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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
K.S. Gupta, Presiding Member and S.K. Naik, Member
TATA AIG GENERAL INSURANCE COMPANY - Appellant
Versus
MARIA ANGELA DA P. MENEZES AND ANR. - Respondents
Revision Petition No. 1028 of 2008 (From the Order dated 10.12.2007 in Appeal No. 29 of 2007 of the State Commission, Panaji, Goa)
Decided on : 10-04-2008
Mr. D.P. Singh, Advocate, for the Appellant; None, for the Respondent
The main legal point established is that the entitlement to a refund of the premium for the unutilized period is determined by the exceptions mentioned in the policy and the correspondence between the parties.
Headnote:
Refund - Travel Insurance Policy - The court upheld the entitlement of the insured for a refund of the premium for the unutilized period based on the exceptions mentioned in the policy and the correspondence between the parties.
Fact of the Case:
The insured purchased a Travel Insurance Policy for a specific period but had to return earlier due to a family emergency. She sought a refund for the unutilized period, which was denied by the insurer.
Finding of the Court:
The court found that the insured's case for a refund fell within the exceptions mentioned in the policy, and the correspondence between the parties supported her entitlement to the refund.
Issues: The main issue was the entitlement of the insured for a refund of the premium for the unutilized period as per the terms and conditions of the policy.
Ratio Decidendi: The court relied on the exceptions mentioned in the correspondence between the parties and held that the insured was entitled to a refund based on those exceptions, despite the insurer's denial.
Final Decision: The court dismissed the revision and upheld the order of the State Commission, affirming the insured's entitlement to the refund.
ORDER
K.S. Gupta, Presiding Member - Challenge in this revision is to the order dated 10.12.2007 of State Consumer Disputes Redressal Commission, Panaji, Goa dismissing appeal against the order dated 14.12.2006 of a District Forum whereby petitioner and respondent No. 2 were directed to make payment of the premium amount for unutilised period in respect of policy No. 4A271890 to respondent No. 1.
2. In nutshell, the facts giving rise to this revision are these. Respondent No. 1/complainant had purchased a Travel Insurance Policy from the petitioner/opposite party No. 1 through their agent, respondent No. 2/opposite party No. 2 for undertaking journey to the United States for the period from 19.4.2004 to 15.10.2004 after paying premium of Rs. 13,991. Respondent No. 1 proceeded to the United States on 19.4.2004. However, she returned to Goa on 2.6.2004 due to sickness of her mother who ultimately died on 5.6.2004. On inquiry by respondent No. 1 from respondent No. 2 as to whether she could get the refund of premium for the unutilized period she was told that she could get it on pro-rata basis only after a new policy is taken. This was indicated by the petitioner in e-mail dated 25.6.2004 to respondent No. 2. Along with letter dated 30.6.2004, the respondent No. 1 forwarded the relevant documents to the petitioner through respondent No. 2. Respondent No. 1 obtained a new policy dated 12.7.2004. On non-refunding the balance amount despite service of legal notice, respondent No. 1 filed complaint which was contested by both the petitioner and respondent No. 2 by filing separate written versions. Plea taken by the petitioner that the policy was to terminate on the last day or on return to India or 180 days from the commencement of journey, whichever is earlier. Premium paid is not refundable. Correspondence exchanged between the petitioner and respondent No. 2 was an internal matter. Pleas taken in the written version by respondent No. 2 need not be referred to as it has not assailed the order of District Forum.
3. Thrust of argument advanced by Mr. D.P. Singh for the petitioner is that as per the terms and conditions of the policy in question, the respondent No. 1 is not entitled to the refund of premium for the unutilized period. E-mail dated 25.6.2004 being internal correspondence between the company and agent, the respondent No. 1 cannot take any advantage of what is mentioned therein. Issuance of Travel Insurance Policy for undertaking journey by respondent No. 1 to the United States for the period from 19.4.2004 to 15.10.2004 by the petitioner is not in dispute. Respondent No. 1 alleged that she returned to Goa on 2.6.2004 due to illness of her mother who later on died on 5.6.2004 and she went back to United States after purchasing a new policy dated 12.7.2004. On entitlement of respondent No. 1 for refund of premium for the unutilized period, e-mail dated 25.6.2004 need be referred to. This e-mail was sent by the petitioner to respondent No. 2 with reference to e-mail dated 23.6.2004. Copy of e-mail dated 23.6.2004 is at page 22 while that of dated 25.6.2004 is at page 23. On being approached by respondent No. 1, e-mail dated 23.6.2004 was sent by respondent No. 2 to the petitioner. This e-mail would show the respondent No. 1 wanted to know if the petitioner could give her credit for the unutilised period at the time of taking fresh insurance. E-mail dated 25.6.2004, omitting immaterial portion, reads thus:
"We refer to your e-mail dated 23.6.2004 to our office.
In keeping with your query we would like to inform you that the client could apply for a refund for the unused days of her old policy. Generally there is no refund of the policy after the first date of validity. However, in case of emergency where refund request was not reported before the first date of validity the following to be the exceptional reason.
Exceptions could be as follows:
(a) Insured has fallen sick Insured's father/Mother/wife/Children have fallen sick.
(b) De
