DIST. CONSUMER  DISPUTES  REDRESAL  COMMISSION

NORTH 24 Pgs., BARASAT.

 C.C. No.100/2018

Date of Filing:                       Date of Admission:                 Date of Disposal:

                                                                                                   08.06.2023

P R E S E N T                :-       Smt. Sukla Sengupta………………….President

:-       Smt. Monisha Shaw …………………. Member.

                                        :-     Sri.  Abhijit Basu      …………………. Member.

          JUDGMENT

          The instant case is filed by the complainant under Section 12 of the C.P.Act, 1986 against the opposite parties.

          The fact of the case in brief is that the complainant has filed this case submitting intera-lia that the O.P. No.1 is an Insurance Company and the O.P. No.2 is a Private Bank Limited. They are running their business under the jurisdiction of this Forum.

          It is further stated by the complainant that he has a savings bank A/c. in the bank of O.P. No.2- Axis Bank at Sodepur, Ghola Branch vide S.B. A/c. No. 91401003087545 since long. It is further stated by the complainant that the O.P. No.2 being an agent of O.P. No.1 insisted the complainant to get mediclaim policy from the O.P. No.1for future safety of his family and also insured him that if he purchased the policy from the O.P.No.1 he would not bother about the hearing of renewal of the policy as the insurance company will receive the same from the bank account directly and moreover he would tax benefit against each

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premium he would pay. Considering the goodwill of the O.P. No.1Company and being satisfied with the assurance of the O.P.. No.2 bank about the hassle free transactions and services, the complainant in order to secure his family future accepted the proposal and accordingly purchased one mediclam policy namely MediPrime, Family Floater Plan Type, from the O.P. No.1- Insurance Company (vide policy No. 0200571249) on payment of the required premium and after observing all sort of formalities as required and informed by the opposite parties for the same. The policy commenced on and from on 28^th day of January of every year and expires on 27^th day of January of the succeeding year and the policy would get renewed by directly debiting the yearly premium from his

savings bank account of the complainant lying with the O.P. No.2- bank. The O.P. No.1 Insurance Company has acknowledged the same through letters. The complainant also received tax benefit letter from the O.P. No.1. In such way the policy was renewed for the period of 28.01.2015 to 27.01.2016 by debiting premium of Rs. 8,930/-from his savings account lying in the O.P. No.2-bank at Sodepur, Ghola Branch. Thereafter, the policy was renewed for the period of 28.01.2016 to 27.01.2017 by debiting premium of Rs. 9,101/- as like and acknowledged the same through letters. The sum insured was Rs. 300,000/-for one year and the complainant insured for himself, his wife-Sujata Biswas and his daughter- Shubhra Biswas under the said policy.

          It is the further case of the complainant is that suddenly on 28.03.2017 his daughter Subhra Biswas was admitted at Zenith Super Specility Hospital at Belgharia with acute pain in right lower abdomen and attending doctor that acute Appendicectomy and advised for immediate operation. Accordingly she was undergone operation on 29.03.2017 at Zeneth Hospital and was discharged from the hospital on 03.04.2017. For the purpose of his daughter’s treatment the medical expenditure was of Rs. 48,905/- as it was billed by the Zeneth Hospital Authority. The photo copy of the insurance policy, letters and bills have been annexed herewith.

The complainant further stated that at the time of admission of his daughter, he informed the hospital authority that the patient is under the coverage of MediPrime family mediclaim policy and all the bills raised by the hospital would be paid by the insurer i.e. O.P. No.1 directly. But during the course of treatment of his daughter the complainant came to know from the Zeneth Hospital Authority that his mediclaim policy in question has been lapsed as it was not renewed after 27.01.2017. The complainant utterly shocked but at that time he was busy with his daughter’s health and could not be able to interfere in this matter. He released his daughter from the hospital by paying the entire bill at his own record amounting to Rs. 48,905/-. The money receipt is annexed.

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Then after recovery of his daughter the complainant went to the O.P. No.2 bank and asked the reason why the policy has already been lapsed when there was sufficient fund in his account. But O.P. No.2 failed to reply the cause of such unwanted incident and advised him to contact with the insurance company i.e. the O.P. No.1. Thereafter the complainant went to the O.P. No.1-Insurance Company but they failed to give any satisfactory answer and could the burden upon the O.P. No.2 Banking Authority. But prior to expiry of the policy on 27.01.2017 the O.P. No.1 Insurance Company did not remind the complainant about the same. However, just to get rid of this situation the complainant make contact with both the opposite parties on several occasions like a shuttle cock but neither of them could be able to give protection to him.

It is alleged by the complainant that only for the negligence on the part of both the opposite parties the complainant suffered a lot of financial expenditure in order to pay the medical bill of his daughter at the hospital. From which it is crystal clear that both the opposite parties caused deficiency in service intentionally for making some wrongful gain.

The complainant stated that when he purchased the insurance policy from the O.P.No.1- Insurance Company at the instance of his banker –O.P.No.2 then he is a consumer and both the opposite parties are the service provider. 

Due to negligence and misbehavior of both the opposite parties the complainant suffered monetary loss, mental pain and agony which is nothing but the deficiency in service on the part of the opposite parties.

 Hence the instant application is filed by the complainant with a prayer to give direction to the O.P.No.1- Insurance Company to pay a sum of Rs. 48,905/- in total to the complainant which has been spent by him.

For the medical expenditure of his daughter and also prayed for giving direction to the opposite parties to pay compensation of a sum of Rs. 1,00,000/ to the complainant for harassment, mental pain and agony along with litigation cost.

          O.P. No.1-Insurance Company has contested the claim application by submitting the written statement/ written version denying all the material allegations leveled against it. He stated by the O.P. No.1 in the written version /written statement that the complainant has suppressed the material facts and did not come before this Commission with clean hand. So, the frivolous, vexatious petition of complaint is liable to be dismissed under 26 of the C.P. Act, 1986.

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The further case of the O.P. No.1 is that the complainant is an account holder with the O.P. Bank. O.P. No.2 being the agent of the O.P. No.1 approached the complainant with a proposal to take a mediclaim from the O.P.No.1-insurance company for the safety of the complainant’s family. It is further stated by the O.P. No.1 that the complainant filled up proposal form bearing No.9630241 for the mediclaim policy known as Mediprime  ( a Family Floater Plan) and the said proposal form has been annexed herewith as Exibit ‘A’. It is further case of the O.P. No.1 that on receipt of the proposal form the premium amount of Rs.8,930/- was directly debited from the savings bank account of the complainant lying with the O.P. No.2- Axis Bank on payment of receipt.

Admittedly the said policy sought to insure the complainant’s wife Mrs. Sujata Biswas, daughter-Miss Subhra Biswas and the complainant himself. On receipt of the required premium the O.P. No.1- Insurance Company issued Mediprime policy for the period on and from 28.01.2015 to 27.01.2016 vide policy No. 0200571249 the said policy being the first policy has been marked as Ext.’B’. The said policy was sent by the O.P. No.1 to the complainant by courier service being Blue Dart Express Limited bearing  Airway bill No. 33192699035 that was duly received by the complainant on 07.02.2015 annexed at Exibit ‘C’.

          It is further stated by the O.P. No.1 that the O.P. No.1 never offer Auto Debit facility of any of its product and the policies can be renewed only upon

receiving the premium amount directly from a customer or upon receiving the payment confirmation from the Company’s agent. It is further stated that the company has no such provision that it send Renewal Notice to its customers for reminding a customer that their policy is about to expiry. The company states that the complainant was specifically made aware of this at that time of signing of the proposal form by the complainant and as such the page 5 of the proposal form which sets out the Auto Debit facility provision has been specifically cancelled by the complainant. The Company may at time and voluntarily sends renewal notice to its customer for their convenience and similarly in this case, the company had sent a renewal notice dated 02.12.2015 to the complainant (Exibit ‘D’.

          It is further stated that on 23.12.2015 the company received payment confirmation from the O.P. No.2 i.e. Axis Bank and the premium amount of Rs. 9,101/-, which was debited from the account of the complainant lying with the O.P. No.2- bank and that renewal of the first policy was done for the period from 28.01.2016 to 27.01.2017 (Exibit ‘F’). The company further stated that in absence of renewal requests and receipt of the premium payable on such renewal the policy would be lapsed in its ordinary course. In the instant case it is the complainant who has failed to pay the required premium for further renewal of

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his mediclaim policy. Thus the policy was dismissed on this ground alone. As per O.P’s case the complainant himself is solely responsible for cancellation of his policy and he has no cause of action to file this case. Thus the same is liable to be dismissed.

          In view of the above stated pleadings in order to adjudicate the matter properly the points for consideration are as follows:-

1. Is the case maintainable in its present form and law?
2. Has the complainants any cause of action to file this case?
3. Is the complainant a consumer under the provision of C.P. Act, 1986?
4. Are the opposite parties service provider ? If so there any deficiency in service on the part of the opposite parties ?
5. Is the complainant entitled to get the relief as prayed for?
6. What other relief or reliefs are the complainants entitled to get?

Decision with Reasons

          All the issues are taken up together for convenience of discussion and to avoid unnecessary repeatation.

          From the materials on record it appears that the parties to this case running their business within the territorial jurisdiction of this Forum and the case value is also within its pecuniary jurisdiction.

          From the materials on record it is also found that the complainant purchased the mediclaim policy from O.P. No.1- Insurance Company through O.P. No.2- Axis Bank vide policy No. 0200571249 on receipt of the required premium of Rs.8,930/-. From the receipt dated 28.01.2015 it appears that it was paid by the complainant through direct debit to bank account being savings bank A/c. No. 9140100308875215 i.e. through Auto Debit system issued by Tata AIG i.e. O.P. No.1- Insurance Company for the period of 28.01.2015 to 27.01.2016.

 From the materials on record and documents i.e. money receipt dated 23.12.2015 it appears that the said policy was renewed on payment of the required premium of Rs. 9,101 through direct debit of the savings bank account of O.P. No.2- Axis Bank for the period of 28.01.2016 to 27.01.2017. It is alleged by the complainant that the opposite parties without giving him any notice all on a sudden lapse the policy due to non- payment of the premium. But it was agreed by the opposite parties that the premium would be paid through Auto Debit system from the savings bank account of the complainant lying with the O.P. No.2- Axis Bank. But from the bank statement it is found that at that time there was sufficient fund in the savings bank account of the complainant when his

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daughter suddenly fallen ill and she was undergone treatment at Zeneth Super Specialty Hospital at Belgharia and after her operation when the complainant placed the claim of the medical expenditure of his daughter to the tune of Rs. 48,905/-. O.P. No.1 repudiated the claim on the pretext that the policy was lapsed as it was not renewed after 27.01.2017. Then cause of action arose on 28.01.2017 and also on 3.4.2017 when the complainant had to pay the entire medical bill at his own. From which it can safely held by this Forum that the complainant has sufficient cause of action to file this case.

          Cause of action arose lastly on 03.04.2017 and the case is filed by the complainant on 09.03.2018 i.e. well within the period of limitation.

          From the above discussion  it is opined by this Forum that the case  well maintainable in the eye of law.

          From the discussion made above it is revealed that admittedly the complainant purchased the mediclaim policy namely MediPrime, Family Floater Plan type from the O.P.. No.1- Insurance Company through the O.P. No.2- Axis Bank wherein the savings bank account of the complainant being A/c. No. 914010030875215 is lying at it’s Sodepur Ghola Branch, 348, Barasat Road, Ghola Bazar, P.S. Ghola, Kolkata-700111. On payment of the required premium amounting to Rs. 8,930/-. Then it can be held by this Forum without having any hesitation that the complainant purchased the mediclaim policy from the O.P. No.1- Insurance Company through the O.P. No.2-Axis Bank on payment of the required premium for his family health became the consumer within the ambit of C.P. Act, 1986 and the O.P. Nos.1 and 2 are the service providers. When it is established fact that the O.P. Nos.1 and 2 are the service providers,  then let us see whether there is / was any sort of deficiency in service on their part or not.

          The O.P. No.1- Insurance Company has denied in its written statement /written version that usually the company does not go for Auto Debit payment of premium rather the O.P. No.1 only renew the policy on receipt of the premium  from the customer himself or from its agent.

From the money receipt dated 28.01.2015 it is palpably clear that the O.P. No.1received the premium of a sum of Rs. 8,930/- from the complainant through direct debit to A/c. bank, Sodepur Ghola of the O.P. No.2- Axis Bank. The another money receipt dated 23.12.2015 also proved the case of the complainant that the O.P. No.2- bank who being the agent of the O.P. No.1- Insurance Company assured that the premium will be paid through Auto Debit system from the savings bank account of the complainant lying with the O.P. No.2- Axis Bank and it will be renewed automatically through Auto Debit

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system. From the documents filed by the complainant it is also proved that the O.P. No.1-Insurance Company informed the complainant through mail to renew the policy which will be expiring on 27.01.2016. So, considering these documents it is crystal clear that the policy in question of the complainant wherein sum insured was of Rs. 3,00,000/-for one year that would not be renewed after 27.01.2017 due to negligence on the part of O.P. Nos. 1 and 2.

          It has come to the notice of the complainant when he placed the claim of mediclam expenditure of his daughter who is also one of the insurer amounting to Rs. 48,905/- for her Appendix operation at Zenith Super Specialty Hospital at Belgharia. From where she was discharged after recovey on 03.04.2017. The O.P. No.1- Insurance Company repudiated the claim of the complainant on the plea that after 27.01.2017 the policy was lapsed as it was not renewed on payment of the required premium. Hence the complainant became speechless and without having any other alternative knocked the door of the Forum for getting relief.

          During the course of argument, Ld. Advocate for the complainant drew attention of this Forum to the fact that since the stage of filing evidence the O.P. No.1 did not fill any urge to appear before this Forum and to take part in the  argument. So, the conduct of the opposite parties also shows that there was negligence and deficiency in service on the part of them. The O.P. No.2-Axis Bank even after getting notice did not fill any urge to appear before this Forum.

Under such circumstances and also considering the conduct of the opposite parties this Forum is of view that there was severe deficiency in service and negligence on the part of the opposite parties and on the contrary the complainant could be able to prove his case beyond all reasonable doubt. The mediclaim policies in question of the complainant and his family has been lapsed due to negligence and deficiency in service on the part of the O.P. Nos. 1 and 2 for which they are liable to give compensation to the complainant.

          In sum being a consumer the complainant could be able to prove his case beyond all the reasonable doubt and is entitled to get the relief as prayed for.

          All the points are thus, considered and decided in favour to the complainant.

          Hence,

                       it is ordered,

          that the case be and the same is decreed on contest against the O.P. No.1 and exparte against the O.P. No.2 with cost of Rs. 2,000/-.

          The complainant do get the decree as prayed for.

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The O.P. Nos. 1 and 2 are directed to pay the entire medical bill for the medical expenditure of the daughter of the complainant paid by him amounting to Rs. 48,905/- to the complainant either jointly or severally within 45 days from the date of this order.

          The O.P. Nos. 1 and 2 are further directed to pay compensation of a sum of Rs. 50,000/- for harassment, mental pain and agony and monetary loss along with litigation cost of Rs. 5,000/- either jointly or severally to the complainant within 45 days from the date of this order.

          If the opposite parties failed to comply the decree within the stipulated period the complainant will be at liberty to execute the same as per law.

Let plain copy of this order be given to the parties free of cost as per CPR, 2005.

Dictated & Corrected by me                      

President

Member                                  Member                                  President