STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

                                         U.T., CHANDIGARH 

                                            (Additional Bench)

Yoginder Aggarwal s/o Shri Dev Raj, aged about 75 years, Ex-Officer of erstwhile State Bank of Patiala, resident of H. No. 1077, Des Raj Street, Patiala. Mobile: 97802-82819 E-mail: yoginderaggarwal179@gmail.com

....... Appellant

VERSUS

1.       State Bank of India Through Asstt. General Manager PPG, State Bank of India, Local Head Office, Sector 17-B, Chandigarh-160017 Phone: 0172-4567325

   2.       The Asstt. General Manager- PPG, State Bank of India, Local Head Office, Sector 17-B, Chandigarh-160017.

 3.      The Deputy Managing Director (HR) & Corporate Development Officer, State Bank of India, Central Office, Mumbai, Through Asstt. General Manager - PPG, State Bank of India, Local Head Office, Sector 17-B, Chandigarh-160017

4.         United India Insurance Co., Ltd., Corporate Cell, Ground Floor, Vulcan Insurance Building 77-Veer Nariman Road, Mumbai-400020 Through Deputy Manager (IBA Cell, LCB).

 5.      Indian Banks Association, World Trade Centre Complex, 6th Floor Centre 1 Building, World Trade Centre Complex, Cuff Parade, Mumbai-400005 through Chairman/Chief Executive.

                                                                                 ...Respondents

Appeal under Section 41 of the Consumer Protection Act, 2019 against order dated 13.06.2024 passed by          District Consumer

Disputes Redressal Commission-II, U.T. Chandigarh in Consumer Complaint No.380/2020.

BEFORE:       MRS. PADMA PANDEY, PRESIDING MEMBER

                        MR.PREETINDER SINGH, MEMBER

For the appellant  :                    Sh.Yoginder Aggarwal, in person.   

For respondent No.1to 3:          Sh. Vishal Gupta, Advocate .

For respondent No. 4:               Sh.G.S.Ahluwalia, Advocate.

For respondent No.5                 None

 PER PADMA PANDEY,PRESIDING MEMBER

                         This appeal is directed against the order dated 13.06.2024, rendered by the District Consumer Disputes Redressal Commission-II, U.T. Chandigarh (hereinafter to be referred as “the Ld. Lower Commission”), vide which, it  dismissed  the complaint bearing No.CC/380/2020 by holding that the complainant failed to prove deficiency in providing service or indulgence into unfair trade practice on the part of the  Opposite Parties.

2.         Before the Ld. Lower Commission, it was case of the complainant/appellant that he is a Retired Officer of erstwhile State Bank of Patiala, an Associate Bank of State Bank of India, since merged with the State Bank of India w.e.f. 01.04.2017 along with other Associate Banks namely State Bank of Mysore, State Bank of Hyderabad, State Bank of Travancore, State Bank of Bikaner & Jaipur( in short referred to as e-ABs) and, as such,  he is now Retired Officer of State Bank of India.  The retirees of e-ABs (i.e. those who have retired prior to 01.04.2017) were covered under IBA Group Mediclaim Policy for Retirees. When  the said policy was going to expire on 31st October 2019, State Bank of India  decided to continue coverage of e-ABs retirees for the next cover period commencing 01.11.2019 and offered renewal of the insurance policy to e-AB retirees on premium rates and terms & conditions proposed by United India Insurance Company (OP No. 4) and agreed upon by the Indian Banks Association (OP No. 5). The Deputy Managing Director (HR) & Corporate Development Officer of State Bank of India (OP No. 3) issued e-Circular No. CDO/PAHRD- PPFG/42/2019-20 dated 07.10.2019 (Annexure C-1).  The complainant opted for Option-1 without domiciliary cover for plan sum insured for Rs.4,00,000/-and gave consent letter to his Pension Paying Branch to deduct premium of Rs.33,193/- from his savings bank account no. 55124600294 and the same was deducted on 23/10/2019 by OP No. 2, in terms of para no. 4 of circular (Annexure C-1).  Later on, he  decided to withdraw/exit from the Insurance Policy w.e.f. 30.01.2020 and submitted letter dated 20.1.2020 (Annexure C-2) addressed to the Pension Paying Branch, SBI, Mall Road Patiala, of the OP Bank with email to OP No.2 which sent the letter of the complainant to the Insurance Company-OP No. 4 by email on 13.01.2020 (Annexure C-4).  In reply to the complainant’s letter dated 10.01.2020, OP No.4 vide letter dated 30.01.2020 stated that there was no provision for mid-term exit of individual insured member from the said policy, and as such his request could not be considered. Subsequently, he served a legal notice dated 12.05.2020 upon the OPs. OP No.4 in reply to the legal notice stated that as per Clause 6.8 of the policy, there is no provision either for withdrawal/cancellation of cover by an individual member and subsequent refund of premium to such individual member.  The complainant  alleged that the OPs never circulated any policy and the OP Bank circulated the terms and conditions of the policy by issuing the circular dated 07.10.2019 and in the said circular there was no mention of Clause 6.8 of the policy.  However, para 3(v)  of the said circular states that the insured may at any time cancel the policy after its commencement.  It was further stated that the OP Bank made mis-representation in the said circular by concealing the vital information by not defining the term ‘insured’ and by not mentioning the condition 6.8 of the policy.  Alleging   deficiency in service and unfair trade practice on the part of the Opposite Parties, a consumer complaint was filed before the Ld. Lower Commission.

3.                    Pursuant to issuance of notice, the Opposite Parties appeared before the Ld. District Commission and contested the complaint. In their joint  written version,  Opposite Parties  No.1 to 3  stated that in order to continue with the Group Health Insurance Policy for the retirees of erstwhile SBOP, the OPs issued  e-circular dated 07.10.2019 wherein all the terms and conditions of the policy were circulated to the members who want to become members of the said policy and the complainant had admitted acknowledgement of the said e-circular.  It was  mentioned in the e- Circular dated 07.10.2019 that the premium rates and terms and conditions proposed by OP No.4 were agreed upon by  OP No. 5 i.e. IBA. According to  clause (v) of para No. 3 of e- Circular dated 07.10.2019 as agreed upon between OP No.4 and 5,  no change in option would be permitted after remittance of premium to UIIC. Any refund after the date of commencement of policy i.e. after 01.11.2019 would be as per Cancellation Clause of the policy, according to which  the Insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company's short period rate as per table given therein.    It was further stated that the policy was opted by State Bank of India through OP No.5-IBA on behalf of retired employees from OP No.4-United India Insurance Company Limited and the individual insured person has no right to cancel the policy. The policy was opted voluntarily by all the employees being well aware that the individual person cannot cancel the policy and the same position was stated in the e-circular dated 07.10.2019 issued by State Bank of India that the Insured may at any time cancel the policy and it is nowhere stated that the individual person can cancel the policy, thus, request for cancellation of policy is wholly untenable and cannot be looked into. It was further stated that the filing of consumer  complaint was only a result of misinterpretation of provisions of e-Circular dated 07.10.2019 and as such the complainant was not entitled to refund of 50% of the premium amount. Denying the remaining allegations and  pleading that there was no deficiency in service or unfair trade practice on their part, a prayer was made for  dismissal of the complaint.

 4.                  In its separate written statement, OP No.4 took preliminary objections inter- stating  alia that the complainant did not fall within the definition of  ‘consumer’ as defined under Section 2 (7) of the Consumer Protection Act, 2019. It was  stated that it had issued Group Health Insurance Tailormade Group Mediclaim Policy (Retirees) (Without Domiciliary Treatment Cover, Policy No.5001002819P113267614 with its validity w.e.f. 01.11.2019 to 31.10.2020 in favour of Indian Bank's Association A/c State Bank of Patiala (Annexure OP4/R-1). It was  further stated that as per clause No. 6.8- Cancellation clause, the insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company's short period rate.   It was further  stated that  Cancellation Clause 6.8 only provides for cancellation of the entire Policy and refund of the premium and there is no provision in the policy for the withdrawal/mid term exit of Insured person from the group health Insurance Policy and subsequent refund of the premium. The policy was purchased by Indian Bank's Association A/c State Bank of Patiala on behalf of its retirees after obtaining their due consent and paid premium, hence,   Indian Bank's Association A/c State Bank of Patiala was the insured who had entered into single contract with OP No.4 for the policy in question and there was no contract with the individual retirees. Thus, only the Insured can cancel the policy as per its terms and conditions and the individual retiree cannot withdraw the policy. Before underwriting the IBA Group Health Policy for 2019-20,   email circulars dated 16.09.2019 and 31.10.2019 were issued  to all IBA member banks clearly stating under point No. 1 & 3 that "Once the retiree opts for any one option, with or without super top up, no withdrawal/change in option will be allowed." In calculating appropriate premium for issuance of group health insurance policies, various underwriting factors were required to be considered among which the total number of lives proposed to be covered and demography of the group are of prime importance. Since OP No.4 had quoted the premium for retirees under IBA tender in consideration of total number of lives proposed at that time, the company was fully justified in protecting premium collected for the retiree policy by not agreeing for mid-term withdrawal of individual members as this would result in reduction of premium and also change the demography of the group due to exercising option of mid-term withdrawal by the retirees. It was further  stated that the insured Indian Bank's Association A/c State Bank of Patiala had not made any demand either to allow mid-term withdrawal by individual retirees or for cancellation of the Group Health Policy of the erstwhile Associate banks of the State Bank of India.  It was further  stated that the complainant vide his application dated 10.01.2020 had requested for mid-term exit from the policy and refund of premium and the insurance company vide letter dated 30.01.2020 had informed the complainant that said policy did not have a provision for mid-term exit of individual insured member from the policy hence his request could not be considered. By denying remaining allegations and  pleading that there was no deficiency in service or unfair trade practice on its part, a prayer was made for dismissal of the  complaint.

5.                Opposite Party No.5 did not appear before the Learned Counsel, despite due service, hence it was  proceeded against ex parte vide order dated 25.06.2021.

6.                   On appraisal of the pleadings, and the evidence adduced on record, Ld. Lower Commission came to conclusion that the complainant failed to prove deficiency in service and unfair trade practice on the part of the Opposite Parties and dismissed the   complaint,  as noticed in the opening para of this order.   

7.              Aggrieved against the aforesaid order passed by the Ld. Lower Commission, the instant Appeal has been filed by the Appellant/Complainant.                                                     

8.                     We have heard  the appellant as well as Learned Counsel for the respective respondents   and have gone through the evidence and record of the case with utmost care and circumspection.

9 .                It is admitted case of the parties that one comprehensive Group  Health Insurance Policy was issued by the United India Insurance Company Ltd. in the name of the insured person i.e. Indian Banks’ Association A/c State Bank of Patial, head Office, the Mall, Patiala-147001”, effective from 1.11.2019 till 31.10.2020 for all the retired employees of State Bank of Patiala who had opted for the same.  The appellant voluntarily opted for the policy and as per terms and conditions of the insurance policy, the sum insured for a retired officer was Rs.4.00 Lakhs. The appellant paid the premium of Rs.33,193/- for availing the benefits of  Group Health Insurance Policy.  The appellant vide letter dated 10.1.2020  written to the Asstt. General Manager, State Bank of India, Patiala sought refund of 50% of the amount of premium as per Clause 3(v) of the Circular dated 7.10.2019 by stating that he had decided to discontinue the coverage with effect from 30.1.2020.Thus, according to the appellant, as per Clause 3(v) of the Circular dated 7.10.2019 and Clause 6.8 of the Policy, the insured person has a right to cancel the policy and to seek refund.

 10.                 The sole controversy revolves in this case around the interpretation of ‘the insured’.  The relevant clauses on which both parties placed reliance are Clause 3(v)  of the e-Circular dated 7.10.2019, and  Clause 6.8 of the policy, which are reproduced as under ;

"(v)         No change in option would be permitted after remittance of premium to UIIC. Any refund after the date of commencement of policy i.e. after 01.11.2019 would be as per Cancellation Clause of the policy, relevant portion of which reads as under:

                The Insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company's short period rate table given below provided no claim has occurred upto date of cancellation.

                       Clause 6.8 of the Group Health Insurance Policy, R-1/2, reads as under ;

                        6.8 Cancellation Clause:

 The Company may at any time cancel this Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-cooperation by the insured giving fifteen days’ notice in writing by Registered A.D. to the insured at his last known address in which case the company shall return to the insured a proportion of the last premium corresponding to the unexpired period of insurance  if no claim has been paid under the policy.

   The insured may at any time cancel this Policy and in such event the Company shall allow refund of premium at Company’s short period rate table given below provided no claim has occurred upto the date of cancellation.........”

11.                A plain reading of the above clauses reveals that the policy can be cancelled by the insured at any time and in that event the Insurance Company shall allow refund of the premium corresponding to the unexpired period of insurance as per the rate given above.  Now we advert to the interpretation of ‘the insured’. Annexure R-1/2 is copy of the Group Health Insurance Policy Tailormade Group Mediclaim Policy (retirees)(without domiciliary treatment cover). On its first page, policy No. is written and the period of insurance was 1.11.2019 to 31.10.2020.  Under the head “Insured” it is written “Indian Bank’s Association A/c:State Bank of Patiala.  On the other page, the detail of policy schedule has been given.  Additional conditions are also given therein and according to condition No.6, after commencement of the policy if any retiree who opts out of the scheme cannot be re-join the scheme and as per condition No.7, at the time of renewal in case any insured person under this policy opts not to be included for the renewal, then he/she will not be allowed to join the scheme on subsequent renewals. Thus, the retiree can opt out the policy  but   an individual retiree has no right to cancel the Policy.  As mentioned in the Policy schedule, the policy was taken for 659 families of retired officers and 200 retired Clerks. The Learned District Commission while coming to the conclusion that the complainant/appellant has failed to make out any case for deficiency in service and unfair trade practice rightly observed  as under ; 

“The policy in question was opted by State Bank of India through OP No.5-IBA on behalf of retired employees from OP No.4-United India Insurance Company Limited and the individual insured person has no right to cancel the policy. The policy has been opted voluntarily by all the employees being well aware that the individual person cannot cancel the policy and the same position has also been stated in the e-circular dated 07.10.2019 issued by State Bank of India that the Insured may at any time cancel the policy and it is nowhere stated that the individual person can cancel the policy, thus, request for cancellation of policy is wholly untenable and cannot be looked into. Thus, the complainant has misinterpreted the provisions of e-Circular dated 07.10.2019.  Moreover, the  insured Indian Bank's Association A/c State Bank of Patiala has not made any demand either to allow mid-term withdrawal by individual retirees or for cancellation of the Group Health Policy of the erstwhile Associate banks of the State Bank of India.    Thus, the complainant has failed to make any case of unfair trade practice or deficiency in service on the part of the OPs.”

12 .            In view of the above, we find that the order passed by the Ld. District Commission is based on correct appreciation of  law on the point and does not suffer from illegality and perversity warranting any interference of this Commission.                

13.            For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed,   with no order as to costs. The order of the Ld. Lower Commission is upheld

14.                 Certified copies of this order be sent to the parties free of charge.

 15.               The file be consigned to Record Room, after completion.