The Branch Manager, the New India Assurance Company Ltd. and Another Vs. Smt.B.Lakshmi Kanthamma - Court Judgment

SooperKanoon Citationsooperkanoon.com/1109586
CourtAndhra Pradesh State Consumer Disputes Redressal Commission SCDRC Hyderabad
Decided OnApr-25-2011
Case NumberF.A.No.585/2009 against C.C.No.36/2008, District Forum, KURNOOL
JudgeHONOURABLE MR. JUSTICE D. APPA RAO, PRESIDENT & SMT M. SHREESHA, MEMBER
AppellantThe Branch Manager, the New India Assurance Company Ltd. and Another
RespondentSmt.B.Lakshmi Kanthamma
Excerpt:
(typed to the dictation of smt.m.shreesha, honble member) aggrieved by the order in cc no.36/2008 on the file of district forum, kurnool opposite parties preferred this appeal. the case of the complainant in brief is that the complainant insured her life with the opposite parties for the last two decades and was extending the insurance cover for many years. she submitted that on earlier occasion also, the opposite parties did not renew the policy and insisted for baseless and unnecessary requirements and upon the indulgence of honble ombudsman and honble forum, it was renewed. it is her case that the complainants medi claim policy once again was kept on hold by the opposite party inspite of receipt of premium well within time. the renewal of the said policy should be done routinely when the required premium is paid within time. she submitted that though they are legally obliged to straight away renew the policy, they are strangely insisting for fresh medical reports without any relevance, authority or mandatory requirement. the complainant submitted that even after she complied with the baseless formalities asked for there was positive response and therefore she got issued a legal notice on 09-12-2007 for which there was no response. hence the complaint for a direction to the opposite parties to renew the medi claim policy and pay rs.50,000/- with interest at 12% p.a. and costs. opposite parties filed written version stating that the complaint is not maintainable and stated that they issued fresh medical policy no.610702/48/05/75006 to the complainant and her husband for the period from 05-8-2995 to 4-8-2006 on the directions of the ombudsman by loading 300% premium due to existing diseases and on account of previous claims, as such, it is not a renew of any previous policy and it is only a fresh policy. in fact the complainant received two claims amounting to rs.1,89,000/- under the old renewed policies and also award of rs.1,00,000/- in c.c.no.36/2006 dated 14-9-2007 as per the orders of honble forum. this shows the attitude of the complainant and dishonest intention to get wrongful gain from them. they submitted that the complainants husband approached for renewal of the policy no. 610702/48/05/75006 prior to its expiry and they advised him to get fresh medical report. they submitted that with regard to existing diseases, the complainants submitted old reports of the complainant on 03-8-2006 and hence they replied on 04-8-2006 to the complainants husband and he on 07-8-2006 requested the opposite party to bifurcate the joint policy and individual policy was issued to him. in continuation to the said process, the opposite party on 30-102-006 addressed a letter sending fresh proposal forms and also requested to send required premium for issual of policy but surprisingly an anti dated cheque dated 17-8-2006 was received by them on 13-11-2006 asking for renewal from 04-8-2006 which is impossible and hence the same was sent back to the complainants husband. they further submitted that after a lapse of one year, the complainant got issued a legal notice dated 09-12-2006 and as the complainants husband was a litigant, pending litigation in c.c.no37/2006, they did not respond to the said notice. they submitted that they refused to receive premium for renewal of previous policies on account of previous heavy claims and the complainant approached insurance ombudsman and the said policy was renewed by loading premium of 300%. they further submitted that renewal of policy is not routine or automatic and it would be renewed only after necessary tests are done and got satisfactory results. they submitted that the policy of the complainant expired by 04-8-2006 itself and it is highly impossible to renew the same as the complainant is a chronic patient and obtained three claims on previous policies and was aged more than 65 years and without medical reports, the policy cannot be renewed and prayed for dismissal of the complaint. based on the evidence adduced i.e. exs.a1 to a4 and b1 to b9 and the pleadings put forward, the district forum allowed the complaint directing the opposite party to renew the policy of the complainant from the due date of its renewal subject to loadings on the premium if any warranted together with compensation of rs.5,000/- and costs of rs.2,000/- and in default pay 12% p.a. interest. aggrieved by the said order, the opposite parties preferred this appeal. the brief point that falls for consideration is whether the complainant is entitled for renewal of the policy which has lapsed on 04-8-2006? it is the complainants case that she has taken hospitalization and domiciliary hospitalization benefit policy covering the period from 05-8-2005 to 04-8-2006 evidenced under ex.a1. when the complainant sought for renewal of the policy along with a letter dated 03-8-2006 and a cheque for the premium amount of rs.17,537/- together with the medical reports, the opposite party vide their letter dated 04-8-2006 (ex.a2) requested the complainant to submit the latest reports. since the policy was not renewed, the complainants got issued a legal notice evidenced under ex.a4 dated 09-12-2007 to immediately renew the policy. ex.b7 is the letter written by the complainants husband to the opposite party requesting them to bifurcate the present joint policy into two separate policies and renew the policy as the test reports are submitted. on 30-10-2006 the opposite party sent a letter to the complainant to answer all the questions in the fresh proposal forms enclosed along with the letter. once again opposite party addressed a letter to the complainant, vide ex.b9 dated 14-11-2006 to send the latest angiogram and doppler test reports. it is the opposite partys case that when they sent fresh proposal forms, the complainants husband issued a cheque dated 17-8-2006 which was received by the opposite party on 13-11-2006 whereas the renewal, if any, was from 04-8-2006. we find force in the contention of the appellant/opposite party that the complainant is aged more than 65 years and ex.b2 and b3 medical reports show ischaemic heart disease, post cabg status and triple vessel disease involving lad, lcx and right coronary artery and based on these two reports dated 05-3-2006 and 04-3-2006 respectively, the appellant insurance company did not renew the policy, more so, the payment of the premium is not within time. we observe from the record that as per ex.a1 the period of insurance is from 05-8-2005 to 04-8-2006 and as the medical reports are dated 04-3-2006 and 05-3-2006 (exs.b2 and b3), the appellant has used its discretion not to renew the policy. we rely on the judgment in ii (2001) cpj 241 of west bengal state commission wherein it was held that renewal of policy depends on mutual consent of party and hence we are of the considered view that even in the instant case, a direction to the appellant/insurance company to compulsorily renew the policy, cannot be given by this commission. in the result this appeal is allowed and the order of the district forum is set aside and consequently the complaint is dismissed. there shall be no order as to costs.
Judgment:

(Typed to the dictation of Smt.M.Shreesha, Honble Member)

Aggrieved by the order in CC No.36/2008 on the file of District Forum, Kurnool opposite parties preferred this appeal.

The case of the complainant in brief is that the complainant insured her life with the opposite parties for the last two decades and was extending the insurance cover for many years. She submitted that on earlier occasion also, the opposite parties did not renew the policy and insisted for baseless and unnecessary requirements and upon the indulgence of Honble Ombudsman and Honble Forum, it was renewed. It is her case that the complainants Medi claim policy once again was kept on hold by the opposite party inspite of receipt of premium well within time. The renewal of the said policy should be done routinely when the required premium is paid within time. She submitted that though they are legally obliged to straight away renew the policy, they are strangely insisting for fresh medical reports without any relevance, authority or mandatory requirement. The complainant submitted that even after she complied with the baseless formalities asked for there was positive response and therefore she got issued a legal notice on 09-12-2007 for which there was no response. Hence the complaint for a direction to the opposite parties to renew the Medi Claim policy and pay Rs.50,000/- with interest at 12% p.a. and costs.

Opposite parties filed written version stating that the complaint is not maintainable and stated that they issued fresh medical policy No.610702/48/05/75006 to the complainant and her husband for the period from 05-8-2995 to 4-8-2006 on the directions of the Ombudsman by loading 300% premium due to existing diseases and on account of previous claims, as such, it is not a renew of any previous policy and it is only a fresh policy. In fact the complainant received two claims amounting to Rs.1,89,000/- under the old renewed policies and also award of Rs.1,00,000/- in C.C.No.36/2006 dated 14-9-2007 as per the orders of Honble Forum. This shows the attitude of the complainant and dishonest intention to get wrongful gain from them. They submitted that the complainants husband approached for renewal of the policy No. 610702/48/05/75006 prior to its expiry and they advised him to get fresh medical report. They submitted that with regard to existing diseases, the complainants submitted old reports of the complainant on 03-8-2006 and hence they replied on 04-8-2006 to the complainants husband and he on 07-8-2006 requested the opposite party to bifurcate the joint policy and individual policy was issued to him. In continuation to the said process, the opposite party on 30-102-006 addressed a letter sending fresh proposal forms and also requested to send required premium for issual of policy but surprisingly an anti dated cheque dated 17-8-2006 was received by them on 13-11-2006 asking for renewal from 04-8-2006 which is impossible and hence the same was sent back to the complainants husband. They further submitted that after a lapse of one year, the complainant got issued a legal notice dated 09-12-2006 and as the complainants husband was a litigant, pending litigation in C.C.No37/2006, they did not respond to the said notice. They submitted that they refused to receive premium for renewal of previous policies on account of previous heavy claims and the complainant approached insurance Ombudsman and the said policy was renewed by loading premium of 300%. They further submitted that renewal of policy is not routine or automatic and it would be renewed only after necessary tests are done and got satisfactory results. They submitted that the policy of the complainant expired by 04-8-2006 itself and it is highly impossible to renew the same as the complainant is a chronic patient and obtained three claims on previous policies and was aged more than 65 years and without medical reports, the policy cannot be renewed and prayed for dismissal of the complaint.

Based on the evidence adduced i.e. Exs.A1 to A4 and B1 to B9 and the pleadings put forward, the District Forum allowed the complaint directing the opposite party to renew the policy of the complainant from the due date of its renewal subject to loadings on the premium if any warranted together with compensation of Rs.5,000/- and costs of Rs.2,000/- and in default pay 12% p.a. interest.

Aggrieved by the said order, the opposite parties preferred this appeal.

The brief point that falls for consideration is whether the complainant is entitled for renewal of the policy which has lapsed on 04-8-2006?

It is the complainants case that she has taken Hospitalization and Domiciliary Hospitalization Benefit policy covering the period from 05-8-2005 to 04-8-2006 evidenced under Ex.A1. When the complainant sought for renewal of the policy along with a letter dated 03-8-2006 and a cheque for the premium amount of Rs.17,537/- together with the medical reports, the opposite party vide their letter dated 04-8-2006 (Ex.A2) requested the complainant to submit the latest reports. Since the policy was not renewed, the complainants got issued a legal notice evidenced under Ex.A4 dated 09-12-2007 to immediately renew the policy. Ex.B7 is the letter written by the complainants husband to the opposite party requesting them to bifurcate the present joint policy into two separate policies and renew the policy as the test reports are submitted. On 30-10-2006 the opposite party sent a letter to the complainant to answer all the questions in the fresh proposal forms enclosed along with the letter. Once again opposite party addressed a letter to the complainant, vide Ex.B9 dated 14-11-2006 to send the latest angiogram and Doppler test reports. It is the opposite partys case that when they sent fresh proposal forms, the complainants husband issued a cheque dated 17-8-2006 which was received by the opposite party on 13-11-2006 whereas the renewal, if any, was from 04-8-2006. We find force in the contention of the appellant/opposite party that the complainant is aged more than 65 years and Ex.B2 and B3 medical reports show ischaemic heart disease, post CABG status and triple vessel disease involving LAD, LCX and right coronary artery and based on these two reports dated 05-3-2006 and 04-3-2006 respectively, the appellant insurance company did not renew the policy, more so, the payment of the premium is not within time. We observe from the record that as per Ex.A1 the period of insurance is from 05-8-2005 to 04-8-2006 and as the medical reports are dated 04-3-2006 and 05-3-2006 (Exs.B2 and B3), the appellant has used its discretion not to renew the policy.

We rely on the judgment in II (2001) CPJ 241 of West Bengal State Commission wherein it was held that renewal of policy depends on mutual consent of party and hence we are of the considered view that even in the instant case, a direction to the appellant/insurance company to compulsorily renew the policy, cannot be given by this Commission.

In the result this appeal is allowed and the order of the District Forum is set aside and consequently the complaint is dismissed. There shall be no order as to costs.