National Consumer Disputes Redressal
G. R. Yoganarasimha vs M/S Reliance General Insurance Co. Ltd. ... on 15 January, 2014
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1018 OF 2012 (Against order dated 16.11.2011 in First Appeal No. 3347/2011 of the State Consumer Disputes Redressal Commission, Karnataka, Bangalore) G.R. Yoganarasimha R/o Flat No. 103/1, Mahabala, 15th Cross, Gayathridevi Park Extension, Vyalikaval, Bangalore- 560 003 Petitioner Versus 1. M/s Reliance General Insurance Co. Ltd. R/o 19, Walchand Hirachand Marg Ballard East, Mumbai- 400 001 Rep. By its Manager Also at: M/s Relaince General Insurance Co. No. 28, East Wing, 5th Floor, Centenary Building, M.G. Road, Bangalore 560 001 2. M/s Alankit Health Care Ltd. No. 42, 46/E, 2nd Floor, Lalbagh Road, Bangalore- 560 027 Rep. by its Branch Manager 3. M/s Federal Mogul Goetze India Ltd. Near Sheshadripuram College, Doddaballapur Road, Yelhanka, Bangalore- 560 004 Respondents BEFORE: HONBLE MR. JUSTICE J.M.MALIK, PRESIDING MEMBER HONBLE DR. S.M. KANTIKAR, MEMBER For the Petitioner : Ms. Jaikriti S. Jadeja, Advocate For the Respondent No.1: Mr. Navneet Kumar, Advocate For the Respondent No.2 : NEMO For the Respondent No.3 : Mr. Nishant Kishore, Advocate PRONOUNCED ON 15th JANUARY, 2014 ORDER
PER DR. S.M. KANTIKAR, MEMBER
1. The Complainant G.R. Yoganarasimha was working as a Deputy General Manager with the M/s Federal Mogul Goetze India Ltd., the OP-3.He retired on 05.01.2003. He had availed Companys Group Health Insurance and the premium was paid by the OP-3. The insurance policy was floated by M/s Reliance General Insurance Co. Ltd. (the OP-1); M/s Alankit Health Care Ltd (OP-2) was the authority who settles the medical claim. The OP-3 entered into an agreement with OP 1 & 2 with regard to the insurance policies. After retirement, since 2003, the complainant continued to pay premium through OP-3 and to be a member of said group insurance scheme, and policy was renewed from time to time. The insurance has been renewed up to 30.06.2010. Based on this Insurance coverage, prior to November, 2009, all medical claims made by the Complainant were settled on a regular basis however, claim in respect of the medical bills raised by Manipal Hospital for Rs.43,402/- and Rs.1,72,810/- towards dialysis and Rs.2,50,669/- towards renal transplantation were denied by the OPs.
2. Alleging deficiency in service, the Complainant filed complaint No.718/2010 before the District Consumer Disputes Redressal Forum (in short, District Forum). The District Forum disposed of this complaint on 8/3/2011 and partly allowed the complaint as;
that the insured, as applicable to the Complainant, is Rs.12.5 lakhs relating to major ailments, for the period from 29.06.2009 to 30.06.2010. It is held that Rs.43,402/- is not proper. The Opposite Parties 1 and 2 are directed to pay Rs.43,402/- (Rupees Forty-three thousand four hundred and two only) to the Complainant with interest at 12% p.a. from 09.01.2010, until actual payment. The Complainant shall be entitled to make fresh claim and request to renew the insurance policy, as discussed above.
3. As per the order of DF, complainant submitted a claim along with a demand draft for Rs.14,000/- to the OP-3 and asked for forwarding the same to OP-1 and 2. It was returned unopened. Hence, the Complainant took a fresh DD for Rs. 14,000/- and handed over to OP-3 which was sent back to him on 05.04.2011 stating that complainant should make his own arrangements for insurance coverage. The OP-3 has renewed the policy of other retired employees, but failed to renew the policy of the Complainant. The complainant contended that it is hostile discrimination. In pursuance of the said order of District Forum the complainant made efforts to claim the remaining amount, the OP did not settle the claim, therefore, the complainant preferred another Complaint No. 1157/2011 before District Forum with the prayer for renewal of insurance policy from 1.7.2010 to 30.6.2011 and pay the claim towards the renal transplant (Rs.250,699/-) and towards dialysis (Rs.172,810/-) , with compensation of Rs.50000/- for deficiency and mental agony etc.
4. The district forum dismissed the complaint vide order dated 30/8/2011 and the State Commission dismissed the First appeal No.3347/2011 filed by Complainant and made an observation as, the remedy sought by the complainant /appellant is in the form of declaratory to renew the policy and make payments cannot attract the provisions of the C.P. Act.
5. Aggrieved by the order of State Commission, this revision petition.
6. The OPs were duly served.
Neither Counsel nor anybody appeared on behalf of OP 1 and 2, hence they were proceeded ex- parte. We have heard the Counsel for the Complainant and the OP-3, perused the orders passed by District forum and the evidence on record.
7. It clearly appears that the OP-3 wants to wriggle out from the litigation and shell out his burden on other OPs. The complainant is a retired employee of OP-3 and OP-3 continued to accept the premiums from other employees and get renewed the insurance policies. The contention of OP-3 is that, it is not the insurance company, now the OP 1 & OP- 2 have stopped the renewal. Regarding the renewal of this policy the OP-3s contention is that, the Complainant has neither paid any service charges to the OP-3, nor has the OP-3 collected any money from the complainant for sending the amount to OP-1 & 2. Earlier, the OP-3 is only a postman doing service freely, but now do not want to extend that service. Hence, complainant is not a consumer of OP-3 and there is no deficiency from OP-3. If there is any discrimination, then the remedy of complainant is elsewhere, to get renewed the policy in question. We are not impressed by this argument of counsel for OP-3.
8. The letters written by the complainant clearly establish that in accordance with the order of District Forum, dated 8.3.2011, the complainant made several possible efforts for his claim and the renewal of policy. But, OP-3 did not heed to the same, and tried to escape from his responsibility towards the retired employee. It was a Group Insurance Scheme and after retirement, since 2003 the OP-3 used to receive premium from the complainant and the policy was renewed from time to time. OP-3 forwarded the premium for renewal of other employees; except the said complainant, after 2010. In our view, this is a deficiency in service and it is absolutely discrimination and intentional act of OP-3.
The Complainant wrote a letter to the OP-3 on 21.07.2010 for Continuation of MIHS for year 2010-2011 (Annexure 4); and the reply received by OP-3; stated about its good will gesture and the coverage up to Rs.3.5 lakhs. The relevant text reproduced as follows:
Notwithstanding the above, we write to inform you that, the MIHS scheme is extended to retired employees as good will gesture and the Company does not take any liability whatsoever on account of it. The company is only facilitating these categories of eligible employees to take their policy from Insurance Company. We do not have any objection to facilitate you to continue your Medi-claim policy as good will gesture on payment basis, provides you withdraw the case against the Company. The renewal will be for only, the sum assured for the Medi-claim policy, applicable to your category. You cannot contend that the coverage for major diseases should be Rs.12.5 lakhs etc. The present coverage for major diseases is only Rs.3.5 lakhs. If the same is acceptable, you may send your request for coverage with the Demand Draft for the premium amount.
It is also made clear that, you are free to take Medi-Claim policy of your choice from any insurance company and there is no compulsion of any kind from us.
9. In this identical matter, we also relied upon the decision of Honble Supreme Court in the Civil Appeal No 2296/2000, Biman Krishna Bose Vs. United India Assurance Co. Ltd and Ors. (2001)6 SSC 477 in which the Lordships directed the respondent company for renewal of appellants mediclaim policy for the expired period, and pay the premium; the respondent company would renew the said mediclaim policy forthwith.
10. For the aforesaid reasons, we are of considered view that the District Forum and State Commission committed error in dismissing the complaint.
11. The revision petition is partly allowed, the Opposite Parties 1 and 2 are directed to settle the claim of complainant to the extent of Rs.3.5 lakhs; and OP-3 is directed to renew the policy of the complainant after taking the premium of Rs.14,000/- for the expired period and shall renew further, time to time, till the complainant needs it. The OP-3 is also directed to pay Rs. 20000/- towards mental agony, and Rs.10, 000/- towards costs to the complainant. The entire order be complied within 90 days from the receipt of this order, otherwise it will carry interest @9% till its realisation.
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(J. M. MALIK, J.) PRESIDING MEMBER ...
(S. M. KANTIKAR) MEMBER MSS/16