Chandigarh

DF-II

CC/380/2020

Yoginder Aggarwal - Complainant(s)

Versus

State Bank of India - Opp.Party(s)

Adv. Rakesh Gupta

13 Jun 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

Yoginder Aggarwal s/o Shri Dev Raj, aged about 71 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

....... Complainant

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

        E-mail: agmppg.lhocha@sbi.co.in

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

E-mail agmppg.lhocha@sbi.co.in

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

E-mail: agmppo.lhocha@sbi.co.in

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).

Email 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.

        E-mail ce@iba.org.in

…. Opposite Parties

ORDER BY AMRINDER SINGH SIDHU, M.A.(Eng.),LLM,PRESIDENT

1.         The complainant has filed the present complaint alleging therein 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 and, therefore, he is now Retired Officer of State Bank of India-OP Nos. 1 to 3.  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  and the said policy was going to expire on 31st October 2019. However, State Bank of India (OP Bank) 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 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 is no provision for mid-term exist of individual insured member from the said policy and as such his request cannot 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 individual members and subsequent refund of premium to such individual members.  The complainant has 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 has further been 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 that the aforesaid acts of omission and commission on the part of the OPs amount to deficiency in service and unfair trade practice, the complainant has filed the instant complaint praying that he is entitled to refund of 50% of the premium amount i.e. Rs.16,596.50P along with interest and compensation for mental agony and physical harassment.  
2.         In their written version, OPs No.1 to 3 have stated that in order to continue with the Group Health Insurance Policy for the retirees of erstwhile SBOP, the OPs issued the 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 ad the complainant had admitted acknowledgement of the e-circular.  It has been 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 the OP No. 5 i.e. IBA.  The relevant clause (v) of para No. 3 of e- Circular dated 07.10.2019 as agreed upon between OP No.4 and 5 is 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.

                It has further been 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 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. The filing of present complaint is only a result of misinterpretation of provisions of e-Circular dated 07.10.2019 and as such the complainant is not entitled to refund of 50% of the premium amount. The remaining allegations have been denied, being false. Pleading that there is no deficiency in service or unfair trade practice on their part, they prayed for dismissal of the complaint.

3.         In its separate written statement, OP No.4 took preliminary objections inter alia that the complainant does not fall within the definition of a consumer as defined under Section 2 (7) of the Consumer Protection Act, 2019  and the complainant has not approached this Commission with clean hands and has suppressed the material facts. It has further been stated that they 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 has further been 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 table given below provided no claim has occurred upto the date of cancellation:-

                It has further been stated that the 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 in the present case Indian Bank's Association A/c State Bank of Patiala is the insured who has entered into single contract with OP No.4 for the policy in question and there is no contract with the individual retirees. 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, they had issued email circulars dated 16.09.2019 and 31.10.2019 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 are 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 is fully justified in protecting premium collected for the retiree policy by not agreeing for mid-term withdrawal of individual members as this will 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 has further been 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 has further been stated that the complainant vide his application dated 10.01.2020 has requested for mid-term exit from the policy and refund of premium and the insurance company vide letter dated 30.01.2020 has informed the complainant that said policy does not have a provision for mid-term exit of individual insured member from the policy hence his request cannot be considered. The remaining allegations have been denied, being false. Pleading that there is no deficiency in service or unfair trade practice on its part, OP No.4 prayed for dismissal of the complaint.

4.         Despite due service OP No.5 failed to put in appearance and as a result thereof it as ordered to be proceeded against exparte vide order dated 25.06.2021.
5.         The complainant filed separate replications to the written reply of OP No.1 to 3 and OP No.4 and controverted their stand and reiterating his own.
6.         The parties filed their respective affidavits and documents in support of their case.
7.         We have heard the Counsel for the contesting parties and have gone through the documents on record, including written submissions.
8.         The main question involved in the present complaint is whether there is any provision for mid-term exist of the individual members from the Group Health Insurance Policy (Annexure R-1/2) or not?
9.         Admittedly, the 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 was issued by OP No.4 in favour of Indian Bank's Association A/c State Bank of Patiala (Annexure OP4/R-1) and the complainant was also one of the Members of the policy in question.   It is also observed that the complainant later on decided to withdraw/exist from the insurance policy 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 who 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 informed that there is no provision for mid-term exist of individual insured member from the said policy and as such his request cannot be considered.
10.         Admittedly, OPs No.1 to 3 issued the 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 receipt of the said e-circular dated 07.10.2019 has also not been disputed by the complainant.   A bare perusal of the Clause (v) of the e-Circular dated 07.10.2019 is amply clear and laid down the following terms and conditions:

i)         That no change in option would be permitted after remittance of premium to United India Insurance Company Limited. So, in terms of clause quoted by complainant, the complainant has no option to opt out of the policy after remittance of premium.

ii)         That it is "The Insured" only who may cancel the policy. Thus in terms of Policy document, the "Indian Banks Association A/e State Bank of Patiala, Head Office: The Mall, Patiala-147001" is the "The Insured" who has the right/entitlement to cancel the policy. Thus the complainant has no right to cancel the policy and to seek refund of the premium paid.

                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.

11.         In view of the foregoing discussion, the present complaint deserves to be dismissed. Accordingly, the same is dismissed with no order as to costs.
12.         Certified copy of this order be sent to the parties, as per rules. After compliance file be consigned to record room.