Date of Filing: 09/01/2018
Date of Judgement : 20/12/2023
Sri Sudip Niyogi, Hon’ble President
BRIEF FACTS
Complainants who have a Savings Bank Account bearing No. 0904219300025 with the Oriental Bank of Commerce i.e. OP 1, on being approached, obtained one Mediclaim Insurance Policy from Oriental Insurance Co. Ltd. i.e. OP 2 with family floaters i.e. for both the complainants and upon getting the necessary paper works. The premium of Rs.6,991/- was paid by cheque bearing No. 10371 for a period of one year. The said cheque was encashed by OP 1 on 9/12/2016. The amount of coverage of the policy was Rs.5 lakh. On 13/12/2016, complainant No. 1 alongwith her husband i.e. complainant No. 2 met with a road accident while travelling through Durgapur Express Way in which OP 2 sustained severe injuries on his face and legs for which he had to be admitted and treated at R.S.V. hospital Pvt. Ltd., Kolkata on that date and thereafter on 16/12/2016, he was discharged from the said hospital and they had to incur an amount of Rs.66,789.50 for medical and other expenses. Subsequently, on being approached by the complainants, OP 1 did not provide any document with regard to the said policy and neglected to render any sort of co-operation to the complainants for getting reimbursement of the amount spent by them. Several letters were issued by them on different dates. Despite having received the same, neither of the OPs did anything. Ultimately complainants lodged a complaint with the Consumer Grievance Redressal Cell, Govt. of West Bengal, but solution remained elusive. Finally, they were compelled to approach this commission seeking relief in the form of directions upon the OPs to reimburse all the amount spent by them alongwith interest, compensation and cost of litigation etc.
Both the OPs contested this case by filing separate written version and also producing evidence. According to OP 1, this complaint is not at all maintainable. After deduction of the amount of premium from the account of the complainant on 9/12/2016, they (OP 1) could not send the same to OP 2 for a couple of days because of the holidays and thus contended that there was no negligence on their part. OP 2, the insurance company claimed that the mediclaim policy bearing No. 311700/48/2017/10114 was issued in favour of the complainants was valid from 20/12/2016 to 19/12/2017 and therefore complainants are not entitled to any relief in this case as on the relevant date on 13/12/2016 when the alleged accident occurred, there was no policy coverage. So, the instant complaint is liable to be dismissed.
Both the parties are found to have filed evidence, exchanged questionnaires and replies only with the exception that OP 2 did not file replies to the questionnaires of the complainants. Written argument was also filed in connection with this case.
Now, the points for consideration are :-
- Whether the instant case is maintainable?
- Whether the complainants are entitled to any relief(s) in this case?
FINDINGS
Both points are taken up together for discussion.
We have gone through the materials on record, including the evidence, documents filed by the parties. Also gone through the written argument submitted in connection with this case.
What we find, it is admitted by OP 1 that one insurance policy was obtained by the complainants from OP2 through OP 1 with whom the complainants have got a Savings Bank Account. It is also admitted that the coverage of the said insurance policy was for one year and the assured amount was Rs.5 lakh. Further, it is admitted and also found from the documents produced on behalf of the complainants, that the amount of premium for one year of Rs.6,991/- was deducted from the Savings Bank Account of the complainants with OP 1 on 9/12/2016. But the interesting thing which has been surfaced/revealed from the documents is that, as claimed by OP 2 that the policy of the complainants was issued for one year from the date of 20/12/2016 to 19/12/2017 in favour of said Sri Sourindra Mohan Dey alongwith his wife Smt. Niva Dey and not from the date of 9/12/2016 when the amount of premium was deducted from the account of the complainants.
The contention of OP 1 is that, after the encashment of the amount of premium on 9/12/2016, the proposal form alongwith D/D was not sent immediately and the same was ultimately sent on 13/12/2016 to OP 2 as there were holidays in between being 2nd Saturday and Sunday. This claim of OP 1 seems not only a ridiculous one, but reveals the lackadaisical attitude on their part as to how they conducted their business. It was not shown by this OP 1 as to what prevented them from taking necessary action immediately, considering the nature and gravity of the matter and particularly when they deducted the amount of the premium from the account of the complainants the same day.
It is found from the questionnaires and replies, OP 1 acted on behalf of OP 2 and also admitted that the relation between OP 1 & 2 was contractual. So, OP 1 acted on behalf of OP 2. Again complainants in their questionnaires to OP 2 suggested that OP 1 acted as an agent of OP 2 to promote the mediclaim policy and also wanted to know as to the mode of transfer of amount of premium in favour of OP 2. Curiously enough, OP 2 avoided issuing any replies to the said questions of the complainants.
In this connection, be it mentioned here that in Civil Appeal No. 6731 of 2022 D-d 23/9/2022 (Smt. Sulakshna-vs-Oriental Insurance Co. Ltd. and another) it was observed by the Hon’ble Appex Court with regard to the insurance claim that the authorizer might have remitted premium with insurance company belatedly, however, for the same, insured cannot be made to suffer. In another case of fire insurance (Ref. Civil Appeal No. 5103 of 2002) D-d 23/9/2008 Deokar Exports Pvt. Ltd.-vs-New India Assurance Co. Ltd., Hon’ble Appex court held that the policy would cover only for period of one year effective from the date of receipt of premium.
Here we find that complainants requested on several occasions in writing, for redressal to both the OPs, but they didn’t get any co-operation from the OPs, for which they were compelled to approach this commission.
The documents produced by the complainants include discharge certificate and final bill raised by the RSV hospital where complainant Sri Sourindra Mohan Dey was treated from a period from 13/12/2016 to 16/12/2016 and it is found that the complainants had to pay Rs.63,102 to the said hospital. This apart, complainants also had to pay expenses on account of medicines etc. thereby making the amount of expenditure in total Rs.66,789.50.
Considering the nature of the complaint and the relief(s) claimed therein, we find that complainants are consumers in accordance with the term as defined by the C.P. Act, 2019 and therefore the instant case is found to be quite maintainable.
As observed above, we find that the complainants are entitled to receive the said amount of Rs.66,789.50 or pay Rs.66,790/- alongwith interest @9% per annum from 18/1/2017 when the complainants first requested by issuing a letter addressed to both the OPs for getting the said amount reimbursed but refused. It is also found that complainants are elderly persons and in persuing their case for getting reimbursement, all through they had to suffer a lot. It is further found that the instant case has been pending since the year of 2018.
So, considering all these, we are inclined to allow for the complainants Rs.30,000/- towards compensation and cost of litigation.
Accordingly, it is
ORDERED
That the instant case stands allowed on contest against both the OPs.
Both the OPs are directed to pay Rs.66,790/- with interest @ 9% from 18/1/2017 until realization of the of the same to the complainants.
Both the OPs are also directed to pay Rs.30,000/- towards compensation and cost of litigation to the complainants.
Both the OPs who are jointly and severally liable, shall comply with this order within a period of 30 days from the date of this order failing which, the complainants shall be at liberty to proceed in accordance with law.
Dictated and corrected by me
PRESIDENT
