COMPLAINT FILED ON:27.07.2010
DISPOSED ON:01.08.2012
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN)
1st DAY OF AUGUST 2012
PRESENT:- SRI. B.S. REDDY PRESIDENT
SRI. A. MUNIYAPPA MEMBER
COMPLAINT No.1745/2010
Complainant OPPOSITE PARTY | S.Sreedhar S/o Late T.Shamanna, Residing at A-72, ‘Bysani Skyway’, 14/1, First Cross, Mountain Road, Jayanagar, 1st Block, Bangalore-560 011. In-person. V/s. The Divisional Manager, United India Insurance Co.Ltd., Divisional Office III, Classic Building, Richmond Road, Bangalore-560 025. Adv:Sri.D.N.Manjunatha Gupta, |
O R D E R S
SRI. B.S. REDDY, PRESIDENT
The complainant filed this complaint U/s.12 of the Consumer Protection Act of 1986, seeking direction against the Opposite Party (herein after called as O.P.) to refund the premium amount of Rs.1,848/- and to pay Rs.5,000/- towards cost of litigation on the allegation of deficiency in service on the part of OP.
2. The case of the complainant to be stated in brief is that:
The complainant is the Holder of a credit card bearing No.4543 6301 2659 9000 issued by the Canara Bank. The Canara Bank has entered into an arrangement with the OP for issue of Group mediclaim insurance for its credit card holders. He is availing the mediclaim cover for a sum of Rs.3,00,000/- under this programme for the past three years. In view of his advancing age and escalation in the cost of medical services, he made a proposal for enhancing the insurance cover to Rs.4,00,000/- at the time of renewal of his mediclaim policy vide application dt.08.01.2010. The complainant received renewal policy No.70300/2010-2011/2/11 dt.01.02.2010 for an insured amount of Rs.3,00,000/- only against his request for Rs.4,00,000/-. When this discrepancy was brought to the notice of the OP, they accepted their mistake and agreed to rectify it. However, instead of issuing a fresh policy for Rs.4,00,000/- by canceling the policy already issued for Rs.3,00,000/-, they subsequently issued a separate policy No.70300/2010-2011/2/50 which was also dt.01.02.2010 for Rs.1,00,000/- charging a premium of Rs.1,848/- instead of collecting the difference of Rs.1,219/-(premium for a policy of Rs.4,00,000/- is Rs.6094/- less already collected for the policy issued Rs.4,875/-). By issuing two mediclaim policies for an aggregate sum of Rs.4,00,000/-, OP has charged the complainant a premium of Rs.6,723/- against a premium of Rs.6,094/- for a single policy of Rs.4,00,000/-. Thus the OP has collected an extra premium of Rs.627/- for NO FAULT of the complainant. The complainant requested the OP to refund the excess premium collected from him vide letter dt.27.04.2010. Since the OP did not respond to his request till 05.07.2010, he had sent an e-mail to the OP on 06.07.2010, which also did not evoke any response from them. The complainant is very much annoyed, aggrieved and suffered mental agony and a sense of harassment due to the irresponsible acts/indifference of the OP, which also prove the deficiency in their service. Hence the complaint.
3. On appearance the OP filed version contending that the complaint filed by the complainant is not maintainable. The complainant has been seeking direction to refund the excess amount of Rs.627/- towards excess premium and compensation of Rs.1,00,000/- and damages of a sum of Rs.1,00,000/- and cost of proceedings Rs.5,000/-. The complainant has obtained two group mediclaim insurance policies for two occasions, firstly he had given proposal sum assured of Rs.3,00,000/- by paying premium of Rs.4,875/- and issued the policy for sum assured Rs.3,00,000/-, at the time of renewal he has given proposal form to enhance the sum assured. Again the complainant has come to the OP’s office and requested the enhance the sum assured Rs.3,00,000/- to Rs.4,00,000/-, for that he has given another proposal for sum assured for Rs.1,00,000/-, and the complainant had paid further sum of Rs.1,848/- to the OP, at the time of renewal of the previous policy the complainant had given a letter for enhancing the sum assured for Rs.3,00,000/- to Rs.4,00,000/- at the time of renewal of the enhanced the sum assured does not arise as per the IRDA Rules, hence on the request of the insured the OP had issued another mediclaim policy for sum assured Rs.1,00,000/- by collecting the premium as per the IRDA in a total sum assured is of Rs.4,00,000/- collecting premium as per the guidelines of IRDA for Rs.3,00,000/- and Rs.1,00,000/- at the time of renewal. If the sum assured policy is enhanced Rs.4,00,000/- from Rs.3,00,000/- the risk coverage of the previous policy will not continue as per the terms and conditions of the mediclaim policy, because of the insured welfare only the OP have issued another policy for sum assured Rs.1,00,000/- by collecting the premium for Rs.1,00,000/- as per the guidelines of IRDA, hence the question of renewal of mediclaim policy from Rs.3,00,000/- to Rs.4,00,000/- does not arise as the complainant had obtained mediclaim policy previously sum assured only for Rs.3,00,000/- and he had paid premium for Rs.3,00,000/- only. If the insured wants to sum assured Rs.4,00,000/- in a single policy he has to cancel the previous policy sum assured Rs.3,00,000/- and he has to obtain fresh policy for sum assured Rs.4,00,000/- at the time of renewal if the mediclaim policy issued for sum assured Rs.4,00,000/- in a single policy as per the request of the insured, the risk of coverage will not be continued in the previous policy, hence the OP had issued another policy for a sum assured for Rs.1,00,000/- collecting the premium of Rs.1,848/-, hence Op had not collected the excess of Rs.627/- towards premium as stated by the complainant. If the complainant had obtained a single mediclaim policy in one time the premium is of Rs.6094+50, as per said version the complainant had asked refund of Rs.627/- from the OP, the question of refund does not arise as the complainant had obtained previous mediclaim policy for sum assured Rs.3,00,000/- not Rs.4,00,000/- and renewal is only for Rs.3,00,000/- but he has paid premium for Rs.3,00,000/- only at the time of obtaining the previous policy.
The complainant had requested to enhance the sum assured from Rs.3,00,000/- to Rs.4,00,000/- and he had paid premium separately for sum of Rs.1,00,000/- at the time of renewal of the previous policy, hence the OP has not issued a single policy of Rs.4,00,000/- and issued two policies one for Rs.3,00,000/- another for Rs.1,00,000/-. If the OP clubbed and issued single policy for Rs.4,00,000/- previous policy will not continue the risk of coverage of the complainant because of this reason only the OP had issued separate policy for sum assured of Rs.1,00,000/- as per the IRDA Rule. The OP collected the premium for Rs.3,00,000/- and for Rs.1,00,000/-. Hence Op has not collected the excess premium of Rs.627/-. There is no mistake on the part of the OP and it is the fault of the complainant only, as per the IRDA norms the OP had collected the premium for Rs.3,00,000/- and for Rs.1,00,000/- separately. OP had explained reason for collecting separately and issued policy separately. Hence the rectification of mistake does not arise and there is no deficiency of service on the part of the OP. All other allegations made in the complaint denied. Hence it is prayed to dismiss the complaint.
4. Initially in the complaint filed the relief claimed was to refund the excess amount of premium of Rs.627/-, to pay damages of Rs.1,00,000/- for causing inconvenience another sum of Rs.1,00,000/- for mental agony and for costs of Rs.5,000/-. After the affidavit evidence of both parties, OP filed Written Arguments and after hearing the arguments when the matter was posted for orders, the complainant filed I.A., for amendment of the complaint seeking the relief for refund of the premium Rs.1,848/- charged to his credit card towards issue of 2nd medi claim policy which was issued without proposal, along with other relief already claimed in the original complaint. OP not filed objection for the said I.A., the same was allowed and amendment was carried out. After amending the complaint, OP has not filed additional version.
5. The complainant filed affidavit evidence and additional affidavit evidence to substantiate the complaint averments and produced documents. The Divisional/Assistant Manager at Division Office No.3 of Op filed affidavit evidence in support of the defence version and produced documents.
6. Both parties filed written arguments.
7. Argument heard on both sides.
8. Points that arise for our consideration are:
Point No.1:- Whether the complainant has proved
the deficiency in service on the part
of the OP?
Point No.2:- If so, whether the complainant is
entitled for the reliefs now claimed?
Point No.3:- To what Order?
9. We record our findings on the above points:
Point No.1:- Affirmative.
Point No.2:- Affirmative in part.
Point No.3:- As per final Order.
R E A S O N S
At the outset it is not at dispute that the complainant being the Credit Card Holder of the Canara Bank availed the mediclaim cover for a sum of Rs.3,00,000/- under the arrangement entered into by the Canara Bank with OP for issue of Group Mediclaim Insurance for its credit card Holders. The complainant made proposal for enhancing the insurance cover to Rs.4,00,000/- at the time of renewal of his mediclaim policy on 08.01.2010 as per Annexure-1, but Op issued renewal policy No.70300/2010-2011/2/11 dt.01.02.2010 for insured amount of Rs.3,00,000/- only as against the request of the complainant for Rs.4,00,000/-. The complainant claims that he has brought to the notice of the OP about the mistake in issuing renewed policy for Rs.3,00,000/- instead of Rs.4,00,000/- then it is stated that OP agreed to rectify the mistake but however instead of issuing fresh policy for Rs.4,00,000/- by canceling the policy already issued for Rs.3,00,000/-, OP issued separate policy as per Annexure-3 for Rs.1,00,000/- dt.01.02.2010 by charging premium of Rs.1,848/-. Thus the complainant claims that the premium for assured sum of Rs.4,00,000/- is Rs.6094/- an amount of Rs.4,875/- was already collected and the difference of Rs.1,219/- ought to have been collected by OP whereas premium of Rs.1,848/- has been collected hence an excess premium of Rs.627/- is collected without any fault on the part of the complainant
10. Further after amending the complaint, the complainant is claiming that the 2nd mediclaim policy issued for Rs.1,00,000/- dt.01.02.2010 by charging premium of Rs.1,848/- is without any proposal form, he never applied for the same, hence the said amount of premium collected through his credit card is to be refunded.
The defence of the OP is that the complainant had obtained two Group Mediclaim Insurance Policies for two occasions, firstly he had given proposal sum assured of Rs.3,00,000/- by paying Rs.4,875/-+Rs.50=Rs.6144/-, they have collected the premium as per the terms and conditions and rules governed by IRDA and issued policy for sum assured of Rs.3,00,000/- at the time of renewal he has given proposal form to enhance the sum assured. Again the complainant has came to the OP’s Office and requested to enhance the sum assured Rs.3,00,000/- to Rs.4,00,000/- for that he has given another proposal for sum assured for Rs.1,00,000/- and complainant had paid further premium of Rs.1,848/-+50=1898/- to the OP, at the time of renewal of the previous policy the complainant had given a letter for enhancing the sum assured for Rs.3,00,000/- to Rs.4,00,000/-, at the time of renewal enhancing the sum assured does not arise as per the IRDA Rules, hence on the request of the complainant, OP had issued another mediclaim policy for sum assured Rs.1,00,000/- after collecting the premium as per the IRDA Rules, in total sum assured is of Rs.4,00,000/-.
It may be noted that at the time of renewal of the policy, the complainant has submitted proposal form as per Annexure-1 wherein he has clearly mentioned the sum assured of Rs.4,00,000/-. Thus it becomes clear that the complainant has requested the Op by submitting the proposal form to enhance the sum assured from Rs.3,00,000/- to Rs.4,00,000/- but OP instead of issuing renewed policy for Rs.4,00,000/- issued the policy for sum assured of Rs.3,00,000/- and another separate policy for Rs.1,00,000/-. OP has not produced any material to show that the complainant has submitted proposal form for issuing the policy for sum assured of Rs.1,00,000/- as contended in the defence version. Sufficient opportunity was given to the Op to produce any proposal form submitted by the complainant for issuing the additional policy for sum assured of Rs.1,00,000/-. In case if the complainant has submitted the proposal form issuance of additional policy for sum assured of Rs.1,00,000/-, nothing prevented OP to produce the proposal form before this Forum. Non production of the proposal form stated to have been submitted by the complainant in respect of that policy leads to draw inference that the complainant has not submitted the proposal form for issuance of additional policy for sum assured of Rs.1,00,000/-. Therefore without the request with the proposal form issuing additional policy for sum assured of Rs.1,00,000/- is not valid and the premium amount taken from the credit card account of the complainant for the said policy amounting to Rs.1,898/- is illegal, OP is liable to refund the said amount to the complainant. Issuing additional policy without proposal form of the complainant and collecting additional premium for the said policy without consent of the complainant amounts to deficiency in service on the part of the OP.
11.We are unable to accept the defence of the Op that if the OP clubbed and issued single policy for Rs.4,00,000/- the previous policy will not continue the risk of coverage of the complainant, because of this reason only the OP had issued separate policy for sum assured Rs.1,00,000/- as per the IRDA Rule. It may be noted that the complainant has produced the renewed policy for the period from 01.02.2011 to 31.01.2012 for sum assured Rs.4,00,000/- to show that the Op has issued policy for Rs.4,00,000/- at the time of renewal in 2011. Thus the contention of the Op at Para-4 of the Written Arguments is not correct. As may be seen from Para-4 of the policy document dt.01.02.2010 Annexure-3 which reads as “the policy being continuously in force and if increased benefits (higher benefit plans) are availed through the policy in force, the increased benefits are not applicable for those illness, diseases contracted/suffered during the previous policy period. The claims for the said illness/disease disability if admitted shall be processed as per previous year policy limits in which the claim was reported”. Thus it becomes clear that the coverage of the policy can be enhanced and the only condition for such an eventuality was that increased benefits are not applicable for those illnesses, decease contracted/suffered during the previous policy period. Therefore, there is no merit in the contention that IRDA Rules does not permit for issuing the renewed policy for the enhanced sum, as such the OP has issued two policies one renewed policy for sum assured of Rs.3,00,000/- and additional policy for sum assured of Rs.1,00,000/-. Under these circumstances, we are of the view that the complainant is entitled for refund of the amount of premium of Rs.1,848/- collected for the 2nd policy of Rs.1,00,000/- along with litigation cost of Rs.1,000/-. Accordingly we proceed to pass the following:
O R D E R
The complaint filed by the complainant is allowed in part.
OP is directed to refund an amount of Rs.1,848/- and pay litigation cost of Rs.1,000/- to the complainant.
This order is to be complied within four weeks from the date of its communication.
Send copy of this order to both the parties free of costs.
(Dictated to the Stenographer and typed in the computer and transcribed by her verified and corrected, and then pronounced in the Open Court by us on this the 1st day of August 2012.)
MEMBER PRESIDENT
Cs:
