Orissa

Cuttak

CC/69/2015

Bajaranga Lal Sharma - Complainant(s)

Versus

The Divisional Manager,National Insurance Ltd - Opp.Party(s)

Self

24 Jun 2019

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

C.C No.69/2015

 

Sri Bajrang Lal Sharma,

Res. of At:IC/67,Sector-9,CDA,

P.S:Markatnagar,Dist:Cuttack.                                                        … Complainant.

 

                Vrs.

 

1.        The Divisional Manager,National Insurance Company Ltd.,

Cuttack Divisioin-1, Cantonment Road, Cuttack.

and its registered office At:3,Middleton Street,Kolkata-700071.

 

2.       Bank of India, Cuttack Branch,

Cuttack.… Opp. Parties.

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:   16.07.2015

Date of Order: 19.06.2019

 

For the complainant        :       Self.

For the O.P.No.1.             :       Mr. A.A.Khan,Adv. & Associates.  .

For the O.P No.2              :        Mr. S.K.Behera,Adv. & Associates.         

 

 

Sri Dhruba Charan Barik,President.

               The complainant having attributed deficiency in service to the O.Ps 1 & 2, has filed this complaint against them seeking appropriate relief in terms of his prayer in the consumer complaint.

1. The sequence of the event leading to institution of this case stated in brief was that the complainant was an account holder under O.P.2 who had taken the insurance policy under Bank of India National Swasthya Bima Scheme in the year 2007-2008.  The scheme was exclusively meant for the account holders of the said bank and the annual premiums as per the agreement, had to be paid by O.P.1 on behalf of the account holders by debiting the required amount to his account.  The said policy had to continue till 2012-2018.  The photo copies of the receipt of payment of such annual premium for the above period have been marked as Annexure-1 to 6. 

It is important to leave a mention here that the policy in dispute was with respect to period 22.10.13 to 21.10.14 which fell due for renewal on 22.10.13.By that time the complainant was away from India from July,2013 to December,2013.He accordingly requested the O.P.2 to pay the premium on due date on his behalf as usual.Similar request was also made to O.P.1 but in vain.On his return to India, the complainant requested O.P.2 for renewal and accordingly on 8.1.14 O.P.2 forwarded the proposal along with premium amount to O.P.1 but the latter returned the proposal for renewal of the policy on the ground that the complainant had crossed the age of 65 years and the premium has not been paid on due date.According to complainant, it is contrary to policy document which stated that the policy can be renewed for life time by charging extra premium of 25% of the specified premium.The photo copy of the said policy document has been filed and marked as Annexure-7.

It is further revealed that the O.P.1 asked the complainant to submit his medical test report as well as of his spouse duly obtained from the Doctors of M.D rank since the complainant had crossed the age limit of 65 years. Accordingly it was done and such medical report having been duly submitted to O.P.1 was rejected on the ground that the medical reports were of 10 days old.In such an event the complainant was compelled to undergo the medical test again.Such type of medical test conducted at the instance of O.P.1 is also contrary to the policy documents which has subjected the complainant, a senior citizen and his spouse to undue harassment and mental agony.The complainant had made a complaint to the head office against O.Ps 1 & 2 vide letter dt.25.3.2014,8.5.2014,28.5.2014,12.8.2014,26.12.2014,21.1.2015,10.3.2015 and 15.5.2015 but of no avail.Annexure-8 series are photo copies of the above letters enclosed with this case.The complainant has filed some other documents in support of his contention.Annexure-9 is the copy of Bank of India National Syasthya Bima Proposal Form from 22.10.2013 to 21.10.2014.Annexure-10 and 11 are respectively photo copies of the pass book of the complainant and letter of the O.P.1 to the complainant about the fixation of the premium before and after he attains the age of 65 years.

In the aforesaid circumstances and having no other alternative, the complainant was constrained to file the complaint against the O.Ps withprayer to direct the O.P.1 to renew the policy from the current year giving retrospective effect so as to render benefits of continuity of the policy to the complainant, to direct the O.Ps to pay Rs.3,320/- to the complainant incurred towards holding medical tests of himself and his spouse without justification, to pay Rs.10,000/- to the complainant towards compensation together with any other relief as deemed just and proper in the interest of justice.

2. O.Ps 1 & 2 filed separate written version of their case and participated in the proceeding.  O.P.1 in its written version has stated that the case is not maintainable and there is no cause of action to file the case.  The complainant is not a consumer U/S-12 of the C.P.Act,1986.  It is also stated that the complainant approached O.P.1 for renewal of his policy more than two months of expiry of the same and by that time he had already crossed the age of 65 years.  Renewal of such policy in that event would be violative of the terms and conditions of the insurance policy.  Copy of the Bank of India National Swasthya Bima prospectus has been filed and marked as Annexure-A.

It is further stated that since the complainant has neither renewed his policy by the due date nor even within the 15 days grace period as per Annexure-A, the premium was not accepted by O.P.1.Ultimately that policy expired on 21.10.14.It is denied that O.P.1 has any knowledge about the request made by O.P.2 for conducting medical test of the complainant.All other facts which have not been specifically admitted by the O.P.1 are deemed to have been traversed for the purpose of this case.Accordingly it is prayed that the complaint is devoid of merit, hence it is liable to be dismissed with cost.

So far as the written version of O.P No.2 is concerned, it goes more or less in the same way like that of O.P.1. Added to it, O.P.2 has admitted that there is no provision for direct payment of the premium to O.P.1 and the amount can be debited to the account of the complainant and credited to the account of O.P No.1 subject to condition that the complainant has consented for it.In the instant case in absence of any such consent or willingness exercised by the complainant for remittance of the said premium by O.P No.2, it could not be done in time and to that extent O.P.2 is not liable in any manner.It is also prayed that in absence of sufficient materials against O.P No.2, the case may be dismissed in limini.

3. We have heard the complainant and the learned counsel for the O.Ps at length and gone through the case records and its annexures.

The short question that falls for consideration in this case is whether the refusal for renewal of the Bank of India National Syasthya Bima Policy which ought to have been renewed on 22.10.13 is legal and valid.The complainant has persistently stated that on the due date of renewal he was abroad and as such, approached the O.P.2 to debit the premium to his account in favour of the O.P.1.Despite the fact, no action was taken by the O.P.2 for which the renewal of the policy was delayed for about 2 months and after his return to India, when the renewal form together with the premium was sent to O.P.1 at the instance of O.P.2 on 8.1.14, it was not accepted on the ground that it was delayed for two months.It is also the stand of the complainant that the premium of his policy was being renewed every year to the debit of his Savings Bank Account by the Banker O.P No.2.Under tie up agreement, the policy holder could not pay the premium directly to the Insurance Company.It is only the banker, who is O.P No.2 can collect the amount and pay the premium to the insurance company on behalf of the complainant/account holder.When admittedly it was not done, O.P.2 is liable for rendering deficient service to the complainant putting him at colossal loss.On the other hand O.P.2 has categorically stated that unless the complainant gives his consent, the premium cannot be debited to the account of the complainant.Hence it is stated that O.P.2 is not at all liable in any manner.

4. The learned counsel for the complainant has stated that he has already given the authorization as usual to O.P.2 for deduction of the premium on or before the due date and this procedure was in vogue previously.  In this connection he has filed the proposal form of the policy for the period from 22.10.13 to 21.10.14 vide Annexure-9.  On perusal of the said document it is found that the complainant has authorized O.P.2 to debit his account with Rs.7079/- towards the premium for the said Syasthya Bima policy and to pay the same to O.P.1.  The fact that this has been the previous practice of the parties is not seriously disputed.  As such it is held that O.P.1 is liable for deficiency in service in as much as he has failed to take necessary steps for renewal of the said policy on due date even without the consent of the complainant as per the authorization made by the complainant to this effect.
5. The next point for consideration was that the complainant has already crossed the age limit of 65 years by the date of renewal of the policy for which it could not be renewed.  On this point it is fairly submitted by  the complainant that as per the policy document, the policy could be renewed up to 80 years/life time by charging an extra premium of 25% of the specified premium, which the O.P did while renewing the said policy last year.  But O.P.1 did not renew the policy even after receipt of the proposal for renewal form from the bank with whom it had tie up agreement.  The complainant has fairly stated that the original policy was being renewed time to time continuously for the last 6 years without any break.  The complainant has also referred to the IRDA circular which has stipulated that the health insurance policy should always be renewed except if there has been any fraud, moral hazards or misrepresentation.  There is no such ground pleaded in this case by the O.Ps.  It is further revealed from the said IRDA circular copy of which is enclosed in this case that delay in renewal beyond grace period does not bar the policy from being renewed.  At best the coverage for the delayed period may not be available but further renewal cannot be denied.  This is the undisputed position as per the IRDA circular admitted by the parties.
6. In the above premises, it is held that there was deficiency in service on the part of the O.Ps for their failure of having not renewed the policy of the complainant as per his request.  Hence ordered;

                                                                                ORDER

In the facts and circumstances of the case, the case of the complainant is allowed on contest against the O.Ps 1 & 2.O.P No.1 is directed to renew the policy of the complainant as prayed by him giving retrospective effect so as to give/render benefits of the continuity of the policy but the coverage for the delayed period will not be available to the complainant.The O.Ps 1 & 2 are directed to pay compensation of Rs.10,000/- to the complainant towards the mental agony and harassment caused to him.This order shall take effect within 45 days from the date of receipt of copy of this order.

                Typed to dictation, corrected and pronounced by the Hon’ble President in the Open Court on this the 19^th day of June,2019  under the seal and signature of this Forum.

                                                                                                                                                  

    (   Sri D.C.Barik )

                                                                                                                      President.

                                                             

                                                                                     

                                                                                                               (Smt. Sarmistha Nath)

                           Member(W)