District Consumer Disputes Redressal Commission, Hooghly

PETITIONER

VS.

OPPOSITE PARTY

Complaint Case No.CC/130/2019

(Date of Filing:-03.09.2019)

1. Sri Ramaprasad Banerjee of

Village and P.O.:- Janai, Dist. Hooghly, Pin:- 712304, W.B.

Versus

1. The Branch Manager, Bank of India, Duttapur Branch P.O. Krishnarampur

Dist. Hooghly Pin:- 712702, West Bengal

2. The Deputy General Manager, Bank of India, 5, BTM Sarani, Brabourne Road, 4^th floor, Kolkata-700001

3. The General Manager, (Customer Excellence and Branch Banking), Chief Nodal Officer (Grievance Redressal), Bank of India Head Office, Star House, C-5, G Block, 3^rd Floor, West Wing, Bandra-Kurla Complex, Mumbai-400051.

4. The Chairman and Managing Director, Bank of India, Head Office, of the same address as mentioned against serial no.3 above

5. The Branch Manager, National Insurance Company, Liluah Branch, Branch Code No. 153501, First floor, Narayan Niwas, ‘Pushpanjaly’ , Phase-1, 268, G. T. Road, Howrah-711204.

6. National Insurance Company Ltd. having its registered office at 3, Middleton Street, Kolkata-700071.

MR. DEBASISH BANDYOPADHYAY, PRESIDENT

MR. DEBASIS BHATTACHARYA, MEMBER

Dtd. 03.01.2023

Final Order/Judgment

Debasis Bhattacharya:- PRESIDING MEMBER

The instant consumer case filed under section 12 of the Consumer Protection Act 1986 originates from the grievances of the complainant arising out of denial of renewal of a medical insurance policy and resultant failure to lodge a claim for reimbursement of certain medical expenses.

To depict the case as presented in the complaint petition in a nutshell, the complainant, a savings bank account holder of the Duttapur Branch of Bank of India was also a beneficiary of BOI National Swasthya Bima Scheme which was actually a medical insurance scheme. The said scheme is reported to have been floated by Bank of India being a Corporate Agent of National Insurance Company Ltd.

The complainant claims that by virtue of the arrangements of the scheme, it was the bank who was supposed to remit the requisite premium to the said Insurance Company periodically by debiting the amount from the beneficiary’s savings bank account.

Reportedly, the policy for the period 28.01.16 to 27.01.17 was renewed for a further period from 00:00 hours of 28.01.17 to 27.01.2018 and the new policy was issued by The Insurance Company on 15.02.17 against proposal sent by the bank.

However, the complainant is reported to have met an accident in the month of April 2018 and had to be admitted in a hospital and undergo a surgery. The medical expenses for the same went to the extent of Rs.1,00,553/-

After being discharged from the hospital, the complainant requested the OP bank by his letter dtd.01.05.18 for sending the requisite forms for submission of the claim for reimbursement of the medical expenses.

Getting no reply to the above, the complainant sent a reminder dtd. 16.05.18 followed by another reminder dtd.27.06.18.

Eventually, the bank in their communication dtd.29.06.18 informed the complainant that the policy had already been expired on midnight of 27.01.2018. It was also claimed by the OP bank that the policy was discontinued as, on being asked, the complainant declined to renew the policy any further.

On receipt of the same, the complainant sent a legal notice dtd.10.08.18 to the OP bank seeking supporting documents in support of their claim.

This time also, in spite of sending two reminders following the legal notice, the OP bank preferred to be non-responsive.

Simultaneously, a legal notice dtd.15.06.19 was also sent to the OP Insurance Company but the same also went in vain.

Hence the instant consumer complaint came up.

The complainant along with his petition has made exhaustive submission of copies of supporting documents viz. bank pass book reflecting debiting of premiums against the policy, BOI National Swasthya bima policy schedule and details of the scheme including terms and conditions, first communication made to the bank and subsequent reminders including legal notices, notices sent to the OP Insurance company and relevant medical documents.

The complainant brings clause 5.5 of the Scheme documents of the medical Insurance Policy to the attention of this Commission, which reads under the head ‘Payment of Premium’ as follows.

It is further understood and agreed that the premium has been remitted by the bank on collection of the same or duly debiting the account of the account holders with prior consent. On such policy of insurance being issued, the company shall not entertain any request for cancellation and consequent refund premium therefore on any grounds whatsoever shall not arise.’

The complainant in view of the above was under the impression that the policy had been renewed duly and was to be continued for the succeeding year also i.e. for the period 28.01.18 to 27.01.19.

The complainant claims that neither The OP bank nor the OP Insurance Company asked him for his willingness or unwillingness.

The complainant further points out that in the instant case, where there was an apparent tie-up between Bank of India and National Insurance Company in the matter of the medical insurance scheme in question, the insurance company cannot shrug off their vicarious liability.

The complainant filed the complaint petition seeking direction upon the opposite party bank to reimburse the medical expenses amounting to Rs.1,00,000/- (vide the additional brief notes of argument) with interest @10% p.a., to pay 20,000/- only as compensation for ‘mental agony and harassment’, and to pay Rs.20,000/- against litigation cost.

  The complainant, who is apparently a consumer in terms of the relevant provision laid down under the Consumer Protection Act 1986 and OP 1 are resident/having their office address within the district of Hooghly. The claim preferred by the complainant does not exceed the limit of Rs.20,00,000/-. Thus this Commission has territorial as well as pecuniary jurisdiction to proceed in the instant case.

The opposite parties no.1 to 4 belonging to the same organization i.e. Bank of India and opposite parties 5 and 6, belonging to National Insurance Company contested the case by filing elaborate rebuttals in their written versions denying therein the allegations leveled against them. All the OPs prayed for treating their respective written versions as evidence on affidavit.

The OP bank in their representations stresses on the point that the bank being an ‘agent’ of the OP Insurance Company was supposed to renew the policy as per verbal and written consent of the policy holder. The OP bank also claims that in the previous occasion the complainant and other account holders came to the bank and informed the bank authorities for renewal of the policy. It is further claimed that this time i.e. in respect of the material period to which the claim pertains, the complainant came to the bank for ‘giving information of renewal of the policy’.

The OP bank claims to have called the complainant over phone in the month of January2018 but the complainant allegedly declined to renew the said policy.

The OP bank stresses on the point that the claim was to be submitted to the concerned TPA of the Insurance Company.

The OP insurance company harps on the same string that it is the duty of the insured to renew his policy for his own interest.

Thus, all the OPs focuses on the issue that it was the duty of the policy holder to renew the policy on his own and the complainant being the policy holder declined to do so.

Decision with reasons:-Materials on records are perused.                  

 The first issue which is clear that the reimbursement of medical expenses was out of question at the material point of time as the policy itself was not renewed at the appropriate juncture. Now the question is that, who was actually responsible for non-renewal of the policy. So far as the written versions and brief notes of arguments of the opposite parties are concerned, it transpires that the opposite parties desperately try to establish that it is the complainant’s reluctance for which the policy could not be renewed.

However, the contents of the written versions (considered as evidence on affidavit also) of all the opposite parties are hollow, superficial, often senseless and devoid of basic logic. The arguments placed in the representations are not accompanied by material evidences. It is nowhere substantiated by enclosing documentary evidences that the complainant expressed his reluctance to renew the policy. The bank does not appear to have sent any communication to the complainant by any postal means or by any electronic means seeking his consent for renewal of the policy. Besides, it is also nowhere established that the consent by the complainant was required at the time of first renewal of the policy and the same was given by the complainant. And here lies the crux of the case.

The scheme documents, the terms and conditions incorporated therein and the entries made in the bank pass book of the complainant firmly indicates that for renewal of the policy, arrangements were made in such a way that premium amount would be debited from the complainant’s account and would be transferred to the Insurance company with a proposal for renewal of the policy from the bank’s end. As regards the documentary evidences submitted by the complainant, the first renewal of the policy was made in that manner.

Considering all the aspects of the issue it transpires that it is just because of the negligence and indifference of the OP bank, the renewal of the policy was not made at the appropriate point of time. And when the negligence became conspicuous, all the opposite parties tried to pass the bucks to the complainant by hook or by crook. For this negligence and indifference the complainant is not supposed to suffer.     

        Now, in view of the discussion made hereinabove and considering the facts and circumstances of the case, this commission is of the view that there was gross deficiency of service on the OP bank’s part and as the insurance scheme was a product of the tie-up between the OP bank and OP insurance Company, the insurance company cannot shrug off their vicarious liability in this matter.

Hence, it is

ORDERED

that the complaint case no.130/2019 is allowed on contest but in part.

The OP bank and the OP insurance company will be jointly and severally liable to make arrangements for renewal of the policy retrospectively with effect from the appropriate date i.e. from the very date on which the preceding policy expired. Consequent upon the renewal, the OP insurance company will reimburse the actual medical expenses, on examination of the original documents related to the medical treatment, with interest @9% p.a. from the date of discharge from the concerned medical institution to the actual date of reimbursement of the medical expenses.

 The entire amount will be payable within 45 days from the date of this order.  

 Apart from the above, the OP bank will be liable to pay Rs.15,000/- to the complainant as compensation for his mental agony, pain and harassment and Rs.5000/- towards litigation cost within 45 days of this order. In case of non-compliance of this order within the stipulated date as mentioned in this order, the opposite parties will be jointly liable to pay Rs.10,000/- towards 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 acknowledgements/sent by ordinary post for information and necessary action.