FINAL ORDER

Samaresh Kr. Mitra, Member.

This case has been filed U/s.12 of the Consumer Protection Act, 1986 filed by the complainant, Mahadeb Patra.

The case of the complainant’s in short is that he was a family floater mediclaim policy holder in the oriental insurance company Ltd., Chinsurah branch, since 6.11.2009. Complainant’s last policy number was 311702/48/2016/1556.  That from 2009-2010 to 2012-2013 there was no claim in the policy of the complainant.  The complainant got no claim discount in the year 2011-2012, 2012-2013 & 2013-2014 at the rate of 5% only though it should be 5%, 10% and 15% for the year 2011-2012, 2012-2013 & 2013-2014 respectively according to the rule printed on the page No.9 of the information booklet provided by the insurance company.

That after operation of the complainant’s father on 15.6.2014 subsequent claim in the year 2014 a loading of 10% was imposed upon the premium on renewal in the year 2014-2015 though it should be 0% loading according to rules.  On the renewal of the policy in the year 2015-2016 a loading of 5% has imposed though it should be 5% no claim discount.  The complainant requested the branch manager to rectify the renewal premium and adjust the excess premium taken in different years during the renewal of the policy.  Finding no result the complainant complained before the Asst. Director, Consumer Affairs, Hooghly on 9.9.2016 against the oriental insurance company Ltd.  On hearing the representative of the insurance company agreed with the complainant and decided to refund the excess premium of Rs.2,962/-. The complainant applied to the branch manager for refund three times with required documents. But till now the insurance company has not refunded the excess premium to the complainant. Finding no other alternative the complainant has compelled to file this case before this Forum for relief with a prayer to direct the opposite party to refund Rs.2,962/- as excess premium, to pay Rs.5000/- for expense of the case and to pay Rs.5000/- towards compensation for mental harassment and for waste of time.

The opposite party contested this case by filing written version denying inter-alia all the material allegations as leveled against him. This opposite party submits that the insurance company have allowed the appropriate discount on premium and after giving such discount the policies were generated under the system and the complainant received the same year wise without raising any objection and that be so the complainant has no right to put his claim before this Ld. Forum.  This opposite party further submits that before issuance of the policy as everything was made clear to the complainant and as he agreed to receive the policies, those policies were generated and delivered to him.  The branch manager had no scope to entertain the grievance of the complainant, if any, at all.  The insurance company had never agreed to refund any money to the complainant as alleged. The complaint is misconceived having no legs to stand upon and the same is liable to be dismissed.

 Both sides files evidence on affidavit and written notes of argument which is taken into consideration while passing final order.

ISSUES / POINTS   FOR   CONSIDERATION

1). Whether the Complainant Sri Mahadeb Patra, is a ‘Consumer’ of the opposite party?

2).Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?

3).Whether the O.Ps carried on unfair trade practice/rendered any deficiency in service towards the Complainant?

4).Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?

DECISION WITH REASONS

 In the light of discussions here in above we find that the issues/points should be decided based on the above perspectives.

(1).Whether the Complainant Sri Mahadeb Patra, is a ‘Consumer’ of the opposite party?

From the materials on record it is transparent that the Complainant is a “Consumer” as provided by the spirit of section 2(1)(d)(ii) of the Consumer Protection Act,1986. The complainant herein is the consumer of the opposite party, as the complainant being nominee of the policy holder who took mediclaim insurance before the opposite party during his lifetime. So the complainant being the beneficiary is entitled to get service from the opposite party as consumer.

(2).Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?

Both the complainant and opposite parties are residents/having office address within the district of Hooghly. The complaint valued Rs.12962/- for loss sustained by the complainant and as compensation for mental agony and other expenses ad valorem which is within Rs.20,00,000/- limit of this Forum. So, this Forum has territorial/pecuniary jurisdiction to entertain and try the case.        

(3).Whether the opposite party carried on Unfair Trade Practice/rendered any deficiency in service towards the Complainant?

It appears from the complaint petition, written version, evidence on affidavit, written notes of argument & the documents on record that the complainant is a bonafide consumer of the opposite party insurance company and paying his premiums regularly so he is entitled to get no claim discount as per clause 9.23 of the policy condition. The specific provision clearly states that a discount of 5% on the premium in respect of each claim free year subject to a maximum of 20% shall be allowed provided the policy is renewed with the company without any break. The complainant in his complaint petition assailed that no claim discount has been allowed up to 5% not more than that, although there is a specific provision regarding the issuance of no claim discount upto 20%. Dispute cropped up in between the complainant and the opposite party when the opposite party failed to allow no claim discount more than 5%. Opposite party in his written version as well as written notes of argument denied the allegations leveled against him and averred that the insurance company have allowed the appropriate discount on premium and after giving such discount the policies were generated under the system and the complainant received the same year wise without raising any objection so the complainant has no right to put his claim before this Ld. Forum. This opposite party further submits that before issuance of the policy as everything was made clear to the complainant and he agreed to receive the policies, those policies were generated and delivered to him. The branch manager had no scope to entertain the grievance of the complainant, if any, at all.  The insurance company had never agreed to refund any money to the complainant as alleged. But the opposite party failed to produce any document in respect of allowing no claim discount more than 5% which the complainant entitled to get. The complainant approached the Assistant Director of Consumer Affairs & Fair Business Practice, Hooghly R.O. to settle the dispute ,wherein the opposite party appeared and agreed to pay a sum of Rs.2962/- but subsequently refused to pay the same for which the complainant sought the recourse of this Forum praying directions upon the opposite party. It is crystal clear from the documents in record that the complainant is entitled to get more than 5% as no claim discount but opposite party failed to allow the same which tantamount to deficiency of service on the part of opposite party. So the compliant petition is deserved to be allowed with cost.

4). Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?

 The discussion made herein before, we have no hesitation to come in a conclusion that the Complainant has abled to prove his case by adducing evidence on affidavit and the Opposite Party is liable to pay compensation for mental pain and agony of the complainant.

ORDER

Hence, it is ordered that the complaint case being No.220 of 2017 be and the same is allowed on contest against the opposite party with a litigation cost of Rs.4,000/-.

 The Opposite Party is directed to pay a sum of Rs.2962/- with interest @8% p.a. from the date of filing the instant complaint petition till the realization, to this complainant.

All the payments are to be made within 45 days from the date of this order.

At the event of failure to comply with the order  the Opposite Party  shall pay cost @ Rs.50/- for each day’s delay, if caused, on expiry of the aforesaid 45 days by depositing the accrued amount, if any, in the  Consumer Legal Aid Account.

  Let a plain copy of this Order be supplied free of cost to the parties/their Ld. Advocates/Agents on record by hand under proper acknowledgement/ sent by ordinary Post for information & necessary action.