BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Tuesday the 4th day of November, 2008
C.C.No. 36/08
Between:
Smt.B. Lakshmi Kanthamma, W/o. B. Ramnath,
H.No.13/122, Santhapeta, Adoni, Kurnool District. ….Complainant
Versus
- The Branch Manager, New India Assurance Company Limited,
Adoni, Kurnool District.
2. The Regional Manager, New India Assurance Company Limited, Regional Office,
Surya Towers, S.P.Road, Secunderabad. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri.N.Nanda Kishore , Advocate, for the complainant, and Sri.P.Ramanjaneyulu, Advocate, for the opposite parties and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. C.Preethi, Lady Member)
C.C.36/08
1. This consumer complaint of the complainant is filed U/S 11 and 12 of C.P.Act, seeking a direction on opposite parties to renew the Medi Claim Policy of the complainant, to pay an amount of Rs.50,000/- with 12% interest, as compensation for suffering and hardship, cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant is insured with opposite parties for past two years decades and said insurance covered has been extended time to time uninterruptedly and the complainant paid the premiums regularly within time . The opposite party has kept on hold the complainants policy bearing No.610702/ 48/ 05/ 20/ 700500006 medi/ claim policy inspite of receipt of premium from the complainant within time , the said conduct of opposite parties in not renewing the policy of the complainant and insisted upon fresh medical reports without any relevancy. The renewal of the said policy should be done routinely as the matter of course as and when required premium is paid within time , failure on part of opposite parties is definitely deficiency in service. The complainant has been put to inmiserably loss and hardship due to negligent attitude of opposite party in refusing to renew the policy inspite of receipt of premium, being vexed the complainant issued legal notice dated 09-12-2007 and opposite parties even after receipt of said notice did not replied and hence the complainant approach the forum for reliefs.
3. In support of her case the complainant relied on the following documents viz., (1) Xerox copy of policy, (2) letter dated 04-08-2006 of opposite party to complainant , (3) letter dated 11-08-2006 of opposite party No.1 to compliant and (4) office copy of legal notice dated 09-12-2007 along with two postal acknowledgements , besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A4 for its appreciation in this case and replies to the interrogatories exchanged.
4. In pursuance to the notice of this forum as to this case of the complainant, the opposite parties appeared through their standing counsel written version was filed by opposite party No.2 and opposite party No.1 filed adoption memo.
5. The written version of opposite parties denies the complaint as not maintainable either in law or on facts and submits that the opposite party has issued fresh medical claim policy No.610702/48/ 05/75006 to the complainant and her husband for a period from 05-08-2005 to 04-08-2006 on the directions of Ombudsman by loading 300% premium due to existing deceases and on account of previous claims, as such it is not a renew of any previous policy and it is only fresh policy. In fact the complainant received two claims amounting to Rs.1,89,000/- under the old renewed policies and also award of Rs.1,00,000/- in C.C.36/06 dated 14-09-2007 as per the orders of Hon’ble Forum. This shows the attitude of complainant and dishonest intention to get a wrongful gain from this opposite parties . It further submits that the complainants husband approached this opposite party for renewal of policy No. 610702/48/ 05/75006 prior to its expiry and advised him to get fresh medical report with regard to existing deceases and the complainants submitted old reports of the complainant on 03-08-2006 and the opposite party on 04-08-2006 replied to the complainant and the complainant husband on 07-08-2006 requested the opposite party to bifurcate the joint policy and individual policy was issued in his name. It continuation to said process the opposite party on 30-10-2006 wrote a letter sending fresh proposal forms and also requested to send required premium for issual of policy. But surprisingly an anti dated cheque dated 17-08-2006 was received by opposite party on 13-11-2006 and asking the renewal from 04-08-2006 which is impossible and the same was sent back to the complainant’s husband. Further after a lapse of one year the complainant got issued legal notice dated 09-12-2006 , as the complainant husband is highly litigant pending the litigation we may did not respond to the said legal notice. It also submits that the complainants claim before the forum in C.C.37/06 was pending the said policy was kept in abeyance. The opposite party refused to receive premium for renewal of previous polices on account of previous heavy claims and the complainant approached insurance Ombudsman and the said policy was renewed by loading premium of 300% . It further submits that the renewal of policy is not at all routine or automatic and it would be renewed only after necessary tests are done and after satisfactorily result only policy will be renewed . The said policy of the complainant is expired by 04-08-2006 itself and it is highly impossible to renew the said policy and there is no deficiency of service on part of it in not renewing the said policy, as the complainant is a chronic patient and also obtained three claims on previous policies and was aged more than 65 years and without having medical reports the policy could not be issued with exclusions of existing deceases and lastly seeks for the dismissal of complaint.
6. In support of their case the opposite parties relied on the following documents viz., (1) letter dated 03-08-2006 of complainant to opposite party No.1 , (2) complainants Angiography of Coronary Arteries in two pages, (3) 2D Echocardiography study of complainant dated 04-03-2006 , (4) prescriptions dated 03-08-2006 pertaining to complainant, (5) diagnostic reportof blood and Urine dated 03-08-2006 of complainant, (6) ECG Graph dated 03-08-2006 of complainant, (7) letter of B.Ramnath dated 07-08-2006 of complainant to OP.No.1 (8) letter dated 30-10-2006 of OP.NO.1 to Ramnath , (9) letter dated 14-11-2006 of OP.No.1 to Ramnath along with acknowledgement, besides to the sworn affidavit of the opposte party No.21 in reiteration of his written version averments and the above documents are marked as Ex.B1 to B9 for its appreciation in this case and replies to the interrogatories exchanged.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties .
8. It is a simple case of the complainant that she was insured with opposite parties under Medi-Claim Policy for the past two decades vide Ex.A1 and the policy vide Ex.A1 bearing No. 610702/48/08/75006 was for a period from 05-08-2005 to 04-08-2006. Before to the expiry of said policy in Ex.A1 the complainants husband approached opposite parties for renewal and the opposite parties vide Ex.A3 requested the complainant to submit certain reports for renewal. The complainant vide Ex.B1 dated 03-08-2006 addressed a letter to opposite party No.1 along with reports in Ex.B1 and B6 and a cheque for Rs.17,357/- and requested to renew the policy in Ex.A1. The opposite party No.1 after receipt of said letter in Ex.B1 replied vide Ex.A2 dated 04-08-2006 stated the tests are carried out on 05-03-2006 and requested to submit latest reports and returned all the papers including the cheque to the complainant. The complainant’s husband after receipt of letter in Ex.A2 requested the opposite parties vide Ex.B7 letter dated -7-08-2006 to bifurcate the present joint policy into separte policies and requested to renew his policy and sent a cheque for Rs.17,537/-to the opposite parties. The Ex.B8 is the letter of opposite party No.1 to the complainant requested to send the filled up proposal form and send the same to opposite party No.1 along with photo and premium of Rs.7,819/- . The Ex.B9 is letter of opposite party No.1 to the complainants husband requesting to send latest medical reports to make proper assessment and further stated the policy cannot renewed from 04-08-2006 as the premium cheques dated 17-08-2006 for Rs.7,819/- . Inspite of said correspondence the opposite parties did not renew the policy of the complainant and the complainant being vexed got issued legal notice dated 09-12-2007 to opposite parties the same grievances as non renewal of her policy after its expiry and request to renew the policy without any further delay.
9. The opposite parties in their written version submitted that they did not renew the said policy stating that the complainant is a chronic patient and she already obtained three claims on previous policies and was aged more than 65 years. It is clear from the above that the opposite parties refused to renew the policy of the complainant on the ground of her past conduct, the past conduct is that the complainant received two claims amounting to Rs.1,89,000/- and RS.1,00,000/- awarded by the forum is C.C.No.33/06 and also the complainant was a chronic patient. If an insured lodges a claim with the insurance company and if the company does not honour the claim , the insured is left with no other alternative except to knock the doors of the Court of Law. Merely because the complainant approached the forum and two claims under the policies was received by her cannot be attributed as bad record to disentitle the complainant to get her policy renewed and this plea of the opposite party is rejected and cannot be looked into.
10. The other plea of opposite party is that the complainant is aged more than 65 years and a chronic patient, the opposite parties for the policy period from 5-8-2005 to 4-8-2006 renewed on the directions of Ombudsman by loading 300% extra premium due to existing diseases. In the present case of renewal also the opposites parties can charge loading extra premium and renew the policy as there are existing diseases ,but cannot refuse to renew the policy taking a plea that the complainant is aged and chronic patient . The opposite parties in taking any decision should act with fairness and in doing so, can take into consideration only relevant material and must not take any irrelevant and extraneous considerations while arriving at a decision. In the present case of the complainant , there appears more arbitrataryness in the decision of the opposite party in refusing to renew the mediclaim policy of the complainant on the ground of her past conduct . Therefore, the refusal by the opposite party to renew the medi claim policy of the complainant appears to be unfair and arbitrary.
11. In this case the complainant is seeking renewal of the policy from date when it fell due for renewal . It is not disputed that the medi claim policy taken by the complainant provided for its renewal and that the complainant applied for its renewal prior to its expiry. A renewal of the policy means repetition of the original policy, and when renewed the original policy is extended and the renewed policy comes into force. On renewal a new contract comes into force on the same terms and conditions as that of the original policy. When an insurance company refuses to renew the mediclaim policy on the ground of extraneous and irrelevant consideration of any diseases which the insured contracted during the period when the policy was not renewed and such disease cannot not be covered under a fresh policy , as such pre- existing diseases would not be covered under fresh policy. Taking the above into consideration, if the opposite parties refuses to renew the policy of an extraneous considerations there by deprive the claim of the insured for the treatment of the diseases which have appeared during that period and further deprive the insured all those disease under exclusion clause , here the mischief and harm done to the insured must be remedied by ordering the insurance company to renew the policy from the due date of its renewal.
12. To sum up, the opposite parties utterly failed to prove their case and there is clear deficiency of service on part of opposite parties in refusing to renew the policy of the complainant and the said policy is required to be renewed with effect from the date when it fell due for its renewal. In arriving at such conclusions the reasonings are adopted with respect from the decision of Supreme Court between Biman Kishna Bose Vs. United India Insurance Company reported in 2001 (6) Supreme Court case Pg.477. Where in the Insurance Company was directed to renew the appellants policy for the expired period.
13. The opposite parties by their conduct in refusing to renew the medi claim policy of the complainant caused sufferance to the complainant, for the said sufferance and the opposite party has to compensate by paying Rs.5,000/- as compensation for mental agony and Rs.2,000/- as costs of the complaint besides renewing the policy from the expired period and the complainant has to pay the required premium.
14. In the result, the complaint is allowed directing the opposite parties to renew the policy of the complainant from the due date of its renewal subject to loadings on the premiums if any warranted. The opposite parties are also directed to pay Rs.5,000/- as compensation for suffered mental agony and Rs.2,000/- as costs of the case. Time granted for compliance of the above order is one month from the date of receipt of this order. In default the supra stated award shall be payable by the opposite parties with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 4th day of November, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Xerox copy of policy.
Ex.A2. Letter dated 04-08-2006 of OP.No.1 to complainant.
Ex.A3. Letter dated 01-08-2006 of OP.No.1 to complainant.
Ex.A4. Office copy of legal notice dated 09-12-2007 along with
two postal acknowledgements.
List of exhibits marked for the opposite parties:
Ex.B1. Letter dated 03-08-2006 of complainant to OP.No.1
Ex.B2. Complainant Angiography of coronary arteries of complainant
in two pages.
Ex.B3. 2D- Echocardiography study of complainant dated 04-03-2006.
Ex.B4. Prescriptions dated 03-08-2006 pertaining to complainant.
Ex.B5. Diagnostic report of blood and urine dated 03-08-2006 of
Complainant .
Ex.B6. ECG Graph dated 03-08-2006 of complainant.
Ex.B7. Letter of B.Ramnath dated 07-08-2006 of complainant to OP.No.1
Ex.B8. Letter dated 30-10-2006 of OP.No.1 to Ramnath
Ex.B9. Letter dated 14-11-2006 of OP.No.1 to Ramnath along with
acknowledgment .
Sd/- Sd/-
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
