SMT. RAVI SUSHA: PRESIDENT

This complaint filed by the complainant U/s 35  of the Consumer Protection Act 2019, for getting an order directing OP to return Rs.1,10,000/- to the complainant together with Rs.1,00,000/- towards compensation for the mental agony and also to direct to pay cost of the litigation expense.

The complainant has stated that the staff of OP approached the complainant in his house at Kadavathur and compelled to take policy of the OP on 12/07/2011.  At the time of taking policy the staff of the OP told the complainant that policy amount will reduce next coming years. Complainant renewed the OP’s policy, but the amount is increasing yearly.  As per the complainant, the payment of annuity installment as per  as per the policy had been paid promptly to OP from the commencement of policy  ie 11/07/2011 till 30/03/2020 and paid Rs.1,10,000/- in total towards premium during this period.  As per the terms and conditions of insurance policy the OP is liable to pay medical expenses of the complainant and his family.  Complainant stated that when the complainant telephoned the OP to renew his policy on March 2020 to 2021.  At that time the OP informed that office is not functioning due to corona disease and assured that the OP will inform the complainant after reopening office.  The complainant contacted the OP on May 2020, at that time also the OP informed they will inform the complainant.    But the OP did not inform the complainant about the renewal on 10/07/2020 the complainant again contacted the OP for renewal.  Then the OP informed that the policy of the complainant was cancelled.  Further submitted the complainant lost his huge money due to the default service of the OP.  In lawyer notice it is stated that policy started from 2012 onwards it is a typing error actually policy started from 2011 onwards till 2020.  The complainant sent lawyer notice to the OP on 20/09/2021 asking to renew the complainant’s policy with all the earlier benefits or return Rs.1,10,000/- with bonus and interest.  The OP received notice, but did not send reply and did not return the amount of the complainant so far.  Hence the complaint.

            OP after receiving notice entered appearance through counsel and filed written version stating that the complainant had taken a Family Health Optima Insurance policy covering himself, his wife and their three children on 12/07/2011 and the same has been renewed up to 30/03/2020 for a sum insured of Rs.3,00,000/- vide policy No.P/181320/01/2019/0077071.  The complainant had taken the policy after fully knowing and convinced with the terms and conditions of the policy.  The allegation of the complainant that at the time of taking the policy, the staff of the OP told that the policy amount will reduce next coming years are baseless and bereft of truth and are denied.  It is submitted that the OP had never made any assurance to the complainant that the policy amount will be reduced.  It is submitted that the complainant has renewed the policy up to 30/03/2020.  As per terms and conditions of the policy, “a grace period of 120 days from the date of expiry of the policy is available of renewal.  If renewal is made within this 30 days period the continuity of benefits will be allowed”.  In this case the grace of the 120 days starts from 30/03/2020 to 28/07/2020 but the complainant has not paid the renewal premium during this period and hence the policy was expired.  The complainant has not made any contact with the OP requesting to renewing the policy during the covid period.  If the complainant had approached the OP as alleged by him, then the OP would have definitely given the renewal without any delay.  But the complainant has not cared to do so.  Also the complainant has options to renew the policy through online which is the frequent method used during that period.  Moreover the complainant has not raise any written representation either through mail or directly to any of the branches of the OP for non renewal of the policy.  It is submitted that as per the terms and condition of the policy, there is a grace period of 120 days is available to renew the policy.  Hence the grace period of the complainant’s policy will be up to 28/07/2020 and the policy of the complainant will not be cancelled on 10/07/2020.  It is the duty of the insured to renew their policy within time in order to avail the continuity benefits.  The OP is not liable for any of the loss suffered by the complainant.  It is submitted that the OP has not received any lawyer notice as allegedly the complainant.  No provision exists for refund of premium of lapsed (expired) policy.  There has been irresponsible imperfect negligent and default behavior and services from the part of the OP.  Because of the negligence of the complainant the policy got cancelled.  Since, there is not deficiency of service from the side of the OP, the complainant is not entitled to any reliefs as stated in the complaint.  Hence, prayed for the dismissal of complaint.

            At the evidence stage, complainant has filed his chief-affidavit and documents.  He was examined as Pw1 and the documents were marked as Ext.A1 to A9.  He has been subjected to cross-examination by the OP.  OP has not adduced their own evidence either through oral or through document.  After that the learned counsel of complainant filed their written argument note.  Learned counsel of OP made oral argument.

            As per the complainant, the payment of annuity installment as per the policy had been paid promptly to OP from the commencement of policy  ie 11/07/2011 till 30/03/2020 and paid Rs.1,10,000/- in total towards premium.  Complainant alleged that when the complainant telephoned the OP to renew his policy on March 2020 to 2021.  At that time the OP informed that office is not functioning due to corona disease and assured that the OP will inform the complainant after reopening office.  The complainant contacted the OP on May 2020, at that time also the OP informed they will inform the complainant.    But the OP did not inform the complainant about the renewal on 10/07/2020.  The complainant again contacted the OP for renewal.  Then the OP informed that the policy of the complainant was cancelled.

            Complainant submitted that OP Insurance Company had cancelled his policy without informing about the online renewal and also about the grace period for renewal of the policy.  Here OP also does not have a case that they informed the insured about the lapse of policy and grace period of its renewal.  It is a fact  that complainant had paid the renewal premium as per the policy condition from 2011 till 2020 without any delay and during March 2020 there was restriction due to Covid pandemic and  offices were closed due to lockdown.  Since there was such restriction in all field, OP ought to have informed the insured in writing about the grace period for renewal of the policy and also about remittance of premium through online.  There is no dispute that complainant had remitted Rs.1,10,0000/- as premium to OP company for the renewal of his policy in dispute.

            Here OP pleaded that the complainant is not entitled for Rs.1,10,000/- being the premium amount as there is no provision exists for refund of premium of lapsed policy.  OP further pleaded that the policy was expired, solely due to the negligence of the complainant in renewing it.  OP company failed to substantiate their contention that there is a provision in the policy that the insured will not get refund of premium remitted in case of lapsed policy.  Mere stating that the said fact in the version itself it not sufficient.

            OP admits that the grace period of the policy will be up to 28/07/2020.  It is not in dispute that the Insurance Company had not sent any communication to the insured stating that the premium due in 2020 and that the insured had been given a grace period up to July 2020 to pay the premium amount.   In such a situation we are of the view that OP cannot later take the plea and rely on the conditions of the policy that the Insurance policy has lapsed.  In view of these facts, we are of the opinion that there is deficiency in service on the part of OP Insurance Company.  Hence complainant is entitled to get refund of the remitted premium amount paid by the complainant to OP from 12/07/2011 till 30/03/2020

            In the result complaint is allowed in part.  OP insurance company directed to return Rs. 1,10,000/- to the complainant.  OP is also directed to give Rs.15,000/- towards              compensation and Rs.5,000/- towards cost of the litigation expense.  OP shall                      comply the order within one month from the date of receipt of the certified copy of this order.  Failing which Rs.1,10,000 + 15,000  carries interest @ 9% per annum from the date of complaint till realization.  Complainant can execute the order as per provisions in Consumer Protection act 2019.

Exts.

A1- Policy certificate of 2011

A2- Photocopy of premium receipt of 2012

A3- Policy certificate of 2014

A4- Policy certificate of 2015

A5- Policy certificate of 2016

A6- Policy certificate of 2018

A7- Policy certificate of 2019

A8- Copy of lawyer notice

A9- Acknowledgment card

Pw1- Complainant

      Sd/                                                                                   Sd/                                                         Sd/

PRESIDENT                                                                  MEMBER                                             MEMBER

Ravi Susha                                                               Molykutty Mathew                                     Sajeesh K.P

(mnp)

/Forward by order/

Assistant Registrar