Date of filing: 27.02.2017 Date of disposal:31.05.2018
Complainant: Sri Taraprasanna Mondal, S/o. Ardhendu Sekhar Mondal, resident of Vill: Chowdhury Chira Mill Lane, Ramkrishnapally, Kalna Road, PO., PS. & Dist: Burdwan, PIN – 713 101.
-VERSUS-
Opposite Party: 1. New India Assurance Company Limited, Represented by its Branch Manager, having its office at R. G. Bhawan (1st Floor), PO: Sripally, PS. & Dist: Burdwan, PIN – 713 103.
2. The Director, New India Assurance Company Limited, having its registered and Head Office at New India Assurance Building, 87, M. G. Road, Fort, Mumbai – 400 001.
Present: Hon’ble President: Smt.Jayanti Maitra(Ray).
Hon’ble Member : Dr. Tapan Kr. Tripathy.
Appeared for the Complainant: Ld. Advocate, Suvro Chakraborty.
Appeared for the Opposite Party No. 1 & 2: Ld. Advocate, Shyamal Kr. Ganguli.
J U D G E M E N T
This complaint is filed by the complainant u/S. 12 of the C.P. Act, 1986 alleging deficiency in service and unfair trade practice against the OPs as the Ops have taken excess amount for the mediclaim policy and did not refund the same.
The case of the complainant in brief is that the complainant for covering the risk of health of his own, his spouse and his son incepted a mediclaim insurance policy from the OP for the first time in the year 2007. Thereafter the complainant on each and every time used to renew the said policy by paying premium amount to the OP and the OP renewed the policy on each and every year. The procedure of renewal was continued up to 29.05.2013 i.e. the date of renewal of policy for the year 2013-14. It is pertinent to mention here that for the year 2013-14 the number of the policy was 51250234130100000157 which was valid from 29.05.2013 to 28.05.2014. The complainant further submits that at the time of renewal of his policy for the year 2014-15 became surprised as the OP asked the complainant for payment of Rs. 12,329=00 towards premium amount. On enquiry the OP stated that as premium amount has been increased so such excess amount is required for renewal. After going through the policy the complainant came to learn that the OP received Rs. 6,320=00 towards premium amount for his coverage whereas total basic premium of Rs. 4,800=00 and family discount was Rs. 480=00, i.e., the OP received Rs. 2,000=00 excess amount but had not described the same in the policy document. The complainant further submits that after receiving policy documents he further asked the OP regarding excess amount of Rs. 2,000=00 but at the first instance they failed to describe the reason. Thereafter the complainant came to learn that Rs. 2,000=00 is received by the OP towards entry load as the age of the complainant cross 60 years. As such the complainant requested the OP for returning the excess amount but the OP kept themselves mum. The complainant wrote letter dated 11.12.2014 requested the OP for refunding the excess amount of Rs. 2,000=00, then the OP assured the complainant that they will adjust the said amount at the time of renewal of the policy for the year 2015-16. The complainant further submits that at the time of renewal of the policy for the period for 2015-16 the OP asked the complainant for paying Rs. 12,329=00 towards premium amount. When the complainant reminded about the assurance of adjustment of excess amount the OP instead of adjusting Rs. 2,000=00 extracted from the complainant at the time of renewal of policy for the year 2014-15 without description, compelled to pay the huge premium. After receiving the policy document the complainant came to learn that the OP added Rs. 2,000=00 on the head “Entry Load”. After going through the “Mediclaim 2012 Policy-Prospectus”, came to learn that “Entry Load” only cam be applicable for those persons who got policy for the first time and whose age is 60 or more. As such the complainant again submitted a letter dated 11.06.2015 before the OP and requested for refunding excess amount for the year 2014-15 & 2015-16. But the OP failed to do the same. Thereafter complainant five times sent e-mail to take immediate step and the OP vide their e-mail on 17.07.2015 acknowledged about the e-mails and letters of the complainant but neither take any step towards refunding the excess amount nor has given any reply till date of filing of this complaint. It is pertinent to mention here that at the time of renewing the policy for the year 2016-17 the OP has not deducted any amount towards “Entry Load”. These acts of the OPs are amounting to deficiency in service and unfair trade practice and they are liable to compensate the complainant. The cause of action of this case firstly arose in the year 2014 and then it was again arisen on 28.05.2015 when the OP handed over the policy document to the complainant. The complainant prayed for directing the Ops to refund Rs. 4,000=00 by holding them liable for their deficiency in service and unfair trade practice, directing the Ops to pay interest @12% p.a. upon the extracted amount, directing the OPs to pay a sum of Rs. 50,000=00 towards mental pain, agony and harassment suffered by the complainant and to pay Rs. 20,000=00 as litigation cost.
The OP-1&2 contested the case by filing conjoint written version denying all the material allegations made by the complainant in his petition of complaint. The case of the OPs in turn is that the complainant incepted a mediclaim policy from the OP-1&2 in the year 2007 for the purpose of covering risk for himself and family members for getting the risk coverage of Rs. 1, 00,000=00 in respect of his wife Jyotsna Mondal, himself and their son Nilkanta Mondal. During the renewal time, the proposer was changed in the name of Nilkanta Mondal. As per policy guideline and policy terms and conditions the old proposer automatically will be deleted from the policy and to reinstate the old proposer as member, it will be incorporated as new member because, as per Mediclaim 2012 policy condition under clause 23 entry loaded will be charged @Rs. 2,000=00 as the complainant attaining the age of 60 years and it will be continued for two years and if there was no claim lodged it will be waived in the third year renewal time. So the OP-1&2 charged entry loading in the year 2014-15 & 2015-16 @Rs. 2,000=00 for two years, i.e. Rs. 4,000=00 and no entry loading charged in the year 2016-17.
The Op-1&2 further stated that the content of Para No. 6 of the complaint the allegation of the complainant is absolutely false and in completely rejected. The complainant intentionally misleading the ld. Forum with false claim. There is no basis of the complaint petition as all the process is system generated and maintaining the policy conditions of the Company. Therefore, there is no question of harassment and deficiency in service and unfair trade practice. So there is no question to compensate the complainant. The case of the complainant is baseless, frivolous and without any basis and the complaint be dismissed on the basis of the settled principle of law with heavy cost.
Decision with reasons:-
To prove the case the comp0laiant has filed his evidence on affidavit where he categorically stated all the facts which he stated in his complaint petition and also the prayer which he made in the complaint. The O.Ps. also filed their evidence on affidavit. O.P. did not file any questionnaire to the complainant. So also the complainant did not file any questionnaires to the O.P. Thereafter, both sides place their elaborate argument in support of their respective cases. The complainant filed documents like policy papers and correspondence between the complainant and the O.Ps. as the complainant asked the O.Ps. to repay the excess insurance amount of Rs.4000/- as alleged. In reply the O.Ps. filed documents Annexure-A. In the written version the O.Ps. statement is that Mediclaim Insurance Policy of 2007 was incepted by the complainant with his wife Jyotsna Mondal covering risk for himself, his wife and his son Nilkanta Mondal for getting the risk coverage of Rs.1,00,000/- each. But during renewal time the proposer was changed in the name of Nilkanta Mondal in place of the complainant. As per policy guideline and as per policy terms and conditions the old proposer automatically will be deleted from the policy and to reinstate the old proposer as member, it will be incorporated as new member. Because as per Mediclaim 2012 Policy condition under clause-23, entry loading will be charged @ 2000/- as the complainant attaining the age of 60 years. It will be continued for two years and if there was no claim lodged it will be waived in the third year renewal time. Therefore, O.Ps. charged entry loading in the year2014-2015 and 2015-2016 @ Rs.2000/- for two years, i.e. Rs.4000/- and no entry loading charged in the year 2016-2017, copy of the policy for 2014-2015, 2015-2016 and 2016-2017 enclosed marked as Annexure-B. Thus, O.Ps. explained as to why the charge of Rs.4000/- as entry loading was received by this O.P. in the year 2014-2015 and 2015-2016. To that extend O.ps. submitted Annexure-A, Mediclaim 2012 Policy Prospectus. In that documents clause-23 explains, what is entry loading; that sum assured up to three lakhs and attaining age 61 to 65 Rs.2000/- is charged as entry load. Complainant however admits that as he attained the age of 60 years Rs.2000/- was charged as entry loading.
After hearing argument of both sides and on perusal of evidence of record as well as documents filed and the Prospectus of Mediclaim Policy 2012 it is clear that the O.P. Insurance Company charged entry loading for successive two years @Rs.2000/- and no entry loading charged in the year 2016-2017. The policy papers of 20162017 is also filed. Therefore, we do not find any deficiency in service and unfair trade practice on the part of the O.Ps. O.Ps. is entitled to receive the entry load as the complainant at the time of renewal the policy the name of the proposer was changed and old proposer automatically is deleted from the policy to reinstate the old proposer as member and complainant’s son is the new member as per the M ediclaim Policy 2012. Therefore, as per clause-23 entry load is charged @ Rs.2000/-. O.Ps. have not received any excess payment from the complainant in this regard and the question of refunding the same does not arise. As a result the complainant is not entitled to get any relief as prayed for. Thus the complaint case fails. Hence, it is
Ordered
that the case be and the same is dismissed on contest against the O.Ps. without any cost.
Let the copies of this order be supplied to the parties free of cost.
Jayanti Maitra (Ray)
Dictated and corrected by me. President
D.C.D.R.F., Burdwan
Jayanti Maitra (Ray)
President
D.C.D.R.F., Burdwan
(Tapan Kr. Tripathy)
Member
D.C.D.R.F., Burdwan
