Present complainant by filing this complaint has alleged that complainant took a Group Medi-Claim Policy with op no.1 for the period from 19.12.2005 to 18.12.2006 under policy No.2005/030400/48/05/21/00003771 after paying the requisite premium.  The policy was renewed in right time after paying the requisite premium order policy No.030400/48/06/21/00004632 and the period from 19.12.2006 to 18.12.2007 and the said policy was due for renewal and for which complainant handed over a cheque being No.188561 dated 18.12.2007 drawn on the Syndicate Bank, Shibpur Branch to the op no.1 for Rs.3,30,000/- to Sailesh Kothari, insurance agent of the ops and the said Sailesh Kothari acknowledged receipt of the cheque by putting his initials on the Bank Voucher of the complainant and the said cheque was towards renewal premium and Group Medi-Claim Policy and that was clearly mentioned in the Bank Voucher and period of renewal was also referred for the period from 18.12.2007 to 18.12.2008 and the said cheque was accepted by the op nos. 1 & 2 as renewal premium because the cheque was deposited by the op nos. 1 & 2 Insurance Company’s Bank account and was encahsed that is confirmed by the complainant and complainant bankers Syndicate Bank.  Thereafter complainant waited for a reasonable period of the renewed policy from the op but no response was but op was not responded.  So complainant visited the office of the op and prayed for the issue of the renewed of policy.  Ops wrote a letter on 17.02.2009 and 26.02.2009 but ops did not respond.  Thereafter complainant approached to Chairman-cum-Managing Director of the ops insurance company, and on 13.04.2009 all on a sudden on 02.04.2009 op sent a cheque No.384584 dated 02.04.2009 for a sum of Rs.3,30,000/- of HSDF Bank to the complainant through a letter dated 18.06.2009 just telling that the cheque was towards refund of premium earlier deposited by the complainant for renewal of the policy.  But the said letter of op did not show any reason as to why premium was being refunded to the complainant and nor did the insurance company intimate the complainant why the policy was cancelled and considering the overact of the op, complainant wrote another letter on 11.04.2009 returning the cheque to the op and that was received by the op.

          But thereafter op did not answer or responded and fact remains that op has been withholding claims of earlier policies for the period for many bills amount and for such act complainant wrote letters but op without referring to any of complainant’s previous letters or personal requests, again wrote letter with stating that complainant have not paid required premium and hence the policy was not renewed.  But truth is that prior to 18.06.2009 no such information was given to the complainant even after receive of the cheque of renewal of premium dated 18.12.2007 and in the above circumstances, the entire act of the op is an act of unfair trade practice when the complainant’s aforesaid cheque through their agent u/s 64V-B(4) of Insurance Act was tendered as advance premium for renewal of complainant’s policy in question to the complainant stating the reason for non-renewal of the Policy in question and most interesting fact is that complainant was sure that op renewed the Policy within reasonable time for which the cheque was not refunded even after encashing the same in the month of December 2007 against the deposited cheque No.188561 dated 18.12.2007 for a sum of Rs.3,30,000/- and for which for negligent and deficient manner of service and also for adopting unfair trade practice, this complaint is filed with a prayer for accepting that amount that renewal of Policy and also for compensation.

 Against the above complaint op appeared and filed written statement and they have stated that the op’s above Bank Voucher is a document of the complainant and said document of the complainants is immaterial so far as the liability of the ops are concerned and the Bank Voucher was prepared by the complainant for its own interest and the insurance company is not aware of the said Bank Voucher and complainant shall have to prove it strictly.

          Further it is submitted that the Bank Voucher does not prove that the said cheque was deposited towards the renewal of the policy as alleged and further agent did not inform the Insurance Company in writing that the cheque was deposited for the renewal of the Policy and moreover the complainant’s policy expired on 17.12.2007 and thereafter complainant did not give any advice to the complainant after renewal of the policy or stating the particulars for renewal of such policy.  But the cheque was deposited by Sailesh Kothari without furnishing the particulars or advice for renewal of the policy and purpose of deposit and accordingly the amount was kept in CD account without assuming any liability and so the said cheque shall be accepted as renewal of premium because cheque was acknowledged by the Insurance Co. which has created no liability whatsoever and for non-submission of any particular detail for renewal of the policy, the op on its own account cannot renew the policy and for which op refunded the same by intimating the fact and as because there is no existing policy.  So there is no question of relationship with the complainant of the company as a consumer and it is specifically mentioned that after receiving the latter dated 17.02.2009 and 26.02.2009, op Company refunded the said amount denying all liabilities and with some malafide intention the complainant did not accept the same and returned it and further submitted that Section 64V-B(4) of the Insurance Act is not applicable in this case because non-renewal of the particular in the same and in the above circumstances, the complaint should be dismissed.

                                 Decision with reasons

          Practically after hearing the Ld. Lawyers of both the parties and also considering the complaint and written version, it is undisputed fact that complainant was the holder of Group Insurance Mediclaim Policy under the op and his policy was started on 19.12.2005 having its Policy No. 2005/030400/48/05/21/00003771 having expiry date on 18.12.2006 and thereafter complainant renewed that policy for the period from 19.12.2006 to 18.12.2007 and the said policy number was 030400/48/06/21/00004632.

          It is admitted fact as accepted by the op also that complainant deposited one cheque being No.188561 dated 28.12.2007 for a sum of Rs.3,30,000/- for renewal purpose through agent Sailesh Kothari and admittedly Sailesh Kothari is the insurance agent of the op and from Annexure-C Bank Voucher of the complainant, it is found that Sailesh Kothari received it knowing fully well that it is for renewal of the said mediclaim policy for further year on 18.12.2007 to 19.12.2008.

          It is also fact that the said cheque was encahsed by the op Insurance Co. on 20.12.2007 which is evident from Syindicate Bank report vide Annexure-D.  It is admitted by the op that on 18.06.2009 op refunded the money stating that he did not pay the required amount against renewal of the premium policy.

          So we are very much confirmed that the complainant deposited the said amount for renewal of premium on 18.12.2007 vide cheque No.188561 dated 18.12.2007 for a sum of Rs.3,30,000/-.  But peculiar factor is that the insurance company even after receipt of the said cheque knowing fully well that it was paid for renewal of the policy, did not inform him forthwith after encashment that complainant did not pay the required premium amount or no such information was made to the complainant even after encashment of the said amount on 20.12.2007 that the some more amount is required for renewal of the same.  But that matter was reported on 18.06.2009 that is long after one year and six months.  Fact remains this matter was reported by the op vide their official letter dated 18.06.2009 by sending the cheque Annexure-H.  Then question is for whose fault the renewal has not been made if we rely upon the letter dated 18.06.2009 of the op Annexure-D we are confirmed that the present op received the cheque for renewal that has been admitted by the op. But renewal has not been made.  No information was given to the complainant that some more amount is required for renewal within proceeding one year and six months prior to ops letter dated 18.06.2009.  Then it is clear that it is no doubt an unfair trade practice on the part of the op and particularly to repudiate the claim which had already been submitted by the complainant in respect of other claims this unfair method was adopted by the op Insurance Co. after lapse of one year and six months from the date of receipt of the said cheaue of Rs.3,30,000/- on 20.12.2007.

          Fact remains that complainant submitted cheque along with papers.  But now the op is not producing those papers of renewals because Bank Vouchers support that it was handed over to the op’s agent for the purpose of renewal of the said policy and it is within the knowledge of the op what is proved from their letter dated 18.06.2009 vide Annexure-H.  Then how the op can discharge their liability by stating that no information was given about renewal for which it was kept in CD A/C.  On the contrary op have failed to prove for what reason they kept the amount for a long time of one year and six months when it is their version that the said amount was not full amount but some more amount is required for renewal.  Why that has not been informed forthwith.  Then it is clear when complainant repeatedly requested them to issue duplicate copy etc and ultimately when letters were sent again and again then op realized that they have committed blunder and at that moment they returned with such observation the amount as required is not sufficient and complainant did not pay the required amount.  So, policy was not renewed and this version of the op confirmed that amount was deposited by the complainant for renewal and it was accepted by the op.  But op never informed the complainant that some more amount is required for renewal.  Considering that fact, it is clear that it is the unfair trade practice on the part of the op and op committed a blunder and only to save their skin and their administrative callousness they returned the cheque after lapse of one year and six months and that is the ops assertion to prove that there was no fault on the part of the complainant or his agent though op is aware of the fact that the amount was deposited for renewal.

          Peculiar factor is that op is unable to explain for what reason they did not inform forthwith after encashment of the amount of renewal that some more amount is required for renewal.  It is no doubt negligent and deficient manner of service on the part of the op for which op is liable to compensate by regularizing all the matters in default compensation otherwise. 

But in this case, Ld. Lawyer for the op by referring two ruling reported in AIR 1991 Delhi, Page-25 and also another ruling of Hon’ble Supreme Court reported in AIR 1984 SC 1014 submitted that the mere receipt and retention of premium does not give rise to a contract.  But that the circumstances may be said that approval can be inferred from the retention of the premium.  But after through study of those rulings we have gathered in the said rulings the fact of the case was otherwise and in those cases practically it was Life Insurance Policy and in case of Life Insurance Policy some other condition is imposed and in one case fact remains that after submission of premium and form of application for purchasing life insurance, the applicant died and before the death of the applicant no policy was issued due to some procedural clause and ultimately it was not accepted.

          But in the present case, it is not a new policy but it is renewal of policy and op has admitted that it was accepted by them on 20.02.2007.  But it is their case that amount was not total premium because some more amount was required for renewal.  Then there is no question of drawing any inference about approval etc because it is a continuing Insurance Policy and amount was for renewal and op accepted and acknowledged it for renewal but did not ever express or informed to the complainant that some more amount is required for renewal.  But everything was disclosed after lapse of one year and six months vide their letter dated 18.06.2009 Annexure-H.  So considering that fact and those rulings we are convinced to hold that those rulings are not applicable in the present case rather it is proved beyond any manner of doubt relying upon the Annexure-H, the letter of the op dated 18.06.2009 that op accepted the premium for renewal but either they failed to renew it for some of their latches and callousness and to save their skin they returned the said amount after lapse of one year and six months discharging their liabilities. 

In the above situation we are confirmed that the unfair trade practice was practiced by the ops only for the purpose for deceiving the complainant from getting the previous benefits in respect of the claim.  But that cannot be very loosely entertained by this Forum because this complainant is a health establishment and it was a Group Insurance Mediclaim Policy and it was the duty of the op to renew it but that had not been done and no doubt for their latches and callousness and at the same time they did not prepare it and did not send it only to avoid previous claim of the complainant and in respect of that claim op has not denied it.

In the light of the above observation, we are convinced to hold that the present ops were negligent manner and deficient in dealing with the business with the present consumer a bonafide consumer.  It is not a petty amount of premium and premium amount was Rs.3,30,000/- that was received and encashed and enjoyed the benefit but did not discharge their liability forthwith after encashment.  So the present complainant is found not at fault and fault was on the part of the ops and practically they adopted an unfair trade practice when they found that the complainant’s amount has been encashed as renewal of the policy so they adopted unfair trade practice and returned the amount stating that required amount has not been paid for renewal.  So, renewal was not made that was reflected in the letter dated 18.06.2009.  Can a prudent and reasonable man will believe that insurance company is so callousness, negligent, deficient to give service to the complainant a bonafide consumer even after receiving Rs.3,30,000/- from him.  So total conduct of the op tantamounts to deficient manner and negligent manner of service and the same time unfair trade practice for which the complainant is entitled to relief against the op when entire allegation of the complaint is proved.

Accordingly, the complaint succeeds.

Hence, it is

                                               ORDERED

That the complaint be and the same is allowed on contest against ops with cost of Rs.10,000/-.

Ops are directed to treat that cheque amount which has been received by the op as a renewal policy along with any amount if it is required and renew the policy for the year 2007-08 and issue such insurance policy for that period.

For any such reason if op fails to issue any such policy in that case op shall have to pay Rs.10,00,000/- to the present complainant along with premium amount of Rs.3,30,000/- and that shall be paid within one month from the date of this order.

Ops are jointly directed to comply the order failing which for each month’s delay punitive damages @ Rs.25,000/- shall be assessed till full satisfaction of the decretal amount.

If op disobeyans the order repeatedly in that case penal proceedings shall be started for which they shall be responsible and liable.