Rajasthan

StateCommission

CC/46/2014

Smt. Bhanwari Devi w/o Lat. Mool Chand Jat - Complainant(s)

Versus

Birla Sunlife Ins. Co. Ltd. - Opp.Party(s)

Lokesh Sharma

18 Aug 2015

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

COMPLAINT CASE NO: 46 /2014

 

Smt.Bhanwari Devi w/o Late Sh.Moolchand r/o Plot No. D-118, Murlipura Scheme,Jaipur.

Vs.

Birla Sunlife Insurance Co. Ltd. Through Director/Manager address- Plot No. 73,Shivraj Nagar, Vaishali Circle, Vaishali Area, Jaipur & ors.

 

 

Date or order 18.8.2015

 

Before:

 

Hon'ble Mr.Vinay Kumar Chawla-Presiding Member

Mr.Liyakat Ali -Member

Mrs.Sunita Ranka-Member

 

Mr.Lokesh Sharma counsel for the complainant

Mr.Vikas Jain counsel for the Insurance Company

 

 

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BY THE STATE COMMISSION

 

Brief facts of this complaint are that husband of the complainant had taken an insurance on his life in July 2012 and had paid the first quarterly premium of Rs.4200/- by cheque which was received by the insurance company and encashed. The original policy for insurance was for Rs. 24 lakhs and the life assured was to get upto Rs.1 lakh as medi claim. The husband of the complainant unfortunately died on 16.9.2012. By that time the deceased had not received any insurance policy from the company. However, the complainant with her son approached the insurance company alongwith death certificate but they were orally told that the proposal of the deceased was not accepted. On 21.5.2014 after the complaint was filed, the insurance company returned the premium by direct deposit into complainant's account.

 

The opposite party has denied the allegations. Mainly they have contended that there is no concluded contract between the deceased and the company. The application of the deceased for the insurance was pending before the company and it had not accepted the proposal. It was however, stated that the late

 

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remission of the premium would not make the company liable for the claim.

 

The learned counsel for the complainant has relied on Anx.3, the letter received on 26.7.2012 by the deceased in which the policy no. 005674530 had been entered. The learned counsel for the complainant has argued that the company had accepted the proposal and issued the policy but it was in the process. When they learnt about the death of complainant's husband, since it was a huge claim they withheld the policy and came up with the defence that proposal was never accepted. He has argued that no policy number can be awarded to an applicant unless the proposal has been accepted.

 

The learned counsel for the opposite party has contended that at the time of death of the deceased his proposal was still under consideration and the proposal has not been accepted. No formal contract had been concluded. He has argued that the proposal was rejected and the premium was returned by cheque to the deceased but it was returned. The learned counsel further argued that E-mail was also sent to the complainant that his proposal has been rejected. He has also submitted that as soon as the proposal is received it is feeded into the computer

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and the system generates a policy number even the proposal is still pending. So on the basis of the policy number the assured does not get any right for claim.

 

The insurance company has relied on I (2015) CPJ 246 ( LIC of India Vs. Saraswati Devi ). In this case it was held that merely on the basis of retention of premium, the complainant does not get right to claim under the policy in absence of concluded contract. He has also relied on IV (2014) CPJ 597 (NC) ( Postmaster General,Rajasthan Vs. Satyanarayan ) in which it was held that the policy could be effective only on the date of acceptance of proposals. The learned counsel for the company has also submitted the written arguments in which he has submitted that the complainant has not come with clean hands and the deceased was sent E-mail informing him rejection of his proposal.

 

We have heard the arguments of the learned counsels for the parties and have considered their arguments and perused the record.

 

It is not disputed that the proposal was submitted to the company in July 2012 and first quarterly premium was paid

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through cheque which was encashed by the company. On 26.7.2012 a letter bearing application no. A-47085693 and policy no. 005674530 was received by the deceased for certain formalities. After 26.7.2012 it has not been shown whether the formalities were completed or not and the case of the company is that it had rejected the proposal and had refunded the premium to the deceased but despite given 2-3 opportunities to the learned counsel, he was not able to produce any details of the refund like returned envelope or any receipt of speed post or registry nor any copy of the refunded cheque was produced instead the learned counsel for the company came with the new defence that rejection of the proposal was sent through e-mail to the deceased. This argument was controverted by the complainant on the ground that the deceased was an illiterate person and had no e-mail account and in his proposal no e-mail address was given by him. It is also evident that the company refunded the premium in May 2014 i.e. after institution of this complaint and notices were served on them. This expressly manifest the mala fide of the company.

 

We are of the opinion that the company cannot allot any policy number unless the proposal has been accepted and in this case the policy number was allotted to the deceased. The policy

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cover was not dispatched to the deceased till September 2012 when they came to know about the death of the deceased, they withheld the policy in view of the large claim amount and then refunded the premium on 10.9.2014 through direct ECS. The company has not come out with records of rejecting the proposal at their end. No official record has been produced, for this the company was given enough opportunity to prove that contract was not concluded. Even accepting that temporary policy number was allotted then computer record of cancellation i.e. non- acceptance of proposal could be produced by the company.

 

The learned counsel for the company has also submitted that there has been no formal claim lodged with the company. Hence, no claim can be processed. We while accepting the complaint direct the complainant to submit a formal claim form and complete the necessary formalities.

 

The complaint is allowed accordingly.

 

 

(Sunita Ranka) (Liyakat Ali) (Vinay Kumar Chawla)

Member Member Presiding Member

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