DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KOZHIKODE

PRESENT: Sri. P.C. PAULACHEN, M.Com, LLB    : PRESIDENT

Smt. PRIYA.S, BAL, LLB, MBA (HRM) :  MEMBER

Friday the 28^th day of June 2024

CC.452/2016

Complainant

                        Madhu,

S/o. Kunhiraman Vaidyar,

‘Ramalakshmi’ House,

Vykkilasseri. P.O,

Vatakara Taluk,

Kozhikode – 673104

(By Adv. Sri. Sugesh Thikkal)

Opposite Parties

1.             The Manager,

Syndicate Bank,

Orkkatteri Branch,

Orkkatteri. P.O,Vatakara Taluk,

Kozhikode - 673501

2.               The Manager,

Vidal Health TPA Pvt. Ltd,

No. 39-4130, 1^st Floor,

Mareena Building,

M.G. Road, Ravipuram,

Ernakulam, Cochin – 682016

(OP1 By Adv. Sri. Saleem, OP2 By Adv. Sri. T.V. Hari)

ORDER

By Sri. P.C. PAULACHEN  – PRESIDENT              

            This is a complaint filed under Section 12 of the Consumer Protection Act, 1986.

2. The case of the complainant, in brief, is as follows:

The complainant is the holder of SB account No. 44072200056755 in the Syndicate bank, Orakkatteri Branch. The complainant insured himself and his family under Group Medical Insurance cum Personal Accident for Syndicate Bank account holders as per Syndarogya Policy scheme. The policy was valid from 23/01/2015 to 22/01/2016. The sum insured for the above family health Insurance was Rs. 2,00,000/-. The complainant paid the premium amount through his account maintained with the first opposite party in accordance with the terms agreed between the first opposite party and the complainant. While the policy was valid and existing, the complainant’s son Mayookh. K.P met with an accident while playing and sustained injury on his right knee and he was taken to Co-operative Hospital, Vatakara and from there referred to Baby Memorial Hospital, Kozhikode and was treated by Ortho specialist and diagnosed ACL complete tear plus posterior hornlateral tear (right) knee and the doctor advised surgery. The complainant was informed from the hospital that the surgery could be done as cashless benefit under Syntarogya Insurance Scheme.

3.  Accordingly, the surgery was fixed on 16/06/2016 and the approximate expense was Rs. 1,40,000/-. The complainant submitted all the relevant documents including Vidal Health Card of Mayookh before the hospital authorities on 10/06/2016 in order to get free medical aid under the policy. But on 13/06/2016, the hospital authorities informed the complainant that Vidal Health Insurance was not approved and hence no benefit of insurance coverage would be there for the treatment. On enquiry, the complainant came to know that the insurance was not renewed in time. The complainant had to borrow money to pay the medical and treatment expenses.
4. There was sufficient funds in his account to pay the insurance premium within time to renew the policy. There was neglect on the part of the first opposite party to pay the premium in time. The opposite parties 1 and 2 are liable to compensate the cost incurred by the complainant in connection with the treatment of his son Mayookh. Hence the complaint to direct the opposite parties to pay a sum of Rs. 1,34,524/- with interest along with compensation of Rs. 3,15,000/- .
5. The second opposite party was set ex-parte. The first opposite party has filed written version.
6. The contentions in the version of the first opposite party, in brief, are as follows; It is admitted that the complainant is a SB account holder of the bank and had joined in a group insurance scheme ‘Syntarogya’, a tie up with United India Insurance Company for the period commencing from 23/01/2015 to 22/01/2016 by making payment of premium amount through demand draft in the name of United India Insurance Company and for which the second opposite party being the third party administrator of the above company issued Vidal Health Card to the complainant’s family members. The rest of the allegations, averments and claims are denied and disputed.     
7. The policy expired on the midnight of 22/01/2016. The policy is issued on yearly basis on expiry of the period. The policy has to be renewed if the party who joins the policy is interested to do so. As such the policy  being issued with the request of the party who approaches the bank, by issuing demand draft. At the time of the injury and treatment the policy period of the medi claim was not in force. On 29/01/2016 the complainant approached the bank and requested to issue demand draft in favour of United India Insurance Company for medi claim policy for a further period of one year and the premium amount through demand draft was forwarded to the company through regional office.
8. The complaint is bad for non-joinder of necessary parties as the United India Insurance Company is not made a party to the proceedings. There was no deficiency of service on the part of the opposite party. The compensation, if any, is liable to be satisfied by the insurance company in terms of the policy coverage.
   With the above contentions, the first opposite party prays for dismissal of the complaint.
9. The complainant filed replication and also amended the complaint. In the replication and in the amended complaint it is stated that the complainant had enquired the real facts after receiving the version and found that the first opposite party had not paid the insurance premium to renew the policy in time. There was sufficient fund in the account of the complainant. The first opposite party is liable to pay the premium from the SB account maintained by the complainant. After knowing the negligence, the first opposite party sent a DD dated 14/06/2016 in favour of the complainant as renewal premium to the insurance company. But the DD was returned with the memo stating that the ‘instrument out dated stale, (bank system not accepting the DD). Renewal premium to be remitted is Rs. 3,570/- and not Rs. 3,584/-’. The first opposite party carelessly issued a demand draft to the insurance company even without verifying the actual amount of premium to be paid and only a lesser amount was sent and that was the reason for the non-renewal of the policy. The complainant could understand the default made by the first opposite party only when the dishonour memo was received after the filing of the present complaint. The complainant issued a lawyer notice to the first opposite party, but it evoked no response.
10. As per the terms agreed between the complainant and the first opposite party, the liability to pay the renewal premium is up on the first opposite party when sufficient fund is provided by the complainant in his account. There was sufficient fund in the account at the relevant time. The complainant could not avail the benefits only due to the negligent and irresponsible act of the first opposite party. According to the complainant, the first opposite party is to be directed to pay him Rs. 1,34,524/- and compensation of Rs. 3,50,000/-.
11. The first opposite party filed additional version wherein all the allegations in the amended complaint and in the replication are denied. On expiry of the policy, the insurance company issues letter to the customers informing about the renewal of the policy. The parties renew policy by collecting demand draft personally by approaching the bank. As requested by the complainant, the bank issued a demand draft for Rs. 3,544/- payable to the insurance company on 29/01/2016 and was forwarded by the bank to the insurance company. The insurance company returned the demand draft to the complainant since it did not tally with the required premium. This fact was known to the complainant before the filing of the complaint and it was suppressed. The complainant could have renewed the policy by curing the defects at the earliest. The breach was on the part of the complainant himself. There is no agreement as alleged in the complaint. The bank officials act as per the guide lines and procedure followed by the bank. For each service there should be written request from the party and their presence is also required. The procedure, practice and custom of the bank do not permit the bank officials to act as their own without proper instruction and request from the party. The complaint is devoid of merits and liable to dismiss.
12. The points that arise for determination in this complaint are;

1. Whether there was any deficiency of service on the part of the opposite parties, as alleged?
2. Reliefs and costs.

13.  The evidence consists of the oral evidence of PWs 1 and 2 and Ext A1 to A9 on the side of the complainant. No evidence was let in by the opposite parties. 
14. Heard. Brief argument note was filed by the complainant. 
15. Point No.1:-   The complainant has approached this Commission alleging   deficiency of service on the part of the first opposite party bank in remitting the premium timely for renewing the Syndarogya Policy of the complainant. The prayer in the complaint is to direct the first opposite party to pay a sum of Rs. 1,34,524/- to him with interest being the amount spent by him for the treatment of his son Mayookh in connection with the injury sustained by him while playing and to pay compensation of Rs. 3,50,000/- .
16. In order to substantiate his case, the complainant got himself examined as PW1, who has filed proof affidavit and deposed in terms of the averments in the complaint and in support of the claim. The Divisional Manger of   the United India Insurance Company was examined as PW2 on the side of the complainant. Ext A1 is the copy of the Vidal Health Card issued to Mayookh. K.P, Ext A2 is the copy of the discharge summary dated 16/06/2016, Ext A3 is the copy of the IP receipt voucher dated 16/06/2016, Ext A4 is the final IP bill details dated 16/06/2016, Ext A5 is the copy of the bank passbook, Ext A6 is the copy of cheque dishonoured statement, Ext A7 is the copy of the lawyer notice dated 11/07/2016, Ext A8 is the postal receipt and Ext A9 is the postal acknowledgment card. 
17. It is not disputed that the complainant is a SB account holder in Syndicate bank Ourakkatteri Branch. He had joined a group insurance scheme Syndarogya. It is the group insurance scheme meant for the account holders of Syndicate Bank. The said group insurance covered the complainant, his wife and 2 children. The period of the policy was from 23/01/2015 to 22/01/2016. The complainant’s son Mayookh. K.P met with an accident while playing and sustained injuries and was under treatment in the hospital for the period from 13/06/2016 to 16/06/2016. The benefits of Syndarogya group insurance scheme could not be availed for the treatment of Mayookh as the policy was not renewed in time after 22/01/2016. There is no serious dispute on the above aspects.
18. The case of the complainant is that the liability to pay the renewal premium of syndarogya Health Insurance Policy is upon the bank when sufficient fund is maintained by the complainant in his account. On the other hand, the case advanced by the opposite party is that the policy has to be renewed only if the party who joined the same is interested to do so and approaches the bank for that purpose with request to issue Demand Draft in favour of the insurance company. According to the first opposite party, without proper instruction and request from the party, they cannot act and withdraw amount from the account to pay the insurance premium.
19. PW1 has categorically asserted before this Commission that as per the terms agreed between himself and the bank, the liability to pay the renewal premium of the policy is on the bank as long as sufficient fund is available in his account. PW1 has asserted that there was sufficient fund available in his SB account as on the relevant date as can be seen from Ext A5 pass book. PW1 has categorically affirmed before this Commission that he joined the insurance scheme as per the offer of the bank and the bank had agreed to send the premium amount yearly from his SB account and he had executed and signed necessary documents in favour of the bank for this purpose. There is absolutely no reason to disbelieve PW1. Even though PW1 was subjected to searching cross examination, nothing has been brought out to discredit his version that the bank had agreed to pay the insurance renewal premium yearly from his SB account, for which, he had executed and signed necessary documents. 
20. In this context, it is worthwhile to have a glance at the evidence tendered by PW2, the Divisional Manager of United India Insurance Company. PW2 has deposed before this Commission that the premium is paid to the insurance company by the bank by way of demand draft and the policy is issued to the bank. The evidence of PW2 remains uncontroverted. PW2 was not even cross examined by the first opposite party.
21. It is pertinent to note that the first opposite party has not adduced any evidence in support of their contention and the relevant documents were not produced. It is a group insurance policy and the master policy and the relevant documents are not produced by the bank for perusal of this Commission. Nothing is produced by the opposite party to show that the first premium was sent by them to the insurance company on written request by the complainant. No contra evidence is let in by the first opposite party against the evidence tendered by PW1 that he had executed and signed necessary documents enabling the bank authorities to pay the yearly renewal premium from his account in order to renew the policy.
22. It is seen that on 14/06/2016 the second opposite party had sent a DD for Rs. 3,554/- to the insurance company towards renewal of the policy. But the DD was returned by the insurance company with a memo stating that the instruments is out dated stale (Bank system not accepting the DD). It is also stated in Ext A6 cheque dishonoured statement that the renewal premium to be remitted is Rs. 3,570/- and not Rs. 3,554/-. According to the first opposite party, the said DD was issued and sent to the insurance company as per the request of the complainant. This is denied by the complainant. If there was any request for a DD from the part of the complainant, nothing prevented the first opposite party from producing such DD request before this Commission to substantiate their contention that they would act only on the request/instruction of the complainant and that there was no standing instruction or agreement in this regard. It is also pertinent to note that the DD is not for the full renewal premium of Rs. 3,570/-. There was shortage of Rs. 16/- as the DD was for Rs. 3,554/-. So it is crystal clear that the bank authorities were not aware of the yearly premium of the group insurance policy made available to the SB account holders. Further it may be noted that the delay in sending the DD is not explained by the first opposite party. There is endorsement in Ext A6 that the DD is dated on 17/02/2016 and revalidated on 14/06/2016 and it was send to the insurance company only on 5/07/2016 as can be seen from Ext A6. In this context, PW2 has given evidence that the insurance company on sending the DD for collection was dishonoured. This also proclaims the negligence, latches and deficiency of service on the part of the first opposite party.
23. Another contention of the first opposite party is that the United India Insurance Company which issued the policy is a necessary party to the proceedings. In this connection, it may be noted that the complainant has no grievance against the said insurance company. At the relevant time, the policy was not alive as it was not renewed. The complainant is not seeking any relief against the insurance company. Moreover, the Divisional Manager of the insurance company was examined as PW2 before this Commission. In these circumstances, the United India Insurance Company is not a necessary party to the proceedings.
24. From the above discussion, what emerges is that there was gross negligence and deficiency of service on the part of the first opposite party to pay the renewal premium in time, as a result of which, the complainant could not avail the benefits under group insurance scheme Syndarogya which was taken through the first opposite party.
25. The complainant had to spent a total amount of Rs. 1,34,524/- for the treatment of his son as evidenced by Ext A4. The complainant is entitled to realise the said amount from the first opposite party. Undoubtedly, the complainant was put to gross mental agony and inconvenience due to the latches on the part of the first opposite party, for which, he is entitled to be compensated adequately. Considering the entire facts and circumstances, we are of the view that a sum of Rs. 10,000/- will be reasonable compensation in this regard. The complainant is also entitled to get Rs. 5,000/- as cost of the proceedings from the first opposite party.
26. Point No. 2:- In the light of the finding on the above point, the complaint is disposed of as follows;

a)  CC.452/2016 is allowed in part.

b)  The first opposite party is hereby directed to pay the complainant a sum of Rs. 1,34,524/- (Rupees one lakh thirty four thousand five hundred and twenty four only) with interest @ 9% per annum from the date of the complaint i.e. 18/10/2016 till actual payment. 

c) The first opposite party is directed to pay a sum of Rs. 10,000/- (Rupees ten thousand only) to the complainant for the mental agony and inconvenience suffered. 

d) The first opposite party is directed to pay a sum of Rs. 5,000/- (Rupees five thousand only) as cost of the proceedings to the complainant.

e)  The order shall be complied with within 30 days of receipt of copy of this order.

Pronounced in open Commission on this, the  28^th day of June,  2024.

Date of Filing:    18/10/2016 

    Sd/-                                                                                           Sd/-

                 PRESIDENT                                                                                   MEMBER                                      

                                                                APPENDIX

Exhibits for the Complainant :

Ext.A1 – Copy of the Vidal Health Card issued to Mayookh. K.P.

Ext.A2 – Copy of the discharge summary dated 16/06/2016.

Ext.A3 – Copy of the IP receipt voucher dated 16/06/2016.

Ext.A4 – Final IP bill details dated 16/06/2016. 

Ext.A5 – Copy of the bank passbook.

Ext.A6 – Copy of cheque dishonoured statement.

Ext.A7 – Copy of the lawyer notice dated 11/07/2016.

Ext.A8 – Postal receipt.

Ext.A9 – Postal acknowledgment card. 

Exhibits for the Opposite Party

Nil.

Witnesses for the Complainant

PW1 -  Madhu (Complainant)

PW2 – Rajesh Kumar.

                        Sd/-                                                                                                   Sd/-

                 PRESIDENT                                                                                   MEMBER                                      

                                 True Copy,      

                                                                                                                                                Sd/-

                                                                                                                                       Assistant Registrar.