O R D E R
By Sri.C.T.Sabu, President
Complainant’s case is that he is an account holder with 1st opposite party Catholic Syrian Bank. His account No. is 0012-00717579-190001. Through a tie up arrangement with 2nd opposite party New India Assurance Co. a tailor made policy was introduced by the 2nd opposite party with the Catholic Syrian Bank for their account holders. The complainant has thus taken a policy named CSB Health Care Policy from the 2nd opposite party through 1st opposite party bank. Premium was directly remitted by the bank debiting the account of the complainant. The CSB Health Care policy No. was 7603003414. Complainant reiterates that the premium was automatically adjusted and debited from the account of the complainant. On 17/11/2014 complainant had to be admitted in a hospital and undergone an operation. Hospitalization and treatment expenses were about Rs.13,546/- and lodged a medi claim with the TPA of New India Assurance – Medi Asst. India TPA (Pvt.) Ltd. with all documents. On 20/1/2015 2nd opposite party had informed that the medi claim cannot be considered and settled on the reason that there is no valid policy in force during the material time and also returned all the bills and other papers. The policy was not timely renewed by the insurance company limited where the premium for it was not released by the first opposite party from the complainant’s account. On enquiry with 1st and 2nd opposite parties it was reliably learnt that lapses were on the part of 1st opposite party Catholic Syrian Bank for not taking the required steps to release the money for renewal and unless and until the premium is tendered in time no risk can be commenced and no lapses can be imposed on the insurer. There is no case that in the bank account sufficient money was not kept. Therefore it is a clear cut case of sheer negligence and deficiency in service on the part of 1st opposite party bank and it is prayed that the complaint may be allowed directing the 1st opposite party to compensate for all the consequences resulted out of non-renewal of the policy in dispute and also pay Rs.13,546/- being the medi claim amount and Rs.20,000/- for policy break and Rs.5,000/- for mental agony and Rs.2,500/- for misbehavior with the complainant by the Branch Manager.
2. Case was admitted. Notice was ordered. Opposite parties appeared before the Forum and filed versions through counsels. 1st opposite party has taken the following contentions: Allegations by the complainant are not fully correct. Premium for the policy on every year is remitted by way of demand draft directly by the complainant. DD commission is also paid to the Bank by the complainant. All the above transactions are undertaken by this opposite party under the strict instructions of the complainant. On 20/9/2014 the complainant had remitted the amount of Rs.2,100/- but no instructions were given to send the same to the insurance company. No signed papers were also given. If any standing instructions were given by the complainant an acknowledgement would have been given to that effect. If any amount needs to be transferred from the S/B account necessary instruction has to be given by the accountholder on every such transfer. In the instant case no such instructions were given to the bank and this opposite party is unable to transfer any amount without any instruction also. Therefore no deficiency in service can be attributed to this opposite party. Complaint may be dismissed with cost.
3.2nd opposite party insurer contention that there was no any valid insurance policy covering the material risk. Previous policy was not renewed by the insured nor any fresh policy was taken covering the risk. Therefore this 2nd opposite party is an unnecessary party and complaint be dismissed with costs to them.
4.Then the case posted for evidence. The points for consideration are the following:
1)Is there any deficiency in service on the part of opposite parties?
2) If yes, on which opposite party?
3)What are the reliefs and costs?
5. Both parties appeared before the Forum and filed proof affidavits along with documents. Complainant filed 11 documents and marked as Exts.P1 to P11. Ext.P1 – Policy brochure, Ext.P2 – Terms and conditions of the policy, Ext.P3 CSB Health Care support group insurance certificate, Ext.P4 – Member card, Ext.P5 – Lr. dtd. 20/1/15 returning of documents, Ext.P6 – Bank statement, Ext.P7 series – Insurance certificate of 2010, 2011, 2012, 2013, Ext.P8 – Copy of the brochure, Ext.P9- Mail sent to 2nd OP, ’Ext.P10 – DD for premium dt. 13/9/2012, Ext.P11 – DD for 13/9/2013.
6. From the side of 1st opposite party 8 documents are produced and marked as Exts.R1 to R8. Ext.R1 – Appln. For DD dt.24/9/2010, Ext.R2 – Cash chalan dt. 12/9/2011 remitting cash in the A/c, Ext.R3 – Appln. For DD dt. 12/9/2011, Ext.R4 – Appln. For DD dt. 13/9/12, Ext.R5 – Chalan copy dt. 12/9/13 for taking DD, Ext.R6 – Appln. For DD dt. 13/9/2013, Ext.R7 – Voucher dt. 20/9/2014 remitting cash in the SB A/c, Ext.R8 – Account statement of complainant No oral evidence was tendered.
7. Appreciation of Evidence: We have examined proof affidavits, documents, argument notes and points raised during the final hearing and we are convinced that there is deficiency in service on the part of all opposite parties. It is a tailor made policy specially introduced for the Catholic Syrian Bank customers. Ext.R1 to R8 documents are not at all supporting the contentions of the 1st opposite party that it is the entire responsibility of the account holder to ensure that premium is paid in time and its renewals are made in time. Such a contention is valid in the case of general customers. While introducing a tailor-made policy through a tie up arrangement the role of each parties are specifically defined. Both parties have failed to produce the MOU entered in to between opposite parties. For the disposal of this case Ext.P1 is sufficient which is a brochure where details are given describing the role of bank especially. This Forum is equally conscious that any brochure of any policy cannot supersede the terms and conditions of the policy. In the absence of any contra evidence on the part of opposite parties we rely on Ext.P1 condition No.9 provides that “Bank’s role under the scheme would be purely to facilitate the payment of premium by charging the premium due to the customer’s account. (italics emphasized). “The bank does not hold any assurance and does not make any representation on claims processing or any other maters connected with insurance for which the full responsibility will be that of the New India Assurance Co. Ltd.” Condition No.9 clearly defines the role of each opposite parties 1 and 2. In an unambiguous terminology this Forum holds that the bank 1st opposite party failed to discharge their role by charging the premium in time and facilitate the remittance of the same for renewal. Complainant cannot be found fault with. There is no case for the opposite parties that there were no sufficient money in his account and also there is no any case that even after reminding or instructing the complainant he was deliberately or otherwise evading from payment.
8.Further the role of insurer is also defined under the condition No.9 is that other than claims processing” or any other matters connected with insurance for which the full responsibility will be that of the New India Assurance Co. Ltd.
9.Forum finds that there is no evidence to show that 2nd opposite party insurer has sent any renewal notice either to the complainant or to the bank. This is a case where the insurance cover is continuing without any break for the last four years. If any break in period of cover due to non-renewal will be disastrous for the complainant. This Forum cannot overlook those disastrous effect to be suffered by the complainant.
10.Therefore we find that there is deficiency in service on the part of both the 1st and 2nd opposite parties. Complainant is entitled to relief as below:
11.Reliefs and costs : We direct the 1st opposite party to pay Rs.13,546/- (Rupees Thirteen thousand five hundred and forty six only) being the claim amount and direct the 2nd opposite party to renew the policy without any break collecting the premium. 1st opposite party bank may facilitate the payment of premium by charging the premium due to the customer’s account. No compensation is awarded . Rs.3,000/- (Rupees Three thousand only) awarded towards cost. Compliance of this order shall be made within 30 days of the receipt of this order. Complaint allowed accordingly.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Commission this the 30th day of June 2021.
Sd/- Sd/-
Sreeja.S C.T.Sabu
Member President
Appendix
Complainant’s Exhibits
Ext.P1 – Policy brochure, Ext.P2 – Terms and conditions of the policy, Ext.P3 CSB Health Care support group insurance certificate, Ext.P4 – Member card, Ext.P5 – Lr. dtd. 20/1/15 returning of documents, Ext.P6 – Bank statement, Ext.P7 series – Insurance certificate of 2010, 2011, 2012, 2013, Ext.P8 – Copy of the brochure, Ext.P9- Mail sent to 2nd OP, Ext.P10 – DD for premium dt. 13/9/2012, Ext.P11 – DD for 13/9/2013
Opposite Parties Exhibits
Ext.R1 – Appln. For DD dt.24/9/2010, Ext.R2 – Cash chalan dt. 12/9/2011 remitting cash in the A/c, Ext.R3 – Appln. For DD dt. 12/9/2011, Ext.R4 – Appln. For DD dt. 13/9/12, Ext.R5 – Chalan copy dt. 12/9/13 for taking DD, Ext.R6 – Appln. For DD dt. 13/9/2013, Ext.R7 – Voucher dt. 20/9/2014 remitting cash in the SB A/c, Ext.R8 – Account statement of complainant
Id/-
President
