Hon'ble Mrs. Rumpa Mandal, Member.
The case of the Complainant in brief is that the Complainant purchased a Mediclaim Policy i.e. Swasthya Bima Policy from the O.P. No.1 i.e. National Insurance Company Ltd. through O.P. No.2 i.e. Branch Manager, Bank of India. The Complainant continued this policy up to 2013 and lastly 5th policy was issued by O.P. No.1 vide policy No.153901/48/17/8500001740. This policy period was 30.12.17 to 29.12.18 and the total premium was paid by the Complainant for Rs.6,202/-. Thereafter O.P. No.1 issued a policy of coverage for mediclaim of Rs.4,00,000/-. O.P. No.1 received the said premium through O.P. No.2 which has the Complainant’s A/C vide No.432416310000200. Complainant filed a written complaint before O.P. No.1 & 2 for renewal of Bank of India and National Swasthya Bima policy. Accordingly, both O.Ps received the same. Subsequently, on 27.12.18 O.P. No.2 issued a letter to O.P. No.1 for renewal of the policy vide policy number as above mentioned with the same previous conditions along with demand draft No.155780 dated 27.12.18 with premium of Rs.6,202/- and O.P. No.1 received the same. But till today after receiving the demand draft O.P. No.1 did not issue any mediclaim policy in favour of the Complainant and his family members. On several occasions Complainant contacted with O.Ps but till today the OP did not issue any renewal policy despite receiving full premium. According to him the mediclaim coverage was expired on 29.12.18 due to O.Ps negligence. So, he suffered mental pain and agony. On 13.02.19 the Complainant filed a written complaint against the O.P No.1 before Consumer Affairs & Fair Business Practice and mediation. Complainant & O.P. N.1 appeared before the mediation. It is admitted by the O.P. No.1 that Complainant paid the premium of said policy within time but specifically the policy was discontinued and he tried to renew the policy but due to some technical problem it could not be renewed. In mediation Complainant wanted to pay the extra premium. During mediation Sri S. Mardi, Senior Branch Manager, National Insurance Company Ltd. told that the said policy was a specially designed policy and it was discontinued from Oct. 03, 2018 and the said policy was subsequently expired on 29.12.18 and thereafter O.P. No.1 tried to renew the same but due to some technical problem it could not be renewed and the said Manger informed him and advised him to switch over to other policy through email. Complainant agreed to give the premium of Rs.7,000/- approax. O.P. No.1 assured that they would try to revive the policy within 15 days.
The O.P. No.1 is contesting the case by filing written version and evidence on affidavit and also files written argument. O.P. No.2 also filed written version and evidence on affidavit but did not file any written argument. It is found from the case record that vide order No.19 dated 31.12.21 the case has already been decided to be heard ex-parte against O.P. No.2.
According to O.P. No.1 the draft of Bank of India for payment of renewal of mediclaim policy which was sent to this OP returned back to the Bank of India.
Having found no other alternative way, at last the Complainant filed this case in this Commission.
The O.P. No.1 submits in his evidence on affidavit that there was a tie up with the O.P. No.1 with the Bank of India and the said tie up remained discontinued from 03.10.18 and the said O.P. No.1 sent one letter to the Branch Manager of O.P. No.2 dated 28.09.2018 and explained that all the existing customers whose policies are expiring between 03.10.18 to 31.12.18 will have an option to renew their policies for one year only with the same rates and conditions provided the renewal is effected on time or within 30 days grace period from the expiry date of policy. All such policy holders shall be allowed to run their full one year term till expiry and subsequent renewal will be on a migrated alternative product only. The O.P claimed that the case should be dismissed.
On the basis of the pleadings of the parties, this Commission sets forth the following points.
POINTS FOR DETERMINATION
- Whether the Complainant is a consumer under section 2(d)(1) of CP Act 1986?
- Whether the non renewal of mediclaim of the complaint was due to the fault of the Complainant?
- Whether the Complainant is entitled to get the relief against the OP as prayed for?
- To what other relief or relief(s) is prayed for?
DECISION WITH REASONS
Point No.1.
Complainant purchased the mediclaim policy i.e. Swasthya Bima policy from the O.P. No.1 through O.P. No.2.
According to CP Act 1986 section 2(d) (i) if any person buys any goods for a consideration, he is a consumer under CP Act, 1986.
In the instant case, Complainant purchased the mediclaim policy from O.P. No.1 through O.P. No.2.
Accordingly, the Complainant is a consumer under CP Act, 1986. Point No.1 is thus answered in positive.
Point No.2 & 3.
Both the Points No.2 & 3 are closely related. Therefore, in deciding these are taken up together for discussion.
From the documents and evidence, it is crystal clear that the Complainant paid premium. This is established through his supported document. But when he approached for renewal of the policy, it was not renewed due to some technical points. O.P. No.1 stated in his evidence on affidavit that as per IRDAI guidelines the Swasthya Bima and Baroda Health had been stopped from 3rd Oct, 2018 and offered alternative product and after end of the renewal of the said policy, the machine did not take its renewal. But the Complainant approached the policy for renewal within time i.e. on 27.12.18. The Complainant averred in his evidence on affidavit that the policy period was continued from 30.12.17 to 29.12.18 and the total premium paid by the Complainant is Rs.6,202/-. So, the O.Ps statement is not tenable and OP has not submitted any document in his favour. The statement of the Complainant is established through pleading & evidence.
The Ld. Lawyer for the Complainant argued that on 27.12.18 O.P. No.2 issued a letter vide reference number mentioned in the complaint petition to O.P. No.1 for renewal the policy of National Swasthya Bima vide policy No. 153901/48/17/8500001740 mentioned in the complaint with some previous conditions alongwith demand draft of premium of Rs.6,202/- and the O.P. No.1 received the same. After receiving of demand draft but till today O.P. No.1 did not issue any mediclaim policy in favour of the Complainant and the premium of policy was paid by the Complainant within time. But the policy was discontinued by O.P. No.1. Although O.P. No.2 deducted Complainant’s S/B account of Rs.6,202/- on 27.12.18 and according O.P. No.1 received the premium. The first policy was issued by the National Insurance on 29.04.19 Complainant filed further prayer for renewal of the policy before O.P. No.2 but till today O.P. No.2 did not reply the same. So, the Ld. Lawyer prays for relief(s) as prayed for in the complaint. So, Point No.2 goes in favour of Complainant. Non-renewal of policy in favour of complaint goes against O.P. No.1 and O.P. No.2.
The Complainant filed some documents in support of his claim as annexures. As per Annexure-A, A1 the Complainant filed a written petition before expiry of 5th mediclaim policy before the O.Ps for renewal of Bank of India National Swasthya Bima policy. This documents proves that the Complainant prayed before O.Ps for renewal and the same was received by the O.P.
So, the documents supports the case of the Complainant. OP has not submitted any other document which goes against Complainant.
As per Annexure-B of Complainant’s documents on 27.12.18 the O.P. No.2 issued a letter to O.P. No.1 for renewal of the policy and in his petition O.P. No.2 mentioned that O.P. No.2 debited the premium of Rs.6,202/- from his A/C No.432416310000200 and the amount sent in favour of NICL vide demand draft No.155780 dated 27.12.18. It stands proved in favour of Complainant. O.P. No.1 has not challenged it. No document is also produced against Complainant.
According to Annexure-C, some insurance certificates is submitted by the Complainant issued by National Insurance Company ltd. It is found from the certificates that the Complainant paid premium and it was paid by Complainant during the valid period of insurance. O.P. No.1 issued policy of coverage for mediclaim of Rs.4,00,000/-. So in the middle of the period O.P. No.1 through O.P. No.2 should not stop the policy and cannot deny its renewal. Thus, the plea of the Complainant stands well proved.
According to Annexure-D during the mediation both the Complainant and O.P. No.1 appeared and it was admitted by the O.P. No.1 that the premium of policy received by O.P. No.1 within time but due to some technical problem it could not be renewed. Complainant was ready to pay extra premium for renewal of the same type and same coverage policy and O.P. No.1 assured for renewal of policy within 15 days but till today the OP did not issue any renewal policy in favour of the Complainant. Thus, the case of the Complainant is established during the mediation. But the said mediation was dropped.
In dealings with the Annexure-E & F, it appears that the Complainant filed a written complaint before O.P. No.1 on 16.03.19 which O.P. No.1 received the same on 20.03.19. From the documentary evidence Annexure-E it goes on in favour of Complainant.
As per Annexure-F & G subsequently OP replied on 21.03.19 but reply was not as per Law. Because O.P. No.1 in his reply mentioned that the complaint could opt for a sum insured of Rs.3.50 Lakhs which would meet his budget. But why O.P. No.1 changed their policy, this point is not mentioned in the reply. So, from the documentary evidence that plea of the Complainant is well established but the plea of the OP is not proved.
National Insurance Company Ltd. Issued a policy in favour of Complainant. Through Annexure-G of documentary evidence it is confirmed.
O.P. No.2 deducted the amount of Rs.6,202/- from Complainant’s S/B account which was Complainant’s salary account. This is the pass book of Complainant under Bank of India. This documentary evidence confirmed Complainant’s version (Annexure-H) O.Ps did not deny from their evidence on affidavit about the veracity of that document.
On 29.04.19 the Complainant filed further prayer for renewal of the policy before the O.P. No.2 but thereafter no reply was given by O.P. No.2. So, the Complainant’s plea is established.
Perused all the documents carefully, which support the case of the Complainant. Having considered all aspects and in view of the discussion made herein above, I am of the view that the Complainant is entitled to get relief as prayed for.
The demeanour of the OP clearly proves the fact that the OP was reluctant to produce the best document which is supposed to be in the custody of the OP. This is clearly an act of deficiency in service.
Regard being also had to the fate of the aforesaid two points 1 & 2 which are decided in favour of the Complainant.
Thus the demeanour of the OP clearly reveals that there was deficiency in service on the part of the O.Ps as a bank and National Insurance Company towards providing service to the Complainant.
In the back drop of the aforesaid discussion vis-à-vis the observations made herein above, I am of the view that the Complainant is entitled to get the relief as prayed for.
Point No. 3 & 4 are therefore decided on behalf of the Complainant.
In the result, the Complaint case succeeds on contest with cost.
Hence, it is
Ordered
That the complaint case No. CC/73/2019 be and the same is allowed on contest with cost of Rs.1,000/-.
The O.P. No.1 is directed to issue fresh policy in favour of BOI, National Swasthya Bima policy and also directed the O.P. No.2 to pay the total premium amount with up to date interest.
The O.P. No.1 & 2 are jointly and severally liable to pay the said money to the Complainant within one month from the date of passing the order failing which the awarded sum shall carry on interest of @ 6% per annum from the date of passing the order till the date of realisation and Rs.1 Lakh from the O.Ps as deficiency in service and mental pain and agony is also directed to pay a sum of Rs.8,000/- as cost of proceedings to the Complainant.
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 is also available in the official website: www.confonet.nic.in.
Dictated and corrected by me.
