Order by:
Sh.Amrinder Singh Sidhu, President
1. This Consumer Complaint has been received by transfer vide order dated 26.11.2021 of Hon’ble President, State Consumer Disputes Redressal Commission, Punjab at Chandigarh under section 48 of CPA Act, vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 from District Consumer Commission, Ludhiana to District Consumer Commission, Moga to decide the same in Camp Court at Ludhiana and said order was ordered to be affected from 14th March, 2022.
2. The complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (now section 35 of Consumer Protection Act, 2019) on the allegations that Umesh Kumar son of Sh.Ranjit Singh (husband of complainant No.1 and father of complainant No.2) had applied for a policy with the Opposite Parties in the name of his minor daughter (complainant No.2) with PWB (Premium Waiver Benefit) on 25.05.2015 and issued cheque No.772322 from his account which was accordingly debited. PWB (Premium Waiver Benefit) means if something happens to the guardian, then the entire payment of sum of Rs.4 lakhs in this case shall be given to Ms.Angel (complainant No.2) and there is no need to pay further premium. Not only this, the medical examination at the time of proposal was also got conducted by the Opposite Parties on Umesh Kumar on 28.05.2015 and as per the procedure on receipt of the proposal, the same is submitted to the division for approval and after due consideration of the medical reports, the proposal was accepted under table 832-16 for an assured sum of Rs.4 lakhs on 19.06.2015. But lateron the Opposite Parties wrongly and illegally made cuttings, interpolations in the said review slip by mentioning without PWB (Premium Waiver Benefit). It is pertinent to mention over here that medical is done only in case policy is PWB with (Premium Waiver Benefit), but in case a person opts for the policy without PWB (Premium Waiver Benefit), there is no need to undergo medical examination. Unfortunately, the proposer namely Umesh Kumar met with an accident on 15.06.2015 and was admitted in Deep Hospital, Ludhiana and thereafter, also remained admitted Dayanand Medical College & Hospital, Ludhiana and died on 28.06.2015. thereafter, the complainants lodged the claim with the Opposite Parties on 3.7.2015 and completed all the formalities, but the Opposite Parties repudiated the claim of the complainants on the ground that the proposer died on 28.06.2015 before issuance of first premium receipt on 20.07.2015, but it is totally wrong and manipulated story made up by the Opposite Parties and as such, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) The Opposite Parties may be directed to pay the sum assured of Rs.4 lakhs under the policy alongwith interest @ 18% per annum and also pay compensation amounting to Rs.3 lakhs or any other relief to which this District Consumer Commission may deem fit be also granted.
3. Opposite Parties appeared through counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this District Consumer Commission. It is submitted that it is admitted that Umesh Kumar proposed insurance in the name of Mss Angel with date of birth 29.04.2006 with PWB (Premium Waiver Benefit) by submitting proposal form No. 360 dated 28.05.2015 in lieu of which proposal as accepted on 20.07.2015 with DOC dated 25.05.2015 without PWB (Premium Waiver Benefit). The proposal for PWB was not acceptable as no consideration amount was received besides other requirements were not fulfilled. It is denied that deceased issued cheque from his account which was debited to his account on 27.05.2015. Moreover, before conclusion of contract the proposer Umesh Kumar met with an accident on 15.06.2015 and admitted in Deep Nursing Home, Ludhiana and as per the summary he was operated on 16.06.2015 and he was further admitted in Dayanand Medical College & Hospital, Ludhiana on 26.06.2015 where he died on 28.06.2015 before issuance of first premium receipt dated 20.07.2015 and hence the proposer died before acceptance of proposal and in view of the above said circumstances, the complainants are not entitled to any claim. Hence the grounds of repudiation is legal, valid and enforceable and in accordance with the terms and conditions of the policy. On merits, Opposite Parties took up the same and similar pleas as taken up by them in the preliminary objections. Hence, the instant complaint is not maintainable and the same may be dismissed with costs.
4. In order to prove his case, the complainant has tendered into evidence his affidavit Ex.CA alongwith copies of documents Ex.C1 to Ex.C10 and closed the evidence on behalf of the complainant.
5. On the other hand, to rebut the evidence of the complainant, Opposite Parties also tendered into evidence the affidavits Ex.RA to RF alongwith copies of documents Ex.R1 to Ex.R68 and closed the evidence.
6. We have heard the ld.counsel for the parties, perused the written submissions of the complainants and also gone through the documents placed on record.
7. Ld.counsel for the Complainant has mainly reiterated the facts as narrated in the complaint and contended that Umesh Kumar son of Sh.Ranjit Singh (husband of complainant No.1 and father of complainant No.2) had applied for a policy with the Opposite Parties in the name of his minor daughter (complainant No.2) with PWB (Premium Waiver Benefit) on 25.05.2015 and issued cheque No.772322 from his account which was accordingly debited. PWB (Premium Waiver Benefit) means if something happens to the guardian, then the entire payment of sum of Rs.4 lakhs in this case shall be given to Ms.Angel (complainant No.2) and there is no need to pay further premium. Not only this, the medical examination at the time of proposal was also got conducted by the Opposite Parties on Umesh Kumar on 28.05.2015 and as per the procedure on receipt of the proposal, the same is submitted to the division for approval and after due consideration of the medical reports, the proposal was accepted under table 832-16 for an assured sum of Rs.4 lakhs on 19.06.2015. But lateron the Opposite Parties wrongly and illegally made cuttings, interpolations in the said review slip by mentioning without PWB (Premium Waiver Benefit). It is pertinent to mention over here that medical is done only in case policy is PWB with (Premium Waiver Benefit), but in case a person opts for the policy without PWB (Premium Waiver Benefit), there is no need to undergo medical examination. Unfortunately, the proposer namely Umesh Kumar met with an accident on 15.06.2015 and was admitted in Deep Hospital, Ludhiana and thereafter, also remained admitted Dayanand Medical College & Hospital, Ludhiana and died on 28.06.2015. thereafter, the complainants lodged the claim with the Opposite Parties on 3.7.2015 and completed all the formalities, but the Opposite Parties repudiated the claim of the complainants on the ground that the proposer died on 28.06.2015 before issuance of first premium receipt on 20.07.2015, but it is totally wrong and manipulated story made up by the Opposite Parties and as such, there is deficiency in service on the part of the Opposite Parties.
8. On the other hand, ld.counsel for the Opposite Parties has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that admittedly Umesh Kumar had proposed insurance in the name of Mss Angel with date of birth 29.04.2006 with PWB (Premium Waiver Benefit) by submitting proposal form No. 360 dated 28.05.2015 in lieu of which proposal as accepted on 20.07.2015 with DOC dated 25.05.2015 without PWB (Premium Waiver Benefit). The proposal for PWB was not acceptable as no consideration amount was received besides other requirements were not fulfilled. It is denied that deceased issued cheque from his account which was debited to his account on 27.05.2015. Moreover, before conclusion of contract the proposer Umesh Kumar met with an accident on 15.06.2015 and admitted in Deep Nursing Home, Ludhiana and as per the summary he was operated on 16.06.2015 and he was further admitted in Dayanand Medical College & Hospital, Ludhiana on 26.06.2015 where he died on 28.06.2015 before issuance of first premium receipt dated 20.07.2015 and hence the proposer died before acceptance of proposal and in view of the above said circumstances, the complainants are not entitled to any claim. Hence the grounds of repudiation is legal, valid and enforceable and in accordance with the terms and conditions of the policy. Now the question for determination is that whether in such a situation, the complainants are entitled to claim the benefit of the unaccepted proposal, the answer to this question is in negative. In this regard, Hon’ble Punjab & Haryana High Court at Chandigarh in case Mrs.Saroj Chandna and others Vs. Life Insurance Corporation of India and another in RSA No. 1276 of 1997 decided on 16th August, 1999 has held that ‘No doubt, the amount was deposited by the deceased with the respondent-corporation in regard to the proposal submitted for insurance on his life, but mere offering the amount which is retained by the respondent- corporation as a premium does not amount to acceptance of the policy. No life insurance policy was issued in the name of the deceased. The argument of the learned counsel for the appellants that no response was given to the communication addressed to the respondent-Corporation in regard to the policy and, therefore, it is deemed to have been accepted, is not a valid argument because there is nothing on the record to show even prima facie the acceptance of the proposal to the offerer (deceased). Contract is completed when the proposal is made and accepted. Therefore, it was rightly held by the first appellate Court that there is no contract between the parties and it has also rightly relied upon the law laid down in Life Insurance Corporation of India v. Vasireddy Komalavalli Kamla and Ors., A.I.R. 1984 Supreme court 1014. Learned counsel for the appellants has not been able to controvert it to hold that the proposition of law laid down in this authority is not applicable to the facts of the case. Mere lapse of time in communicating the acceptance cannot be made a ground for holding that the proposal stood accepted. The Corporation before entering into contract is required to enquire into information supplied and that naturally takes some time. It is not shown that any time frame was fixed between the parties for accepting the proposal and on the lapse of it, the proposal was deemed to have been accepted.” Not only this, in the similar facts and circumstances of the case, Hon’ble National Consumer Disputes Redressal Commission, New Delhi in First Appeal No. 303 of 2017 also held that “the husband of the complainant had applied for the insurance cover and submitted a proposal form alongwith cheque to insurance company, but he unfortunately passed away within a month after submission of proposal form, Life Insurance Corporation of India has rightly repudiated the claim on the ground of un-concluded contract.” On the other hand, the rulings cited by the complainants are not applicable to the facts of the present case and the same are distinguished and as such, we hold that there is no deficiency in service on the part of the Opposite Parties.
9. In view of the aforesaid facts and circumstances of the case, the instant complaint stands dismissed. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost by District Consumer Commission, Ludhiana and thereafter, the file be consigned to record room after compliance.
10. Reason for delay in deciding the complaint.
This Consumer Complaint was originally filed at District Consumer Disputes Redressal Forum (Now Commission) at Ludhiana and it keep pending over there until Hon’ble State Consumer Disputes Redressal Commission, Punjab vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 has transferred the instant Consumer Complaint alongwith Other Complaints to District Consumer Commission, Moga with directions to work on this file onward from 14th March, 2022 and accordingly District Consumer Commission, Moga has decided the present complaint today i.e.23.05.2022 at Camp Court, Ludhiana, as early as possible as it could decide the same
Announced in Open Commission at Camp Court, Ludhiana.
Dated: 23.05.2022.
