Ld. Advocate(s)
For Complainant .. Joydip Mitra
For OP/OPs .. P.Ghosh & Rajkumar Mandol
Date of Filing : 18.05.2016
Date of Disposal : 22.01.2020
: JUDGMENT & ORDER dtd. 22.01.2020 :
The case of the complainant, in brief, is that the complainant has a pension A/C under the OP 1 being A/C No. S/B 40631211000142. The OP No. 1 being the agent of National Insurance Co. Ltd. gave a proposal for a Group Mediclaim policy for his family. As per proposal of OP No. 1, the complainant took a Group Mediclaim policy for his family in the year 2011, the first policy coverage was 02.02.2011 to 01.02.2012 and thereafter the said policy runs continuously by paying premium, which was auto debited by the OP No. 1 from the A/C No. SB 40631211000142 each year. On 26.02.2015 the OP No. 1 auto debited the premium amount of Rs. 4,734/- from the A/C of the complainant for continuation of the said policy for the period from 2015 to 2016. From the beginning of May, 2015 the complainant was suffering from some illness and he was in need to be hospitalized but due to non availability of policy certificate, he made a contact on 21.05.2015 through email with the OP No. 1 and requested them to send the policy certificate. Thereafter, on 22.05.2015 the complainant received an email from the OP No. 1 and surprised that the policy date was delayed without continuation of the previous policy though the OP No. 1 debited the policy amount within due time. In the mean time the complainant and his wife turned seriously ill and they were in need to be hospitalized and the complainant spent Rs. 75,000/- and the complainant also informed this matter to the OP No. 1. Thereafter, the complainant met with the OP No. 1 and OP No. 2 several times and requested them for continuation of the previous policy and reimbursement of their claim but OPs No. 1 & 2 did not take any proper step. On 28.11.2015 a legal notice was sent to the OPs to settle the matter regarding renewal and reimbursement of the said mediclaim policy but in vain. The cause of action arose on and from 26.02.2015 and its continuing day by day. Finding no other alternative, the complainant has filed this case and prayed before the Forum to pass an order against the OP to pay a sum of Rs. 75,000/- along with interest, continuation of the previous policy, compensation and litigation cost.
The complainant has filed some documents in support of his case which are in the record are as below:-
1. Annexure – 1 – Certificate of Policy of 2011 to 2012
2. Annexure – 2 – Certificate of Policy of 2012 to 2013
3. Annexure – 3 – Certificate of Policy of 2013 to 2014
4. Annexure – 4 & 4/1 – Copy of Bank Pass Book of Biman Kr. Deb
5. Annexure – 5 & 5/1 – Copy of Email
6. Annexure – 6 – Certificate of Policy of 2015 to 2016
7. Annexure – 7 – Copy of Courier Slip
8. Annexure – 8 – Copy of Legal notice dtd. 28.11.15
On the other hand, OP No. 1 and OP No. 2 have contested this case separately by filing separate written versions wherein they have denied the entire allegations brought by the complainant.
The specific contention of the OP No. 1 is that the complainant took a Mediclaim policy from the National Insurance Co. Ltd. and the said policy continuously ran up to 01.03.2015. Thereafter, as per request of the complainant on 25.02.2015, the OP bank immediately debited his A/C prepared the Draft on 26.02.2015 and the employee of the National Insurance Co. Ltd. took the draft from the bank on 26.02.2015. The duty of the applicant policy holder and National Insurance Co. Ltd. are to receive the Draft from the Bank Branch and to deposit it to the National Insurance Co. Ltd. to renew or re-issue the insurance policy. But it is not the duty and responsibility of the Bank to deposit the said Draft in the Office of the National Insurance Co. Ltd. Usually the Employee of National Insurance Co. Ltd. collected such Draft and various other documents from several other Branches of Bank of India, some time the policy holder by self deposited the premium Draft to the Office of the National Insurance Co. Ltd. The bank issued or prepared the Draft on 26.02.15 and obviously the National Insurance Co. Ltd. received the draft through its employee prior expire the continuation period. So the OP No. 1 prays before the Forum that considering the above all grounds and circumstances and the documents etc., the case may be dismissed with cost.
The OP No. 1 has filed some documents to defend his case which are below:-
- BOINS Bima Policy proposal form
- Requisition letter by the complainant to the OP No. 1
- Copy of Bank’s Transactions statements dtd. 26.02.2015
The specific contention of the OP No. 2 is that the Bank of India was the policy holder being No. 154302/48/13/8500002364 for the period of 02.03.2014 to 01.03.2015 and due to nonpayment of renewal premium within 01.03.2015 the effective legal force and /or terms & conditions of the policy has been ended and/or terminated just after the end of validity period of the said policy. Subsequently, Bank of India, Chakdaha Municipality Branch purchased a policy being No. 154302/48/15/850000325 for the period of 22.05.2015 to 21.05.2016 subject to the terms and conditions, limitation and exception to the policy. There is no deficiency in service on the part of the OP No. 2 regarding settlement of claim of the complainant. So the present complaint of the complainant may be dismissed with cost.
The complainant has also filed affidavit-in-chief, BNA, interrogatories and replies and the OPs have filed BNA, interrogatories and replies too.
Points for discussion
- Whether the complainant is a consumer under the CP Act, 1986?
- Whether there was any deficiency in service from the side of the OPs?
- Whether the complainant is entitled to get any relief /reliefs as prayed for?
Decision with reasons
Point No. 1:
It is admitted fact that there is a relationship of consumer and service provider between the parties.
In this case the OP No. 1 being the agent of National Insurance Company Ltd. gave a proposal to the complainant for a Group Mediclaim Policy for his family and subsequently the complainant took this mediclaim policy from the OP No. 1. Therefore it can be said that the complainant is a consumer under the OP as per Consumer Protection Act, 1986.
This point goes in favour of the complainant.
Point No. 2:
It is fact that on 26.02.15, the OP No. 1 debited the premium amount Rs. 4,734/- from the account of the complainant being No. SB 40631211000142 for continuation of the said Group Mediclaim policy for the period of 2015-2016 and it is clear from the Annexure – 4/A i.e., Bank Pass Book of the complainant.
Be it mentioned further that the complainant paid the policy premium within time and being a Corporate Agent, OP No. 1 debited the policy premium, so OPs No. 1 & 2 cannot escape their liability.
We have perused the Annexure – 1, 2 and 3, from which it is crystal clear that the complainant paid the policy premium time to time to the OPs and in this regard the OPs issued policy certificate to the complainant time to time. It means the complainant has discharged his duty properly but on the other hand, the OPs purposely and negligently avoided their liability and as such the complainant suffered pecuniary loss of Rs. 75,000/-.
That the OPs had enough knowledge about the incident and in fact the OPs had purposely and negligently kept the matter pending, for the reasons best known to them and as such, this fact proves that there is a gross negligence and deficiency in service on their part.
Therefore, it is very much clear that the entire activities of the OPs are willful inaction and latches on their part and both the OPs are solely responsible for unnecessary suffering and harassment of the complainant. Thus, it is clear case of deficiency in service by the OPs.
Point No. 3.
On the basis of discussion as a whole, we are of the view that the complainant is entitled to get reliefs as prayed for.
In the net result, the case succeeds.
Hence, it is
O R D E R E D,
That the case be and the same is allowed on contest against the OPs No. 1 and 2.
The OPs No. 1 and 2 are hereby directed to pay a sum of Rs. 75,000/- either jointly or severally to the complainant along with interest @ 12% p.a. upon Rs. 75,000/- to be calculated from the date of filing of this case i.e. 18.05.16 within 30 days from the date of this order, failing which a further interest @ 10% p.a. shall be imposed on the total amount till full realization.
The OPs No 1 and 2 are further directed to pay Rs. 30,000/- as compensation for causing mental pain and harassment of the complainant and also Rs. 20,000/- as litigation cost either jointly or severally to the complainant within 30 days from the date of his order.
Let a plain copy of this judgment/order be supplied to the parties forthwith free of cost.
