Hon'ble Mr. Subhas Ch. Guin, Member.
The fact of the complaint petition in a nutshell is that Complainant No.1 opened a saving Bank account with the Axis Bank(O.P. No.1), Cooch Behar Branch, Sunity Road, P.O. & Dist- Cooch Behar having A/C No.918010033142116 on 18.04.20 and on 21.04.20 Complainant No.1 & 2 opened a Health Insurance Policy with TATA AIG General Insurance Company Ltd.(O.P. NO.2), Cooch Behar Office, B.C. Road, P.O. & Dist- Cooch Behar as per proposal of O.P. No.1 having policy No.02852791770000 and client ID No.6618364160 which was valid from 21.04.18 to 20.04.20 with a payment of premium of Rs.24,962/-. Then before the expiry of the said health insurance policy the Complainant No.1 intimated the O.P. NO.1 through telephone for renewal of the same as it was lock down due to Covid-19. Accordingly, the O.P. No.1 deducted Rs.14,489/- from the Complainant No.1 S/B Account for renewal of the said policy and handed over one master policy NO.0237868334998164 which was valid from 13.04.20 to 12.04.21. After few days O.P. No.2 called the Complainant No.1 through mobile for renewal of the said health insurance policy for which Complainant No.1 contacted the O.P. No.1 and from there it was revealed that O.P. No.2 issued one new health insurance policy in lieu of renewal of the previous health insurance policy without signature of parties and in the name of all Complainants. So, the Complainant No.1 claimed that it was a gross negligence of the O.Ps. Thereafter Complainant No.1 requested the O.Ps to cancel the new policy and renew the previous policy but they did not do it. Subsequently, the Complainant No.1 filed a complaint through e-mail before the O.P. NO.2 on 10.07.20 to which they replied. The reply of the O.P. No.2 stated that they issued new policy as per application received from Axis Bank(O.P.No.1). Then the O.P. No.2 issued renewal policy No.023860569200 for a period from 28.08.2020 to 27.08.2022 after four months but till then O.Ps did not cancel the new policy and refund the amount for the same. Afterwards Complainant No.1 filed a complaint before the Consumer Affairs Department, Cooch behar for mediation. Both parties appeared on the date of mediation on 21.12.20 and O.P. No.1 admitted the negligence of the O.Ps and he also stated that new policy would be cancelled and amount for the same would be refunded within seven days. But after a lapse of 3 months O.Ps did not refund the amount of Rs. 14,489/- to the Complainant. Finding no other alternative, the Complainants filed this instant case for redressal of their grievances. He prayed for a direction to the O.Ps to pay Rs.14,489/- as new policy premium with interest Rs.1,00,000/- for deficiency in service and unfair trade practice and Rs.20,000/- as litigation cost.
Ultimately O.P. No.1 credited the amount of Rs.14,489/- to the Complainant’s S/B account on 29.04.21 after filing this case. Summons were served upon the O.Ps. O.P. No.1 contested the case by filing written version, evidence on affidavit and written arguments. O.P. No.1 in his defence plea stated that the Complainant obtained a health insurance policy e.g. TATA AIG Mediprime Policy bearing No.0285279177 through Axis Bank(O.P. No.1) for the period 21.04.18 to 20.04.20 with payment of Rs.24,692/- for sum insured Rs.5,00,000/- for self and spouse. On being requested by the Complainant to renew the abovesaid policy, the O.P. No.2 issued a group medicare policy bearing No.0237868334 for a period 13.04.20 to 12.04.21 on payment of Rs.14,489/- with sum insured Rs.5,00,000/- for self, spouse and a child instead of renewing the existing policy in the name of the Complainant No.1 and his spouse. O.P. No.1 also confessed that this act of issuance of new policy was due to omission on their part but they acted promptly to rectify the same and got a medicare policy bearing No.023860569200 issued by the O.P. No.2 on payment of Rs.26,285/- for a period 28.08.2020 to 27.08.2022 for a sum of Rs.5,00,000/- for self and spouse and the same was delivered to the Complainant on 18.09.20 through Bluedart Courier vide receipt No.37699620976. O.P. No.1 also submitted that the amount of Rs.14,489/- which was deducted for issuing new policy from the account of the Complainant was credited to the same account. Thus the grievances of the Complainant had been redressed and there was no deficiency in service on the part of the O.P. No.1. So, the O.P. No.1 prayed for dismissal of this instant case to save precious time of the Ld. Commission.
On receipt of summon, the O.P. No.2 appeared before the Commission and filed written version. The Ld. Advocate for the O.P. No.2 did not file evidence on affidavit as well as written argument although she was given many chance to file the same. From the case record it is seen that the case was decided ex-parte against the O.P. No.2 twice and vacated with a cost of Rs.500/- last time. The demeanour of the O.P. No.2 reflects the casual approach of the O.P. No.2 to drag the case. The Ld. Advocate for the O.P. No.2 did not advance the oral argument also. So the fate of the instant case will be dependent on the written version only. Ld. Advocate for the O.P. No.2 stated in her written version that entire grievance of the Complainant was against the O.P. No.1. So, they had been made party in this case by mistake. The entire allegation of the Complainant was related to issuance of the new health insurance policy in lieu of renewal of the existing policy which was due to negligence on the part of O.P. No.1. O.P. No.2 only facilitates insurance policies after receiving information and premium from the O.P. No.1. O.P. No.2 also submitted that they acted promptly and contacted O.P. No.1 after receiving complaint from the Complainant and asked them to resolve the issue promptly. Thus by their interference the matter was resolved at the earliest. Therefore, the O.P. No.2 is no way liable for deficiency in service. So, the Complainant is not entitled to any kind of relief in this case.
Perused the case record and documents filed by the Complainant and O.Ps at length and also heard the arguments advanced by the both parties. In order to adjudicate the case properly as well as the assessment of the evidence the following points are required to be determined.
- Is there any deficiency in service on the part of the O.Ps?
- Is the Complainant entitled to get any relief as prayed for in the complaint petition?
Decisions with reason
Point No.1.
The Complainant requested the O.P. No.1 to renew his health insurance policy issued by the O.P. No.2. Instead of renewal of the said policy he got a new health insurance policy in favour of him, his spouse and a child issued by the O.P. No.2 although the old policy was in favour of him and his spouse only. The TATA AIG General Insurance Company Ltd., the O.P No.2 generally issues insurance policy on payment of insurance premium with the instruction from the O.,P. No.1. Thus, the O.P. No.2 facilitates the issuance of insurance policy and acts as a facilitator. In this case, the O.P. No2 acting as a facilitator issued a new health insurance policy with instruction from the O.P. No.1 in lieu of renewal of the existing health insurance policy which was requested by the Complainant. This act of omission and Commission was admitted by the O.P. No.1. The O.P. No.1 admitted their negligence in supplying wrong information to the O.P. No.2 who later issued a new health insurance policy in lieu of renewing the existing one. The O.P. No.2 did not cross check the names of the insured on receipt of an instruction form the O.P. No.1. Had the O.P. No.2 been vigilant in issuing the policy, this mistake would have been averted in this digital era. The O.P. No.2 company had done the job in a casual manner. This casual approach of the O.P. No.2 tantamounts to deficiency in service. Therefore, the Commission is of the view that there is a deficiency in service on the parts of both O.Ps. Thus this point is answered in affirmative and decided in favour of the Complainant.
Point No.2.
In the aforesaid discussion of point No.1, the Commission comes to a conclusion that there is a deficiency in service on the parts of both O.Ps. Thus this deficiency in service put the Complainant in mental pain agony and harassment. Therefore, the Complainant is entitled to get relief as prayed for in the complaint petition.
Thus this point answered in affirmative and decided in favour of the Complainant.
In the result the case succeeds on contest with cost.
Hence, it is
Ordered
That the instant case No. CC/15/2021 be and the same is allowed on contest with cost.
The O.Ps are directed to pay Rs.30,000/- to the Complainant jointly or severally towards deficiency in service, mental pain and agony and to pay Rs.10,000/- for litigation cost. The O.Ps are further directed to pay the awarded sum within 30 days from the date of this order failing which the awarded sum shall carry an interest @ 6% per annum till its realization.
Let a plain copy of this Order be supplied to the concerned party by hand/by Registered Post with A/D forthwith, free of cost, for information & necessary action as per rule.
The copy of the Final Order be also available in the official website: www.confonet.nic.in.
Dictated and corrected by me.
