Delhi

North East

RBT/CC/258/2022

SUNIL KUMAR JAIN - Complainant(s)

Versus

RELIGARE HEALTH INSURANCE CO.LTD. - Opp.Party(s)

24 Apr 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

 

                                             RBT/Complaint Case No. 258/22

 

 

 

In the matter of:

 

 

 

	Sh. Sunil Kr. Jain S/o Sh. Niranjan Lal Jain R/o H-1, Ansal Villa, Satbari, Delhi-110074	Complainant
	Versus
	Religare Health Insurance Co. Ltd. 601-6th Floor Pearl Omaxe, Netaji  Subhash Place, Pitampura, New Delhi-110034   Also at Registered Office:- Religare Health Insurance Co. Ltd. 5th Floor, 19,Chawla House, Nehru Place,New Delhi-110019	Opposite Party

 

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                           DATE OF ORDER:

25.09.18 12.10.22 24.04.23

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

ORDER

Surinder Kumar Sharma, President

The Complainant has filed the present complaint under Section 12 of the Consumer protection Act, 1986.

Case of the Complainant           

1. The case of the Complainant as revealed from the record is that on 30.01.18 official of Opposite Party company called wife of Complainant and convinced her to port her policy from Max Bupa to Opposite Party company. On 05.02.18 official of Opposite Party approached Complainant and gave him proposal form no. 1100402725658 which Complainant filled and submitted with required documents and with a cheque of Rs. 69,933/- as insured premium to agent of Opposite Party. On 10.02.18 agent of Opposite Party called Complainant and informed him that his proposal was accepted and mediclaim insurance policy will be issued soon and thereafter on 15.03.18 Complainant received mediclaim policy bearing no. 12091428 dated 16.02.18. The Complainant stated that the policy documents sent by Opposite Party did not match with true information provided by Complainant in proposal form and proposal form contained in policy certificate was entirely different and forged with signatures of Complainant. The Opposite Party company annexed different proposal form bearing no. 1100402725714 having wrong information. The Complainant stated that the actual proposal form bearing no. 1100402725658 filled by Complainant was not annexed with the policy. The Opposite Party company made various discrepancies in the policy certificate no. 12091428 issued to Complainant which are different from information provided by Complainant in proposal form. The Complainant informed about this matter to concerned officers of Opposite Party and sent various emails but all in vain. The Complainant stated that agent of Opposite Party admitted his fraud and gave assurance to Complainant that he will receive the amended policy but Complainant never received the amended policy. Hence, this shows deficiency on the part of Opposite Party. Complainant has prayed for reissue the said policy with necessary amendments with the correct information declared by Complainant and Rs. 4,50,000/- for mental harassment. He has also prayed for Rs. 50,000/- as litigation cost.

Case of the Opposite Party

2. The Opposite Party contested the case and filed written statement. It is stated by Opposite Party that all the allegations made by the Complainant are false and frivolous. It is submitted that the Complainant was well aware of the fact that the Policy issued to the Complainant was on the basis of proposal form bearing proposal no. 1100402725714 undersigned by the Complainant. It is pertinent to mention here that the Complainant has submitted declarations for Name and Mobile No. with opposite company and has accepted the fact that the Complainant has applied for portability with Opposite Party company having said proposal no. These two declarations itself clarifies the fact that the Complainant was well aware about the proposal form submitted by him on the basis of which the policy was issued.
3. Further, the Opposite Party company has received the above mentioned proposal from and has underwrite the same and issued the policy to Complainant accordingly. It is also the case of the Opposite Party that as per the disclosure made in the alleged proposal form bearing proposal no. 1100402725658 attached by Complainant in the complaint, the Opposite Party company would not have issued the policy to the Complainant at first as the Complainant was diagnosed with cancer in 2017 (as per alleged proposal form). As per the Opposite Party company’s underwriting guidelines approved by IRDAI, diseases like cancer are rejected out rightly.
4. It is submitted that Opposite Party company never received any new proposal form with changes in the medical history of the Complainant and his spouse. It is pertinent to mention that even if the Opposite Party company would have received the new proposal form with disclosures of CA Prostate (cancer) the Opposite Party company would have rejected the proposal and would not have issued the policy as per company’s underwriting guidelines approved by IRDAI. Further the Opposite Party has prayed for dismissal of the complaint filed by the Complainant.

Rejoinder to the written statement of Opposite Party

5. The Complainant filed rejoinder to the written statement of Opposite Party wherein the Complainant has denied the pleas raised by the Opposite Party and has reiterated the assertions made in the complaint.

 

 

Evidence of the Complainant

6. The Complainant in support of his complaint filed his affidavit wherein he has supported the averments made in the complaint.

Evidence of the Opposite Party

7. In order to prove its case, Opposite Party has filed affidavit of Shri Sachin Kumar Verma, Constituted Attorney of Opposite Party, wherein the averments made in the written statement of Opposite Party have been supported.

Arguments & Conclusion

8. We have heard the Ld. Counsel for the Complainant. We have also perused the file and the written arguments filed by and Parties. The case of the Complainant is that he has submitted the proposal form which was filled and signed by him at the time of porting the previous health policy to the Opposite Party.  His case is that the proposal form which was sent to him along with the health policy was a different one from the proposal form which he has submitted.  It is his case that the proposal form which was sent to him by the Opposite Party along with the health policy did not bear his signature and his signatures and other information had been forged by the Opposite Party.
9. The allegations of the Complainant against the Opposite Party are that it has forged his signatures. As per the law laid down by the Hon’ble Supreme Court of India in the case of The Chairman & Managing Director, City Union Bank Ltd. & Anr. vs. R. Chandramohan reported in 2023 LiveLaw (SC) 251. Such a complaint cannot be entertained by this Commission. The relevant portion of the said judgment is as under:

“12.  The proceedings before the Commission being summary in nature, the complaints involving highly disputed questions of facts or the cases involving tortious acts or criminality like fraud or cheating, could not be decided be the Forum/Commission under the said Act.  The “deciciency in service”, as well settled, has to be distinuished from the criminal acts or tortious acts.  there could not be any presumtion with regard to the willful fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance in service, as contemlatd in Section 2(1)  (g) of the Act.  The burden of proving the deficiency in service would always be upon the person aeging it.”

 

10. Therefore, in view of the above judgment the complaint cannot be entertained and the complaint be dismissed accordingly.
11. Order announced on 24.04.23.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room. 

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma) President