Date of filing: 22.02.2017                                                            Date of disposal: 09.03.2018

Complainant: Chirodip Majumdar, Circus Maidan, Near Asoke Lodge, P.O.-Katwa, Dist.-

                           Burdwan, West Bengal, Pin-713130.

-VERSUS-

Opposite Party: The New India Assurance Company Ltd., Katwa Branch, Kachari Road, P.O.-

                               Katwa, Dist.-Burdwan, West Bengal, Pin-713130.

Present: Hon’ble President: Smt.Jayanti Maitra(Ray).

                Hon’ble Member:  Miss Nivedita Ghosh.

               Hon’ble Member :  Dr. Tapan Kr. Tripathy.

Appeared for the Complainant: Complainant himself.

Appeared for the Opposite Party:  Ld. Advocate, Ahibhushan De.

JUDGEMENT

This is a case U/s. 12 of the C.P. Act for an award directing the O.P. to allow the complainant an opportunity to pay premium within a certain date  and to accept the premium with all continuation benefits and effect from 24.08.2016 and to pay Rs.1000/- as cost to the complainant.

The complainant’s case in short is that he purchased a policy from the O.P. in the name of the complainant, his wife and his son on 18.8.2005.  The complainant renewed the policy every year and as such policy covered him and his family for the period from 24.8.2015 to 23.8.2016.  For continuation of his policy for the period 24.8.2016 to 23.8.2017, the complainant paid Rs.6,707/- to the O.P. on 8.8.2016. 

The petitioner was orally informed by the agent of the O.P.  about the dishonor of the cheque on 6.10.2016.  The complainant immediately submitted a prayer before the O.P. to continue his policy on 7.10.2016.  Thereafter the complainant sent another representation on 01.11.2016 reminding the O.P. about his earlier prayer.  By a letter dated  21.09.2016 the O.P. informed the complainant about the dishonor of the cheque due to insufficient fund and cancellation of the policy.  It is pertinent to mention here that said cancellation letter of policy dated 21.9.2016 was posted by the O.P. on 04.11.2016 and it is received by the complainant on 05.11.2016, which is around three months after the date of submission of the cheque.  On 12.12.2016 the complainant sent another representation to the O.P. requesting to reconsider of the decision of cancellation of the policy.  But O.P. by sending a letter on 14.12.2016 informed that ‘it is not possible on their part to give continuation of the policy.

The complainant further stated that he was not given any opportunity of renewing his policy within grace period of thirty days as permitted by clause 2.8 (pp.32) and 5.10 (pp.44) of Mediclaim 2012 Policy.  The discontinuity of the insurance policy affects the complainant from the benefit of computation of 24 months and in some cases 48 months period of waiting for eligibility of medical aid as stated in clause 4.1 (pp.39), 4.3.1 (pp.39-40) and 4.3.2 (pp.40) and from the no claim discount as permitted under clause 5.12 (pp.45) and from cumulative bonus as earned due to claim free years as permitted under clause 5.13 (pp.45) and from health check up benefit as stated in clause 3.7 (pp.39) of Mediclaim 2012 policy and such other benefit. Finding no other alternative the complainant filed this case before this Forum for relief as stated above.

The O.P. contested this case by filing written version denying all the material allegations as alleged by the complainant.  The O.P. submits that the complainant, Chirodip Majumder had issued a cheque  being No.107604 dated 08.08.2016 for Rs.6,707/- drawn on SBI, Katwa Branch, Katwa in favour of the O.P. for renewal of his previous policy being No.51290234152500000231 for the period from 24.8.2015 to 23.08.2016, issued by this O.P. and on the basis of the cheque of Rs.6,707/- the policy was issued from 24.08.2016 to 23.08.2017 in favour of the complainant.  Thereafter it was found that the said cheque of Rs.6,707/- dated 08.08.2016 has been dishonoured, which was sent for collection by this O.P. before the bank due to ‘Fund Insufficient’ and this O.P. orally informed the said matter to the complainant through his agent and it was duly acknowledged the said information of Dishonour of Cheque vide letter dated 07.10.2016 issued by the complainant.  Thereafter, this O.P. informed the said matter of Dishonour of Cheque to the complainant on 21.09.2016.  In the said letter it is also stated that if any policy issued against the said cheque then the said policy stands cancelled since inception and this O.P. are not on ‘Risk’ in respect of the policy No.51290234162500000186 and it was requested to the complainant in the said letter to surrender the said policy being No.51290234162500000186.  The Branch Manager of O.P. informed the complainant on 14.12.2016 regarding the cancellation of Mediclaim Policy No.51290234162500000186 w.e.f. 24.08.2016 to 23.08.2017 in response to the letter of the complainant.  The New India Assurance Company Ltd. duly informed to the complainant vide its aforesaid letter dated 14.12.2016 that ‘it is not possible for this O.P. to give continuation in any circumstances after 30 (thirty) days of Expiry of the policy’.

This O.P. further stated that as per terms and conditions of the Mediclaim-2012 Policy issued by this O.P., it will be found in Clause 2.8 that continuous coverage means uninterrupted coverage with this O.P. Insurance Company till the date of commencement of period of Insurance of the Insured Person under Mediclaim 2007 Policy or under Mediclaim Insurance (Individual) Policy or under Mediclaim-2012 from the time the coverage incepted under any of this policy.  A break in Insurance for a period not exceeding 30 (thirty) days shall not be reckoned as an interruption in coverage for the purpose of this clause.  As per Clause No.4, no claim will be payable under this policy unless the Insured Person has Continuous Coverage in excess of 24 months as per clause 4.3.1.  Moreover unless the insured person has continuous coverage in excess of 48 months with the Insurance Company, the expenses relating to the treatment of Joint Replacement due to Degenerative condition and Age relative Osteoarthritis & Osteoporosis are not payable as per Clause No.4.3.2.  As per Clause No.5.2, unless premium is paid before commencement of Risk this policy shall have no effect.  As per Clause No.5.10 (Renewal Clause), this O.P. Insurance Company shall Renew the Policy, if the insured shall remit the requisite premium to the Insurance Company prior to expiry of the period of insurance in his schedule.  In the said point No.5.10, it has also specifically stated that if the insured failed to remit premium for renewal before expiry of the period of insurance this O.P. may accept renewal of the policy, if it is effected within 30 (thirty) days of the expiry of the period of insurance.  On such acceptance of Renewal, this O.P., Insurance Company shall not be liable for any claim arising out of illness contracted or injury sustained or hospitalization commencing in the interim period after expiry of the earlier policy and prior to date of commencement of subsequent policy. As such under the aforesaid facts and circumstances, the complainant/insured is not entitled to get the benefit of renewal of the insurance as prayed for.  This O.P. Insurance Company further submits that the cancellation of the Insurance Policy in question is not at all improper and illegal and as such the instant complaint petition filed by the complainant, Chirodip Majumder, is liable to be summarily dismissed.

DECISION WITHREASONS

            To prove this case the complainant has filed his evidence on affidavit stating all the facts which he has  stated in his complaint petition.  He also filed documents in support of his prayer.

            The O.P. prayed for considering his written version supported by affidavit as his evidence.  Thereafter, the complainant files questionnaires against the version of the O.P. and O.P. files the answer of the questionnaires.  Thereafter both parties filed their written argument.  We have gone through the petition of complaint, evidence on record, questionnaires and answers to questionnaires and also gone through the documents filed by the O.P.  We gave patience hearing to the argument advanced by the parties.  It is admitted fact that the policy of the complainant started from 18.08.2005 and was renewed time to time.  The dispute arises at the time of renewal of the policy for the period from 24.08.2016 to 23.08.2017.  Complainant admittedly paid his premium by issuing a cheque of Rs.6,707/- dated 08.08.2016 and the documents filed showing that O.P. collected the same.  The collection receipt is also filed.  Thereafter, complainant was informed by his agent about the dishonour of the cheque.  It is also admitted by the O.P. in his written version.  Complainant stated that immediately after receiving the information he sent letter dated 7.10.2016 requesting to consider his case and renew the policy giving all continuing benefit.   The copy of letter dated 7.10.2016 is also filed.  He filed the second letter on 1.11.2016 where he earnestly prayed to consider his case and to continue his policy.

 O.P. however replied by its letter dated 21.9.2016 wherein O.P. alleged that the cheque of Rs.6,707/- received by the O.P. was dishonoured due to insufficient fund.  There is no other documents to show that O.P. informed in writing to the complainant regarding dishonor of the cheque.  The interesting point is that the postal receipt of the said letter goes to show that the letter was posted on 4.11.2016.  The track report is also clear in this regard and on 5.11.2016 the letter was delivered to the petitioner.  Therefore, the complainant has been able to prove that the letter dated 21.9.2016 practically was posted on 4.11.2016after a long gap.  There is no evidence from the O.P’s side to deny this fact.  Moreover, policy expired on 23.8.2016- and for continuation of the same as per point No.5.10 terms and conditions of the policy, if the insured failed to remit the premium for renewal before expiry of the period the Insurance Company may accept renewal of the policy, if it is effected within 30 days of the policy.  In this case the policy of the complainant expired on 23.8.2016 and the 30 days for continuation upto  22.9.2016.  We see that O.P. has posted the letter on 4.11.2016 but mentioned the date 21.9.2016 on the letter to give effect of 30 days of the grace period.    If, O.P. informed the petitioner within reasonable period after bouncing of the cheque then complainant have had the opportunity to pay his premium within the grace period of 30 days and can avoid the fate of cancellation of the policy.  From careful scrutiny of the letters of the complainant dated 7.10.2016, 1.11.2016 and 12.12.2016 and also the letter purported to be written on 21.9.2016 by the O.P. and thereafter letter dated 14.12.2016 ultimately informing complaint inability to continue the policy is nothing but prepared for the purpose of  avoiding the liability of the O.P.  The complainant alleges that in not informing the complainant about the fate of the cheque in time and thereby complainant lost his valuable opportunity to continue policy within grace period of 30 days as per terms and conditions of the policy ( Point No.5.10).  We find no intentional alleges by the complainant.  On the other hand the letters sent by the complainant one after another seeking continuation of the policy is very much clear that the complainant was very eager to continue the policy since the policy he initiated on 18.8.2005 and had been renewing the same time to time up to  23.8.2016.  But O.P. by its letter dated 14.12.2016 regretted that it is not possible for the company to give continuation of policy in any circumstances, after 30 days of the expiry of the policy.  As the letter was posted on 4.11.2016 and was received by the complainant only on 5.11.2016, which is proved sufficiently by the postal document, we find that O.P. Insurance Company are very much deficient and negligent in service in not informing the complaint about the bouncing of cheque of the payment of premium within reasonable time of such bouncing.   In such circumstances, we allow the prayer of the complainant with the following directions.  C.F. paid is correct.

  Hence, it is

Ordered

that the case be and the same is allowed in part on contest against the O.P. without any cost.

The order of cancellation of Insurance Policy is improper.  The complainant is entitled to get benefit of renewal of the policy. Petitioner should be given opportunity to pay the premium and O.P. should accept the same and continue the policy after giving all the benefits of continuity of the policy with effect from 24.08.2016.  No further order as prayed for as compensation, cost etc. is allowed.

 Let the copies of this order be supplied to the parties free of cost.

                     Jayanti Maitra (Ray)

             Dictated and corrected by me.                                                        President       

                                                                                                                    D.C.D.R.F., Burdwan

                   Jayanti Maitra (Ray)                   

                           President

                   D.C.D.R.F., Burdwan

              (Nivedita Ghosh)                                                              (Dr. Tapan Kr. Tripathy)

                    Member                                                                             Member    

            D.C.D.R.F., Burdwan                                                              D.C.D.R.F., Burdwan