves to be dismissed on this ground alone. It is the contention of the Opposite Party No. 3 that BOI National Swasthya Bima Policy was started in the year 2008 and was continued for the period of 10 years until 03-10-2018. That the withdrawal of the co-branded health product BOI National Swasthya Bima Policy was Pan India and not to any specific region or person and the intimation of the same was made to all consumers sufficiently in advance and for those policies expiring between 03-10-2018 to 31-12-2018 it was provided that they may be renewed on the same rates terms and conditions for further period of one year only provided, the renewal is affected on time or within 30 days of expiry of current policy.

14. That the communication also specifically provided that the renewals falling due on 01-01-2019 and later shall not be renewed but the Policy holder can migrate to alternative products namely National Parivar Mediclaim Policy-Family Floater Policy, National Mediclaim Policy-For Single Insured. That the Complainant has migrated to National Mediclaim Policy.

15. It is stated by the Opposite Party No. 3 that there was no contract between the Opposite Party No. 3 and the Complainant that the “BOI Swasthya Bima Policy” cannot be discontinued/withdrawn. Moreover, that no such term or condition can be implied in the Contract of Insurance. That the Contract of Insurance by it’s very nature is set down for a specific period during which the insurer undertakes to indemnify the insured and that after the lapse of the said period there cannot be any obligation upon the insurer to either continue with same contract of insurance or renew the same with the insured; the same being in the realm of contract. And infact, even in the “BOI National Swasthya Bima Policy” there is a specific condition that the “Policy may be renewed by mutual consent”.

16. The Opposite Party No. 3 states that BOI National Swasthya Bima Policy was a co-branded health product started in the year 2008 and withdrawn in 2018. That it is pertinent to note that under the BOI National Swasthya Bima Policy taken by the Complainant, the Opposite Party No.3 has settled 3 claims of the Complainant thereunder.

17. The Opposite Party No. 3 states that BOI National Swasthya Bima Policy bearing No. 270907501810000067 was the last medical insurance policy under BOI National Swasthya Bima Policy which was effective from 04-06-2018 to 03-06-2019. That although the said BOI National Swasthya Bima Policy was withdrawn and discontinued from October, 2018, the benefits of the said insurance were continued for the Complainant until the expiry of the policy i.e. midnight of 03-06-2019. The Opposite Party No. 3 has stated to note that it is not the case of the Complainant that Policy No. 270907501810000067 was terminated /cancelled in October 2018 or that risk cover there under was not given to the Complainant after 2018 or upto midnight of 03-06-2019.

18. The Opposite Party No. 3 states that the contention of the Complainant or the styling thereof as “macro level brochure/advertisement” or “micro-level terms” is misleading incorrect and false. It is stated by OP-3 that the reference to the feature “renewable up to 80 years at 25% loading premium” means that a person can seek renewal upto his/her at age 80 and not beyond age 80 and does not mean that the BOI National Swasthya Bima Policy should be continued by National Insurance Company Ltd. till every insured under said policy reaches the age of 80 years. And that to impute such a meaning to the above words would mean that a person who is aged 20 years in January 2018 would have a right to demand that Insurance Company should continue with the BOI National Swasthya Bima Policy for the next 60 years i.e. still he/she attains 80 years. The Opposite Party No. 3 states that such an interpretation or construction is unreasonable, impractical and illogical and by no cannons of interpretation can be imputed. That Per contra the terms and conditions of the BOI National Swasthya Bima Policy categorically and expressly provide that policy may be renewed by mutual consent.

19. The Opposite Party No. 3 states that the contents of Paragraph No. 4 of the Complaint are irrelevant to decide the present complaint nonetheless the claims raised have been paid and settled by the Opposite Party No. 3. Also states that the Complainant has made a false statement that “when he went to renew the policy 2019-2020 he was stunned to be told that the Respondents would not renew the said Medical Policy ......”. And that it is pertinent to note that the BOI National Swasthya Bima Policy No. 270907501810000067 was valid upto midnight of 03-06-2019.

20. The Opposite Party No. 3 states that the Complainant was informed in October, 2018 that the Insurance Company has decided to withdraw the BOI National Swasthya Bima Policy and that in this regard it may be seen that the Complainant himself has produced a letter dated November, 2018. That the Complainant has also entered into e-mail correspondence prior thereto as such the contention that it was only when complainant went to renew the Policy 2019-2020 that he was stunned to learn that the Policy is discontinued is incorrect, misleading and denied as false. The Opposite Party No. 3 further stated that in fact the Complainant himself has got medical insurance policy from them (OP-3) after the lapse of BOI National Swasthya Bima Policy No. 270907501810000067 and which negates the contention made in para 5 including that the complainant would be left in lurch without any medical cover or that there is a 7-10x plus costs.

21. That the OP-3 states that sufficiently in advance of withdrawal of the said Medical Scheme the OP-3 had issued Notice stating that there are alternate products which can be opted for and on migration continuity benefits will be provided and the Complainant has already availed the benefits of the migration of the Policy and has been given the continuity benefits and is already insured under the National Mediclaim Policy. The OP-3 also stated that they deny that there is repudiation of contract or agreement terms by them( Opposite Party -3) and that the decision to withdraw/ discontinuance was a policy decision by the National Insurance Company applicable PAN India and to all Policy  holders. That OP-3 denies that there was any termination or that the BOI National Swasthya Bima Policy was discontinued/withdrawn of losses as alleged or that anything to this effect was told to the Complainant by the OP-3 and hence question of resolving the matter with Complainant does not arise.

22. The OP-3 states that they deny that the intimation letter is invalid, unilateral or arbitrary, denies that there was no information on the website, the complainant was not informed or the other policy holders were not informed and further denies that there was any requirement of giving a hearing to the policy holders or afford the policy holders an opportunity in terms of natural justice. The OP-3 states with respect to the paragraph 7 of the Complaint, the OP-3 denies that the Respondents wrongfully or mis-sold to Complainant National Mediclaim Policy or for a higher premium. The premium amount of Rs. 28,027 is as per the National Mediclaim Policy and the policy was not sold under any misinterpretation as alleged. The OP-3 stated that the Complainant has obtained for the National Mediclaim Policy and has paid the premium without any demurer or protest. And that the objections now sought to be raised are purely by way of an afterthought and does not have relevance to the present complaint. The OP-3 denies that the BOI National Swasthya Bima Policy was altogether or completely free from any restrictions or co-payments. The OP-3 states that the matters stated about the cost and implication of the new policy v/s withdrawn policy are garbled and difficult to comprehend and in any event disputed. And be that as it may in so far as the joining age is concerned the complainant has already obtained new Policy National Mediclaim Policy and as such is not affected in any manner. That in so far as the premium the same is not about 100k but Rs. 28,027/-.

23. The Opposite Party denied that the BOI National Swasthya Bima Policy is wrongfully withdrawn and further denied that they are negligent or in dereliction of their duty towards the public or that there is deficiency in service or any unfair trade practice or that OP-3 is liable in official and in personal capacity or that consequential costs or expenses of legal costs or leave of absence be latched onto the Respondents (Opposite Parties) themselves.

24. The OP-3 moved an application to seek leave to file additional written statement dated 07-12-2021 and the Order was passed on 07-12-2021 stating that the application was allowed. Accordingly the OP-3 filed their additional written statement wherein it is submitted that the Complainant had filed the instant complaint based on the BOI National Swasthya Bima which he (the Complainant) sought to replace by filing an Application dated 16-02-2021 citing that the Complainant had mistakenly placed the wrong version of a document and prayed to be permitted to replace with the correct version and the said application was allowed by the Honourable Commission vide it’s Order dated 30-09-2021. That pursuant to the said Order dated 30-09-2021, the Complainant replaced the said BOI National Swasthya Bima and is now relying on BOI National Swasthya Bima Policy. That the Complainant has filed the Complaint based on BOI National Swasthya Bima and is now relying on another insurance policy i.e. the BOI National Swasthya Bima Policy. That this has completely changed the nature of the Complaint as the most crucial document has been replaced.

25. The OP-3 states that the Complainant ought to have filed another proceeding as this has given rise to a new cause of action and the Complainant cannot change the nature of the Complaint at this juncture. The OP-3 states that the Complainant has deliberately replaced the said Insurance policy to get away with the limitation to file a new Complaint after realizing that the Complaint has been filed by the Complainant without any merits.

26. That it is further stated by the OP-3 that the BOI National Swasthya Bima Policy mentions that “the Upper age limit for primary member entering the scheme should not exceed 65 years. The minimum age for members to enter in to the scheme be 3 months. However, renewals are allowed upto 80 years at a premium to be fixed by the Company”. The OP-3 also states that a person of 3 months entering in the contract cannot demand that the Policy should continue with the BOI National Swasthya Bima Policy for the next 80 years till the Policy Holder turns 80 years of age on the ground that when the said insured will attain 66 years the insured will not get any other Medical Policy or that he would be left in lurch without any medical cover. The OP-3 submits that such an interpretation is impractical. The Opposite Party No. 3 submits that merely because a person is above the age of 65 years or more he cannot compel the Insurance Company to continue the Insurance Policy. If such an interpretation is accepted then the Insurance Company has to continue with the Policy even when the Company is going in losses. That the Honourable Commission must take note of the Complainant’s conduct and dismiss the Complainant. That the Complaint is wholly meritless and that the Complainant is not entitled for any of the reliefs as prayed against OP-3. That the Complaint may be dismissed as against the OP-3 with costs.

27. That the OP-4 and OP-5 states that the Complaint is filed beyond the prescribed period of limitation and therefore liable to be dismissed. That the decision to discontinue the BOI National Swasthya Bima Policy was taken by National Insurance and communicated to the Bank of India (BOI) by communication dated 26-09-2018 and the BOI thereafter communicated the decision to all it’s branches by communication dated 28-09-2018. Thus from the end of September, 2018, all the branches of BOI had put up a notice for the customers about the discontinuation of the policy. Thus, the petition which is filed two years after the date of discontinuation is barred by limitation.

28. It is further stated that OP-4 and OP-5 along with OP Nos. 1 to 3 had floated BOI National Swasthya Bima Policy for the customers of BOI. The said policy was through National Insurance, who are entitled to carry on insurance business in India. The OP-4 and OP-5 or the BOI does not have requisite authorizations to carry out insurance business. Thus, in essence, the scheme was by National Insurance, specially tailor-made for the customers of BOI. The said policy was for benefit of the customers of BOI and also of National Insurance because they could attract and tap into huge consumers base of BOI. The bank also benefitted because some new consumers came to the bank and opened accounts for the purpose of availing the said scheme. That the policy document issued to the customers and more particularly to the Complainant was issued by National Insurance Co. Ltd. The said policy document clearly sets out that the disbursement towards the claim by the policy holder shall be dealt with and paid by the National Insurance Co. Ltd. alone and there is no mention of BOI anywhere for the purpose of any  liability under the claim, pursuant to the insurance policy.

29. The OP- 4 and OP-5 stated that Clause 3 of Additional Conditions of the policy document specifically stated that the policy was renewable by mutual consent. Thus, it must be noted that mutual consent, which included consent of the Insurance Company as well as the policy holder for renewal. Thus, the Complainant can have no grievance if the Insurance Company has decided not to continue with the scheme or not to renew policies under the said scheme. That it is not the case where Complainant’s claim was not considered by sudden discontinuation of policy before it’s expiry. There is absolutely no cause of action for the Complainant either against the Insurance Company or against the BOI in this regard to maintain the present complaint. It is also stated by OP-4 and OP-5 that the material on record, more particularly the notice displayed by the Bank contains clear instructions about discontinuation of the scheme and also option to migrate to alternate policies was communicated. (Copy of the notice as displayed by the Bank is herein Annexed as Exhibit “A” along with the Written Statement of OP-4 and OP-5). That the OP-4 and OP-5 states that by communication dated 26-09-2018 addressed by the General Manager of National Insurance Co. Ltd. to the General Manager of BOI Ltd., the bank was intimated about withdrawal of BOI National Swasthya Bima Policy (Copy of the communication dated  26-09-2018 is herein Annexed as Exhibit “B” along with the Written Statement of OP-4 and OP-5). Thereafter , by communication dated 28-09-2018, BOI, Head Office intimated all it’s branches about the same and thereafter the said notice was displayed on Notice Board of the Bank which was for the purpose of bringing to notice of the customers, the development of discontinuation of the BOI National Swasthya Bima Policy. (Copy of the communication dated 28-09-2018 is herein Annexed as Exhibit “C” along with the Written Statement of OP-4 and OP-5).

30. The OP-4 and OP-5 states that the present complaint raises virtually the same issue and cause of action as raised in CC No. 20/2020 against the insurers and thus a second complaint on the same is not maintainable. The OP-4 and OP-5 have stated that they deny that the policy was compulsorily required to be renewable till the age of 80. And that although the policy contains a clause that the policy will be renewed till the age of 80, it is stated that this is not an enforceable clause. And as stated earlier, that the policy was required to be renewed by mutual consent of both parties. Withdrawal of the same is withdrawal of consent for renewal by the Insurance Company and therefore there is absolutely no cause of action to ask for renewal unilaterally. And that the complainant cannot compel the Opposite Parties to renew the policy as and by way of the present complaint.

31. It is further stated by the OP-4 and OP-5 that they specifically deny that the discontinuation of the scheme was wrongful or unilateral or arbitrary or amounted to repudiation of an Agreement/Contract Terms of the Opposite Parties. And that in this regard, OP Nos. 4 and 5 have repeated and reiterated that the policy was not terminated but the scheme was discontinued and all existing policies were honoured in their tenure and however, there cannot be any grievances made by the Complainant on discontinuation of policy. And that the Complainant could have availed alternate schemes, which were displayed in the notice, if he (Complainant) so desired. It is further stated by the OP-4 and OP-5 that there was no “issue” which required resolution and that the Complainant was explained that the scheme is discontinued and also a copy of the intimation letter was furnished and thus the Complainant cannot have any grievance on this count.

32. It is also stated by the OP-4 and OP-5 that they have not sold any “National Mediclaim Policy” to the Complainant and further specifically deny of receiving any premium of Rs. 28,027/- from the Complainant. And for that matter, OP-4 and OP-5 specifically deny that they have demanded or received any premium towards Mediclaim Policy as alleged by the Complainant. It is further stated by the OP-4 and OP-5 that they are not concerned with the new policy, which the Complainant claims to have availed and are not concerned with any of the difference in the premium charged by OP No. 1 to 3 and also are not concerned with the quantum of the amount to be charged for such policy. And it is stated by OP-4 and OP-5 that the Complainant has unnecessarily dragged BOI in the present litigation and therefore the Complaint is required to be dismissed in limine with exemplary cost from the Complainant.

33. That the Opposite Party No. 4 and 5 further in their written submission stated that the above complaint is in respect of the alleged termination of a “BOI National Swasthya Bima Policy” by the Respondents (Opposite Parties). That it is alleged in the Complaint that the Complainant is unable to get any health insurance cover at the rates as affordable as “BOI National Swasthya Bima Policy”.The OP-4 and OP-5 states that it is the case of the complainant that “BOI National Swasthya Bima Policy” which came to be discontinued gave a health insurance coverage upto Rs. 5,00,000/- at a nominal premium of Rs. 9,293/- per year, as against which the Complainant now has to shell out an amount of Rs. 28,027/- as an insurance premium to avail an alternate Health Insurance Scheme. That it is further alleged in the Complaint that the alternate health insurance schemes floated are full of restrictions and is riddled with co-payments and cost implication and the complainant also alleges that the insurance premium towards the erstwhile policy was only Rs. 9.5 thousand and which has been considerably risen to Rs. 65,000/- towards the new Health Insurance Schemes. It is also alleged in the Complaint that no insurance company would be willing to extend the complainant the health insurance scheme at the age of 72 at an affordable premium as was offered by the National Insurance Company and have also raised various grievance over the rising insurance premiums.

34. It is stated by the OP-4 and OP-5 that the Complainant has further alleged that for all the above reasons, there has been an unfair trade practice, deficiency of service on part of the Respondents (Opposite Parties) and therefore the Complainant has prayed to reinstate the same medical insurance at an annual premium of Rs. 10,000/- or less amount or in the alternate to pay to the Complainant Rs. 12 lakhs with other expenses.

35. It is submitted by the OP-4 and OP-5 that there is no cause of action against the Respondent (OP-4 and OP-5) Bank of India. It is further submitted by OP-4 and OP-5 that “BOI National Swasthya Bima Policy” was tailor made by the OP-4, OP-5 and the OP-1, OP-3 particularly for the Bank of India Customers. The OP-4 and OP-5 submit that the deductions and disbursements towards the premium or claim was entirely looked after by the National Insurance Company Ltd., as it is authorised to carry insurance business in India. This position is clear from the policy document attached to the Complaint. The Bank of India was not a via-medium for the payment of the insurance premium or to honor any claim.

36. It is the contention of OP-4 and OP-5 that the Bank of India has taken due care to inform it’s customers about the decision of National Insurance Company to discontinue “BOI National Swasthya Bima Policy”. The OP-4 and OP-5 submitted that the Complainant has acknowledged at para 6 of the Complaint that the withdrawal of the “BOI National Swasthya Bima Policy” by the Insurance Company was informed to the Complainant.

37. The OP-4 and OP-5 also states that the Respondent No. 3 (OP-3) vide letter dated 26-09-2018 had informed Bank of India that the Insurance Company has discontinued “BOI National Swasthya Bima Policy” w.e.f. 03-10-2018, and that no such policy will be issued thereafter. The said letter is at Exhibited as Exhibit “A” to the written version of the OP-4 and OP-5. That the OP-1 and OP-3 had also informed Bank of India that the policies expiring between 03-10-2018 to 31-12-2018 were renewable for a period of one year. The said notice is exhibited as Exhibit “B” to the written version of these respondents (OP-4 and OP-5) and that the Complaint is dated 31-10-2020 and is filed thereafter. Therefore, the present Complaint is filed beyond 2 years of prescribed limitation period and thus the present complaint is liable to be dismissed being barred by limitation.

38. It is stated by the OP-4 and OP-5 that the Complainant has further alleged that for all the above reasons, there has been an unfair trade practice, deficiency of service on part of the Respondents (Opposite Parties) and therefore the Complainant has prayed to reinstate the same medical insurance at an annual premium of Rs. 10,000/- or less amount or in the alternate to pay to the Complainant Rs. 12 lakhs with other expenses.

39. The OP-4 and OP-5 also submits that it is the National Insurance Company who has discontinued “BOI National Swasthya Bima Policy” and for this reason, deficiency in service or unfair trade practices cannot be attributed to the OP-4 and OP-5. That nowhere in the Complaint has the Complainant raised any grievance about dishonour of the claim. And that for the above mentioned reasons it is submitted by OP-4 and OP-5 that there is no cause of action against the OP-4 and OP-5 and thus the Complaint is liable to be dismissed against the Respondents (OP-4 and OP-5).

40. The Complainant and the OP-3, OP-4 and OP-5 filed their Affidavit-in-Evidence and the Written Arguments/Written submissions. Complainant have relied on the following judgements in his written arguments which are as follows:-

1. SC 2000 in Biman Bose vs. United India Insurance.
2. Gujarat HC 2003 in United India Insurance vs. Mohanlal Aggarwal.
3. Delhi HC 2007 in Akshoy Paul vs. The New India Assurance.
4. Delhi HC 2005 in Mukut Duggal vs. United India Insurance.
5. NC (2014) in DDA vs. DC Sharma

We have heard the Oral Arguments advanced by the Complainant present in person, Ld. Adv. Amey Kakodakar for the OP-3 and Adv. Mr. P. Vaze for OP-4 and OP-5 . We have perused the Complaint, the Affidavit-in-Evidence of the Complainant, OP-3, OP-4 and OP-5 and taken into consideration the advanced Oral and Written Arguments of the Complainant and the Opposite Parties (OP-3, OP-4 and OP-5) upon which the following points arise for our determination and consideration :

1. Whether there is deficiency of services and Unfair Trade Practices on part of the Opposite Parties?

Ans. Negative

Our answer to the same is in negative for the following reasons

                                                Reason to Point (a)

Upon perusal of the complaint and documentary evidences it can be seen in the present complaint that the Opposite Party No.1, 2 and 3 referred as “insurers/insurance company” together with Opposite Party No. 4 and 5 referred as “bank” jointly floated a medical insurance scheme named as “BOI National Swasthya Bima Policy” referred to as “the policy/medical policy” exclusively for the customers of the Bank.  That the grievance of the Complainant is that the “BOI National Swasthya Bima Policy” has been discontinued by the Opposite Party and therefore the Complainant could not obtain the renewal of the said “BOI National Swasthya Bima Policy” after the lapse of the BOI National Swasthya Bima Policy No. 270907501810000067 previously taken by the Complainant and thus had to take another Medical Insurance Policy.

That it is the contention of the Opposite Party No. 3 that BOI National Swasthya Bima Policy was started in the year 2008 and was continued for the period of 10 years until 03-10-2018. That the withdrawal of the co-branded health product BOI National Swasthya Bima Policy was Pan India and not to any specific region or person and the intimation of the same was made to all consumers sufficiently in advance and for those policies expiring between 03-10-2018 to 31-12-2018 it was provided that they may be renewed on the same rates terms and conditions for further period of one year only provided, the renewal is affected on time or within 30 days of expiry of current policy.

That the communication also specifically provided that the renewals falling due on 01-01-2019 and later shall not be renewed but the Policy holder can migrate to alternative products namely National Parivar Mediclaim Policy-Family Floater Policy, National Mediclaim Policy-For Single Insured. And that the Complainant himself has migrated to National Mediclaim Policy. It is seen from the contentions of the OP-4 and OP-5 that the Complainant has acknowledged at para 6 of the Complaint that the withdrawal of the “BOI National Swasthya Bima Policy” by the Insurance Company was informed to the Complainant.

It is seen from the contention of the Opposite Party No. 3 is that there was no contract between the Opposite Party No. 3 and the Complainant that the “BOI Swasthya Bima Policy” cannot be discontinued/withdrawn. Moreover, that no such term or condition can be implied in the Contract of Insurance. That the Contract of Insurance by it’s very nature is set down for a specific period during which the insurer undertakes to indemnify the insured and that after the lapse of the said period there cannot be any obligation upon the insurer to either continue with same contract of insurance or renew the same with the insured; the same being in the realm of contract. And infact, even in the “BOI National Swasthya Bima Policy” there is a specific condition that the “Policy may be renewed by mutual consent”.

And that the BOI National Swasthya Bima Policy bearing No. 270907501810000067 was the last medical insurance policy under BOI National Swasthya Bima Policy which was effective from 04-06-2018 to 03-06-2019. That although the said BOI National Swasthya Bima Policy was withdrawn and discontinued from October, 2018, the benefits of the said insurance were continued for the Complainant until the expiry of the policy i.e. midnight of 03-06-2019. That the said contention made by the OP-3 is also affirmed from the facts averred by the Complainant in his Complaint that he had an ongoing medical insurance policy of the maximum cover amount of Rs. 5.0 lakhs, the last of which was from 04-06-2018 to 03-06-2019 for a premium amount of Rs. 9,293 and which was renewable till age 80. The question that is disputed is the latter part which states “which was renewable till age of 80”. The contention of this dispute by the OP-3 is that “ And that the reference to the feature “renewable up to 80 years at 25% loading premium” means that a person can seek renewal upto his/her at age 80 and not beyond age 80 and does not mean that the BOI National Swasthya Bima Policy should be continued by National Insurance Company Ltd. till every insured under said policy reaches the age of 80 years. And that to impute such a meaning to the above words would mean that a person who is aged 20 years in January 2018 would have a right to demand that Insurance Company should continue with the BOI National Swasthya Bima Policy for the next 60 years i.e. still he/she attains 80 years. And that such an interpretation or construction is unreasonable, impractical and illogical and by no cannons of interpretation can be imputed. That the BOI National Swasthya Bima Policy categorically and expressly provides that policy may be renewed by mutual consent in their terms and conditions”.

As from the contentions of OP-3 it can be gathered that is impractical and unreasonably irrational ask and expectations or otherwise by default it means that any policy that is floated has to remain perpetually which would not be possible for any insurance company to affirm on it. It is also seen from the fact that the said insurance policy is renewed annually upon payment of the premium on time to continue the benefits. This also leaves room for the insured to also switch to any other insurance companies to avail the insurance to meet the needs of the insured. The liability of the insurance company is for the period when the insurance is in force and the OP-3 has taken care of the fact by continuing the policy benefits till the end of the policy renewal date even after having informed the Complainant in October, 2018 that the Insurance Company has decided to withdraw the BOI National Swasthya Bima Policy.

It is also seen from the contention of the OP-3 that a person of 3 months entering in the contract cannot demand that the Policy should continue with the BOI National Swasthya Bima Policy for the next 80 years till the Policy Holder turns 80 years of age on the ground that when the said insured will attain 66 years the insured will not get any other Medical Policy or that he would be left in lurch without any medical cover. And that because a person is above the age of 65 years or more he cannot compel the Insurance Company to continue the Insurance Policy and that if such an interpretation is accepted then the Insurance Company has to continue with the Policy even when the Company is going in losses.

It is seen from the contention of OP-4 and OP-5 that they deny that the policy was compulsorily required to be renewable till the age of 80. And that although the policy contains a clause that the policy will be renewed till the age of 80, it is stated that this is not an enforceable clause. And as stated earlier, that the policy was required to be renewed by mutual consent of both parties and that Withdrawal of the same is withdrawal of consent for renewal by the Insurance Company and therefore there is absolutely no cause of action to ask for renewal unilaterally. And that the complainant cannot compel the Opposite Parties to renew the policy as and by way of the present complaint. 

Further to that it is the contention of the Opposite Party No. 3 that the contention of the Complainant or the styling thereof as “macro level brochure/advertisement” or “micro-level terms” is misleading incorrect and false. And that the Complainant was informed in October, 2018 that the Insurance Company has decided to withdraw the BOI National Swasthya Bima Policy and that in this regard it may be seen that the Complainant himself has produced a letter dated November, 2018 which shows that the complainant was informed about the discontinuance of the BOI National Swasthya Bima Policy. Moreover, it is the contention of the Opposite Party No. 3 that in fact the Complainant himself has got medical insurance policy from them (OP-3) after the lapse of BOI National Swasthya Bima Policy No. 270907501810000067 and which negates the contention made in para 5 including that the complainant would be left in lurch without any medical cover or that there is a 7-10x plus costs.

Also it can be observed from the contentions of the OP-3 that they have sufficiently in advance of withdrawal of the said Medical Scheme the OP-3 had issued Notice stating that there are alternate products which can be opted for and on migration continuity benefits will be provided and the Complainant has already availed the benefits of the migration of the Policy and has been given the continuity benefits and is already insured under the National Mediclaim Policy and thus the facts and contentions of the OP-3 negates the statements that the complainant on account of discontinuance of the said medical scheme was left in the lurch without any medical cover especially as at his age in the 70’s.

That it can observed from the BOI National Swasthya Bima Policy, a document relied at  EA3 by the Complainant (as an Annexure along with the Application to replace Annexure  3 pages 8-9(verso) with it’s correct version as Annexure 3a pages 8a-9a(verso) wherein it is stated at Point 3 under the Additional Conditions that “The policy may be renewed by mutual consent, the Company shall not however be bound to give notice that it is due for renewal and the Company may at any time cancel this 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. The Company shall, however, remain liable for any claim, which arose prior to the date of cancellation. It is understood and agreed that the premium has been remitted by the bank, on collection of the same by duly debiting the account of account holders with their prior consent. On such policy of insurance being issued, the Company shall not entertain any request for cancellation and consequent refund of premium therefore on any grounds whatsoever” That it can be inferred from the fact that there is no any repudiation of contract or agreement terms by them ( Opposite Party -3) and that the decision to withdraw/ discontinuance was a policy decision by the National Insurance Company applicable PAN India and to all Policy  holders. Further to that, it can be seen that the intimation letter is valid which was handed over to the Complainant, that the complainant and the other policy holders were informed and this can be observed from the material record more particularly the notice displayed by the Bank contains clear instructions about discontinuation of the scheme and also option to migrate to alternate policies was communicated. (Copy of the notice as displayed by the Bank is herein Annexed as Exhibit “A” along with the Written Statement of OP-4 and OP-5). That the OP-4 and OP-5 states that by communication dated 26-09-2018 addressed by the General Manager of National Insurance Co. Ltd. to the General Manager of BOI Ltd., the bank was intimated about withdrawal of BOI National Swasthya Bima Policy (Copy of the communication dated 26-09-2018 is herein Annexed as Exhibit “B” along with the Written Statement of OP-4 and OP-5). Thereafter , by communication dated 28-09-2018, BOI, Head Office intimated all it’s branches about the same and thereafter the said notice was displayed on Notice Board of the Bank which was for the purpose of bringing to notice of the customers, the development of discontinuation of the BOI National Swasthya Bima Policy. (Copy of the communication dated 28-09-2018 is herein Annexed as Exhibit “C” along with the Written Statement of OP-4 and OP-5).

It is the contention of OP-3 that the premium amount of Rs. 28,027 is as per the National Mediclaim Policy and the policy was not sold under any misinterpretation as alleged. The Complainant has obtained for the National Mediclaim Policy and has paid the premium without any demurer or protest. Also the OP-3 has denied that the BOI National Swasthya Bima Policy was altogether or completely free from any restrictions or co-payments. And that as far as the joining age is concerned, the complainant has already obtained new Policy National Mediclaim Policy and as such is not affected in any manner and that in so far as the premium, the same is not about 100k but Rs. 28,027/-.

It is seen from the Contentions of the Opposite Party No. 4 and 5 that the “BOI National Swasthya Bima Policy” was floated by the Respondent (OP-1 and OP-3) (National Insurance Company) as it has requisite authorisation to carry out insurance business in India. Morever, that the insurance premiums were directly payable by the policy holder to the National Insurance Company as well as the disbursement of claim was supposed to be done by the Respondent Insurance Company. Also that the insurance policy was renewable at the mutual consent of the insured and insurer. And that the Bank of India has taken due care to inform it’s customers about the decision of National Insurance Company to discontinue “BOI National Swasthya Bima Policy” and that this fact can be ascertained from the documents relied upon by the OP-4 and OP-5 along with their Written Version/Written Statement i.e. a) For Display on Notice Board –Notice to all existing Policy holders-BOI National Swasthya Bima. b) Withdrawal of BOI National Swastha Bima Policy dated 26-09-2018 c) Discontinuation of BOI National Swasthya Bima Policy dated 28-09-2018.

It is seen that according to rules, an insurer can withdraw or discontinue any product after seeking permission from the Insurance Regulatory and Development Authority of India and explaining the reasons for doing so. However, it has to offer customers a suitable alternative and it is observed from the Exhibit B as relied upon by the OP-4 and 5 along with their  written version/written statement  i.e. “Withdrawal of BOI National Swastha Bima Policy dated 26-09-2018”  stating that “Kindly refer to our letter dated 19^th September, 2018 informing our decision to withdraw the co-branded “BOI National Swasthya Bima Policy” with effect from 03^rd October, 2018. We are offering the following 2 alternative Health Insurance Products which are duly approved by the IRDAI and are being issued by us in the market can be opted by the customers 1.National Parivar Mediclaim Policy(NPMP)-Family Floater Policy, 2. National Mediclaim Policy(NMP)-For Single Customer” which clearly affirms that there is no unfair trade practice on part of the Opposite Party(ies) (Insurance Company/Bankers).

There is an option to migrate to any of the alternative policy offered by the insurer where the premium could be much higher than what is being paid for the existing policy due to price revision as well as addition of features. The main advantage of shifting is that the policy will not be considered as discontinued which means an individual will continue to enjoy the benefits that have accumulated under the earlier policy and it is beneficial to avail of the upgrade. That the policyholder may lose benefits if he was to discontinue the existing policy and buy a new one as the customer may need to wait for four years until any pre-existing illnesses are covered. And in the present instance it can be observed from the contentions of the OP-3 that they have sufficiently in advance of withdrawal of the said Medical Scheme, the OP-3 had issued Notice stating that there are alternate products which can be opted for and on migration continuity benefits will be provided and the Complainant has already availed the benefits of the migration of the Policy and has been given the continuity benefits and is already insured under the National Mediclaim Policy and thus the facts and contentions of the OP-3 negates the statements that the complainant on account of discontinuance of the said medical scheme was left in the lurch without any medical cover especially as at his age in the 70’s as most insurers would not give medical policy to new individuals above the age of 65 years and that the few that would provide such cover would do so at a huge cost of 7-10x plus cost-sharing. The Collection receipt (National Mediclaim Policy issued by the National Insurance Company Limited) at Annexure 8 at pg. 19 of the Complaint as relied upon by the Complainant clearly points out the fact that the complainant has migrated to one of the alternative Health Insurance Products which are duly approved by the IRDAI and are being issued by them in the market to be opted by the customers i.e. National Mediclaim Policy(NMP)-For Single Customer” and this itself ascertains that the Complainant was not left in the lurch without any medical cover especially at his age in the 70’s and Moreover it is seen that that although the said BOI National Swasthya Bima Policy was withdrawn and discontinued from October, 2018, the benefits of the said insurance were continued for the Complainant until the expiry of the policy i.e. midnight of 03-06-2019.

Moreover, the Complaint does not disclose any deficiency in service by the Opposite Party No. 3 and further reiterates that there is no deficiency of service by or under the said Policy committed by the Opposite Party No. 3 or otherwise suffered by the Complainant. That the discontinuance/withdrawal of the BOI National Swasthya Bima Policy by the Opposite Party does not result in nor amounts to the deficiency of the service as defined in Section 2(11) of the Consumer Protection Act, 2019.

Thus in the light of the facts and list of documents as relied upon by the Complainant and the Opposite Parties i.e. OP No. 4 and OP-5 which substantiates the averred facts stated and submitted by the OP-3, OP-4 and OP-5 and negates the averred facts in the Complaint regarding deficiency of services and Unfair Trade Practices on part of the Opposite Parties.

2. Whether the Complainant has suffered monetary losses, damages or injury and is entitled to compensation/relief(s)?

Ans. Negative

Our answer to the same is in negative for the following reasons

Reason to point (b)

We have perused the complaint, list of documents annexed, Affidavit-in-Evidence of the Complainant and the Opposite Parties, Written arguments and advanced oral arguments of the Complainant and by the Ld. Adv. for the Opposite Parties, and upon which it can be observed that the Complainant has not suffered any monetary loss, damages or injury of any nature as alleged by the complainant.

The OP-3 also stated that there is no any repudiation of contract or agreement terms by them( Opposite Party -3) and that the decision to withdraw/ discontinuance was a policy decision by the National Insurance Company applicable PAN India and to all Policy  holders. That there was no any termination or that the BOI National Swasthya Bima Policy was discontinued/withdrawn of losses as alleged or that anything to this effect was told to the Complainant by the OP-3 and hence question of resolving the matter with Complainant does not arise.

It is seen that the Complainant was informed in October, 2018 that the Insurance Company has decided to withdraw the BOI National Swasthya Bima Policy and that in this regard it may be seen that the Complainant himself has produced a letter dated November, 2018 which shows that the complainant was informed about the discontinuance of the BOI National Swasthya Bima Policy.

It is noticed from the averred facts of the OP-3 that the intimation letter is valid, the complainant and the other policy holders were informed. This can be affirmed from the documents relied upon by the OP-4 and OP-5 to ascertain the facts as averred by them in the Written Version/Written Statement which are as follows :-

a) For Display on Notice Board –Notice to all existing Policy holders-BOI National Swasthya Bima stating that “It is brought to the notice of all policyholders of “BOI National Swasthya Bima Policy” that the said product is being withdrawn by National Insurance Company Ltd. with effect from 3^rd October, 2018’.

That it was also intimated to the existing policy holders that”....... whose policies are expiring between 03-10-2018 to 31-12-2018 shall however, have the option to renew the same for a further period of one year, and such renewal should be effected well in time, or maximum within 30 days of expiry of current policy”.

That the communication also specifically provided that the renewals falling due on 01-01-2019 and later shall not be renewed but the Policy holder can migrate to alternative products namely 1. National Parivar Mediclaim Policy-Family Floater Policy, 2. National Mediclaim Policy-For Single Insured.

b) Withdrawal of BOI National Swastha Bima Policy dated 26-09-2018 stating that “Kindly refer to our letter dated 19^th September, 2018 informing our decision to withdraw the co-branded “BOI National Swasthya Bima Policy” with effect from 03^rd October, 2018. We are offering the following 2 alternative Health Insurance Products which are duly approved by the IRDAI and are being issued by us in the market can be opted by the customers 1.National Parivar Mediclaim Policy(NPMP)-Family Floater Policy, 2. National Mediclaim Policy(NMP)-For Single Customer”

c) Discontinuation of BOI National Swasthya Bima Policy dated 28-09-2018 stating that ‘National Insurance Company Limited (NICL) in it’s communication dated 19^th September. 2018 which was received on 25^th September, 2018 has conveyed it’s decision to discontinue the co-branded product “BOI Swasthya Bima Policy” in the present form citing the unsustainability of the product. Accordingly, BOI National Swasthya Bima Policy is being withdrawn with effect from 00.00 hrs of 3^rd October, 2018’.

These documents clearly shows that the Opposite Parties have taken steps to inform the insured (Complainant) which has been affirmed by the Complainant in his complaint.

It is seen as per the contention of the OP-3, the premium amount of Rs. 28,027 is as per the National Mediclaim Policy and the policy was not sold under any misinterpretation as alleged. The Complainant has obtained for the National Mediclaim Policy and has paid the premium without any demurer or protest. Also the OP-3 has denied that the BOI National Swasthya Bima Policy was altogether or completely free from any restrictions or co-payments. And that as far as the joining age is concerned, the complainant has already obtained new Policy National Mediclaim Policy and as such is not affected in any manner and that in so far as the premium, the same is not about 100k but Rs. 28,027/-. That the issue has been exaggerated by the complainant in terms of the premium paid for the new policy (National Mediclaim Policy) which can be inferred from the facts stated in the complaint and the contentions of the Opposite Party. The Complainant has also not spelled out or failed to explain out the several conditionalities as stated in his complaint.

It can be inferred that the Opposite Parties have not caused any mental, physical and financial trauma to the complainant. Hence, upon consideration of the averred facts and the documents on record, we derive an opinion that there is no monetary losses suffered, incurred any damage or injury and thus the Complainant is not entitled to any compensation/relief(s).

In the light of the above perused complaint along with annexed documents, written version annexed with documentary evidences on record to substantiate the averred facts, Affidavit in Evidence, Written Arguments, advanced oral arguments and upon considerations and discussions, we find that the complainant has not made out any case of deficiency in service and Unfair Trade Practice against the Opposite Parties. That the Complaint is wholly meritless and Complainant fails to spell out the existence of any cause of action against the Opposite Parties and in favour of the Complainant and has also failed to prove the loss ratio or the kind of damage/injury incurred to him and as such the Complainant is not entitled for the reliefs claimed.

Accordingly we pass the following order :-

ORDER

The Complaint is dismissed with no order as to costs.

Pronounced in Open Court.

Proceedings  closed.

                                                                         Ms. Bela N. Naik

         President

                                                                                 Mr. Auroliano De Oliveira

              Member

Ms. Rejitha Rajan                                                                                                               Member