Karnataka

Kolar

CC/28/2020

Sri.Srinivasa - Complainant(s)

Versus

The Manager, Star Health & Allied Insurance Company Limited - Opp.Party(s)

19 Jan 2021

ORDER

                                                   Date of Filing: 13.08.2020

Date of Order: 19.01.2021

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, OLD D.C. OFFICE PREMISES, KOLAR.

 

Dated: 19^TH DAY OF JANUARY 2021

PRESENT

SRI. K.N. LAKSHMINARAYANA, B.Sc., LLB., …… PRESIDENT

SRI. B.M. NAGARAJA, B.A., LLB., ….. MEMBER

 

CONSUMER COMPLAINT NO. 28 OF 2020

Sri. Srinivasa,

S/o. Late Chowdappa,

Aged About 63 Years,

R/at: A Block, Vemgal Village,

Vemgal Hobli,

Kolar Taluk.                                                                   ….  COMPLAINANT.

(Rep. by Sri. B.V.Shivashankar, Advocate)

- V/s –

1) The Manager,

Star Health & Allied Insurance

Company Limited, No.57,

3^rd & 4^th Floor, Double Road,

Indiranagara, Bangalore-38.

(Rep. by Sri. G.R.Ramachandra Murthy, Advocate)

2) The Branch Manager,

Star Health & Allied Insurance

Company Limited, 1^st Floor,

New Kolar Nursing Home Building,

Antharagange Road, Kolar.

(Rep. by Sri.G.R.Ramachandra Murthy, Advocate)                                            

                                                                                 …. OPPOSITE PARTIES.

 

ORDER

BY SRI. K.N. LAKSHMINARAYANA, PRESIDENT

01.   The complainant has filed this Consumer Complaint against OP Nos.1 & 2 and prays to direct the OPs to return the premium amount of Rs.25,352/- with compensation and interest and to allow the complaint.

02.   The brief facts of the complainant’s case is that, one of the agent of the OPs Mr. Mohan had insisted the complainant to get health insurance policy in favour of complainant and his family members from OP No.2.  The complainant had obtained health insurance policy from OP No.2 on 20.03.2020 vide proposal form No.1503396 and the complainant has paid a sum of Rs.25,352/- on cash to OP No.2.  The OP No.2 had issued proposal form to the complainant and also premium receipt on 21.03.2020 vide customer ID No. AA0011412592 and thereafter OP No.2 did not issue the policy to the compliant.  The complainant has made several requests and demands with OP No.2 to get the policy bond and OP No.2 postponed the same and the OPs have cheated the complainant without issuing policy bond.  On 06.06.2020 the complainant issued legal notice to OPs through RPAD and the same was served on 10.06.2020 and in-spite of that, OP has not complied the legal notice and the complainant has filed this consumer complaint against the OPs.

03.   OP Nos.1 & 2 appeared through the counsel and OP No.2 has filed version and contended that, the complaint is not maintainable either in law or on facts.  The complainant has not approached this Commission with clean hands and the allegations made in Para-2 to 6 of the complaint are all false.  The OP has contended that, the complainant has approached the OPs for policy which was processed and the complainant was asked to appear before the Medical Team of the OP-company and the complainant never turned up and not submitted himself for medical examination and his policy was not accepted.  The premium amount of Rs.25,352/- was refunded to the complainant’s account in Pragathi Gramina Bank in his account No.162201156682212 on 10.06.2020 vide NEFT.  The complainant has encashed the said amount and after receiving the said amount the complainant has approached this Hon’ble Commission with false allegations.  The OPs have requested the complainant to come for medical checkup at their cost, but the complainant without any reason due to his negligence has not attended the medical checkup and the OPs have refunded the amount.  After refund of the amount the complainant has approached this Commission.  The OPs have issued advance premium receipt and not issued policy and there is no fault on the OPs and prays to dismiss the complaint.

04.   The complainant has filed affidavit evidence by way of examination-in-chief and got exhibited seven documents as Annexure-C.1 to C.7.  The Branch Manager of OP No.2 has filed affidavit evidence by way of examination-in-chief and not produced any document.

05.   Heard arguments on both sides.  The counsel for complainant has filed written arguments.

06.   Now the points that do arise for our consideration are that:-

(1) Whether the complainant has made out deficiency of service against OPs and is entitled for the relief as prayed by him?

 

(2) What order?

 

07.   Our findings on the above points are that:-

POINT (1):-      Is in the Negative.

POINT (2):-      As per the final order

for the following:-

REASONS

08.   POINT (1):-  We have perused the complaint, version, affidavit evidence of both the parties and written arguments filed by the complainant and the documents produced by the complainant.  The complainant’s case is that, the agent of the OP No.2 has insisted the complainant to get Health Insurance Policy from OP No.2 in favour of the complainant and his family members.  On 20.03.2020 the complainant paid Rs.25,352/- on cash and in that regard OP No.2 has issued proposal form and advance premium receipt for receiving the amount as per Annexure-C.1 and C.2 respectively.  And from the date of payment of premium amount OP No.2 did not issue policy bond to the complainant and the OPs have also not replied to the legal notice in-spite of service of the same and filed this consumer complaint against OPs.  On the other hand, the OP No.2 has specifically contended that, the complainant approached the OPs for policy which was processed and the complainant was asked to appear before the medical team of the OP-company and the complainant never turned-up and not submitted himself for medical examination and his policy was not accepted.  The premium amount of Rs.25,352/- was refunded to the complainant’s account at Pragathi Gramina Bank, on his account No.162201156682212 on 10.06.2020 vide NEFT. The complainant has encashed the said amount and after receiving the said amount the complainant approached this Commission with false allegations.

09.   On perusal of the above said material facts, it clearly goes to show that, the complainant after paying the premium of Rs.25,352/- on 20.03.2020 as per Exhibit-C.2 the OP No.2 has issued advance premium receipt as Exhibit-C.1.  But thereafter the complainant has not subjected himself for medical check-up at the cost of OPs and due to his negligence, as the complainant has not attended the medical check-up OP No.2 has returned the advance premium amount of Rs.25,352/- on 10.06.2020 to the complainant’s account at Pragathi Gramina Bank for his account No.162201156682212 through NEFT and in spite of receiving the said advance premium amount the complainant has approached this Commission to get wrongful gain.

10.   Now it is relevant to state here that, in the complaint the complainant prays to direct the OPs to return the premium amount of Rs.25,352/- with compensation and interest.  But in the affidavit by way of examination-in-chief he has sworn that, the Hon’ble Court may be pleased to award compensation of Rs.5,00,000/- and direct the OPs to pay the said amount and premium amount along with interest.  But in the complaint the complainant has not stated about the compensation of Rs.5,00,000/- and in the written arguments filed by the complainant he prays to direct the OPs to pay premium amount with interest and compensation from the date of premium interest @ 18% in all Rs.6,00,000/-.  The same is contradictory to one another.  The complainant is not definite in seeking the relief against OPs.  Further the complainant in his written argument has go beyond the averments which are not stated neither in the complaint nor in the affidavit evidence by way of examination-in-chief and the same are improvement of the case of the complainant and are all rejected.  Further Para-3 & 4 of the written arguments are all improvement of the case of the complainant which have no bearing.  The complainant in the written arguments has stated at Para-6 that, he has no knowledge of crediting of the amount to his Bank account and the same is came to know by the complainant after filing version, but the said fact has also not stated in his examination-in-chief and it clearly discloses that, the complainant has intentionally made false allegations against the OPs in-spite of knowing the crediting of the amount to the account of the complainant.  Hence the complainant is not entitled to seek the said amount which was already remitted to the complainant’s account and he cannot seek such relief once again before this commission.

11.   Now it is relevant to state here that, contract of insurance is based on “utmost bonafide and good faith” but the complainant has not done by subjecting himself for medical examination.  In recent days, it is common that, no person will undergo medical examination before taking policy and it is to be made mandate with respect to health insurance policy, on any age group and medical certificate is to be attached to the proforma.  Such persons need not go to the doctors of insurance company by wasting their precious time and they can do medical checkup at any Government Hospital by saying the fact of taking health insurance policy and attach the certificate in the proforma.  It is no doubt true that, Consumer Protection Act is for the beneficiary of consumers, if it is in the genuine cases only and not in all cases.  

12.   The complainant has contended that, he made several requests and demands with OP No.2 to get policy bond, but OP postponed the same on one or the other reason.  On the other hand, OP No.2 has contended that, they requested the complainant to come for medical checkup at their cost, but the complainant not attended the medical check-up.  But to support their contention they have not produced any supporting document/evidence.  Hence the said contentions of the parties are all goes in vain.

13.   Further it is relevant to state here that, pre-payment of premium is not a condition prescribed by law, but it is the general practice of the insurance companies and almost a common practice of all the insurers.  A contract of insurance is concluded only when the party to whom an offer is made accept it unconditionally and that acceptance is communicated to the proposer.  But here in the case on hand the OP No.2 has not at all accepted the proposal of the complainant and the acceptance is also not communication to the proposer.  That being so, there is no conclude contract between the parties and hence the OP No.2 has returned the premium amount to the complainant as the complainant has not subjected himself for medical examination.  In this regard the Hon’ble Apex Court has held that, mere receipt and retention of premium and until preparation of the policy document does not amount to acceptance as reported in 1984 (2) SCC Page-179 in the case of Life Insurance Corporation of India Vs Komal Valli.  The principal of the above said citation is attracted to the facts of the case on hand.  Hence as discussed above, it clearly goes to show about the negligence on the part of the complainant for not subjecting himself for medical examination and hence there is no deficiency of service on the part of OPs. 

14.   Now it is relevant to state here that, the complainant and his counsel are not respecting to the Court while addressing arguments and even they have not listen to the say of the court and hence the complainant is not entitled for any relief as prayed by him and accordingly we answer Point No.1 is in the Negative.

15.   POINT (2):-      In view of the finding on Point No.1 and the discussion made thereon, we proceed to pass the following:-

ORDER

01.   The Consumer Complaint filed by the complainant is dismissed.

02.   Send a copy of this order to both parties immediately.

 

(Dictated to the Stenographer, transcribed by him, corrected and then pronounced by us on this 19^TH DAY OF JANUARY 2021)

 

 

 

                  MEMBER                               PRESIDENT