The brief facts of the case are that the complainant is a bachelor and a retired high school teacher. In the year 2011 in order to avail medical facility in moderate way the complainant opened a mediclaim policy being No. 150703/48/10/8500002294 up to the limit of Rs. 3,00000/- (Three Lakh) towards incurring medical treatment sponsored by the National Insurance Company Ltd. and he has been continuing said policy  for a long period since 2011.

            BOI National Swatshya Bima Policy is a unique health insurance policy in tie up with national insurance company limited and this health policy is especially for Bank of India account holder or card holder. Being an account holder of the Op No.1 (Bank of India) bearing account No.432410110012029 the complainant intended to shift his policy to the BOI and accordingly his medi-claim policy bearing No. 150703/48/10/8500002294 has been shifted to BOI as BOI National Swasthya Bima Policy and renumbered as 150703/48/16/8500002016 with all renewal facilities and thus the complainant become the consumer of both the opposite parties. As per norms the BOI (Op No.1) being agent of the said policy (Agent Code 92060100004354) has to remit the premium amount of the policy to the Op No.2 from the account of the complainant alike other policy holders having account with the bank and by this way the renewal premium amount was being deducted from the account of the complainant for the year 2016 and 2017.

            The Op No.1 in negligent manner refrained from sending the premium amount towards renewal of the existing policy of the complainant to the Op No.2 within the stipulated time. The Op No.1 had an obligation to send the renewal amount to the Op No.2 by deducting the amount from the SB account of the complainant by 28.02.2018 but Op No.1 did not perform his duties and liabilities imposed as per terms and norms of the policy and thus despite of having no fault on the part of the complaint, he is debarring from getting all facilities as awarded to the old policy holder and the Op No.1 negligently refrained from doing their incumbent act causing loss and injury to the complainant.

            The complainant submitted applications of the Op No.1 on 29.05.2018 and 18.06.2018 with a request to take all measures for renewal of his existing policy with all continuity benefit as there was no negligence on the part of the complainant but the OP No.1 kept mum and did not act in terms of the letter of the complainant. It is established that there is a gross negligence and deficiency in rendering service towards the policy holder on the part of the Op No.1. but the Ops are trying to escape from their liability for wrongful gain causing injustice to the complainant. Under such circumstances the complainant has been compelled to file this case for a direction upon the Op No. 1 and 2 to give effect of the policy by way of its renewal with all continuity benefits, directing the Ops to pay the amount equivalent to the coverage of the policy for Rs. 3,00000/- with accrued interest  to the complainant and further directing the Ops to pay a sum of Rs. 10,000/- only as compensation for mental pain and agony caused to the complaint and further to pay a sum Rs. 10,000/- towards litigation cost.   

            Notice was issued upon the Op No. 1 and 2 and both of the Ops have appeared before this Forum and contested the case by filing two separate set of written version. It has been admitted by the OP No.1 that the BOI National Swasthya Bima Policy is a unique policy in tie up with the National Insurance Company Ltd. and the Op No.1 being the corporate authorized/agent of the National Insurance Company Ltd. is doing all for the said purpose and the complainant is a customer/policy holder of NICL previously and at present the complaint joined in the said policy under the Op No.1. It has been further stated by the Op No.1 that the complainant is an account holder of the Op No.1 bank vide account No.432410110012030 and the premium amount for renewal of the policy would be deducted/debited from the said account and credited to the National Swasthya Bima Policy account after obtaining the list/names of the policy holders from the national Insurance company Limited but in the concern month i.e. in the month February 2018 a list of consumer was received by the Op No.1 but in the said list the name of the complainant was not written. As per list of the Op No.2 the Op No.1 bank deposited/credited policy premium amount to the concern authority the February 2018 but in the said list the name of the complaint has not written/mentioned by the Op No.2 and also the complainant did not communicate with the Op No.1but after the statutory period of one month on 29.05.2018 the complainant appeared before the bank authority regarding renewal of his policy but unfortunately a delay of three month was there and the grace period of one month was already over  and regarding the renewal of the said policy the senior manager of BOI had also contacted with the zonal office and also the branch manager of National Insurance Company. Ltd. for solution of the matter but received no response from their end. It has been further contended by the Op No.1 that there is no negligence or deficiency in service on the part of the Op No.1 and as such the complainant is not entitled to get any relief against the Op No.1 and the instant case is liable to be dismissed with cost against the complainant.

            OPW-2 has contested the case by filing a separate written  version the sum and substance of which is that the complainant was the consumer to the Op No.2 through BOI under BOI National Swasthya Bima Policy but it was not continued latter and as such the policy of the complainant has been discontinued and the BOI did not renew the said policy within the grace period and Op No.2 NIC in no way is liable for such discontinuances and under such circumstances the case is liable to be dismissed against the Op No.2.

            In this case the complainant has submitted deposition and supplementary deposition in chief by way of affidavit as PW-1 together with following documents:

1. Insurance policy vide No. 150703/48/10/8500002294  …. 1 sheet (Xerox).
2. Insurance Policy vide No. 150703/48/11/8500002343 …..1sheet (Xerox).
3. Insurance Policy vide No. 150703/48/12/8500002189 … 3 sheet with premium certificate (Xerox).
4. Insurance Policy vide No. 150703/48/13/8500002233 .… 2 sheet (Xerox).
5. Insurance Policy vide No. 150703/48/14/8500002276…… 2 sheet with premium certificate (Xerox).
6. Insurance Policy vide No. 150703/48/15/8500002435 …..2 sheet with premium certificate (Xerox).
7. Insurance Policy vide No. 150703/48/16/8500002016 …. 2 sheet (Xerox).
8. Letter dated 29.05.2018 & 18.06.2018 to The Branch Manager, Bank of India, Balurghat Branch, Submitted by the complainant for renewing BOI National Swasthya Bima Policy (Xerox).…….2 sheet.
9. Bank Account detail vide A/C No. 432410110012029 in the name of Amar Kumar Sarkar (Xerox).                ……… 2 sheet.
10. Xerox of A/C No. 432410110012030 in the name of Tarun Sarkar.
11. Debit mandate form for BOI National Swasthya Bima Policy (Xerox).

            On behalf of Op-1 the senior manage Sri Chinmay Panigrahi has submitted evidence as Opw-1 together with following documents:

1. List of customers in the months of February 2018 and March 2018.
2. Renewal letter of Noresh Chandra Munda, Gauri Sankar Das and Santanu Das.
3. Letter from the senior manager of Bank of India (three sheets.)
4. Xerox copy of pass book in the name of Amar Kumar Sarkar complainant …………(2 sheets).

Op-2 has submitted in writing to accept the written version as their evidence in chief.

                                  Points for discussion:

1. Is the complainant a consumer to the opposite party No.1 and 2?
2. Is there any deficiency in service on the part of the opposite parties?
3. Is the complainant entitled to get any relief/reliefs as prayed for?

DECISION  WITH  REASONS

Point-1: This issue is not disputed by the Ld. Advocates of Op No. 1 and 2 during their course of argument. Moreover, after going through the facts and circumstances of the case with regard to the materials and evidence of the parties on record this Forum is of the view that the complainant is a consumer to the Op No. 1 and 2.

Point No. 2 & 3: These two issues are taken up together for discussion for the sake of convenience and brevity.

This is admitted position that the complainant is a mediclaim policy holder since 2011 sponsored by National Insurance Company Limited. This is also not disputed that BOI National Swasthya Bima Policy is a unique policy in tie up with the National Insurance company Limited and the complainant subsequently shifted his  said policy to the Op No.1 under BOI National Swasthya Biba Policy being a account holder having his account number 432410110012030 and his previous policy number was renumbered as 150703/48/16/8500002016 and as per norms BOI (Op No.1) deducted the renewal premium amount from the account of the complainant during the year 2016 and 2017 alike other policy holders and sent the same to the Op No.2 for renewal of the policy.

This is the specific case of the complainant that Op No.1 had an obligation to send the renewal premium amount to the Op No.2 by deducting the amount from the SB account of the complainant by 28.02.2018 but Op No.1 did not perform his duties and liabilities as per terms and norms of the policy and thus despite of having no fault on the part of the complainant he is debarring from getting all facilities as awarded to the old policy holder.

In order to substantiate his case the complainant has submitted his deposition in chief as PW-1 and certain documents. On perusal of the document it is clear that complainant opened one mediclaim policy in the year 2011 with National Insurance Company Limited (Op No.2) and he has been continuing the policy since 2011 by paying renewal premium amount of the policy every year. It further appears from the documents submitted on the side of the complainant that BOI National Swasthya Bima Policy is in tie up with National Insurance company Limited and being an account holder of BOI the complainant subsequently shifted his policy to BOI and his earlier medical policy bearing No. 150703/48/10/8500002294 has been shifted to BOI as BOI National Swasthya Bima policy and renumbered as 150703/48/1618508500002016 with all renewal facilities and in the year 2016 and 2017 the BOI (Op No.1) has duly renewed the policy of the complainant by sending the premium amount from the savings bank account of the complainant to the Op No.2. The debit mandate form for BOI National Swasthya Bima Policy also shows that the policy holder has authorized the bank to auto debit the renewal premium every year from the account of the policy holder on the respective renewal due date subject to availability of the product at the same or higher/lower premium as applicable from time to time and also subject to the terms and condition prevailing at the time of renewal and in the said mandate it has been stated that if the policy holder fails to maintain the sufficient balance to pay premium on the due date of renewal bank will not be held liable for any risks responsibilities or lapse of policy.

The OP No.1 has also admitted in their written version as well as  written argument that the complainant has SB account with the Op No.1 and the mediclaim policy which was continued by the complainant since 2011 has been shifted to the BOI under BOI National Swasthya Bima Policy. It is also not disputed by the Op No.1 that in the year 2016 and 2017 the renewal premium amount was being deducted from the account of the complainant and sent to the Op -2 for renewal of the aforesaid policy of the complainant.

The Op-1 has taken the plea that renewal list of February 2018 in respect of the policy holders sent by the NIC (OP-2) to the OP-1 did not bear the name of the complainant, moreover, the complainant who is a well educated person and was well aware of the fact that the policy renewal month is February in every year did not communicate with the Op No.1 for renewal of the policy. But from the terms and norms of the policy it is clear that OP No.2 has no obligation to inform the Op No.1 to deposit the renewal premium amount of the policy holder. The debit mandate form for BOI National Swasthya Bima policy also disclosed that the policy holder has authorized the bank to auto debit the renewal premium amount every year from the account of the policy holder on the respective due date. It is no one’s case that the complainant had no sufficient fund in his account at the relevant point of time.    

From the aforesaid statements it is crystal clear that Op-1 did not take any initiative for renewal of the policy of the complainant within the statutory period i.e. by 28.02.2018 by deducting the renewal amount from the SB account of the complainant and sending the same amount to the Op No.2. Op No.1 also failed to take any step for renewal of the policy within the grace period of one month and when the complainant by letter dt. 29.05.2018 and 18.06.2018 requested the Op-1 to take necessary measures for renewal of his existing policy with all continuity benefit the senior Manager of Op-1 had contacted with the zonal office of the Op-2 for solution of the matter but received no response from Op No.2.

On perusal of the entire materials and evidence of the parties on record it is established that the Op No.1 negligently refrained from sending the premium amount towards renewal of the existing policy of the complainant to the Op no.2 within the stipulated period although it was their incumbent duty and obligation to send the renewal amount to the Op no.2 by deducting the amount from the SB account of the complainant by 28.02.2018 and due to such negligent act of the Op No.1 the complainant is debarring from getting all facilities as awarded to the old policy holder despite of having no fault on his part. It is clear from the acts and conduct of the OP No.1 that there is gross negligence and deficiency in rendering service towards the policy holder on the part of the Op No.1 which not only undesirable but also unfortunate from the end of a nationalized bank.

In view of the above findings the Op No. 1 and 2 are directed to give effect of the policy of the complainant by way of its renewal with all continuity benefits and Op No.1 is further directed to pay a sum of Rs. 10,000/- as compensation for mental pain and agony to the complaint and Op No. 1 is further directed to pay a sum of Rs 5000/- towards litigation cost.

Thus point number 2 and 3 are decided in favour of the complainant.  

Hence, it is

                                                O R D E R E D

That the Consumer complaint case No.71/2018 be and the same is allowed in part on contest with cost against Op No. 1 and 2.  Op No.1 and 2 are directed to give effect of the policy of the complainant by way of its renewal with all continuity benefits within 30 days from the date of passing this order and Op No.1 is further directed to pay sum of Rs. 10,000/- as compensation for causing mental pain and agony to the complainant within 45 days from the date of passing this order by issuing an account payee chaque in favour of the complainant. And Op No.1 is further directed to pay a sum of Rs. 5000/- to the complainant towards litigation cost by issuing an account payee chaque in favour of the complainant. In default the petitioner is at liberty to execute the order as per law.

            Let a plain copy of this order be furnished to the parties forthwith free of cost.