- Sri Rajesh Kumar Bajpai,
1B, Tottee Lane, P.S. New Market, Kolkata-16. _________ Complainant
____Versus____
- Reliance General Insurance Co. Ltd.,
570, Nigam Cross Road, Nest to Royal
Industrial Estate, Wadala (W), Mumbai-400031 and
Policy Servicing Office,
38-B, Jawaharlal Nehru Road, 8th Floor,
Kolkata-71, P.S. Shakespeare Sarani. ________ Opposite Party
Present : Dr. Subir Kumar Chaudhuri, Member.
Smt. Samiksha Bhattacharya, Member
Order No. 25 Dated 06-02-2014.
The case of the complainant in short is that by way of advertisements and through their agents o.p. offered a mediclaim policy under “Plan Gold” against payment of yearly premium of Rs.1492/- for the sum insured Rs.1 lakh with certain benefits i.e. hospitalization expenditure, domiciliary hospitalization etc. believing in good faith and being allured by the representation and assurance given by o.p. complainant subscribed the mediclaim insurance policy under Plan Gold being policy no.282520078723 (policy valid till 11.7.08). Surprisingly o.p. went on increasing the premium rate every year. O.p. realized Rs.1986/- for the period from19.7.08 to 18.7.09, Rs.1417/- for the period from19.7.09 to 18.7.10 and Rs.7646/- for the period from 19.7.10 to 18.7.11. For this increasing rate of premium complainant took up the matter over phone as well as by personal representation. However, to keep his policy alive complainant continued to pay the premiums. O.p. assured the complainant that excess amount will be refunded to him after settlement of grievances raised by him. But o.p. took no effective steps. Complainant lodged his grievances to IRDA vide his letter dt.4.11.10. Pursuant to that complaint lodged by the complainant o.p. vide their letter dt.24.11.10 rendered explanation in support of their increasing premium rates. O.p. also sent another letter dt.24.11.10 assuring to review the complainant’s complaint. Complainant again sent a letter to IRDA on 4.1.11. But complainant did not receive any further response from o.p. Decision of increasing the premium rate by o.p. is illegal, arbitrary and unfair trade practice and also against the principle of natural justice. As this policy is a contract by the parties it cannot be changed unilaterally. Therefore, complainant prays o.p. to pay premium at existing offered and agreed rate of Rs.1492/- per year and to refund the excess amount paid by the complainant along with compensation.
O.ps. had entered their appearance in this case by filing w/v and denied all the material allegations.
In their w/v o.p. has stated that no cause of action has been arising in the instant case. O.p. has been carrying general insurance business according to provision of IRDA. O.p. was forced to increase the annual premium for the health insurance cover due to (i) health claim inflation rate, (ii) increasing incidents of illness and hospitalization, (iii) increase in the cost of health care and (iv) rates prevailing in Indian insurance market. They have also mentioned the premium structure for health insurance cover had been made for all the existing customers and also for any new customers. O.p. cannot provide any special privilege to any particular insured. O.p. has also issued renewal notice to the insured well in advance and the insured has enough opportunity to choose another insurance company for obtaining health insurance cover at a lower rate. So there is no deficiency on the part of o.p. and as such, the instant complaint is liable to be dismissed with exemplary cost.
Decision with reasons:
We have gone through the pleadings of the parties, evidence and documents in particular. It is admitted fact that complainant has one mediclaim policy under Plan Gold against payment of yearly premium for the sum insured of Rs.1 lakh. It is also admitted fact that this mediclaim policy is continuing irrespective of difference in premium rate. Complainant has alleged in his complaint that he has given the enhanced premium rate under protest, but when the question was put to complaint on this very issue whether complainant raised any protest letter to o.p. The complainant’s answer was he had made repeated personal visits at Kolkata office of o.p. and raised his protest. So it is evident that he had not sent any protest letter. Moreover, complainant discloses in his answers that he did not know other companies which are doing business of health insurance in India. This is not believable as the complainant is a practicing lawyer. Insurance premium cannot be increased suo moto by any insurance company. IRDA is the best authority to decide the amount of premium. Consumer Forum is not in a position to decide the premium rate. This o.p. is also guided by IRDA Act, 1999. Complainant being proposer was not enforced to take policy and he had optioned to choose any other insurance company. Insurance policy is nothing but a contract where insured is a proposer and such proposal if accepted by an insured, after payment of requisite premium the policy is issued and the contract of insurance comes into force. U/s 13 of the Contract Act, 1872 the consent has been defined as “Two or more persons are said to consent when they agree upon the same think in the same sense”. Here in the instant case the complainant was not enforced to approach o.p. for his insurance needs. As the complainant paid the enhanced premium the allegation of forceful enforcement does not stand. In this connection, we have also relied upon the case of LIC of India vs. Consumer Educational Research Centre reported in (1995) (5) SCC 482. Therefore, the complainant is not entitled to any relief as there is no deficiency in service on the part of o.p.
Hence, ordered,
That the case is dismissed on contest without cost against the o.p.
