Madhya Pradesh

StateCommission

A/16/237

BHARAT KUMAR - Complainant(s)

Versus

BIRLA SUNLIFE INSU.CO. - Opp.Party(s)

SH.D.JOSHI

22 Jul 2024

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                         

PLOT NO.76, ARERA HILLS, BHOPAL

 

FIRST APPEAL NO. 237 OF 2016

(Arising out of order dated 29.12.2015 passed in C.C.No.621/2010 by District Commission, Bhopal)

 

BHARAT KUMAR PUSWANI,

S/O SHRI SHYAM SUNDER PURSWANI,

R/O E-7, MX-50 ARERA COLONY,

BHOPAL (M.P.)                                                                                                               … APPELLANT.

 

                Versus

 

1. BIRLA SUNLIFE INSURANCE CO.LTD.

    ONE INDIABULLS CENTRE,

    TOWER 1 15^TH AND 16^TH FLOOR,

    JUPITER MILL COMPOUND,

    841 SENAPATI BAPAT MARG,

    ELPHINSTONE ROAD, MUMBAI.

 

2. BIRLA SUNLIFE INSURANCE CO.LTD.

    THROUGH BRANCH MANAGER,

    QUALITY BUSINESS CENTRE, MEZZANINE FLOOR,

    M.P.NAGAR, PLOT NO.7, ZONE-II,

    BHOPAL (M.P.)                                                                                           …. RESPONDENTS.

 

BEFORE :

            HON’BLE SHRI A. K. TIWARI        :         ACTING PRESIDENT

            HON’BLE DR. SRIKANT PANDEY        :       MEMBER         

           

COUNSEL FOR PARTIES :

                Ms. Meenakshi Patidar appears on behalf of Shri Devashish Mathur, learned counsel for the appellant.

            Shri Rajesh Giri, learned counsel for the respondents.

 

O R D E R

(Passed On 22.07.2024)

                                The following order of the Commission was delivered by A. K. Tiwari, Acting President:

            This appeal by the complainant/appellant is directed against the order dated 29.12.2015 passed by the District Consumer Disputes Redressal Commission, Bhopal (for short ‘District Commission’) in

 

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C.C.No.621/2010 whereby the District Commission has dismissed the complaint filed by him.

2.                Facts of the case in short are that the complainant had obtained a life insurance policy from the opposite party no.1 through their agent at Bhopal and a life insurance policy no.001124238 was provided to him covering the life of the complainant at Rs.14,55,125/- with the enhanced sum assured of Rs.5 lacs therefore totaling Rs.19,55,125/- for which annual premium of Rs.99,928/- was to be paid.  He paid premium for first year of the policy on 13.07.2017 thereafter he could not pay the second premium falling due in July 2008 and thereafter as well.  On 23.03.2010 he received a letter from the insurance company informing that net amount due to revive the policy was Rs.1,99,855/-.  Thereafter the complainant on 26.06.2010 approached the insurance company with a cheque of Rs.1,99,855/- but he was informed that they are examininig the request made by the complainant for reinstatement of the policy and same will be informed. It is alleged that suddenly on 12.07.2010 the opposite parties unilaterally decided to cancel the policy and refused to reinstate the same on the ground that the state of health of the complainant was classified as having some risk classification and therefore on the ground of some personal medical history and instead offered to refund the deposit paid.

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3.                It is further submitted that on 21.07.2010, the opposite parties unilaterally sent an amount of Rs.5,409.68/- towards the alleged surrender value of the policy whereas the complainant neither surrendered the policy nor the policy was ever cancelled and the opposite parties do not have any right to refuse reinstatement of the policy on the ground of medical history of the complainant.  The complainant therefore alleging deficiency in service on part of opposite parties approached the District Commission seeking direction to reinstate the policy on receipt of reinstatement premium of Rs.1,99,855/- and to pay compensation of Rs.1,25,000/-.

4.                The opposite parties ini their reply admitting the issurance of policy on 19.07.2007 submitted that the renewal premium was due on the said policy on yearly basis however, the complainant failed to pay subsequent renewal premiums due to which the said policy got lapsed on 19.07.2008. Several reminders were sent to the complainant in this regard. In the reminder it has been specifically mentioned that the reinstatement of policies involving medical cases is subject to the decision of underwriting in your policy contract. Thereafter on 17.12.2009, the complainant deposited the premium amount of Rs.1,99,855/- towards outstanding premium for last two years. Since the complainant requested to reinstate the policy after 180 days, a requirement for Certificate of Insurability (COI)

 

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was raised and a requirement letter was sent to the complainant on 23.12.2009.

5.                It is further submitted that on 29.12.2010, the opposite parties received a letter from the complainant to refund the premium amount citing some financial problem.  Since the complainant had opted not to continue the said policy and failed to submit COI, the premium amount of Rs.1,99,855/- was refunded to the complainant and he was intimated. Thereafter on 20.03.2010, the complainant submitted COI towards reinstatement of the policy but he failed to deposit the outstanding premium hence he was asked to pay the outstanding premium so that reinstatement request could be processed. While waiting for receiving the outstanding premium from the complainant, they verified COI submitted by the complainant and it was observed that he is suffering from NHL (Cancer).  That as per information provided by the complainant about his health in COI, the opposite parties acting well within its rights, declined the reinstatement request of the complailnant to revive the said policy.  Accordingly refunded cash surrender value Rs.5,409.68/- after deducting surrender charges Rs.68,841.96/- from fund value of Rs.74,251.64/- as on date of surrender vide cheque number 114611 in July 2010.  Thus it is prayed hat the complaint be dismissed.

 

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6.                The District Commission dismissed the complaint holding that as per policy provisions, the insurance company was well within its right to accept or reject the reinstatement/revival request of the complainant.  Hence this appeal.

7.                Heard. Perused the record.

8.                Learned counsel for the complainant/appellant argued that District Commission failed to appreciate the documents filed by the complainant and completely relied upon the version of the opposite parties without there being any supported documents.  He argued that the District Commission completely failed to appreciate the fact that the complainant had received a letter from the opposite parties stating that the net amount due for reviving the policy was Rs.1,99,855/- which itself make it evident that the policy could be renewed on payment of aforesaid sum and the complainant approached the opposite parties for paying the aforesaid amount and getting the policy revived but the opposite parties completely ignored and overlooked the said request. He further argued that the opposite parties unilaterally cancelled the aforesaid policy stating vague and baseless grounds of some risk classification in the health of the complainant. He therefore prayed for setting aside the impugned order.

9.                Learned counsel for the opposite parties/respondents insurance company argued that it is true that the insurance company

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asked him to pay outstanding premiums along with health record. On examining the health record of the complainant, the insurance company was well within its right either to accept or refuse the revival/reinstate of the policy.  Looking to the health condition of the complainant, the insurance company denied to revive/reinstate the policy in question and hence there has been no deficiency in service on part of the insurance company.  He argued that the District Commission has rightly dismissed the complaint.  He therefore prayed for dismissing the appeal.

10.              Having regard to the aforesaid pleadings and having gone through the record we find that after payment of first premium in the year 2007 the complainant failed to pay the premiums in the year 2008 and 2009 and therefore the subject policy was lapsed.  On 17.12.2009 the complainant deposited outstanding premium for last two years Rs.1,99,855/- but since the complainant requested to reinstate the policy after 180 days, a requirement of Certificate of Insurability (COI) was raised on 23.12.2009. On 29.12.2009, the complainant sought refund of premium amount deposited on account of some financial problem (Exhibit D) and the insurance company refunded the same to the complainant.

11.              Again on 20.03.2010 the complainant submitting the COI for reinstatement of the policy but failed to deposit the outstanding premiums.  He was asked to pay the outstanding premiums so that his prayer to

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revive/reinstate the policy could be processed. On examing the COI (Exhibit F) submitted by the complainant for reinstatement of the policy, it was found that he was suffering from NHL (Cancer), the opposite parties declined reinstatement of the policy and refunded surrender value of Rs.5,409.68/- to the complainant.  The aforesaid facts were neither denied nor controverted by the complainant.

12.              On going through the policy document (C-3) we find that in head of Revival it is clearly mentioned that “To revive your policy, you must pay all due and unpaid policy premiums till date and provide us with evidence of insurability satisfactory to us with respect to the Life Insured. The effective date of the revival is when these requirements are met and approved by us.” Here in the present case, though the complainant submitted COI but firstly deposited unpaid premiums and thereafter got refunded the same.

13.              Annexure C-7 is requirement letter for lapsed policy dated 23.03.2010 addressing to the complainant wherein it is stated that “The reinstatement of policies involving medical cases is subject o the decision of underwriting.” Meaning thereby looking to the health condition and medical issues, medical history of the life assured, the insurance company was well within its right to accept or reject the request for revival/reinstatement of the policy.  In the instant case, the insurance

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company looking to the medical history shown in COI, denied to accept revival/reinstatement of policy in question and while doing so it cannot be said that the insurance company has committed deficiency in service.

14.              In view of the above discussion, we find that the District Commission after appreciating the evidence available on record has passed a well-reasoned order and we do not find any illegality or infirmity in the impugned order.  Accordingly, the impugned order is hereby affirmed.

15.              In the result, this appeal fails and is hereby dismissed. No order as to costs.

                         (A. K. Tiwari)                    (Dr. Srikant Pandey)

                     Acting President                            Member