This case has arisen out of an application U/s 12 of the Consumer Protection Act, 1986.
The case of the complainant is that he purchased a health insurance policy vide No:0000000003759538 dated 04.12.2015 for himself from S.B.I, Gen. Ins. through its corporate Agent/O.P.No-4, with which his account is lying and at the time of purchase of policy it was settled that the premium of the policy will automatically deducted from his savings A/c No:-32730716684. On 06.12.2015 and 20.12.2016 O.P.No-1 deducted Rs.2,600/- from his account as premium.
That in the year 2018 complainant feel some problem and visited Dr. Kalishankar Bhattacharjee and other doctors who came to conclusion that complainant is suffering from fever etc so doctors suggested him laparoscopic operation on 25.11.2018 and complainant was admitted in the Upasam Nursing Home Pvt. Ltd and the doctor operated him and after 03 days he was released from nursing home and continue his treatment from home.
That at the time of payment of bill complainant shows his health insurance policy but nursing home authority refused to accept as the policy is lapsed due to non-payment of premium. The complainant then paid nursing home bill Rs.42,806/- & submitted claim before the O.Ps but on 16.02.2019 he was told that the policy became lapse due to non-payment of premium.
That on 26.04.2019 complainant wrote a letter to O.P.No-4 but no action was taken. On 30.05.2019 O.P.No-4 sent a letter to the complainant for producing original documents and advised to meet with one Mr. Arup Kundu but did not mention anything about that person so complainant failed to find out said Arup Kundu. Complainant several times met with O.Ps for his claim but all efforts gone in vain.
Complainant filed this complaint with prayer for getting Rs.42,806/-, compensation of Rs.50,000/-, Rs.10,000/- for mental pain & agony and litigation cost of Rs.5,000/-.
O.P.No-4/Bank contested the case by filing W.V stating that as the premium was paid automatically from the account of complainant and it is admitted that in previous two occasions premium was paid Rs.2,600/- each and at the time of incident no sufficient balance maintained in his account and in consequence thereof premium could not be deducted automatically and policy was lapsed. O.P.No-4 has no role to deduct last premium due to want of money in the said account of the complainant. O.P.No-4 prays for dismissal of the case.
O.P.No-1&3 also contested the case by filing Written statement admitting purchase of policy by the complainant on 04.12.2015 for the period from 04.12.2015 to 03.12.2016 for sum assured Rs.1,00,000/-, subject to terms, conditions and exclusions mentioned in the Group Health Ins. Policy, which was renewed on 20.12.2016 for the period from 20.12.2016 to 19.12.2017 on payment of same premium Rs.2,600/-.
That after 19.12.2017 O.P.No:3 did neither issue any insurance policy in name of complainant nor receive any insurance premium from him for the following year. On filing of the claim complainant was requested to submit original insurance policy for the period of 2018 and original insurance premium receipt for 2018 but his claim could not be completed due to non-submission of those documents by the complainant. Till date since there is no submission of required documents by complainant, no inference would be drawn as to admissibility of the claim within the precincts of the terms, conditions and exclusions of the policy. They also pray for dismissal of the case.
No separate W.V is submitted on behalf of O.P.No-2.
Points for consideration is:-
- Whether there was any deficiency in service or unfair practice on the part of the O.Ps which gives cause of action to file the complaint and the complainant is entitled to get the claim?
D e c i s i o n w i t h r e a s o n s:-
Admittedly complainant Subhajit Dutta purchased a Health Insurance Policy dated 04.12.2015 for himself from O.P.No-3/SBI Gen. Insurance through its corporate agent O.P.No-4/Bank valid for the period from 04.12.2015 to 03.12.2016 by paying premium Rs.2,600/- for sum assured Rs.1,00,000/-, a Group Health Insurance Policy vide Master Policy No:0000000003759538 & after expiry of validity date/period complainant renewed the said policy vide No:0000000003759538-01 by paying premium Rs.2,600/- valid for the period from 20.12.2016 to 19.12.2017, subject to terms, conditions and exclusions mentioned in the Group Health Ins. Policy.
The case of the complainant is that at the time of purchase of said policy it was settled that the premium of said policy will be deducted from his savings A/c No:32730716684, automatically.
Complainant’s case is that in the year 2018 he was treated by Dr. Kalishankar Bhattacharjee & Ors and admitted to Upasam Nursing Home, Raiganj on 25.11.2018 and Laparoscopic surgery was done and after 03 days he was released and when he shows his insurance policy Nursing Home Authority refused to accept as the policy has lapsed due to non-payment of premium so he paid the bill amount.
Complainant himself admits that he was told by Nursing Home and the O.Ps that on expiry of 19.12.2017 there was no renewal of said policy, in other words, policy was lapsed on 19.12.2017.
O.P.No-4/Bank stated that at the relevant time as no sufficient balance was maintained in his account premium could not be deducted automatically and policy was lapsed and it has no role to deduct last premium due to want of money in complainant’s account lying with it.
Statement of account of complainant’s savings account with S.B.I, Kaliyaganj Branch shows balance Rs.1459.98 Cr on 07.12.2017 & Rs.1492.98 Cr on 25.12.2017 and Rs.7,000/- was credited by NEFT (Pay) on 29.12.2017. Therefore it is clear that on 19.12.2017 or 20.12.2017(till 28.12.2017) renewal premium of Rs.2,600/- for the year 2018 would not be deducted by O.P.No-4/Bank automatically from the savings account of the complainant.
O.P.No-3/Insurance Company stated that neither it received any insurance premium nor renewed complainant’s policy for the following year i.e for the year 2018.
It appears that on filing of the claim by the complainant he was requested to produce required documents:-
- Original Insurance Policy for the period of 2018
- Original Insurance Premium receipt for 2018
But the claim of the complainant could not be processed due to non-submission of those original documents. Till date, since there is no submission of the required documents by complainant, no inference could be drawn as to admissibility of the claim within the precincts of the terms, condition & exclusions of the policy.
Ld. Advocate for the complainant strenuously argued that 30 days grace period will be available to the complainant for renewal of the policy after 19.12.2017. Respectfully we differ with such an argument because in case of renewal of Life Insurance policies it will be available but it is unavailable in case of Medical Insurance policy & Car insurance policy which are restricted or confined for the period as shown in the policies and no grace period will be available in case of Medical Insurance policy & Car Insurance policy.
The complainant himself was solely responsible to keep adequate balance in his savings account for automatic/SI debit from his account towards the insurance premium and being failed to keep adequate balance in his account the complainant himself allowed the Medical Insurance policy lapsed & the entire responsibility is of the complainant himself.
Under the above facts and discussion, we are of considered view that there was no deficiency in service or unfair trade practice on the part of O.P.No-1, 2 & 3 in not allowing the claim of the petitioner for non-submission of required documents and O.P.No-4 has no role in the matter, consequently there was no cause of action to file the complaint and the petitioner is not entitled to get any relief as prayed for.
In the result the case fails.
Hence, it is
O R D E R E D
that the C.C-13/2020 be and the same is dismissed on contest against the O.Ps but without any cost.
Let a copy of this order be given to the parties free of cost.
