Before the District Consumer Dispute Redressal Commission [Central], 5th Floor ISBT Building, Kashmere Gate, Delhi
Complaint Case No.-80/2017
Rakesh Ranjan s/o Ramjee Prasad
r/o D-196, Gali No. D-5-A, Ganesh Nagar
Pandav Nagar Complex, Delhi-110092 ...Complainant
Versus
M/s SBI General Insurance Company Ltd.
7B, Ground Floor, Pusa Road, Opposite to
Rachna Cinema & Metro Pillar No.-153,
Rajendra Park, New Delhi-110060
2nd Address:
M/s SBI General Insurance Company Ltd.
H. O.- Natraj, 101,201,301, Junction of Western
Express Highway, Andheri Kurla Road,
Andheri (East), Mumbai-400069 ...Opposite Party
Date of filing: 10.03.2017
Order Reserved on: 02.01.2023
Date of Order: 21.01.2023
Coram: Shri Inder Jeet Singh, President
Shri Vyas Muni Rai, Member
Ms. Shahina, Member (Female)
Inder Jeet Singh
ORDER
1. (Introduction to the dispute of parties) : The complainant/Insured took medi-claim insurance policy from Insurer/Opposite Party, he also paid requisite premium, however, he exercised option of free look-period and got his insurance policy prior to receipt of insurance policy/cover but he was paid 50% of the paid premium by OP instead of his entitlement of refund of entire paid premium. Whereas, OP has justified deduction of 50% of premium as complainant failed to exercise option within 15 days period from receipt of policy being the term and condition of free look period.
2. (Matrix of case of parties) : On 16.3.2015, the complainant purchased medi-claim policy no.0000000002674135 against payment of premium of Rs.19,081/-. However, because of financial constraints, he was not interested to continue the policy, thus on 8.4.2015 he being in free-look period (as he had not received the insurance cover) requested the OP to refund his entire paid premium as till then contract was not completed as per IRDA guidelines and policy guidelines of OP. However, on 7.5.2015 he was paid Rs.9,540/- by OP. Thence complainant had sent various requests and also legal notice dated 12.2.2016 but the amount was not refunded. The OP had rejected his claim vide its letter/reply dated 9.5.2016. That is why complaint was filed for deficiency in services in refund of that amount, apart from compensation of Rs.50,000/ & litigation cost of Rs.5,000/-, which include cost of legal notice.
Whereas, the OP does not dispute of obtaining of insurance medi-claim policy by the complainant as well as payment of premium. However, the complaint is opposed that complainant's request for cancellation had reached to OP on 13.4.2015 against policy inception date of 16.3.2015, whereas policy provides free look period of 15 days. Since request for cancellation was beyond free look period, thus refund is to be made on short period basis. There is also a clause that for the period of policy remained in force, the insured had policy coverage against risk mentioned in the policy, therefore, consideration needs to be deducted for that period. Moreover, an agent is not authorized to receive any request, the complainant ought to have approach the OP directly.
3.1 (Evidence & Submission): Complainant Shri Rakesh Ranjan filed his own affidavit, referring the record filed inclusive of as to how and what premium was paid through bank transaction. Ms. Arti Goel, Executive (Legal) of OP lead evidence for OP, which is replica of reply.
3.2: Although both the sides had filed their respective written arguments, however, later general notice was issued to OP at its both the addresses, but it had not caused appearance. Complainant made the submissions himself stating that he himself is aware of acts and evidence, he does not need services of any counsel, his counsel had also expired long back. Complainant has also placed on record the instructions dated 2.9.2009 on Free Look Period in Health Insurance Policies issued by General Insurance Companies. Thus, in order to appreciate rival claim, the record will also be assessed in addition to written submission.
4.1 (Findings): After analyzing the record and considering the rival claims, the following conclusions are drawn:-
(i) It is not disputed that complainant took medi-claim insurance policy from OP, he had paid premium and on his request, the policy was cancelled, however, he was refunded premium of Rs.9,541/-. (being 50% of paid premium).
(ii) As per instruction dated 2.9.2009 (clause-1) and general condition no.2 describing insured's right that free look period will be 15 days from the receipt of policy, which too at the inception of the policy. In reply dated 9.5.2016 to legal notice of complainant, OP gives details that policy was issued on 20.3.2015 and mail to this effect was sent to its agent on 21.3.2015.
However, there is no proof of any record that OP had delivered the insurance policy to the complainant prior to exercise of option by the complainant to cancel his policy. Moreover, contents of reply dated 9.5.2015 also confirms that insurance policy was not sent to complainant. Thus, it establishes plea of complainant that he had not received the insurance policy cover, when he requested for refund of premium and his option to cancel the policy was during the free look period.
(iii) The OP took strong plea that there is a clause for deductions, however, it may be done for expenses or if policy commences, then proportionate to risk, but OP had not given any details of expenses or proportionate amount as to how 50% of premium was to be deducted, when request for cancellation was made during free look period in first April 2015 and premium was paid on 16.3.2015.
In reply dated 9.5.2015, the period of policy described is from 16.3.2015 to 15.3.2016 but policy issue date was 20.3.2015, which was not delivered to complainant. Thus, risk period was from 16.3.2015 to 8.4.2015/13.4.205 [i.e. 23 days/or 28 days]. The proportionate amount, if computed for larger side period of 28 days, it comes to Rs.1464/-. This amount could be deducted as proportionate amount of risk cover premium. Thus by deducting Rs.1,464/- out of non-refunded amount of Rs.9540/-, the remaining amount to Rs.8076/-.
(iv) It would not demerit the case of complainant, if the request for cancellation within the free look period was through agent or directly.
(v) There is deficiency of services on the part of OP .
4.2: Therefore, the complainant has proved his claim of non- refund of premium amount to the extent of Rs.8,076/. Accordingly, the complainant is held entitled claim of non- refund of premium amount to the extent of Rs.8,076/-. To that extent, complaint is allowed in favour of complainant and against the OP.
4.3: The amount of damages, for suffering trauma and inconvenience for seeking relief of his valid claim, is quantified as Rs. 4,000/- in her favour and against the OP.
4.4 : The complainant is held entitle for interest at the rate 6 % p.a., on the aforementioned amounts, from the date of filing of the complaint till realization of the amount.
4.5 :The complainant started claiming his claim by way of requests, mails. legal notice, then filing of complaint. Costs is quantified as Rs.2,000/- in his favour and against the OP.
4.6: The OP shall pay the amount within 30 days from the date of receipt of the Order.
5 : Copy of this Order be sent/provided forthwith to the parties free of cost as per regulations.
6: Announced on this 21st day of January, 2023 [माघ 1, साका 1944].
