Delhi

North East

CC/255/2017

SMT. SHANTI - Complainant(s)

Versus

THE MANAGER ,BANK OF MAHARASHTRA & ANR. - Opp.Party(s)

17 Oct 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No.255/17

 

 

 

 

 

 

In the matter of:

 

	Smt. Shanti W/o Sh. Anil Kumar R/o H.No. 19-A, Street No.2 D-Block, Brijpuri, Delhi-110094	Complainant
	Versus
1.           2.	The Manager Bank of Maharashtra C-4/74A,C-Block, Opp. Gokalpuri Yamuna Vihar, Delhi-110053   The Manager M/S United India Insurance Company (Bank of Maharashtra) Divl. Office at 10203, Jamna House Near Vishal Nagar Mart Padam Singh Road, Karol Bagh, New Delhi-110005	Opposite Parties

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                          DATE OF ORDER:

02.08.17 07.06.22 17.10.22

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

 

 

 

 

ORDER

      Anil Kumar Bamba, Member

The Complainant has filed the present complaint under Section 12 of the Consumer protection Act, 1986.

Case of the Complainant

1. The facts of the case are that the Complainant is having an account in Opposite Party No.1 branch. The Complainant stated that the Opposite Party No.2 had launched a medi-claim policy and told the Complainant that the amount of the policy be deducted directly from the Opposite Party No.1 bank. The Complainant submitted that she had purchased a policy named as Maha Swasthya Yojna for her entire family through Opposite Party No.1 bearing no. 1622012015484100000 6445 for an amount of Rs. 3,50,000/- valid from 16.01.15 to 15.01.16. On 14.01.16, the Complainant renewed her policy bearing Demand Draft no. 296675 amounting to Rs. 5,589/- which was deducted from her savings bank account no. 60006633350 by Opposite Party No.1. Unfortunately, the Complainant fell ill as she was suffering from abdomen pain and got admitted in Panchsheel Hospital on 20.07.16 for treatment and discharged from the hospital on 22.07.16. The Complainant stated that she had incurred a bill of Rs. 13,026/-. The hospital forwarded the medical bills to branch office of Opposite Party No.2 but the manager of branch office of Opposite Party No.2 had refused to release the amount and the Complainant paid the bills from her own pocket. Thereafter, the Complainant visited the office of branch manager of Opposite Party No.2 asked them why they had not released his amount then the officials of Opposite Party No.2 stated that the policy was not renewed on time as the Opposite Party No.1 had not sent the demand draft on time due to which the policy has lapsed and the Opposite Party No.2 started a new policy of the Complainant bearing no. 0405002815P-114206814 valid from 22.02.16 to 21.02.17. The Complainant submitted that she had visited the office of Opposite Party No.1 and came to know that the Opposite Party No.2 had received the Demand Draft no. 296675 dated 16.01.16 from Opposite Party No.1 on 19.02.16 due to which the lapse occurred and the Opposite Party No.2 issued a new policy to the Complainant. The Complainant stated that the policy amount is deducted on 14.01.16 from her bank account. The Complainant made various visits to the Opposite Parties but she did not get any satisfactory response from the Opposite Parties. The Complainant sent a legal notice to Opposite Parties on 01.06.17 and the Opposite Party gave vague reply to notice on 16.06.17 but did not release the medi-claim policy amount in question. Hence, this shows deficiency on the part of Opposite Parties. Complainant has prayed to direct the Opposite Party to release the amount of medi-claim policy as per bills as well as Misc. expenses amount to Rs. 13,026/- along with interest @ 18 % p.a. She has also prayed for Rs. 2,00,000/- on account of metal torture and harassment.

Case of the Opposite Party No.1

2. The Opposite Party No. 1 contested the case and filed written statement. It is stated by the Opposite Party No. 1 that Opposite party No.2 has launched a policy in collaboration with the Opposite Party No. 1 whereas the work of the Opposite Party No.1 was limited only to facilitate the issuance of policy for and on behalf of the insured and insurer.
3. Further, it is submitted that the complainant has approached the Opposite Party No.1 and taken a medi-claim policy through the Opposite Party No. 2 valid from 16.01.15 to 15.01.16 vide policy no. 1622012015484100000106445 which was requested by the complainant on 14.01.16 for further renewal from period 16.01.16 to 15.01.17.
4. That the Opposite Party No.1 acting on the request of the complainant debited the premium amount of Rs. 5,589/- from the saving account of the complainant and made a demand draft of  Rs. 5,589/- bearing no. 296675 dated 14.01.16 in favour of the Opposite Party No.2 and forwarded the same to them for further renewal of the said policy.
5. It is submitted that in terms of the RBI policy, the Opposite Party No. 1 is as an agent of Opposite Party No. 2 for securing policies. The Opposite Party No.1 being the agent of the Opposite Party No.2 accepted the premium amount on their behalf and forwarded the same to them for renewal of the aforesaid policy. So that Opposite Party No.1 cannot be held responsible for renewal or issuance or settlement of claim. There is no deficiency in service on the part of Opposite Party No.1 as they not only made a demand draft within time but also forwarded the same to the Opposite Party No. 2 for renewal of the said policy. The Opposite Party No. 1 acting in the capacity of an agent of the Opposite Party No. 2 cannot be held responsible for the negligence/or deficiency in service of the Opposite Party No. 2.
6. That even though for the sake of arguments if it is assumed that the Opposite Party No.2 received late the premium for renewal of the said policy, yet they are bound to renew the said policy and not to issue new policy as it was well within their knowledge that premium advanced to them is for renewal of the aforesaid existing policy and not for issuance of any new policy.

Case of Opposite Party No. 2

7. The Opposite Party No. 2 contested the case and filed written statement. It is stated by the Opposite Party No. 2 that the Complainant is holding a Maha Bank Swastha Yojana (Group Health Insurance Scheme) Policy vide No. 0405002815P114206814 for the period of 22.02.16 to 21.02.17. It is submitted that this policy is not a renewal policy of previous policy, previous policy no. 1622012015484100000106445 was valid from 16.01.15 to 15.01.16.
8. That the health insurance is a contract like other contract and subject to terms and condition of the said contract, and the complainant in any case is bound by the terms and condition of the policy as the same was signed by him. It is submitted that Opposite Party No.2 received the request for issuing the policy with cheque Demand Draft No. 296675 amounting      Rs. 5,589/- on 22.02.16 from Opposite Party No.1 and Opposite Party No.2 without any delay issued a new policy 0405002815P114206814 on the very same day.
9. That as per record, it is evident that disease for which treatment received by the complainant was excluded for first inception year. It is submitted that previous policy no.1622012015484100000106445 was valid from 16.01.15 to 15.01.16 has not been renewed timely due to which the policy has been lapsed and when Opposite Party No.2 received the request for issuing the policy with cheque/DD No. 296675 amounting Rs. 5,589/- on 22.02.16 from Opposite Party No. 1, Opposite Party No.2 without any delay issued a fresh policy 0405002815P114206814  on the same day and as per exclusion 4.3 the company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any insured person in connection with or  in respect of calculus diseases unless the insured has 24 months of continuous coverage( as per special conditions for Maha Bank Swastha Yojna Exclusion 4.2 in this clause the waiting period of two years shall be read as one year).

Rejoinder to the written statement of Opposite Party No.2

10. The Complainant filed rejoinder to the written statement of Opposite Party No.2 wherein he has reaffirmed the averments made in the complaint and has denied the averments made in the written statement.

Evidence of the Complainant

11. The Complainant in support of her complaint filed her affidavit wherein she has supported the averments made in the complaint.

Evidence of the Opposite Parties

12. In order to prove its case Opposite Party No.1 has filed affidavit of Shri Nishant Kumar, Senior Manager in Opposite Party No.1, having its Head office at “Lokmangal” 1501, Shivajinagar, Pune, and Opposite Party No.2 filed affidavit of Shri Sanjay Sharma, Manager/Authorised representative in Opposite Party No.2, having its office at 10203, Padam Singh Road, Karol Bagh, New Delhi wherein the averments made in the written statements of Opposite Party No.1 and Opposite Party No.2 have been supported.

Arguments and conclusion

13. We have heard the Ld. Counsels for the parties. We have also perused the file and the written arguments filed by the Complainant and Opposite Party No.2. The case of the Complainant is that she was having account with Opposite Party No.1 and Opposite Party No.1 offered to the Complainant Medi-Claim Policy launched by Opposite Party No.2. On the persuasion of Opposite Party No.1, she had purchased policy Plan A as Maha Bank Swasthya Yojan, ( Group Health Insurance Scheme) for her entire family through Bank vide policy no. 1622012015484100000106445 for amount of  Rs. 3,50,000/- which was valid from 16.01.15 to 15.01.16. Thereafter Complainant timely renewed the policy through Opposite Party No.1 and paid premium vide DD no. 296675 dated 14.01.16 of Rs. 5,589/- and said amount was deducted from the saving account of Complainant which was maintained by Opposite Party No.1 well with in time and Opposite Party No.1 assured the Complainant that the said amount as already been sent to the Opposite Party No.2 for medi-claim policy of the Complainant and her other family member.
14. The Complainant fell ill and admitted to the hospital on 20.07.16 and remained under treatment in the hospital and after recovery, discharged from the hospital on 22.07.16. The hospital forwarded the medical Bill of treatment to the tune of Rs. 13,026/- to the Branch office of Opposite Party No.2 which was refused and Complainant has to pay the bill from her own pocket. The reason of rejection was Opposite Party No.2 did not receive the premium amount within time limit and was received on 22.02.16. On her enquiry, it was revealed that premium amount was transferred by Opposite Party No.1 to Opposite Party No.2 on 19.02.16 i.e. after the period of the policy has been lapsed.
15. The case of the Opposite Party No.1 is that the Complainant has approached the Opposite Party No.1 and taken medi-claim policy from the Opposite Party No.1 valid from 16.01.15 to 15.01.16 which was requested by Complainant on 14.01.16 for further renewal from period 16.01.16 to 15.01.17. Further, it is submitted by the Opposite Party No.1 that acting on the request of Complainant deducted amount of Rs. 5,589/- from the saving account of Complainant made a Demand Draft of Rs. 5,589/- on 14.01.16 in favour of Opposite Party No.2 and forwarded the same to them for further renewal of the said policy and in terms of the RBI policy, Opposite Party No.1 is an agent of Opposite Party No.2 for securing policy. The Opposite Party No.1 being agent of Opposite Party No.2 accepted the premium amount on their behalf and forwarded the same to Opposite Party No.2 for renewal of the policy and Opposite Party No.1 cannot held responsible for renewal or issuance or settlement of claim. So, there is no deficiency of service on behalf of Opposite Party No.1, since on their part as they not only made the Demand Draft within time but also forwarded the same to the Opposite Party No.2 for renewal of the said policy. Opposite Party No.1 acting in the capacity of an agent of Opposite Party No.2 cannot be held responsible for the negligence/or any deficiency of service of the Opposite Party No.2.
16. The case of the Opposite Party No.2 is that that complainant is holding a Maha Bank Swastha Yojana (Group Health Insurance Scheme) Policy vide No. 0405002815P114206814 for the period of 22.02.16 to 21.02.17. It is submitted that this policy is not a renewal policy of previous policy, previous policy no. 1622012015484100000106445 was valid from 16.01.15 to 15.01.16.
17. That the health insurance is a contract like other contract and subject to terms and condition of the said contract, and the complainant in any case is bound by the terms and condition of the policy as the same was signed by him. It is further submitted that Opposite Party No.2 received the request for issuing the policy with cheque DD No. 296675 amounting Rs. 5,589/- on 22.02.16 from Opposite Party No.1 and Opposite Party No.2 without any delay issued a new policy 0405002815P114206814 on the very same day.
18. In view of the above discussion, It is clear from the facts that the Complainant paid premium for the renewal of the policy within time to the Opposite Party No.1 which was not denied by the Opposite Party No.1. It is further clear that Opposite Party No.2 received the premium amount for renewal of policy only after the expiry of the policy.  This is a case of negligence and deficiency in service of the Opposite Party No.1 for not forwarding premium amount on time and medi-claim of the Complainant was rejected by Opposite Party No.2 on the ground that they had received premium for the renewal of the policy after expiry of the first policy. Therefore, the complaint is allowed. Opposite Party No.1 is directed to pay Rs. 13,026/- to the Complainant along with interest              @ 6 % p.a. from the date of filing the complaint till recovery and Rs. 20,000/- on account of mental torture & harassment and litigation expenses along with interest @ 6 % p.a. from the date of this order till  its recovery.
19. Order announced on 17.10.2022.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room.

 

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma) President