ORDER (ORAL)

V.K. Jain, Presiding Member—The complainant/petitioner was working as a General Manager with Nagarjuna Fertilizers & Chemicals Ltd. In the year 1991, the above referred company took a Group Medical Insurance Policy from the respondent in respect of its employees and their family members.

2. The complainants left the employment of the above referred company in February 2003. Before leaving the employment of the company, the complainant had taken a medicare policy from the Yanam Branch of the respondent in the year 2001-2002. The said policy was renewed upto 30.10.2005. The complainant sent a letter dated 03.10.2005 to the respondent for sending the proposal form for renewal of the policy but was informed that in view of very high claim ratio, it had been decided not to renew the policy taken by him. This, according to the respondent, was done towards implementation of measures for loss minimization. Since the policy was not renewed after 30.10.2005, the complainant approached the concerned District Forum by way of a consumer complaint.

3. The District Forum, vide its order dated 29.12.2006, directed as under:

“The complainant is directed to remit to the 1st opposite party an amount of Rs.21,043/- (total of net premium of Rs.19,095/- which was paid by him for the Mediguard Policy for the previous year 31-10-2004 to 30-10-2005 and service tax of Rs.1,948/-) on or before 8-1-2007 alongwith a covering letter requesting for renewal of Mediguard Policy for one year from 31-10-2005 to 30-10-2006 covering himself, his wife, his daughter and his mother for the same insured sums of Rs.3,20,000/-, Rs.3,00,000/-, Rs.1,65,000/- and Rs.3,30,000/- respectively. The opposite party shall, immediately after receipt of such application from the complainant and remittance of the amount of Rs.21,043/- by him, consider his request for renewal of the Mediguard Policy but it shall be within his discretion to reduce the amount of insurance in respect of the complainant’s wife and to demand payment of loaded premium on the amount of insurance of is wife. The 1st opposite party shall prescribe a date for payment of any extra amount payable by the complainant and in case the complainant pays the same, the 1st opposite party shall issue renewal Mediguard Policy accordingly effective from 31-10-2005 to 30-10-2006. In case the complainant does not comply with the direction issued to him above, the question of the 1st opposite party considering request of the complainant to renew the Mediguard Policy does not arise. The opposite parties 2 to 4 shall issue necessary instructions to the 1st opposite party in this regard. The request of the complainant for direction to the opposite parties to pay any damages is refused.

4. Being aggrieved from the order passed by the District Forum, the complainant approached the concerned State Commission by way of an appeal. The said appeal having been dismissed, he is before this Commission.

5. It would thus be seen that the individual mediclaim policy was taken by the complainant for the first time from Yanam Branch of the Respondent company in the year 2001-2002 and the said policy was renewed till 2004-2005 when it expired on 30.10.2005.

6. It is also an admitted position that the complainant wanted renewal of the said policy but considering the claims made by him in the past, the respondent was not willing to renew the policy.

7. After the order of the District Forum, the complainant sought renewal of the said policy for the period from 31.10.2005 to 30.10.2006 paying a premium of Rs.21,043/-. In response, the insurer proposed to reduce the cover in respect of his wife to Rs.1 lac and also sought a total premium of Rs.1,04,091/- which the complainant was unwilling to pay.

8. The question as to whether a Public Sector insurance company is justified in denying renewal of a mediclaim policy, came up or the consideration of the Hon’ble Supreme Court in United India Insurance Company Limited Vs. Manubhai Dharmasi