State Consumer Disputes Redressal Commission
Roop Kishore vs Reliance General Insurance Company ... on 12 October, 2017
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH
First Appeal No. 875 of 2016
Date of Institution : 18.11.2016
Date of Reserve : 04.10.2017
Date of Decision : 12.10.2017
Roop Kishore Fatepuria, House No. 375-CX, Model Town
Extension, Ludhiana.
....Appellant/Complainant
Versus
1. Reliance General Insurance Company, Regional Office,
Reliance Centre, 19, Walchand Hiralal Marg, Ballard Estate,
Mumbai 400 001
2. Reliance General Insurance Company, Policy Serving
Branch Office, 7th Floor Surya Tower, 108, The Mall, Ludhiana
through its Manager.
3. Insurance Regulatory & Development Authority of India
(IRDA), Gate No. 3, Jeevan Tara Building, Ist Floor, Sansad Marg,
New Delhi 110 001 through its Chairman.
....Respondents/Ops
First Appeal against the order dated
27.09.2016 of the District Consumer
Disputes Redressal Forum, Ludhiana.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member.
Shri Rajinder Kumar Goyal, Member
Present:-
For the appellant : Sh. I.S. Ratta, Advocate
For respondent Nos.1&2: Sh. Sandeep Suri, Advocate
For respondent No.3: Ex.-parte.
First Appeal No. 875 of 2016 2
GURCHARAN SINGH SARAN, PRESIDING JUDICIAL MEMBER
ORDER
The appellant/complainant (hereinafter referred as the complainant) has filed the present appeal against the order dated 27.09.2016 passed in consumer complaint No. 46 dated 19.01.2015 by the District Consumer Disputes Redressal Forum, Ludhiana (hereinafter referred as the District Forum) vide which the complaint filed by the complainant was allowed to the extent that the letter dated 15.8.2014 Ex. C-1 issued by Op was quashed and that the complainant will be entitled to the benefits of individual medi claim policy Ex. C-8 for the period 29.11.2013 to 28.11.2014 midnight. However, it was held that the complainant was entitled to continuation of the policy on the same terms. It was further directed that Op Nos. 1 & 2 will pay Rs. 5,000/- as compensation and Rs. 5,000/- as litigation expenses to the complainant. It was further ordered that the amount will be paid within 40 days of the date of receipt of the copy of the order. Whereas complaint against Op No. 3 was dismissed vide order dated 16.9.2015.
2. Complaint was filed by the complainant under the Consumer Protection Act, 1986 (in short 'the Act') against the respondents/opposite parties (hereinafter referred as Ops) on the averments that relying upon the representation of Op Nos. 1 & 2, the complainant obtained Reliance Individual Medi Claim Policy for himself and his wife in the year 2001 and since then he is First Appeal No. 875 of 2016 3 continuing with the policy year after year. Lastly, the policy was issued for the period 29.11.2013 to 28.11.2014 vide policy bearing No. 2001732811000664 with sum assured of Rs. 1,50,000/-. After paying the premium of Rs. 2191/- and sum assured of Rs. 1,12,500/- in the name of his wife at the premium of Rs. 1638/- and gross premium of Rs. 3829/-. The complainant received a letter dated 15.8.2014 from Op Nos. 1 & 2 vide which it was informed to the complainant that the policy Reliance Individual Medi Claim Policy has since been withdrawn w.e.f. 9.6.2014 and will not be available for renewal. The complainant visited their Ludhiana office and requested the official of Ops to withdraw this letter dated 15.8.2014 but they kept on delaying the matter on one pretext or the other by making whimsical and illogical excuses that approval has been granted by IRDA and their officials induced the complainant to have any new policy, as under:-
i) Reliance Health Wise Policy in which amount insured is Rs. 2,00,000/- & premium is Rs. 16837/-.
ii) Reliance Health Gain Policy in which amount insured is Rs. 3,00,000/- & premium is Rs. 38764/-.
Whereas the complainant and his wife were availing the policy for the last 13 years having its premium of Rs. 3829/- only. Arbitrarily withdrawn of the policy by Op Nos. 1 & 2 amounted to deficiency in service and unfair trade practice on its part because it was done without notice to the complainant. Alleging unfair trade practice and deficiency in service on the part of the Op, complaint was filed by the complainant before the District Forum seeking directions First Appeal No. 875 of 2016 4 against the Ops to withdraw the letter dated 15.8.2014 and continue next policy of 2014-15 on existing terms and conditions by accepting the premium as per the terms of the previous policy, pay Rs. 2,50,000/- as compensation and Rs. 21,000/- as litigation expenses.
3. Complaint was dismissed against Op No. 3 vide order dated 16.9.2015 whereas Op Nos. 1 & 2 in their written reply took the preliminary objections that the complaint is not maintainable for want of cause of action; the Ops are providing different kinds of IRDA approved policies with latest features to individuals and groups, as per their requirement to cover their risk; IRDA is the controlling body of all its general insurance companies. Insurance Company can provide any of its product with the approval of IRDA. Op can withdraw any of its old product and launch a new product with the permission of IRDA; the complainant had individual mediclaim policy No. 2001732811000664 from the Ops but the said product had some shortcomings, therefore, it was discontinued/withdrawn from the approval of IRDA and started new products in its place. Accordingly, intimation was given to the complainant vide letter dated 15.8.2014. The complainant also suggested the complainant to migrate into other health insurance products in order to maintain continuity in risk coverage; there is no deficiency in service on the part of Ops. On merits, the averments stated in the preliminary objections were reiterated. Policy was issued but that policy stand withdrawn/discontinued with the approval of IRDA and in its place new policies were First Appeal No. 875 of 2016 5 introduced. Intimation was given to the complainant and he was advised to go for their new product. There was no deficiency in service on the part of the Op. Complaint is without merit, it be dismissed.
4. Before the District Forum, the parties were allowed to lead their respective evidence.
5. In support of his allegations, the complainant had tendered into evidence the complainant has tendered his affidavit Ex. CA and documents Exs. C-1 to C-8. On the other hand, Ops had tendered into evidence affidavit of Amit Chawla, Manager as Ex. RA and documents Exs. R-1 to R-8.
6. After going through the allegations in the complaint, written version filed by Ops, evidence and documents brought on the record, the complaint was allowed as referred above.
7. Aggrieved with the order passed by the learned District Forum, the appellant/complainant has filed the present appeal.
8. We have heard the learned counsel for the appellant and learned counsel for respondents No. 1 & 2 and have carefully gone through the record of the case.
9. It was argued by the counsel for the appellant/complainant that the District Forum vide its order has allowed the full term of the policy for the period 29.11.2013 to 28.11.2014 but had failed to pass any order with regard to continue/issue next policy for the year 2014-2015 on the existing terms and conditions after accepting the premium of the policy. Then legal notice was issued by the complainant on 21.11.2014 First Appeal No. 875 of 2016 6 (Ex. C-2). Alongwith that a cheque of Rs. 3873/- was issued in favour of the Op. However, Op vide their reply Ex. C-7 stated that this product was not in consonance with IRDA (Health Insurance) Regulations, 2013 and they had sought IRDA approval for withdrawl of this product for which approval was accorded by the IRDA. No loss of continuity as they had offered the complainant with the option of migrating to any of their existing products within the grace period and that they are not in a position to offer it due to withdrawl of individual mediclaim policy.
10. The version of the appellant/complainant is that even if they have withdrawn the product, it cannot be issued to the new customers but it could be issued to the old customers. In this regard, he has referred to Regulation 5 of IRDA Health Insurance Regulations, 2013 wherein it has been provided that insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage to the insured. To support it, he has relied upon the judgment of the Hon'ble Gujarat High Court (2004) ACJ 1657 "Mohanlal Aggarwal versus New India Assurance Co. Ltd." wherein it was observed by the Hon'ble High Court that renewal of a medical claim insurance policy cannot be refused despite timely payment of the renewal premium on the ground that continuance of the cover would become more onerous or burdensome for the insurer due to the insured contracting a covered disease during the period of the existing policy. In that case, the Ops before renewal of the next policy issued a letter to the insurer to the effect that policy could be renewed only subject First Appeal No. 875 of 2016 7 to the exclusion of 5 diseases, which was not acceptable to the complainant and accordingly this litigation and the order so passed by the Hon'ble High Court as referred above.
11. However, the counsel for the respondents/Ops argued that this judgment of the Hon'ble Gujarat High Court is not applicable to the facts of the present case. In that case, the Company had done changes in the terms and conditions before further renewal of the policy in favour of the complainant, which he was getting since 1990 and changes were proposed in 2002. In case it would have been so, then the directions could be passed not to go for such changes, in case the person is continuing with the policy for such a long period. However, here the said policy stand withdrawn/discontinued with the approval of IRDA and it is clear from the notice dated 15.8.2014 (Ex. C-1) vide which it was intimated that as per IRDA approval, individual mediclaim policy will be withdrawn effective from 9.6.2014 and will not be available. This preposition has not been disputed by the complainant. In case the policy stand withdrawn then how such a policy could be given to any of its customer and there is a letter of IRDA dated 28.2.2014 addressed to the Op in reference to their letter that "keeping in view Regulation 5(b) which states Insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage of insured, the company would be expected to guide the policyholders about suitable alternatives and accordingly, the Ops had offered their two other products, which the complainant could opt not to loose the continuity of its previous First Appeal No. 875 of 2016 8 policies. Counsel for the complainant has not referred any regulation from IRDA (Health Insurance) Regulations, 2013 that in case any policy has been withdrawn, it could not be issued to the new customers but it could be issued to the old customers, therefore, the contention raised by the counsel for the complainant is not acceptable. He has also referred to the judgment of the Hon'ble National Commission passed in Revision Petition No. 3050 of 2007 "Life of India & Ors. Versus Smt. Shakuntala Devi & Anr.", pronounced on 15.11.2011 wherein it was observed by the Hon'ble National Commission that 'we agree with the counsel for petitioner that it is well established through various court rulings including of this Commission in R.P. No. 50-51 of 2011 (decided on 4.4.2011), that the revival of a policy amounts to a new contract and therefore, a fresh declaration is taken at the time of revival of the policy and, therefore, no benefit can accrue to Respondent in this case by taking the shelter of Section 45 of the Insurance Act, 1938.' Accordingly, it was argued by the counsel for the Op that the order has been rightly passed by the District Forum. Appeal is without merit, it be dismissed.
12. We have considered the contentions as it is raised by the counsel for the parties.
13. There is no dispute that the complainant and his wife get individual policies from the Ops since 2001 and lastly it was issued for the year 2013-2014 and in between notice dated 15.8.2014 was issued for discontinuation of the policy. In fact it was a notice that individual mediclaim cannot be extended further. First Appeal No. 875 of 2016 9 Then District Forum in its order has allowed the full term of the policy. The dispute is with regard to its further renewal. Once the individual mediclaim policy stand withdrawn vide letter dated 9.6.2014 from the IRDA then whether the said policy can be renewed in favour of the complainant. The complainant has relied upon Regulation 5(b) of the IRDA referred above. We agree with the preposition raised by the counsel for the Ops that insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage to the insurer. It is fully applicable in case the product being taken by the complainant is available with the Ops. However, a reference can be made to the letter dated 28.2.2014 issued by the IRDA in the name of the Op wherein it has been referred as under:-
"1. Keeping in view Regulation 5(b) which states Insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage of insured, the company would be expected to guide the policyholders about suitable alternatives."
14. The counsel for the complainant has referred only Clause 5(b) of the IRDA (Health Insurance) Regulations, 2013 but itself left to another line incorporated in the letter dated 28.2.2014 that the Company would be expected to guide the policyholders about suitable alternatives. In this regard, again a reference can be made to Ex. C-1 wherein they have referred to other two policies available with the Ops, therefore, they had given the other alternatives to the complainant. The counsel for the complainant First Appeal No. 875 of 2016 10 was unable to refer any provisions under IRDA (Health Insurance) Regulations, 2013 that once the policy has been withdrawn by the Ops with the approval of the IRDA, whether it can be issued to its old customers. So far as the judgment of "Mohanlal Aggarwal versus New India Assurance Co. Ltd."(supra), in that case, the insured was getting the policy since 1990 and in 2002, they included 5 big diseases under the exclusion clauses. In that context, renewal of the policy was ordered by the Hon'ble High Court. But in that case the product was there and not withdrawn from the market, therefore, the facts in the judgment delivered by the Hon'ble Gujarat High Court are different from the facts of this case. With regard to the judgment of the Hon'ble National Commission passed in Revision Petition No. 3050 of 2007 "Life of India & Ors. Versus Smt. Shakuntala Devi & Anr.", pronounced on 15.11.2011. The judgment relied upon by the counsel for the Ops is also not applicable because it relates to revival of the policy and not renewal of the policy.
15. In nutshell, we are of the opinion that counsel for the complainant was unable to prove how the complainant is entitled for renewal of the policy on the same terms and conditions and on the same premium once that policy is no more in the market and has been withdrawn from the market with the approval of the IRDA, therefore, no order can be passed for renewal of its policy for year 2014-2015 onwards.
16. Sequel to the above, we do not see any merit in the appeal and the same is dismissed with no order as to costs. First Appeal No. 875 of 2016 11
17. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
18. Order be communicated to the parties as per rules.
(GURCHARAN SINGH SARAN) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER October 12, 2017.
as