Shri Partha Kumar Basu, Hon’ble Member :

The consumer complaint is filed without mention of any act or section thereof.  Hence, the instant complaint was taken up U/S 35 of the Consumer Protection Act.

The instant petition is regarding dispute about a general insurance matter with a prayer against the OP for continuation of the insurance police along with Bonus and a compensation of Rs.1,00,000/- for mental agony.

The case has been running ex-parte against the OP as per order dated 06.10.2023 since no W/V was filed. Neither of the OPs appeared in spite of service of notice as per postal track report. 

The case of the complainant as averred is that the petitioner’s husband was insured under the Group Medical Scheme as follows :-

    For Mr. Subimal Dewan

1. from 26.09.2020 to 25.09.2021 with annual premium of Rs.7,107/- (annexure A)
2. from 26.09.2021 to 25.09.2022 with annual premium of Rs.7,107/-(annexure B)
3. from 26.09.2022 to 25.09.2023 with annual premium of Rs.17,768/-(annexure C)

For the complainant Mrs. Jayashree Dewan

1. from 26.09.2020 to 25.09.2021 with annual premium of Rs.7,107/-(annexure D)
2. from 26.09.2021 to 25.09.2022 with annual premium of Rs.7,107/-(annexure E)

The above said payment of insurance premium was through an arrangement of direct debit from Insureds’ banker for renewal from time to time.

It is the case of the complainant that all the above 3 annual insurance certificates of her husband Mr. Subimal Dewan got auto-generated by renewal from 2020-21 to 2021-22 to 2022-23, but in case of the complainant Mrs. Jayashree Dewan herself, though the certificate was renewed from 2020-21 to 2021-22 to 2022-23 got discontinued in absence of direct debit from the banker  in the 3^rd years i.e. from 26.09.2022 to 25.09.2023.

The complainant therefore alleges deficient service on the part of the OP and prays for continuation of her policy along with bonus and a compensation to the tune of Rs.1,00,000/- for suffering from mental pain and agony.  The complainant filed exhibits as stated above as per annexures A, B, C, D & E to substantiate her claims. 

The complainant approached and visited the office of the OP Insurance Company on various dates but without any result.  The complainant also filed complaint and the office of CA & FBP, South 24 Parganas but without any respite. 

Hence, the case.

As the case has been running ex-parte against the OPs hence the dispute was examined as per records and documents and exhibits as available. From the records it appears that the husband of the insured enjoyed uninterrupted insurance coverage since inception on 26.09.2020 under Group Medicare for a Sum Insured of Rs.5,00,000/- against an annual premium of Rs.7,107/- under Family Health Plan Insurance. It is quite conspicuous from the sequel of exhibits that there was a direct debit arrangement for payment / renewal of the Health Insurance Scheme with the banker of the customer when the annual premiums of both the Insured were being realised by debiting the same bank account in perpetuity.  However, in the case of the complainant and the copy of the Bank Statement (Running Page 26-35) of the complaint petition, it is evident that there used to be a regular debit entry of Rs.7,107/- in respect of both the complainant and her husband in 2019 on 19.09.2019, in 2020 on 24.09.2020, in 2021 on 03.09.2021 and in 2022 on 09.09.2022 for Rs.17,767.85.  At the relevant point of time as on 09.09.2022 there was a closing balance of Rs.81,625.57/- available in the same joint account of the complainant and her husband.

As per the Insurance Certificates, both the insured are their members of the same Health Insurance Policy since 26.09.2017 i.e. for the 6^th year and as per general condition of the said Health Insurance policy states as follows : -

“The Policy is lifelong renewable upon timely payment of premium. Grace period of 30 days from the policy expiry is available.  Renewal premium will change only when you move into higher group or change of plan / coverage”.

Hence, it is quite apparent, especially in view of non-submission or any resistance either in the W/V or in final hearing by the ex-parte OP Insurance Company to contest this complaint petition, that the auto-debit facility, although did work for her husband Mr Subimal Dewan as a group insurance member, but did not work for the complainant herself being another member of the group due to some reason or the other for which the complainant may not be responsible, especially in view of having sufficient balance in the same bank account. Hence the complaint’s petition is allowed on account of unfair trade practice being carried out by the opposite parties for not providing the facilities as agreed by opposite parties to the complainant. The complainant has suffered a mental pain & agony at the hands of the opposite parties. The act & conduct of the opposite parties amounts to deficiency in service and the complainants are required to be compensated in accordance with law.

Hence, it is

ORDERED

That the complaint case succeeds ex-parte and the complainant is entitled to a compensation along with a cost.

1. The Insurance policy of the complainant be reinstated immediately with all continued benefits as specified under the same policy terms & conditions without change in Sum Assured or continuity benefit or annual premium.

2. The OP1 and OP2 are jointly and severally liable and are directed to make payment of a compensation to the tune of Rs. 10,000/- (Rs. Ten Thousand) only to the complainant for mental pain, agony and harassment suffered by her.

3. The OP1 and OP2, jointly and severally, are directed to make payment of cost of the litigation expenses for Rs. 5,000/- (Rs. Five Thousand) only.

Compliance of all the above orders be made within a period of 30 days from the date of this order in default will attract a simple interest @ 10% per annum till the date of actual compliance.

The complainant shall be at liberty to put the entire order into execution if the above orders are not complied by the OPs within stipulated timeframe.

The final order shall be available at the following website www.confonet.in.

Dictated and corrected by me.

             Member