O R D E R
By Sri. C.T. Sabu, President :
Complainant case is that she and her family members comprising her husband and her two daughters were insured with 1st opposite party since March 2007 under Mediclaim Insurance. Every year remittance of premium was made through 2nd opposite party, the Catholic Syrian Bank Ltd., Parappukkara Branch. Policy in dispute had to be renewed from 31/03/2013 to 30/03/2014. As was done in the yesteryears the 2nd opposite party deducted a sum of Rs.2,389/- from the SB Account of the complainant (0325-00112250-190001) on 22/03/2013 and sent a DD No.9818631 dtd. 22/03/2013 for the same amount to the 1st opposite party through professional courier which was duly accepted by the authorised signatory of the 1st opposite party on 25/03/2013 as evidenced by the professional courier service entry. Complainant alleges that the opposite party failed to account the DD having the No.981863 and also failed to renew the policy for the period 31/03/2012 to 30/03/2013. Subsequently a claim was lodged with the 1st opposite party for the hospitalisation expenses of her husband Mr. M.J. Thomas who was admitted in a Hospital on 20/05/2013. The claim amount was for Rs.13,080/-. Complainant states that the above claim was made for the 1st time. The 1st opposite party was not pleased to admit the claim and replied the complainant that they are not in receipt of the premium amount for renewal for the period 31/03/2012 to 30/03/2013. Complainant also states that she had produced the proof of delivery of DD No.981863 dtd. 22/03/2013 to the company by the Catholic Syrian Bank Ltd., Parappukkara. Then the 1st opposite party advised to wait and thereafter instructed to get a duplicate copy of the DD No. 981863 for Rs.2,389/- from the CSB Ltd. As per the direction of the opposite party the complainant produced a duplicate copy of DD No.000047000 dtd.27/06/2013 to the opposite party. Complainant strongly alleges that 1st opposite party has intentionally delayed in taking necessary action to find out the DD No. 981863 dtd. 22/03/2013 which was received on 25/03/2013.
2) Later as per letter No.760300/TCR/13/14 dtd.11/09/2013 the Divisional Office, Thrissur has issued a letter informing the complainant that with the DD No.981940 dtd. 27/06/2013 policy cannot be renewed since there is a gap of more than five months.
3) As reiterated by the complainant the non-renewal of the policy even after receiving the premium in time and also not admitting the lodged claim for Rs.13,080/- tantamount to deficiency in service.
4) Therefore, it is prayed that the complaint may be allowed directing the opposite party to renew the mediclaim policy from 30/03/2013 to 30/03/2014 and to settle the claim for Rs.13,080/-. Besides, Rs.10,000/- towards compensation for hardships.
5) Admitted the case. Issued notice to opposite parties. Opposite parties appeared before the Commission through counsels. Filed separate versions challenging the contentions of the complainant.
6) 1st opposite party has taken a plea that they have not received the DD and hence could not renew the policy. In the absence of a renewed policy they are unable to honour the claim if any. It is stated by the opposite party that on insistence by the complainant the opposite party permitted the complainant to furnish the Duplicate copy of the DD dtd. 22/03/2013. To the surprise of this 1st opposite party as stated, the Bank sent a DD with a different number and dtd. 27/06/2013. The Bank instead of sending the duplicate copy of the DD dtd. 22/03/2013 had issued a fresh DD which clearly shows no DD was issued earlier. As there is no deficiency in service compliant may be dismissed with cost to the 1st opposite party.
7) Second opposite party in their version states that they are not liable in any case. There is no deficiency in service on their part. As right stated by the complainant the DD was taken for Rs.2,389/- and sent to the 1st opposite party through professional courier. The amount was deduct from the complainant’s account. The 2nd opposite party issued duplicate demand draft as and when requested by the complainant without any delay. The original demand draft was issued on 22/03/2013 and sent the same to 1st opposite party on the same day ie, on 22/03/2013 itself through professional courier. The said DD was received by the 1st opposite party on 25/03/2013. 2nd opposite party states in the objection that the first opposite party sent letter to the 2nd opposite party conveying that the said DD is accepted by them on 25/03/2013, but the same could not be located in their office and requested to sent a duplicate DD. On such an advice also a duplicate draft was issued immediately. Here all the allegations against the 2nd opposite party are denied being false. Complaint may therefore be dismissed with cost.
8) Then the case posted for evidence. The points for consideration are the following.
a) Is there any deficiency in service or unfair trade practice from
the part of opposite parties ?
b) If so what cost and reliefs ?
9) Both parties filed proof affidavits, documents and argument notes. Documents produced by the complainant are marked as Ext. P1 to P10. Ext. P1 is the copy of CSB Health Care Support Group Insurance Certificate dtd. 01/04/2010; Ext. P2 is the copy of CSB Health Care Support Group Insurance Certificate dtd. 31/03/2011; Ext. P3 is the copy of CSB Health Care Support Group Insurance Certificate dtd.04/04/2012; Ext. P4 is the copy of Pass book of Aleykutty Thomas; Ext. P5 is the copy of Invoice for the period 01/03/13 to 31/03/13 issued by professional courier; Ext. P6 is the copy of Daily Delivery Statement of Professional Courier dtd. 25/03/2013; Ext. P7 is the claim form submitted by the complainant dtd. 30/05/2013; Ext. P8 is the copy of Duplicate DD issued by Catholic Syrian Bank Ltd., dtd.27/06/13; Ext. P9 is the copy of letter issued by New India Assurance Co. Ltd., dtd. 11/09/13 and Ext. P10 is the Advance notice dtd. 06/11/2013 with acknowledgement card.
10) From the side of opposite parties 8 documents are produced. 3 by 1st opposite party and 5 by 2nd opposite party. Ext. R1 is the CSB Health Care Support Group Insurance Policy Conditions; Ext. R2 is the Letter by Catholic Syrian bank; Ext. R3 is the reply letter by Sr. Divisional manager, New India Assurance Co. Ltd.; Ext. R4 is the Letter received by the 1st opposite party dtd. 27/06/13; Ext. R5 is the DD dtd. 22/03/13; Ext. R6 is the copy of Daily Delivery Statement of Professional couriers dtd. 25/03/13; Ext. R7 is the Receipt of Professional couriers dtd. 22/03/13 and Ext. R8 is the copy of invoice of Professional couriers for the period 01/03/13 to 31/03/13.
Appreciation of Evidence :
11) On meticulous examination of proof affidavits and documents produced by both parties this Commission is convinced beyond any shadow of doubt that the first opposite party has failed to exercise reasonable care and prudence of an ordinary reasonable authority. Ext. R4 clearly shows that they have received the DD and they have admitted the same in the R4 Exhibit. Ext. R5, Ext. R6, Ext. R7, Ext. R8 are clear documents corroborating the same. On contrary to the above, the flat denial of the 1st opposite party that they have not received the DD in the objection filed is misleading this Hon’ble Commission. We express our grave concern and dissatisfaction against the 1st opposite party for such grave and erroneous negative attitude. A public authority should not have represented before this Commission in such a callous way. Similarly the request for a duplicate DD by the 1st opposite party is another wrong step as well as a futile exercise. An insurance company Manager ought to have some basic knowledge of banking practice with regard to the issuance of Duplicate of Original DD. One cannot issue a duplicate of DD with the same date of the Original DD. In the circumstances there are serious lapses on the 1st opposite party. Their gross negligence amounts to serious deficiency in service.
Relief and costs :
12) We are inclined to give a right verdict in favour of the complainant. Complainant has taken sincere efforts to renew the policy remitting the required premium in time through the Bank – 2nd opposite party. 1st opposite is directed to renew the policy from 31/03/2013 to 30/03/2014 having remitted the premium and also settle the hospitalisation expenses of Rs.13,080/- (Rupees Thirteen thousand and eighty only) and to pay Rs.10,000/- (Rupees Ten thousand only) towards compensation for hardships caused to the complainant with cost of Rs.5,000/- (Rupees Five thousand only) within 30 days.
Allowed the compliant accordingly.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Commission this the 30th day of November 2020.
Sreeja S. Dr.K.Radhakrishnan Nair C. T. Sabu
Member Member President
Appendix
Complainant’s Exhibits :
Ext. P1 copy of CSB Health Care Support Group Insurance Certificate
dtd. 01/04/2010
Ext. P2 copy of CSB Health Care Support Group Insurance Certificate
dtd. 31/03/2011
Ext. P3 copy of CSB Health Care Support Group Insurance Certificate
dtd.04/04/2012
Ext. P4 copy of Pass book of Aleykutty Thomas
Ext. P5 copy of Invoice for the period 01/03/13 to 31/03/13 issued by
professional courier
Ext. P6 copy of Daily Delivery Statement of Professional Courier
dtd. 25/03/2013
Ext. P7 claim form submitted by the complainant dtd. 30/05/2013
Ext. P8 copy of Duplicate DD issued by Catholic Syrian Bank Ltd.,
dtd.27/06/13
Ext. P9 copy of letter issued by New India Assurance Co. Ltd., dtd. 11/09/13
Ext. P10 Advance notice dtd. 06/11/2013 with acknowledgement card.
1st Opposite Party’s Exhibits :
Ext. R1 CSB Health Care Support Group Insurance Policy Conditions
Ext. R2 Letter by Catholic Syrian bank
Ext. R3 reply letter by Sr. Divisional manager, New India Assurance Co. Ltd.;
2nd Opposite Parties Exhibits :
Ext. R4 Letter received by the 1st opposite party dtd. 27/06/13
Ext. R5 DD dtd. 22/03/13
Ext. R6 copy of Daily Delivery Statement of Professional couriers dtd. 25/03/13
Ext. R7 Receipt of Professional couriers dtd. 22/03/13
Ext. R8 copy of invoice of Professional couriers for the period 01/03/13 to
31/03/13.
President
