PRESIDENT

 1)       By this complaint the Complainant has prayed to direct the Opposite Parties to renew Policy No.111400/34/08/11/00018467 from 03/01/2010 to 02/01/2011 and further from 03/01/2011 to 02/01/2012 and also further policies at the rate of original premium of Rs.4,797/- per annum which is payable from the date of renew.  It is also prayed that the Opposite Parties be restore the bonus of Rs.52,500/-.  It is further prayed that the Opposite Parties be directed, if they are unable to renew the policy and restoring the bonus then in that case they be directed to pay principal amount of insurance of Rs.1,50,000/- + Rs.52,500/- bonus amount = Rs.2,02,500/- with interest @18% from 03/01/2010 till its full realization as per the particulars of claim marked as Exh.‘N’ to the complaint.  It is also prayed that the Opposite Parties be directed to refund the difference of colleting the insurance premium from Rs.4,697/- to Rs.7,483/- i.e. Rs.2,786/- for the period 2008-09 and 2009-10, having total of Rs.5,572/- with interest @ 18% per annum from the date of collecting as per the particulars of claim marked in Exh.‘N’ to the complaint.  It is also prayed that the Opposite Parties be directed to pay compensation for mental agony, trouble and stress suffered by the Complainant to the tune of Rs.1,00,000/- as claimed in Exh.‘N’ to the complaint.  The complainant has also prayed the Opposite Parties be directed further interest @ 18% on Rs.3,62,405/- from the date of complaint till realization of the said amount and cost of the complaint.

 2)        According to the Complainant, he is the consumer as provided under Sec.2(1)(d)(ii) of the Consumer Protection Act, 1986 (hereinafter referred to the Act).  The Opposite Parties are guilty of deficiency of service and unfair trade practice within the definition under Sec.2(1)(g) and 2(1)(r) of the said Act.   It is alleged that the Complainant is covered by Medical Insurance Policy issued by Opposite Party No.1 since 1991.  The Complainant has been regularly renewing the said policy.  According to the Complainant, the current policy in respect of which the dispute/complaint arose was issued for the period 03/01/09 to 02/01/2010 having Policy No.111400/34/08/11/00018467.  According to the Complainant, he maintained good health and there was no claim on account of his health.  However, the Opposite Parties without any reason and without any prior intimation or notice has increased the annual premium from Rs.4697/- to Rs.7,483/- for the period 2008-09 and 2009-10.  According to the Complainant on receipt of the above policies he had made written requests to the Opposite Parties and to the Chairman of the Opposite Parties to reconsider the exorbitant loading in annual premium by letter date 02/03/09, 13/05/09, 23/07/09, 01/02/2009 11/11/02010 . The copies of which are at Exh.‘B’.  It is the case of the Complainant that the Consumer Forum has observed that Insurance Company cannot load the premium since the same being arbitrary unjustified and contradicting the terms of policy and the same is deficiency in service and unfair trade practice and the Forum has observed that the Opposite Parties to refund the excess load so charged to the consumer.  The Complainant has relied the copy of newspaper report, reporting such cases marked at Exh.‘C’.

 3)        According to the Complainant the renewal of his policy due on 02/01/2010 but the Opposite Parties did not send any renewal notice to the complainant.  However, he had made out his blank cheque on 01/01/2010 so that any recovery agent comes from the office of the Opposite Parties and the cheque can be delivered to him. It is submitted that inspite of non receipt of notice of renewal of policy and for collection of cheque the Complainant sent readymade blank cheque to the office of Opposite Party No.1 on 08/01/2010 through his son Pratik Hasmukh Mehta, however, the Opposite Party No.1 refused to accept the cheque and renew the policy. The Complainant also personally visited to the office of the Opposite Party No.1 on or about 15/01/2010 but as the manager was busy with his staff the Complainant was asked to approach the agent who was not traceable, the Development Office was also not available before 4 p.m.  It is submitted that the Complainant had contacted various authorities as alleged in the complainant and forwarded various letters marked as Exh.‘D’ to ‘M’. It is alleged that the Complainant came across the press release that Insurance Companies cannot refuse to renew health policy as per the guidelines of I.R.D.A. and as per the Judicial Orders. The Complainant also relied the said newspaper report.  The Complainant has thus, submitted that it be held and declare that the Opposite Parties are guilty of deficiency in service and unfair trade practice as per the provisions of the Act and prayed for the reliefs as per para 1 of this order.

 4)        The Opposite Parties filed their written statement and contested the claim.  It is contended that there is no deficiency in service and unfair trade practices on the part of Opposite Parties within the meaning and definition of the Act.  It is admitted that the Complainant is covered by Mediclaim Policy since 1991 and was renewing till the date of complaint.  It is contended that the premium payable by the policy holders depend upon various factors and is fixed as per the guidelines issued by I.R.D.A.  It is contended that the business of the Insurance Companies is run as per the guidelines of I.R.D.A. and not on any newspaper reporting and judgment and orders passed by the Consumer Forums as the basis of case to case cannot be common.  It is denied that the Opposite Parties refused to renew the policies of the Complainant inspite of due payment.  It is contended that the Complainant has not disclosed true facts of the case and tried to mislead the Forum hence, the complaint is liable to be dismissed with cost

5)        The Complainant has filed rejoinder to the written statement of the Opposite Parties.  The Opposite Parties filed affidavit of Paunikar, Divisional Manager of Opposite Party No.1.  The Complainant has filed written argument.  The Opposite Parties did not file written argument.  We heard the Complainant and Smt. Kalpana Trivedi, Advocate for the Opposite Parties.

 6)        While considering the claim made by the Complainant as regards increase of premium from Rs.4,697/- to Rs.7,483/- for the period 2008-09 and 2009-10 we have to consider the documents i.e. the policy premium receipt 05/06/2007 for the policy period 06/06/07 to 05/07/08  placed on record.  It appears that the Opposite Parties have accepted total premium of Rs.4,697/- from the Complainant and as per receipt dtd.02/01/09 for the policy period 03/01/09 to 02/01/2010, the Opposite Parties have accepted total premium of Rs.7,483/- from the Complainant.  Thus, the case made out by the Complainant that the Opposite Parties have increased the premium for the period 2008-09 and 2009-10 is proved by the Complainant.  The Complainant has come out with the case that he maintains good health and therefore, there was no claim on account of his good health.  The Opposite Parties have also no contended that the Complainant had submitted any claim from the year 2007 onwards till the filing of this complaint regarding his hospitalization and the same was granted by the Opposite Parties.  The bonus of Rs.52,500/- is also shown due to the Complainant as per the document at Exh.‘A’ filed with the complaint.  It appears that the Opposite Parties have increased the premium of more than 50% while renewal of the policy for the period 2008-09 and 2009-10 against the Complainant.  In the present case the Opposite Parties in their written statement have not justified how the premium which is increased of the aforesaid period is justifiable.  On perusal of the premium receipt dtd.05/06/07, it appears that under the said policy the Complainant and his wife both were insured and the sum assured of each of them was shown at Rs.1,00,000/-.  In the premium receipt dtd.02/01/09 which is placed on Exh.‘I’ the name of insured person is only shown of Complainant and the sum assured is shown to the tune of Rs.1,50,000/- that means that under the earlier policy for 2007-08 the Opposite Parties assured to pay sum of Rs.2,00,000/- in total to the above two insured persons.  However, in the later policy the Opposite Parties assured to pay Rs.1,50,000/- to only one individual i.e. Complainant by increasing the premium of Rs.2,786/-. The Hon’ble Supreme Court in the case of Biman Krishna Bose V/s. United India Insurance Co. Ltd. held that –

            “A renewal of an insurance policy means repetition of the original policy.  When renewed, the policy is extended and the renewed policy in the identical terms from a different date of its expiration comes into force.  In common parlance, by renewal, the old policy is revived and it is sort of a substitution of obligations under the old policy unless such policies provided otherwise.  It may be that on renewal, a new contract come into being, but the said contract is on the same terms and conditions as that of original”. 

            Considering the aforesaid observations and the Opposite Parties have not brought on record as to why the insurance premium has been increased more than 50% of the earlier premium which the Complainant used to pay to the Opposite Parties, in our view thus, the case made out by the Complainant that the Opposite Parties by increasing the insurance premium without any justification have indulged in unfair trade practice against the Complainant can be said proved by the Complainant. 

 7)        The Case made out by the Complainant that the Opposite Parties did not accept the request for the renewal of his policy though he had submitted the cheque dtd.01/01/2010 for the renewal of policy for the period 03/01/2010 to 02/01/2011 without receipt of any renewal notice from the Opposite Parties alongwith his son on 08/01/2010 and the Opposite Parties be directed to renew the policy for the aforesaid period and further from 03/01/2011 to 02/01/2012 and so on at the rate of original premium of Rs.4,697/- p.a. can be accepted as the Complainant has placed on record the xerox copy of the blank cheque issued in the name of Opposite Party of Syndicate Bank at Exh.‘G’ to the complaint.  The Complainant has also placed on record the letters issued by him to the office of Insurance Ombudsman at Exh.‘D’ & ‘E’ making complaint against the Opposite Parties regarding non acceptance of the cheque dtd.01/01/2010 for renewal of his policy.  The observations of Hon’ble Delhi High Court in the case of Mukut Lal Duggal V/s. United India Insurance Co. Ltd., reported in 2006 ACJ 1576 in our view can be said applicable in the present case in which it is held that the movement insured pays the premium in time the acceptance of that offer is complete and there would be no option with the insurer to deny renewal.  The Hon’ble Supreme Court in the case of Biman Krishna Bose (Supra) also held that once it is found that the act of the Insurance Company was arbitrary in refusing to renew the policy, the policy is required to be renewed with effect from the date when it fell due for its renewal.  Considering the aforesaid observation and the facts alleged by the Complainant in this case and as the Opposite Parties did not bring any contrary evidence against the case made out by the Complainant, we hold that the Opposite Parties are liable to renew the medical policy in favour of the Complainant for the period 03/01/2010 to 02/01/2011 and further from 03/01/2011 to 02/01/2012 and also for further period from 03/01/2013 to 01/01/2014 on the same terms and conditions on payment of premium of Rs.4,697/- towards each policy period indicated above.  However, for future it is open to the Opposite Parties to load the premium to a limited extent in case of high payment for insurance cover, if any paid to the Complainant.  In view of the aforesaid discussion we find that the Opposite Parties are guilty in deficiency in service as they failed to renew the policy for the period 03/01/2010 to 02/01/2011 though the Complainant has offered the payment by cheque on 01/01/2010.  We also hold that the Opposite Parties have wrongly increase the premium though the Complainant has not filed any claim during the period since he obtained the medical policy till filing of the complaint and thereby adopted unfair trade practice against the Complainant.  In the result in view of the prayers made by the complaint as per the order below the following directions needs to be issued against the Opposite Parties.  Hence, the order -

O R D E R

i.                    Complaint No.74/2011 is partly allowed against the Opposite Parties.

ii.                 The Opposite Parties are directed to refund an amount of Rs.5,572/- (Rs.Five Thousand Five Hundred Seventy Two Only) with interest @ 6% p.a. from the date of this complaint till its realization to the Complainant.

iii.               The Opposite Parties are directed to renew the Policy No.11400/34/08/11/00018467 for the period 03/01/2010 to 02/01/2011, for the period 03/01/2011 to 02/01/2012 and for the period 03/01/2013 to 02/01/2014 on payment of amount of Rs.4,697/- (Rs.Four Thousand Six Hundred Ninety Seven Only) by the Complainant towards each policy period to the Opposite Parties within the period of one month from the date of this order.  Failure to comply by the Complainant the order of renewal of the policies for the aforesaid period in favour of Complainant would be inoperative.

iv.               The Opposite Parties are directed to add the bonus amount due in favour of the Complainant while issuing the policies for the aforesaid period and on the same terms and conditions, if the Complainant pays the premium as directed above within the stipulated period while issuing the policies in favour of the Complainant. The Opposite Parties are, however at liberty to load the premium to a limited extend in case of high payments for insurance cover would be made to the Complainant in future.

v.                  The Opposite Parties are directed to pay compensation for mental agony and hardship suffered by the Complainant to the tune of Rs.15,000/- (Rs.Fifteen Thousand Only) and cost of Rs.3,000/- (Rs.Three Thousand Only) towards this complaint.  

vi.               The Opposite Parties are directed to comply the aforesaid order of Clause ii & iv within one month from the date of receipt of this order.   The Opposite Parties are further directed to comply the order Clause no. iii & iv after one month on compliance of the directions given to the Complainant regarding payment of premium for the renewal of policies 2010-11, 2011-12, 2012-13.

vii.             Certified copies of this order be furnished to the parties.