BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, ROHTAK.
Complaint No. 158.
Date of institution:- 22.03.2023
Date of decision:- 08.09.2023
Vijender Singh (aged 42 year) son of Late Sh. Chand Ram, Jagdish Colony Hansi District Hisar, Aadhar No. 832899093493 Mobile No. 9728691784 (Now residing at House No. 934/28 Bharat Colony Rohtak.
.......... …Complainant
Versus
1. The Manager, Care Health Insurance Limited Vipul Tech Square, Tower C, 3rd
Floor, Golf Course Rd, Sector-43, Gurugram, Haryana 122009.
Email:-customerfirst@careinsurance.com
2. The Manager Care Health Insurance Limited, Registered Office: 5th Floor, 19
Chawla House, Nehru Place, New Delhi-110019.
...................Opposite parties
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT
DR. TRIPTI PANNU, MEMBER.
DR. VIJENDER SINGH, MEMBER
Present: Sh. Mannu Malik, Adv. for the Complainant.
Sh. Puneet Chahal, Adv. for the opposite parties
ORDER
TRIPTI PANNU, MEMBER:
1. Brief facts of the case as per the complainant are that he had purchased a care classic plan of care health insurance policy for the families from the opposite parties vide policy No. 61947336 commencing w.e.f. 14.2.2023 to 13.02.2024 and paid a sum of Rs.15,325/- as premium. On 20.02.2023, the complainant has received the aforesaid policy through whatsapp. After reading the terms & conditions of the policy, the complainant contacted the customer care of the opposite parties and made the request for cancellation of policy vide request ID No. 2303013220 dated 01.03.2023. The complainant has also sent the mail to the opposite parties for cancellation of policy. On 13.03.2023 the opposite parties cancelled the policy of the complainant and refunded the amount of Rs. 11494/- only after deduction 25% of the policy’s premium amount of Rs.15325/-, whereas, the complainant has made the request with the opposite parties within 15 days for cancellation of said policy. The complainant has received the aforesaid policy through whatsapp on 20.02.2023, and the policy has been cancelled vide request ID No. 2303013220 dated 01.03.2023, so as per terms and conditions of the policy, the opposite parties are liable to refund the whole amount of Rs.15325/- to the complainant, but the opposite parties refunded the amount of Rs.11494/- after deduction of 25% from the premium amount. The complainant has not yet been received the policy bond via registered post from the opposite parties. The opposite parties have violated the terms and condition of the insurance policies as the policy bond has not been issued by opposite parties to the complainant through the registered posts. Therefore, there is deficiency in service on the part of the opposite parties. Hence, this complaint and it is prayed that the complaint may be accepted and opposite parties be directed to refund the amount of Rs.3831/- along with interest @ 24 percent and compensation of Rs. 20000/- for mental and physical harassment as well as Rs. 10000/- as litigation charges to the complainant.
2. Pursuant to notice issued by this Commission, the opposite parties put in appearance and filed written statement by taking preliminary objections that the complaint is not maintainable in the present Commission and the complaint is false, malicious and incorrect and has been filed just to avail undue advantage. On merits, it is contended that the health insurance policy namely “CARE Classic” bearing policy No. 61947336 from 14.02.2023 till 13.02.2024 has been issued to the complainant covering only the complainant and his son, spouse and daughter for a sum insured upto Rs. 5,00,000/- subject to policy terms and conditions. On 01.03.2023 the said policy has been cancelled on the request of the insured . It is further contended that the policy run up to a one month, the company refunded the amount after deduction of 25% of the policy’s premium amount as per terms and conditions of the policy. The terms and conditions of the policy were explained to the complainant at the time of proposing policy and the same was served to the complainant along with the policy schedule. Hence, there is no deficiency in service on the part of the answering opposite parties and dismissal of complaint with cost has been sought.
3. In evidence, the complainant has tendered his own affidavit Ex. CW1/A and documents Ex. C1 and Ex.C2 and closed the evidence on 03.07.2023. On the other hand, the opposite parties has tendered the affidavit Ex. RW1/A and documents Ex. R1 to Ex. R3 and closed the evidence on dated 09.08.2023.
4. We have heard ld. counsel for the parties and also perused the material placed on file very carefully. During the course of arguments, learned counsel for the complainant has pleaded that the opposite parties have not yet been issued the original policy bond along with terms and conditions to the complainant, rather only the policy was sent by the opposite parties on the Whatsapp of the complainant’s contact number on 20.02.2023. The complainant cancel the insurance policy on 01.03.2023 in free look period. Hence, the opposite parties are liable to refund the whole amount of Rs. 15325/- to the complainant. On the other hand, learned counsel for the opposite parties has argued that after deduction of 25% of the premium amount, an amount of Rs. 11494/- has been deposited in the account of the complainant. It is further contended that as per clause 7.8 of the policy under the head ‘Free Look Period” it is clearly mentioned that : “The policy holder may, within 15 days from the receipt of the policy document, return the policy stating reasons for his objection, if the policy holders disagrees with any policy terms and conditions.” It is further contended that the terms and conditions of the policy were explained to the complainant at the time of proposing policy and the same was served to the complainant along with the policy schedule.
5. After hearing both the parties, it is observed that the terms and conditions of the policy were not received by the complainant at the time of issuance of policy and it is clear from the Ex. C2, that the policy was issued by the opposite parties only on the Whatsapp of the complainant’s contact number on 20.02.2023. The opposite parties have not produced any cogent evidence such as postal receipt and courier receipt etc. from which it can be stated that the policy along with terms and conditions was sent to the complainant. It has also been admitted by the opposite parties in their reply that on 01.03.2023 the policy was cancelled after considering the request of the complainant. We have observed the Clause 7.8 of Ex. R2 (terms and conditions of the policy) produced by the opposite parties in which it has been mentioned about the “FREE LOOK PERIOD”, : “The policy holder may, within 15 days from the receipt of the policy document, return the policy stating reasons for his objection, if the policy holders disagrees with any policy terms and conditions”. We think that the free look period of 15 days starts after receiving the original policy bond along with terms and conditions from the opposite parties to the complainant. But in this case, policy was not sent to the complainant by the opposite party through registered post. When the policy was not received by the complainant then the terms and conditions of the same could not have been applied and the plea taken by the opposite parties regarding deduction of 25% amount is illegal. Hence there is deficiency in service on the part of the opposite parties and the opposite parties are liable to refund the entire amount of Rs.15325/- to the complainant, but the opposite parties have only refunded the amount of Rs.11494/- to the complainant after deduction 25% of the premium amount. Hence opposite parties are liable to refund the remaining amount of Rs.3831/- to the complainant.
6. In view of the above facts and circumstances of the case, we hereby allow the complaint and direct the opposite parties to pay the amount of Rs.3831/-(Rupees three thousand eight hundred and thirty one only) along with interest @ 9% p.a. from the date of deposit i.e. 14.2.2023 till its realization and shall also pay Rs. 5000/- (Rupees five thousand only) as compensation on account of deficiency in service and Rs. 5000/- (Rupees five thousand only) as litigation expenses to the complainant within one month from the date of decision, failing which the opposite parties shall pay the interest @ 12% on the aforesaid amount of Rs.3831/-(Rupees three thousand eight hundred and thirty one only) to the complainant from the date of filing of complaint i.e. 22.03.2023 till its realization to the complainant.
7. Copies of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open Court:
08.09.2023
.......................................................... Nagender Singh Kadian, President
……..…………………………..
Tripti Pannu, Member.
………………………………..
Vijender Singh, Member.
