JUSTICE V.K.JAIN (ORAL)

The complainant submitted an online application to the opposite party, namely, ICICI Prudential Life Insurance Company for grant of ICICI Prudential Life  Protect Smart Policy. He also paid a premium of Rs.22964/-. He also underwent a medical check-up on 28.5.2018. The medical check-up of the complainant revealed that he was a Diabetic and had raised level of blood sugar and HbA1C. The aforesaid illness was also disclosed by the complainant in the online application which he had submitted. Vide email dated 6.6.2018, the OP informed the complainant that the plan sought by him was based on the assumption of standard health indicators and habits. Therefore, they had to revise the premium upwards, if some of the health indicators or life style habits indicated an impact on long term health. He was further informed that based upon his medical test report, they had to revise his premium on payment of which he would not only be covered for existing health condition, but would also avoid the risk of not getting a life cover if his medical condition was to deteriorate. He was given options to either take the term and insurance cover offered  by the insurer as per  his original application on a higher premium or to take  a lower insurance cover on the premium which he had already paid. The offers given to him comprised coverage of  Rs.75 lakhs on premium of Rs.31107/- or coverage of Rs.51,50,000/- on the premium which he had already paid.

2.      Neither of the offers made by the opposite party was accepted by the complainant who has now approached this Commission after the premium paid by him was refunded to him.

3.      The correspondence exchanged between the parties clearly show that the offers made by the opposite party having not been accepted by the complainant  and no insurance policy having been issued to him, there was no concluded contract of insurance between the parties. It is submitted by the learned counsel for the complainant that since the complainant had disclosed his ailment in the online application submitted by him and the premium paid by him was also accepted by the opposite party, the contract stood concluded between them. I, however, cannot accept the contention. The online proposal was never accepted by the insurer. The insurer has a  right to ask the proposer to have a medical check-up in order to find out the true state of his health. Once such an option was exercised by the insurer, there would be no concluded contract of insurance without such medical check-up and consideration of the application based upon the medical evaluation and the information submitted by him in the application. The complainant having undergone the medical check-up at the behest of the opposite party is also indicative that there was no concluded contract of insurance merely on submission of the online application and payment of the premium.

4.      The opposite party after considering the report of the medical check-up of the complainant alongwith the information disclosed in the application form submitted by him gave two alternative offers to the complainant. He could have accepted either of the two offers made to him by the opposite party. Alternatively, he could have  sought refund of the amount which he had paid to the opposite party while submitting the online application. Admittedly, he did not accept either of the offers given to him by the opposite party. Therefore, the opposite party was justified in refunding the premium which the complainant had paid while submitting the online application.

5.      An insurer, in my opinion, is entitled to demand a higher premium based upon the risk profile of the proposer which includes the state of his health, as evaluated by way of his medical check-up. Subject to statutory prescription, if any, the insurer has a discretion to accept a proposal or not and even to demand a higher premium than the usual premium applicable on a person suffering from no ailment at all. The complainant is a Diabetic and, therefore, there is a greater risk to his life as compared to a person who is absolutely healthy, fit and fine. No rule or regulation mandatorily requiring the insurer to accept every proposal submitted for grant of an insurance policy has been brought to my notice. Also, no rule or regulation precluding an insurer from demanding a higher premium based upon the risk profile of the proposer has been brought to my notice. As noted earlier, there was no concluded contract of insurance between the parties, since the proposal was not accepted by issuance of insurance policy in favour of the complainant nor was he at any stage informed that the proposal which he had submitted by filling an online application form had been accepted by the opposite party. Therefore, no case of deficiency is made out. More importantly, no insurance policy having been issued to the complainant he cannot even be said to be a consumer of  the opposite party  since the relationship of insurer and insured did not come into existence.

6.      For the reasons stated hereinabove, I do not find any merit in the consumer complaint, which is accordingly dismissed with no order as to cost.