BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.19 of 2018
Date of Instt. 08.01.2018
Date of Decision: 21.05.2019
Mrs. Saroj Sharma w/o Late Lt. Col MM Sharma R/o 137 MIG Housing Board Colony, Urban Estate-1, Jalandhar through Ranjit Singh S/o Gurdial Singh R/o 1056 Urban Estate-1, Jalandhar-authorized representative authority holder.
..........Complainant
Versus
1. Relegare Health Insurance Company Ltd. Vipul Technical Square, Tower C 3rd Floor, Golf Course Road, Sector 43, Gurgaon-122009 through its Authorized Representative.
2. Relegare Health Insurance Company Ltd. SCO 44, 2nd Floor, PUDA Complex, Opposite District Administration Complex, Jalandhar through its Branch Manager.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Jyotsna (Member)
Present: Smt. Harleen Kaur, Adv Counsel for the Complainant.
Sh. R. K. Sharma, Adv Counsel for the OPs No.1 & 2.
Order
Karnail Singh (President)
1. Brief facts of the case of the complainant are that she was allured to get insurance policy of the OP, by agent Mr. Sanjeev Setia and accordingly, the complainant came into the contact of said agent of LIC and accordingly, complainant opted for life insurance policy of OP, bearing policy No.10531210 and paid its premium of Rs.25,000/-. The proposal form, the policy documents and ID Card No.53155069 were received by the complainant from OP No.1 on 09.02.2016. The complainant returned the said policy document and the ID Card, unacceptable, to the OP No.1 alongwith her rejection application dated 11.02.2016. It stood duly delivered to the OP No.1 on 13.02.2016. The complainant had contended therein that the above said agent had misguided and misrepresented her to opt for the policy in question, which she did not need and suitable to her and accordingly, the complainant asked the OP No.1 to refund full amount paid by her. The complainant is a senior citizen and a typical house wife studied upto 9th class pass and as such, she could not analyze the issue involved in correct perspective. Hence, she was misled and requested OP No.1 on 19.02.2016 to continue that policy, but the complainant did not receive back the original policy as well as proposal form and ID Card from the OP No.1. Thereafter, complainant again sent a request to OP No.1 on 26.04.2016 to cancel the policy in question and returned back the premium amount, on the analogy that the policy has been cancelled after the lapse of one month. However, OP No.1 refunded to her Rs.12,640/- i.e. 50% of the premium amount paid by her without assigning any valid cogent and convincing justifiable reason.
2. That the complainant approached the OP No.1 through ID email and requested to refund the balance premium amount paid by her. The OP No.1 replied to her that the policy in question had been cancelled under Short Scale Cancellation Term and that 50% of refund was allowed to her. On 12.09.2016 and then again on 20.09.2016, the complainant represented to the OP No.1 that the policy document had never been received back by the complainant and as such, question of lock period of one month does not arise thus in turn entitling the complainant to full refund. She got the reply that the OP No.1 that the policy documents stood delivered back to the complainant through Blue Dart Courier on 26.02.2016. The complainant asked the OP No.1 on 09.12.2016 to furnish the scanned copy of the receipt said to have been rendered by the complainant to Blue Dart Courier on 26.02.2016, which was acknowledged by them, but did not reply for reasons best known to them and thereafter, the complainant sent third reminder on 24.03.2017, but no response was received, then complainant lodged formal, written and signed complaint with Customer Service Department on 04.05.2017 and ultimately, confirmed on 09.05.2017 by the OP No.1 that the policy document has not been sent by them to the complainant as she did not make specific request for it and then complainant asked them on 29.05.2017 to quote the specific clause under which it was incumbent on the part of the complainant to have sent such a follow up request to them. No relevant response has been received by the complainant from the OPs. The policy No.10531210 of the OP No.1 was rejected by the complainant well within 15 days Free Look Period. The version of the OP No.1 to the effect that the policy document had been delivered back to the complainant by Blue Dart Courier on 26.02.2016, stood proved downright false by their sadly act and conduct at the statement and as such necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to refund to the complainant the balance amount of Rs.12,660/- of premium amount alongwith interest @ 12% per annum and further OPs be directed to pay compensation of Rs.50,000/- and litigation expenses of Rs.10,000/-.
3. Notice of the complaint was given to the OPs, who appeared through its counsel and filed joint reply, whereby contested the complaint by taking preliminary objections that the instant complaint is not maintainable against the OPs as the complainant cannot take advantage of her own wrongs. The complainant purchased Health Insurance Policy bearing No.10531210 for the period 03.02.2016 to 02.02.2017 with sum insured of Rs.5,00,000/-. The said policy was dispatched to the complainant on 05.02.2016 and the same was delivered to the complainant on 09.02.2016, the complainant requested for the cancellation of the policy on 11.02.2016, i.e. within 15 days of receipt of the policy kit (within Free Look Period) by sending a request for cancellation of policy vide registered letter. However, before the policy could be cancelled, the complainant requested for the continuation of the policy, vide an other letter dated 19.02.2016. Subsequently, in the month of April i.e. on 26.04.2016, the complainant again approached the OPs for cancellation of the policy and as such, on the request of the complainant, the policy was cancelled and the appropriate premium was refunded as per the policy terms and conditions. A letter dated 30.04.2016 to this effect was sent to the complainant, duly notifying that the policy is cancelled and the premium refunded as per policy terms and conditions. Copy of the Policy Certificate is attached. It is further submitted that the complainant had again applied for cancellation of the policy in the month of April, i.e. within period of one to three months after the inception of the policy, the policy was cancelled and the premium was refunded in accordance to the applicable clause 7.11 (b) of the policy terms and conditions. Since the policy was cancelled in the month of April, that is within 1-3 months from the inception of the policy, the refunded premium according to the policy terms and conditions is 50%. Accordingly, out of the premium amount of Rs.25,232/-, on deduction of 50%, Rs.12,616/- were refunded back to the complainant. Free Look Period is not applicable in the present case and as the premium which was refundable as per terms and conditions of the insurance policy, the same was returned, as such, the complaint is liable to be dismissed. On merits, it is admitted that the complainant purchased the policy and thereafter, make a request for cancellation and then again asked for continuation of the said policy and then again in the month of April, 2016 got it cancelled and 50% premium amount paid by the complainant has been refunded back to the complainant, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
4. In order to prove the case of the complainant, Sh. Ranjit Singh, Authority Holder on behalf of the complainant tendered into evidence his own affidavit Ex.CA alongwith document Ex.C-1 and closed the evidence.
5. Similarly, counsel for the OPs tendered into evidence affidavit of Kashif Muzaffar Nazki as Ex.OA along with some documents Ex.O-1 to Ex.O-7 and closed the evidence.
7. We have heard the learned counsel for the respective parties and also gone through the written arguments submitted by counsel for both the parties as well as case file very minutely.
8. Precisely, we find there is no dispute in regard to getting health insurance policy bearing No.10531210 for the period 03.02.2016 to 02.02.2017 by the complainant after making a premium of Rs.25,000/-. It is also admitted by both the parties that the complainant received the policy document on 09.02.2016, but the complainant sent a request for cancellation of the said insurance policy on 11.02.2016, but again the complainant requested for continuation of the policy, vide an other letter dated 19.02.2016 and subsequently, in the month of April i.e. 26.04.2016, the complainant again approached to the OP for cancellation of the policy. Upto this extent, there is no dispute between the parties.
9. Now question arises whether the OP has rightly deducted 50% premium amount at the time of reimbursement to the complainant and whether Clause 7.11 (b) of the terms and conditions of the insurance policy is attracted in the instant case or not, for better judgment, we like to produce the aforesaid provison 7.11 (b) as under:-
“The Policy holder may also give 15 days notice in writing to the company, for the cancellation of this policy, in which case the company shall from the date of receipt of the notice, cancel the policy and refund the premium for an unexpired period of this policy, at the short period scales as mentioned below, provided no claim has been made under the policy”.
If the total period of the policy is 1-3 months, then 50% deduction can be made. It is not a case of free look period rather the instant case is fall under the terms and conditions 7.11 (b) and extract of the same are placed on the file by the OP as Ex.O-3 and policy document Ex.O-1 and cancellation request of the complainant as Ex.O-2. It is admitted that the complainant had made twicely request for cancellation of the policy within a period of 1-3 months and obviously, the provision of Clause 7.11 (b) is invoked in the instant case and by applying that Clause, the OP has rightly deducted 50% amount of the premium and remaining was rightly reimbursed to the complainant and as such, we do not find any negligence or unfair trade practice on the part of the OP and find that there is no solid substances in the argument of learned counsel for the complainant, therefore, complaint of the complainant is dismissed with no order of cost. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.
10. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jyotsna Karnail Singh
21.05.2019 Member President
