Chandigarh

StateCommission

A/81/2023

UNITED INDIA INSURANCE COMPANY LTD. - Complainant(s)

Versus

SUKH LAL SONI - Opp.Party(s)

GURPREET SINGH AHLUWALIA

09 Jun 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Appeal No.	:	81 of 2023
Date of Institution	:	28.04.2023
Date of Decision	:	09.06.2023

 

United India Insurance Company Limited SCO 123-124, Sector 17B, Chandigarh 160017.

……Appellant/opposite party

V e r s u s

 

Sukh Lal Soni resident of H. No. 501, Sector 32-A, Chandigarh.

 

…..Respondent/complainant

 

BEFORE:              JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT.

                             MR.RAJESH K. ARYA, MEMBER.

                            

Present:-              Sh.Gurpreet Singh Ahluwalia, Advocate for the appellant (on VC).

                             Sh.Sukh Lal, respondent in person.

                                      

JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

 

The appellant has come up in this appeal assailing the order dated 08.02.2023 passed by the District Consumer Disputes Redressal Commission-I, U.T., Chandigarh (in short the District Commission), whereby the consumer complaint bearing no.319 of 2021 was partly allowed, as under:-

1. to refund the excess premium amount charged from the complainant for the year 2020-2021 and 2021-2022 and to continue the insurance policy on original/existing terms and conditions.
2. to pay Rs.20,000/- to the complainant as compensation for causing mental agony and harassment to him;
3. to pay 7000/- to the complainant as costs of litigation.

This order be complied with by the OPs within thirty days from the date of receipt of its certified copy, failing which, they shall make the payment of amounts mentioned at Sr.No.(i)&(ii) above, with interest @ 12% per annum from the date of this order, till realization, apart from.

2.           Alongwith this appeal, the appellant/opposite party has also filed miscellaneous application bearing no.344 of 2023 for condonation of delay of 5 days in filing the same. Arguments on this application were heard.  For the reasons recorded in this application and also on hearing arguments of the parties, we are of the considered view that there is sufficient cause to condone the small delay of 5 days, in filing this appeal. Resultantly,   the delay of 5 days in filing this appeal stands condoned. This application stands allowed and is disposed of,  accordingly.
3.           Now coming to the main appeal, before the District  Commission, it was the case of the  respondent/complainant that he and his wife purchased a medical policy from the opposite party under Synd Arogya Scheme with Syndicate Bank 10 years ago. The coverage of the policy was till 80 years as per brochure Annexure I.  The policy was due for renewal on 18.7.2020 but the opposite party did not renew the same on its original terms and conditions and quoted very high premium on the plea that the said scheme is not prevalent as the Syndicate Bank  has merged with Canara Bank. As such, left with no alternative, the complainant got the policy renewed on the arbitrary terms and conditions. Moreover, the policy was in the name of Adarsh Soni but the same was renewed in the name of complainant who is senior in age, so as to charge higher premium which was not earlier practice.
4.           In the reply filed before the District Commission, the appellant/opposite party stated that the complainant is policy holder of Synd Arogya and subscribed the policy after going through the terms and conditions.  It was averred that the opposite party had entered into MOU with Syndicate Bank for providing medical insurance to the staff and clients of the syndicate bank. The policy was a tailor made policy on the basis of Group Health Insurance Scheme, which was sold at the rates agreed between the bank and insurance company. It was stated that lesser rates were provided to the bank and the complainant subscribed the policy as syndicate bank’s staff/client. However, the Government vide notification G.S.R. 155(E) in the Gazette of India Extraordinary on March 4 2020 amalgamated the syndicate bank into Canara Bank with effect from April 1 2020 and accordingly the Syndicate Bank issued notice dated 21.3.2020 to the insurance company for termination of corporate agency agreement between them. After receipt of notice dated 21.3.2020 from Syndicate Bank, the insurance company could not renew the policy of the complainant on the same premium which was charged during the existence of corporate agency agreement with Syndicate Bank.
5.           The complainant filed rejoinder to the written reply of the opposite party controverting their stand and reiterating his own version.
6.           The District Commission after hearing the complainant in person and counsel for the opposite party and on going through the documents on record, partly allowed the consumer complaint, in the manner stated above. 
7.           Hence this appeal.
8.           Record of the District Commission was requisitioned and received by this Commission.
9.           We have heard the contesting parties and scanned the material available on the record, very carefully.
10.           Before this Commission, it has been vehemently contended by counsel for the appellant that the appellant declined to renew the policy in question, under the subsidized rates because of the reason that the Syndicate Bank with which the appellant was in contract of insurance for its employees was severed post its merger with Canara Bank, after receipt of notice dated 21.03.2020, Annexure A-2, as such, consequent thereto, the policy in question was  renewed  as a general customer, where the premium was determined keeping in view of the age of the customer. 
11.           On the other hand, the respondent in person submitted that the order passed by the District Commission did not suffer from any illegality and as such is liable to be upheld.
12.           We have heard the rival contentions of the parties and have scanned the entire material available on record.
13.           The first question which needs to be decided is, as to whether, the appellant has been able to prove that the policy in question was issued in favour of the respondent/complainant on subsidized rates or not? It may be stated here that not even a single document has been placed on record by the appellant to convince this Commission that the policy in question was issued on subsidized rates for the employees of the Syndicate Bank, which later on merged with Canara Bank. Even in the brochure Annexure A-1 (on paper book of the District Commission), we did not find anything mentioned with regard to subsidized rates of the policy in question. Whereas, on the other hand, it is found mentioned therein that the premium is attractive because of heavy Group Discount. In our considered opinion once such a discount has been given by the appellant at the initial stage in order to sell its insurance product to the group of employees of Syndicate Bank including the respondent, later on the appellant cannot wriggle out of the same, by terming it as subsidy. As such, plea taken by the counsel for the appellant in this regard stands rejected.
14.           Even otherwise, as per para No. 1 of the IRDA circular No. IRDAI/HLT/REG/CIR/049/03/2021 dated 16.3.2021 placed on record before the District Commission by the complainant alongwith rejoinder as Annexure I, clearly reveals that general and health insurers are not allowed to modify the existing benefits, add new benefits in the existing products which leads to imposing an increase in premiums. There is nothing on record to prove, as to on what basis, the appellant had modified/revised the premium rates at such exorbitant rates, thereby violating the  provisions of the  circular dated 16.03.2021.  The District Commission was also right in holding so.
15.           Keeping in view the above discussion, we are of the considered view that the impugned order passed by the District Commission, partly allowing the consumer complaint, being based on the correct appreciation of evidence and law on the point, does not suffer from illegality or perversity, warranting interference of this Commission. Resultantly, this appeal stands dismissed with no order as to costs.
16.           Certified copies of this order be sent to the parties, free of charge.
17.           The appeal file be consigned to Record Room, after completion and record of the District Commission concerned be sent back.

Pronounced

09.06.2023

 

Sd/-

 [JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

Sd/-

 (RAJESH K. ARYA)

MEMBER

 

Rg.