1.      The present Revision Petition has been filed by the Petitioner under Section ­­­21(b) of the Consumer Protection Act, 1986 (the “Act”) against impugned order dated 14.11.2017, passed by the Tamil Nadu State Consumer Disputes Redressal Commission, Chennai (‘for short ‘State Commission’) in First Appeal No.464 of 2012. In this appeal, the Complainant appeal was allowed partly, thereby set aside the Order dated 30.04.2012, passed by the District Consumer Disputes Redressal Forum, Chennai, South (For short “District Forum”) in Consumer Complaint No. 684 of 2009, wherein the Complaint filed by the Complainant (Respondent No. 1 herein) was dismissed.

2.      For convenience, the parties in the present matter are denoted as per their positions in the Consumer Complaint before the District Forum. S. Ramu is identified as the Complainant (Respondent No. 1 herein). Meanwhile, M/s. HDFC Bank Ltd. is identified as OP-1 Bank (Petitioner herein) & M/s. TTK Health Care Services Pvt. Ltd is identified as OP-2 (Respondent No.2 herein), in the present matter.

3.      In brief, the OP-1 Bank issued a credit card named "HDFC Bank Health Plus Credit Card" in 2003, providing cashless medical reimbursement benefits up to Rs.50,000/- for critical care and up to Rs.1,50,000/- for Medi-claim, on payment of an annual membership fee. The Complainant, along with his wife and daughter as add-on members, enjoyed these benefits until September 2011. However, in July 2007, he received a letter from OP-2 (TPA), informing about third-party administrative services authorized by United India Insurance Company, effective from 01.07.2007. Despite the Complainant's membership fee being debited on 15.10.2008, an account statement received on 19.03.2009 showed a reversal of the membership fee, service tax, and cess, leading to confusion. Upon contacting OP-1's customer service, he learned that his Health Plus Credit Card membership was reversed, compelling him to switch to a "Master Platinum Card." This unilateral decision, over five months after the fee payment for 2008-09, was neither communicated nor explained adequately by OP-1 despite multiple inquiries by him. Notably, there was no prior intimation from OP-1 regarding the discontinuation of the scheme. On 23.03.2009, the Complainant's wife was hospitalized and he incurred a medical expenditure of Rs.17714/-. On filing a claim with OP-2 on 31.03.2009, it was rejected on the grounds of policy non-renewal. Further, while seeking admission for cardiac treatment at another hospital he incurred expenses of Rs.95,620/- and the claim of his wife was denied due to non-renewal of the policy, forcing him pay for it.

4.      Being aggrieved, the Complainant filed CC 684/2009 seeking Rs.1,13,336/- towards the medical expenditure along with interest @ 12%; and direction to OP-1 Bank to renew and continue the insurance cover. He further sought compensation of Rs.17,00,000/- for the hardship humiliation mental agony and health crisis meted out to him and his family members; Rs.1,00,000/-as compensation for hardship and mental agony; and further directions to OPs to cease and desist from such unfair trade practice and to pay costs.

5.      In reply before the District Forum, OP-1 acknowledged issuing a Health Plus credit card to the Complainant on 20.09.2003, which was later upgraded to a Titanium card effective from 08.08.2009. The Complainant accepted the credit card, thereby agreeing to the terms and conditions outlined thereat. OP-1 withdrew the Health Plus credit card and TPA card across all accounts in August 2008, notifying customers, including the Complainant vide letter dated 11.10.2008 served on 13.10.2010. The scheme discontinuation was notified in the monthly card statements. Subsequently, he filed claims for medical expenses incurred in March 2009 and April 2009, post the scheme withdrawal, which OP-1 declined to pay. Despite the scheme withdrawal in August 2008 itself, as an exceptional service gesture, OP-1 proposed pay Rs.50,000/-, which he rejected. Following the withdrawal, all customers were issued fresh Titanium Credit Cards, including the Complainant, on 14.08.2009. The annual fee of Rs.950/- collected from him on 15.10.2008 for the Health Plus credit card cannot be considered as an insurance premium. Thus, the reversal of the annual fees collected from him on 13.03.2009 was justified. OP-1 also highlighted that the maximum Medi-claim benefit under the withdrawn scheme was only Rs.50,000/-, which was offered as an exceptional service gesture but he declined. OP-2 remained absent, leading to be placed ex-parte.

6.      The District Forum in its Order dated 30.04.2012, dismissed the Complaint as it deserves no merit citing the following reasons:

“9.      The complainant was issued with Health Prus Credit Card bearing No.5176358010146883 by the 1^st opposite party with effect from 20.09.2003 was admitted. In Ex A2, Rs.950/- was shown as membership fee service tax and cess tax which was shown as Collected under Ex A2 was reversed. The 1^st opposite party had withdrawn the Health Plus Credit Card and TPA during August 2008. Perusal of Ex A6 shows that the 1^st opposite party had informed the complainant about discontinuation of Health Plus card and reversal of membership fee and service tax. The complainant had raised claims for the hospital expenses under Ex A12 after 7 months from the withdrawal of the scheme and the same was rejected by the 2^nd opposite party under Ex A14 stating that "Policy was not renewed with us”. The 1^st opposite party as an exceptional service gesture proposed a sum of Rs.50,000/- under Ex B5 to the complainant and the same was not accepted by the complainant. No relief can be given since the scheme under which the complainant seeks remedy was not in existence, on the date of hospitalization of the-complainant's wife and the scheme was withdrawn during, August 2008 itself. In the above circumstances we do not find any deficiency in service and unfair trade practice on the part of the opposite parties

10. Point No.2: In the result, the complaint deserves no merits and is liable to be dismissed. Accordingly, the complaint is dismissed. No costs.”

7.      Being aggrieved by the District Forum Order, the Complainant/ Respondent No. 1 filed an Appeal No. 464 of 2012 and the State Commission, in its order dated 14.11.2017, allowed the appeal and set aside the order of the District Forum, with the following reasons:

“9  A cumulative reading of the above admitted facts and the facts emerging from the circumstances and the evidence available in this case would lead any prudent man to come to the conclusion that though the first opposite party had power/authority to modify or withdraw the insurance claim as per the terms and conditions of the agreement as the insurance being a contractual liability the 1^st opposite party had not proved in this cases by any lawful and acceptable evidence that the 1^st opposite party had withdrawn the said insurance scheme. If so held then the 1^st opposite party was bound to reimburse the medical expenditures incurred by the complainant and the act of the 1^st opposite party in refusing to entertain the claim made by the complainant and in putting up false or unlawful grounds for refusing the same would clearly amount to deficiency in service and adoption of unfair trade practice and this point is answered in favour of the complainant/appellant.  

10. As far as the 2^nd opposite party is concerned admittedly insurance premium amount though collected by the 1^st opposite party from the complainant was not remitted to the account of the 2^nd opposite party or the insurance company and as such the 2^nd opposite party was under no legal obligation to entertain any insurance claim made by the complainant and hence we hold that no deficiency in service or unfair trade practice could be attributed to the 2^nd opposite party.

13. In the result the appeal is partly allowed and the 1^st opposite party is directed to pay the complainant Rs.113336/- being the medical expenses incurred for complainants wife together with interest at the rate of 12% per annum from 01.04.2009 till the date of payment and Rs.200000/- as compensation for mental agony humiliation and hardship  within 4 weeks from the date of receipt of copy of this order failing which the amounts shall carry interest at the rate of 12% per annum from the date of default till the date of payment.  The 1^st opposite party is also directed to pay cost of Rs.10000/- to the complainant. The appeal as against the 2^nd respondent/2^nd opposite party is dismissed without cost.”

8.      Being dissatisfied by the Impugned Order dated 14.11.2017 passed by the State Commission, the Petitioner/OP-1 filed Revision Petition No. 658 of 2018 and raised several grounds in the petition:

(a) The impugned order is erroneous and suggestive of bias, as the State Commission hastily allowed the Respondent's claim without considering its maintainability. The claim is based on the amount assured as Mediclaim through the Petitioner bank's credit card. However, while awarding the claim, the State Commission failed to assess whether the amount claimed by the Complainant falls within the coverage of the policy. The terms of the policy state that the card includes free cashless Mediclaim of Rs.50,000, along with a critical illness cover of Rs.1,50,000, which specifically covers certain illnesses. The claim of Respondent was for ailments covered under general Mediclaim with an upper limit of Rs.50,000. However, the State Commission awarded Rs. 1,13,336/- (along with 12% p.a. interest), surpassing the assured amount and disregarding the contractual limit between the parties.

b) The impugned order is illegal and unjust as the State Commission awarded compensation disproportionate to the damages suffered by the Complainant and awarded Rs. 2,00,000/- in compensation for a claim of Rs.1,13,336/- filed against Rs.50,0000 sum assured.

c) The State Commission gravely erred in failing to note that the total claim of the Respondent includes expenses incurred in March 2009 and from 16.04.2009 to 18.04.2009. He filed a Mediclaim of Rs.17,716/- with OP-2 on 31.03.2009, which was rejected on 09.04.2009, stating the reason "policy was not renewed with us."

d) The Petitioner Bank admittedly offered a cashless Mediclaim of Rs. 50,000/- to the respondent out of goodwill. However, the State Commission imposed compensation of Rs. 2,00,000/-.

9.      Upon notice to the present Revision Petition, the Respondent No. 1/Complainant submitted written arguments appreciating the Order passed by the Ld. State Commission. On the other hand, Respondent No. 2/OP-2 did not appear despite being given multiple opportunities, resulting in placed ex-parte vide order on 01.01.2024.

10.    In his arguments, the Counsel for Petitioner/OP-1 reiterated the grounds of the petition and vehemently contended that the impugned Order is illegal, perverse, and untenable. The decision of the State Commission's decision to award disproportionate compensation to the Respondent is unjustifiable. He emphasized that the compensation granted exceeds the terms of the policy, which is contrary to settled law. He stressed that the terms and conditions of the insurance contract should be strictly construed, and any deviation from these terms renders the decision is illegal and unsustainable. Therefore, he urged to set aside the impugned order.

11.  The learned Counsel for the Complainant reiterated the facts of the complaint and argued that the Revision Petitioner's liability to reimburse the medical expenditure arises due to the discontinuation of the scheme prior to the medical expenses. He pointed that the Petitioner's offer of Rs.50,000/- indicates an attempt to evade larger liability, demonstrating their awareness of negligence. It was only after numerous attempts to settle the claims with the Petitioner Bank and TTK Health Care Services that he learnt about the termination of policy. The Counsel highlighted that an email dated 23.03.2009 was sent by the Respondent No. 2 - TTK Health Care Services Pvt Ltd, along with claim forms outlining the procedure for submitting claims against the bill of St. Isabela’s Hospital, and the claims were acknowledged, indicating that the policy was active. The Petitioner’s claim of policy withdrawal is an afterthought lacking bona fide intentions. In light of these circumstances, the Counsel asserted that the order of State Commission warrants no interference.

12.    The central issue in this case is the responsibility of the Petitioner/ OP-1 (Bank) regarding the Mediclaim Scheme provided through the credit card to the Complainant and the subsequent rejection of his claims. The key questions to be determined include:

1. Whether the withdrawal of the Mediclaim scheme by the Petitioner/OP-1 was justified?.
2. Whether the Petitioner adhered to the terms of the contract?
3. Whether the rejection of the Complainant's claim by the Petitioner/OP-2 (TPA) aligns with the terms of the policy and the circumstances surrounding the scheme discontinuation?

13.    In the present case, it is an established position that the Petitioner issued a credit card with cashless medi-claim benefits, which were availed by the Complainant until September 2011. However, confusion arose when the membership fee was debited and reversed, and the scheme was discontinued. Thereafter, when his wife required medical treatment, the claims were refused by OP1, citing discontinuation of the scheme. Despite OP-1's offer of Rs.50,000 as a goodwill gesture, the Complainant declined. Therefore, in these circumstances, the Complainant is entitled to a lump sum compensation of Rs.50,000 for the deficiency in service in not properly intimating the discontinuation of the scheme.

14.    Based on the above discussion, the impugned orders of the learned District Forum dated 30.04.2012 and the learned State Commission dated 14.11.2017 are set aside. OP-1 is directed to pay Rs.50,000 as compensation along with simple interest @ 9% from the date of the claim till the date of payment within a period of one month from the date of this order. In the event of delay beyond one month, the simple interest applicable shall be @ 12% for such extended period. In addition, OP-1 is also directed to pay the Complainant Rs.10,000 towards costs of litigation costs.

15.    The Revision Petition No.658 of 2018 is disposed of accordingly.

16.    All other pending Applications, if any, stand disposed of.