Per Shri S.R.Khanzode, Hon’ble Judicial Member:-
This appeal takes an exception to an order dated 05/12/2009 passed in consumer complaint no.2008/576, The Oriental Insurance Company Limited V/s. V.N.Balkrishnan Nair passed by District Consumer Disputes Redressal Forum, Thane (the ‘Forum’ in short). Undisputed facts are that respondent/complainant (hereinafter referred as ‘complainant’) had taken a mediclaim policy from org. opponent/appellant (hereinafter referred as ‘opponent’) in the year 2001. As per the terms of insurance policy, the sum insured to be increased progressively by 5% each three year subject to maximum accumulation of 10 claim free years of insurance. It is also not disputed that till the year 2006 it worked smoothly, but thereafter as per change in policy of the insurance company, new mediclaim policy was issued in place of the existing one and while issuing the policy, the above referred term of progressive increase of insurance cover by 5% was deleted and the premium rate is modified. It is the grievance of the complainant that without making any change of the existing terms for the 10 assured years, the policy ought to have been continued and no higher rate of premium should have been charged. Consumer complaint is filed accordingly.
Forum below upholding the contention of the complainant, partly allowed the consumer complaint and directed the opponents to renew the mediclaim policy on the existing terms i.e. old terms giving benefit of cumulative bonus and further ordered to pay compensation of `1,000/- towards the mental torture to the complainant. Feeling aggrieved thereby, the appellant-original opponent has preferred this appeal.
We heard Adv.Mr.A.S.Vidyarthi for the appellant and Adv.Mr.Girish Pariyani for the respondent. Perused the papers.
It is submitted on behalf of Shri Vidyarthi appearing for the appellant/opponent that in the year 2006, the policy in respect of mediclaim insurance policy witnessed a change as reflected in the department circular dated 23/08/2006 bearing circular no.HO/MISC/2/2006/AGM(T)-88/CR-6053. As a result thereof, the mediclaim policy which was issued for a limited period of one year, when the issue as to renewal of the insurance policy arose, mediclaim policy for the following year was issued as per the change in the policy. However, giving benefits to the complainants the insurance limit of `2 Lakhs was raised to `3 Lakhs. Since the insurance is a contract, one can justify such change but nevertheless since the original mediclaim policy assure certain benefits to the policy holder, namely, the complainant whereby without change in rate of premium, he was suppose to get additional insurance cover i.e. for each claim free year of insurance subject to maximum accumulation of 10 claim free years of insurance, there was progressive increase by 5% in the sum insured. While issuing new policy, considering the 5% additional cover for each claim free years (for maximum 10 years), the insurance cover for `2,00,000/- was extended to `3, 00,000/-. This takes care of affording additional insurance cover for each claim free years, supra. However, though such benefit was to be extended without charging additional premium, increased premium was asked and collected from the complainant. This unilateral act on the part of the insurance company, in the given circumstances, is illegal and thus, the insurance company acted arbitrarily in this area of action.
As earlier observed since the parties have privity of contract of insurance, consumer Fora cannot change or alter them. Therefore, direction given to issue the policy on old terms is a direction contrary to the empowerment of consumer Fora as per provision of Section 14 of Consumer Protection Act, 1986 (hereinafter referred as Act). Therefore, such direction as per impugned order cannot be supported with.
Further, though the insurance company perhaps was right in issuing the new mediclaim policy as per change in the policy still the opponent/insurance company acted arbitrary to the disadvantage of the complainant when it charged more premium than the one charged for existing insurance policy. As far as benefits of the progressive increase of the cover for no claim year is covered while issuing the new policy by raising the insurance cover upto `3,00,000/-, supra. Therefore, holding the appellant guilty for deficiency in service, supra, the complainant is entitled to get compensation which may also cover the additional expenses incurred for paying the enhanced premium. Ld. Counsel appearing for the appellant conceded that if the compensation amount by way of refund which was awarded at `1,000/- if raised up to `20,000/-, it would be just and proper to cover the compensation on all these issues. Complainant also fairly conceded to the same. We also find it just and proper to accept this submission.
For the reasons stated above, we hold accordingly and pass the following order:-
:-ORDER-:
1. Appeal is partly allowed. The impugned order dated 05/12/2009 is modified.
2. The direction of District Consumer Disputes Redressal Forum to issue policy of old terms contained in para 2 of the operative part of the impugned order is set aside.
3. It is further directed that appellant/org. opponent to refund `20,000/- instead of `1,000/-to the respondent/org. complainant which is collected as additional premium. Rest of the order is confirmed.
4. Parties to bear their own costs.
5. Copies of the order be furnished to the parties.
Pronounced
Dated 1st February 2011.
