BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

VAZHUTHACAUD, THIRUVANANTHAPURAM.

PRESENT

SRI. P. SUDHIR                                       :  PRESIDENT

SMT. R. SATHI                                         :  MEMBER

SMT. LIJU B. NAIR                                  :  MEMBER

I.A. No. 186/2014

in

C.C. No. 541/2013

ORDER DATED: 16.04.2018

Complainant:

C.S. Vijayakumari, Maniveena, Pakaloor, Pallichal P.O, Nemom (via), Thiruvananthapuram-20.

                             (By Adv. K. Radhakrishnan)

Opposite party:

Branch Manager, Star Health & Allied Insurance, NMC/21, 2^nd Floor, S.N. Complex, Neyyattinkara, Thiruvananthapuram-695 121.

        (By Adv. Mann Janarddanam Nair)

ORDER

This I.A filed by opposite party to hear the question of maintainability on the ground that there is neither cause of action for the complaint nor there was any deficiency in the service on the part of the opposite parties.  Dispute relating to pricing not covered under Consumer Protection Act.  Pricing in insurance business means the premium which is payable as consideration for every policy approved by the IRDA.  Hence the complaint before this Forum with regard to pricing of product is not maintainable.  The complainant is not a consumer under Consumer Protection Act as she was not a policy holder of the opposite party at the time of filing the above complaint or at any time thereafter.  Since there is no contract existing between the opposite party and the complainant, element of consideration for rendering of service by this opposite party was completely absent.  IRDA (Health Insurance) Regulations, 2013 clearly states that any subsequent revision or modification in a policy which is approved by the authority shall be notified to each policy holder at least 3 months prior to the date when such revision or modification comes into effect.  The notice shall set out the reason for such revision or modification, in particular the reason for an increase in premium and the quantum of such increase.  At the time of renewing the policy for 2013-14, this opposite party has sent such a notice dated 14.06.2013 to the complainant stating the revised terms and conditions of the policy and the premium.  This opposite party has sent the notice 6 months in advance thereby complying with the provisions of Act.  The premium for 2013-14 has been calculated as per the revised mediclassic insurance policy conditions and informed the complainant that the renewal premium of Rs. 12,107/- has to be paid for covering 3 persons for a sum insured of Rs. 1,50,000/- per person.  It is submitted that “No health insurance product shall be marketed by any insurer unless it has the prior clearance of the IRDA as per the File & Use procedure”.  Opposite party specifically stated in the letter that the revised terms, conditions and rates come into effect from 01.04.2013 in respect of fresh policies and the changes come into effect in respect of renewals from 01.07.2013, i.e; all renewals due on or after 01.07.2013 will be governed by the revised provisions only.  Moreover the opposite party has sent a renewal notice dated 16.11.2013 to the complainant in which it has been specifically stated that the product has been changed and the premium rates were also changed.  Since health insurance policy is an annual contract, the risk for the period of one year has been accepted by the opposite party on four occasions for which the complainant had paid the premium.  Such premium for the period for which the insurance company has been on risk is non-refundable.  Risk stood covered for periods for which premium has been paid.  No provision exists for refund of premium of lapsed (expired) policy.  The customer or insured has no vested right in law to insist that the same product of old vintage must be continuously offered at the same pricing even when the insurer had ceased to market such products as they had modified and revised and obtained approval from IRDA for a newer and higher end product.  There is no scope of alleged deficiency in service to sustain this complaint.  He has been offered one in terms of present, new and refurbished product of old vintage with additional features and coverage and corresponding revised price tag.  It is now left to the insured to opt for such renewal or not. 

Complainant filed objection stating that when the complainant approached the opposite party for the renewal of the policy for the 5^th year the opposite party refused to renew that policy stating that there is no policy covering Rs. 50,000/- and the company has stopped the same and they have policy of Rs. 1,50,000/- as minimum sum.  The complainant has to remit a renewal premium of Rs. 12,100/- instead of Rs. 4,015/- remitted for the 4^th year.  No intimation has been given by the opposite party to the complainant regarding the modification of the policy though the IRDA Regulation 2013 clearly requires that any subsequent revision or modification in a policy which is approved by the authority shall be notified to each policy holder at least three months prior to the date when such revision or modification comes into effect.  It is false and baseless that the opposite party has sent a notice on 14.06.2013 stating the revised terms and conditions of the policy and the premium.  The complainant was informed of the revised terms and conditions of the policy and the premium only when the complainant approached the opposite party for renewal of the policy during December 2013.  The opposite party refused to renew the policy and sent back the complainant. 

Perused the petition, objection and documents.  It is seen that opposite party has informed the complainant regarding the change in policy within the stipulated time.  Complainant has come with a prayer to get back the policy amount after the expiry of the policy, i.e; after coverage of risk.  The policy taken is separate and pricing of policy is approved by IRDA.  Complainant cannot insist for renewal on old policy conditions.  Pricing will not come under Consumer Protection Act and we are of the opinion that complaint is not maintainable before this Forum.  Hence I.A allowed and complaint dismissed as not maintainable.   

In the result, I.A allowed and complaint dismissed as not maintainable. 

.   

        Sd/-

P.SUDHIR                             : PRESIDENT

         Sd/-

R. SATHI                               : MEMBER

          Sd/-

LIJU B. NAIR                        : MEMBER

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