Haryana

Bhiwani

CC/158/2022

Deepak Sharma - Complainant(s)

Versus

Star Health - Opp.Party(s)

Krishan Goyat

12 Nov 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

                                                            Consumer Complaint No. :  158 of 2022

                                                       Date of Institution            : 01.08.2022

                                                                 Date of order                   : 12.11.2024

 

Deepak Kumar Sharma son of Sh. Mahavir Singh R/o H.No.79-B, D.C. Colony, Bhiwani, Tehsil and District Bhiwani.

  

           ……Complainant.

 

Versus

 

1. Star Health and Allied Insurance Co. Ltd., Branch Office: SCF No.47, Panchayat Bhawan Pocket, Bhiwani through its Branch Manager.

 

2. Star Health and Allied Insurance Co. Ltd., SCO 5-A, Second Floor, Sector 7-C,Chandigarh-160019 through its authorized signatory.

 

3. Star Health and Allied Insurance Co. Ltd., G-8, 1^st Floor, Hauz Khas Market, New Delhi-110016 through its authorized signatory.

 

4. Star Health and Allied Insurance Co. Ltd., New Tank Street, Valuar Kottam, High Road, Nungambakkam, Chennai through its authorized signatory.

 

…… Opposite Parties.

 

COMPLAINT U/S 35 OF CONSUMER PROECTION ACT, 2019.

 

BEFORE:       Mrs. Saroj Bala Bohra, Presiding Member.

  Ms. Shashi Kiran Panwar, Member.

 

Present:-        Sh. Krishan Goyat, Advocate for complainant.

                     Sh. Avinash Sardana, Advocate for OPs.

 

ORDER:

 

Saroj Bala Bohra, Presiding Member:

 

1.                 In brief, facts of this case are that complainant and his family members purchased a medi-claim insurance policy from OPs which was valid from 11.04.2021 to 10.04.2022 by paying a premium of Rs.15,900/- and the premium was payable in 12 monthly installments of Rs.1325/- each. It is submitted that complainant deposited the installments for 10 months i.e. upto January 2022.  It has been contended that OPs shown 0 (zero) EMI of insurance premium under the policy then complainant lodged a complaint with the Ops through e-mail on 10.02.2022. Upon which, at the instance of OPs, complainant deposited EMI in the office of OP NO.1 on 12.02.2022 and receipt thereof was sent to the OPs through e-mail. Complainant also deposited EMI on 10.03.2022 for the month of March 2022.  It is submitted that on 11.03.2022, e-mail received from OPs to get renewed the insurance policy on 26.03.3022 and complainant deposited Rs.16,462/- and policy was renewed from 11.04.2022 to 10.04.2023. However, OPs apprised the complainant on 18.06.2022 that his both the insurance policies have been cancelled on 14.06.2022, without any intimation to the complainant.  Thereafter complainant made correspondence with OPs and IRDA on 20.06.2022 and 21.06.2022, respectively but of no avail.  Hence, the present complaint has been preferred alleging deficiency in service on the part of Ops resulting into monetary loss as well as mental and physical harassment. In the end, prayer has been made to direct the Ops to renew the insurance policy bearing no.P/211128/01/2023/00004 from its original alongwith all previous benefits. Further to pay Rs.1.00 lac as losses suffered by complainant due to negligent act and conduct of Ops alongwith interest @ 18% till payment and to pay Rs.10,000/- towards compensation for harassment besides Rs.5500/- as litigation expenses. Any other relief, to which this Commission deems fit, has also been sought.

2.                 Upon notice, OPs appeared through counsel and tendered reply raising preliminary objections qua maintainability of complaint, deficiency in service, locus standi & cause of action and suppression of material facts. On merits, it is submitted that the complainant had got the policy No.P/211128/01/2022/000030 renewed on 11.04.2021 for a period from 11.04.2021 to 10.04.2022 on 12 monthly installments of Rs.1325/- each for a total premium of Rs.15,900/-. It is submitted that complainant deposited Rs.1325/- towards the last month installment on 10.03.2022 at Branch Office, Bhiwani but in endorsement copy collection number, collection date and premium amount was shown zero due to technical issue and hence premium of last installment was refunded to insured through Demand Draft. However, OP advised the insured to return the D.D. to restore the policy but the customer did not return it.  It is submitted that in the meantime policy no.P/211128/01/2022/000030 was renewed by paying full premium and the policy was renewed vide policy no.P/211128/01/2023/000004 for a period from 11.04.2022 to 10.04.2023.  It is urged that due to non-receipt of premium of last month installment of March-April 2022, the first policy was cancelled on 20.09.2022 and consequently, the next year (current renewed policy) was also cancelled on 14.06.2022. It is suggested that as per IRDA guidelines, the Ops cannot accept the lapsed EMI premium and as such cancelled the previous insurance policy as well as current renewed policy.  As such, OPs denied for any deficiency in service on their part and also entitlement of complainant for any relief. In the end, prayer has been made to dismiss the complaint with  special costs.

3.                 In evidence of complainant, his affidavit Ex.CW1/A alongwith documents Annexure C-1 to Annexure C-15 were tendered and then closed the evidence.

4.                 In evidence of OPs, affidavit of Mr. Sumit Kumar Sharma, Senior Manager of OP company as Ex. RW1/A alongwith documents Annexure R-1 to Annexure R-5 were filed and then closed the evidence.

5.                 We have heard learned counsels for the parties and perused the record carefully.

6.                 At the outset, the case of complainant is that OP insurance company arbitrarily and negligently cancelled his medi-claim policy without any notice or intimation. Hence, by filing this complaint, complainant has sought restoration of the insurance policy as well as to pay him compensation besides litigation expenses etc.

7.                 Admittedly, the complainant has paid monthly installments of the first insurance policy bearing no.P/211128/01/2022/000030 upto 11 months but the last installment paid by complainant could not be generated in their computer system, allegedly due to technical issue because of which amount of last installment was refunded to the complainant. The OP insurance company has averred in their pleadings that on paying full premium by complainant the first policy was renewed vide policy no. P/211128/01/2023/000004 for a period from 11.04.2022 to 10.04.2023. The OPs have further pleaded that since, the complainant had not paid the last installment of first policy, therefore, it was cancelled on 02.09.2022 and consequently, the renewed policy also had to cancel on 14.06.2022.

8.                 After hearing learned counsels for the parties and going through the record, we have observed that complainant has paid all the installments of first policy and if there was any problem of receiving of the amount of last premium, it was admittedly due to technical issue, as such, complainant should not be suffered for any technical issue arisen due to any reason on eh part of OPs. It is pertinent to mention here that since the first policy was successful, therefore, it was renewed for a further period of one year from 11.04.2022 to 10.04.2023 on getting full premium for it from complainant. It means that the first policy was successful thereafter it was renewed for a further period of one year. It is very astonishing to us, that once, the OP insurance company is issuing/renewing policy then cancelling it by its own without any cogent and convincing reason and without prior notice to complainant/insured person. It is worthwhile to mention here that a person get such insurance policy for future prospects and to secure his life when it needed medical assistance but the OPs are just taking it in a casual manner and because of such behavior gullible persons like complainant are suffering a lot.

9.                 In view of the above discussion, we are of the considered opinion that it is an admitted case of negligence, arbitrariness and deficiency in service as well as unfair trade practice resulting into financial loss as well as mental pain and physical harassment to the complainant which cannot be compensated in terms of money, however, it may helpful in providing some relief to him. In the present situation, the case law delivered by Hon’ble Punjab & Haryana High Court in CWP No.26178 of 2016 titled as National Insurance Co.Ltd. Vs. Sandeep & others reported in 2017 (1) RCR (Civil) Page 621 wherein it has been  held that “Insurance companies give lucrative offers to attract customers-However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company.” is much relevant in the present context. Therefore, the prayer of complainant through this complaint is genuine and thus the complaint is allowed. The policy is liable to be continued from its last day of expiry alongwith all previous benefits of the policy since its inception. Complainant is also entitled to get compensation for harassment from the OPs. So, the OPs jointly and severally, are directed to comply with the following directions within 40 days from the date of order:-

1. To continue the policy to the complainant from 11.04.2023 subject to payment of the premium by complainant for further renewal, if any, alongwith all previous benefits of the policy since its inception.

(ii)      To pay a sum of Rs.50,000/- (Rs. Fifty thousand) to the complainant on account of losses suffered by him  due to negligent act and conduct of OPs including compensation for harassment.

(iii)     To pay Rs.11,000/- (Rs. Eleven thousand) as litigation expenses.

                    In case of non-compliance, all the awarded amounts shall attract simple interest @ 9% per annum for the period of default. 

                    The complainant shall be entitled to the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite parties may also be liable for prosecution under Section 72 of the said Act which envisages punishment of imprisonment, which may extend to three years or fine upto rupees one lac or with both.  Copies of this order be sent to the parties concerned, free of costs.  File be consigned to the record room, after due compliance. 

Announced.

Dated: 12.11.2024