(Delivered by Honble President (FAC) Sri B. Srinivasu) This is a complaint filed under Section 12 of the Consumer Protection Act, 1986.
1. The representatives of the opposite party company offered Happy Family Floater Policy to the complainants and accordingly, the complainant obtained policy from 29-4- 2010 to 28-4-2011 by paying Rs.9,552/- The said policy was renewed from time to time up to 28-4-2015. The premium amount also enhanced up to Rs.24,921/-. On 4-3-2016, the opposite parties sent renewal notice to the complainants to pay Rs.48,235/-. At this stage, the complainants came to know about PNB Oriental Royal Medi claim Policy through their bankers and obtained that policy by paying premium of Rs.6,960/-. There is a clear negligence and deficiency of service on the part of the opposite parties as they collected excess premium under Happy Family Floater Policy and the complainants are entitled for refund of excess premium of Rs.40,588/-. Hence the complaint.
22. The opposite parties filed version admitting the issuance of Happy Family Floater policies since 2010 from time to time on receipts of premiums up to 2015 and subsequent policy through the Punjab National Bank, but contended that both the policies obtained by the complainants are different policies and the complainants cannot claim refund of the premium by comparing two different policies. The PNB Oriental Royal Mediclaim policy is meant only for the customers of Punjab National Bank and the insurance company has given discount on the collection of premium and it is a master policy. Hence, there is no deficiency of service and the complaint is liable to be dismissed with costs.
3. The complainant filed his chief affidavit and got marked Exs.A-1 to A-20. The senior Branchy Manager of the 2nd opposite party filed his chief affidavit on behalf of the opposite parties and got marked Exs.B-1 and B-2.
4. Heard both sides.
5. Now, the point for consideration are :-
1) Whether there is any deficiency in service on the part of the opposite parties in collecting the premiums under Happy Family floater policy?
2) Whether the complainant is entitled to claim refund of the alleged excess amount paid under the premiums?
3) To what relief? 6.POINTS 1 and 2:- The case of the complainants is that they obtained Happy Family Floater Policy from the opposite parties by paying premiums as demanded by the company from 2010 and continued till 2016. Subsequently, the complainants came to know about the PNB Oriental Royal Mediclaim Insurance Policy for less premium compare with Happy Family Floater Policy. The complainants claim is that the opposite parties illegally collected excess premium under Happy Family Floater Policy than the subsequent policy hence, they are entitled for refund of the premium amount from the opposite parties besides compensation and costs. The documents got marked by the complainants are all admitted by the other side and no need to discuss at length.
7. The opposite party while admitting the issuance of policies, payment of premiums as alleged by the complainants, contending that both the policies are different and the complainants cannot claim refund of the premium amounts by comparing two different policies. PNB Oriental Royal Mediclaim Insurance Policy for Punjab National Bank Account Holders/employees is offered by the opposite parties with discount as it is master policy. The terms and conditions of the policy are also different and the complainants agreed for the said terms and conditions and obtained the policy and now they cannot claim refund of the premium amount. Hence, the complaint is liable to be dismissed.
38. On perusal of the complaint, counter and the documents relied upon by the both sides, it is observed that the complainants obtained the insurance policies of two different types for which the opposite parties collected different premiums and the terms and conditions of the policies are also different. Generally, the insurance companies promote various types of policies basing on the market analysis and fix the premiums thereon considering the promotional expenditure, risk factors and the percentage of claims under the said policies. Some times, the analysis may also not work out and the presumptions found futile and the insurance companies may discontinue the policies, but only after completion of the promised period of insurance. However, during the policy period, the insurance company cannot escape from its liability in paying the genuine claims on the ground of non-profitability. Issuance of policy is a contract between the insurer and the insured and the terms and conditions of the policy are binding on both parties. Here in this case, the opposite parties offered Happy Family Floater Policy for a particular amount of premium for which the complainants expressed their acceptance by paying the said premium and entered into a contract of insurance. After lapse of policy period, the complainants cannot question the quantum of premium amount by comparing with other policies. The complainants would have verified the amicable and suitable policies before entering into a contract of insurance with the opposite parties.
9. In view of the foregoing discussions, we, the Forum, hold that there is no breach of contract on either side and there is no deficiency of service on the part of the opposite parties and the complainant is not entitled for the refund of any part of the premiums and the complaint is liable to be dismissed. The points are answered accordingly. Point No.3: In the result, the complaint is dismissed, but under the circumstances, without costs. Typed by the stenographer, corrected by me and pronounced by us in the open Forum, this the 25th day of July, 2017.. PRESIDENT (FAC) MEMBER Appendix of evidence Witnesses examined For the complainant: -None- For the opposite parties: -None- 4Documents marked On behalf of the complainant: Ex.A1 Original copy of happy family floated policy schedule. Ex.A2 Original copy of happy family floated policy schedule. Ex.A3 Original copy of happy family floated policy schedule and receipt. Ex.A4 15.03.2013 Photocopy of claims payment statement. Ex.A5 to A8 Original copies of happy family floated policy schedules. Ex.A9 26.03.2011 Photocopy of letter issued by OP to A. Chandra Nag. Ex.A10 Original copy of PNB-Oriental Royal mediclaim insurance policy. Ex.A11 Original copy of PNB-Oriental Royal mediclaim insurance policy schedule.. Ex.A12 Original copy of PNB-Oriental Royal mediclaim insurance policy schedule.. Ex.A13 09.06.2016 Photocopy of legal notice got issued by complainant to OPs. Exs.A14 to A17 Postal acknowledgements. Ex.A18 23.06.2016 Photocopy of reply issued by Insurance Regulatory and Development Authority of India. Ex.A19 14.06.2016 Original copy of reply to complainants counsel to Insurance Ombudsman. Ex.A20 Written copy of schedule. On behalf of the opposite parties: Ex.B1 Copy of Happy Family Floater Policy-2015-Prospects. Ex.B2 Copy of PNB-Oriental Royal mediclaim insurance PRESIDENT (FAC)