C.C. filed on:29.01.2016

C.C. Disposed on:17.02.2017

BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, TUMKUR

DATED THIS THE 17^th DAY OF FEBRUARY –  2017

C.C. No. 17 OF 2016

:PRESENT:

SMT. PRATHIBHA. R.K. BAL LLM. PRESIDENT,

SMT. GIRIJA, B.A. LADY MEMBER

COMPLAINANT/S:

1.       Naseem Unnisa

          W/o Late Afroz Pasha,

          Aged about 45 years.

2.       Mahammed Thoushid

          S/o Late Afroz Pasha,

          Aged about 24 years.

3.       Mujahid Pasha

          S/o Late Afroz Pasha

          Aged about 19 years.

4.       Anjum Ara

          S/o Late Afroz Pasha,

          Aged about 17 years

          Since minor represented by

          her mother 1^st Complainant.

          All are residents of Veerasagara

          Village, Tumakuru Taluk,

          Tumakuru District.

( By Sri/Smt.  B.S. Doreswamy –  Advocate)

-V/s-

OPPOSITE PARTY/IES

1.       The Manager,

          Reliance Money Solution Pvt. Ltd.,

          2^nd Floor, Vishrutha Building,

          Batawadi Circle, NH-4,

          Tumakuru.

2.       The Manager,

          Reliance Life Insurance Company Limited,

          Office at No.28, 4^th Floor, Centenary

          Building, M.G.Road, Bangaluru.

 (By Sri./Smt. K.P.Manju Prakash, Advocate)

: O R D E R :

BY SMT. PRATHIBHA R.K. - PRESIDENT

The complainants have filed this complaint under section 12 of the Consumer Protection Act 1986 against the OPs alleging deficiency in service on the part of OPs and prays to direct the OPs to pay the policy benefit of Rs.2,80,000/- + bonus and death benefit covered under the policy and further prays to direct the Ops to pay damages of Rs.1,00,000/- along with interest towards pain and suffering, mental shock and agony including cost.  

The brief facts of the complaint are as under:-

2.       The complainants submit that the Afroz Pasha who is the husband of the 1^st complainant and Father of complainant Nos. 2 to 4.  The complainants further submit that late Mr.Afroz Pasha had obtained life insurance policy from OP/Company dated16/11/2015 under the R.G.M.B. scheme by paying half yearly premium amount of Rs.7,500/- vide receipt No.091522144.  The complainants further submit that Mr.Afroz Pasha had died in a road traffic accident on 04/12/2015 by leaving beyond the complainants as his legal heirs.  Thereafter the complainants submitted a claim form to the OP/Company to settle the death benefits of insured Afroz Pasha.  But the Ops have failed to settle the death benefits of insured Afroz Pasha i.e. sum assured + bonus and death benefits.  Due to this act of the Ops, the complainants have suffered mental agony and also financial problem and facing trouble after the death of the insured.

          The complainants further submit that though the complainants have produced sufficient records to the OP/Company and the policy was in force at the time of death of Afroz Pasha, the Ops have failed to settle the death benefits as per the terms and conditions of the policy.  Hence, the complainant filed this complaint alleging deficiency in service on the part of Ops.        

3.       Upon service of notice, the OPs appeared through their counsel and filed the version contending that the complaint is not maintainable as there is no cause of action against the OP/Company.  There is no valid contract between the OP/Company and the husband of the complainant No.1 

          The OPs further submit that the contract of insurance is concluded only when party to whom offer has been made accepts unconditionally and communicates his acceptance to person making offer and mere receipt and retention of deposit to be adjusted against the first premium even until after the death of the applicant or mere preparation of the policy document is not acceptance since the acceptance must be significant by some acts agreed on by the parties and the said principle also reiterated by Hon’ble Apex Court in the case between Life Insurance Corporation of India Vs. Raja Vasireddy Komalavalli Kamba and Ors (1984) 2SCC719 as under:

“The mere receipt and retention of premium until after the death of the applicant or the mere preparation of the policy document is not acceptance.  Acceptance must be signified by some act or acts agreed on by the parties or from which the law raises a presumption of acceptance”

          The Ops further submitted that before issuance of policy, pre insurance verification call was made by the OP in which the husband of the 1^st complainant mentioned that he is having diabetes and also taking insulin regularly.  Hence, the OP company issued a letter dated:26/11/2015 to Mr.Afroz Pasha requesting him to submit additional information regarding diabetes.  But Mr.Afroz Pasha had not supplied the same.

          The Ops further submitted that the above information was not mentioned in the proposal form submitted by the husband of the complainant.  Due to medical history mismatch, the policy was withdrawn and the same is accepted by underwriters.  The initial premium amount of Rs.7,500/- paid by the insured was refunded back to him through cheque No.801602, Dt:08.01.2016.  Since, at the initial stage itself, the policy was withdrawn the complainants cannot claim any benefits from the policy.  The Ops further submitted that the contents of Para-4, 5, 6, 8, 9 and prayer clause are wrong and thereby they denied the same.  The Ops further submitted that the complaint filed by the complainant is baseless, frivolous and not substantiated by any evidence or any basis for claim and therefore requested to dismiss the complaint in the interest of justice and equity.    

4.       Both parties have filed their affidavit evidence. The complainant has marked the documents as Ex.C1 to C9. The OPs have marked the documents as Ex.R1 & R2.  Heard the arguments and then posted the case for orders.

5.       Based on the above materials, the following issues will arise for our consideration.

1. Whether there was deficiency in service on the part of the OPs as alleged by the complainant?

2. What Order?

  6.     Our answer to the above issues are as under:-

Issue No (1)          :        In the Negative

Issue No (2)                    :        As per final order below

:REASONS:

Issue Nos.(1) & (2):-

7.       On perusal of the pleadings, evidence and documents produced by both the parties, it is an admitted fact that the husband of the complainant Mr.Afroz Pasha had obtained the policy under R.G.M.B. scheme dated:16/11/2015 and paid half yearly premium of Rs.7,500/- vide receipt No.091522144.  It is also an admitted fact that the husband of the 1^st complainant died in a road traffic accident on 04/12/2015.  To substantiate the case of the complainant the complainant has produced some documents such as original premium paid receipt as Ex.C1, true copy of FIR as Ex.C2, True copy of P.M. report as Ex.C3, death certificate as Ex.C4, office copy of legal notice as Ex.C5, RPAD receipt and acknowledgment as Ex.C6 & 7, reply notice as Ex.C8 and cheque bearing No.801602 as Ex.C9. 

8.       The contention of the complainants is that the Ops have not settled the death benefit of the insured though the policy was in force at the time of death of insured Mr.Afroz Pasha.

9.       Admittedly, late Mr.Afroz Pasha had obtained the policy by paying half yearly premium of Rs.7,500/- Dt:16/11/2015 vide receipt No.091522144 as per Ex.C1.  The OPs have issued a proposal form and the complainant had accepted the proposal form which was filled and signed by late Mr.Afroz Pasha, the husband of 1^st complainant as per Ex.R1.  Thereafter the Ops have not issued the policy and in the meanwhile, the OP No.2 had sent a letter to late Mr.Afroz Pasha on 26/11/2015 and asked to submit some documents as per Ex.R2.  Thereafter the husband of the 1^st complainant had died in the road traffic accident on 04/12/2015. 

10.     The contention of the OP is that the OP/Company before issuance of the policy a pre insurance verification call was made to late Mr.Afroz Pasha.  Late Mr.Afroz Pasha had informed that he is a diabetic patient and taking insulin.  But in the proposal form, nowhere he has mentioned that he was suffering from any medical ailment prior to applying for policy.  Hence, the OP/Company issued a letter dated:26/11/2015 as per Ex.R2 requesting Mr.Afroz Pash to submit some documents, but late Mr.Afroz Pasha had not supplied the documents.  Hence, the OP/Company had not issued the policy.  The letter dated:26/11/2015/Ex.R2 reads as under:-

“We would like to inform you that your application has been assessed and there are certain requirements that need to be complied with before processing the same.  Request you to provide us with the below listed requirement(s)/document(s).

HbA1c [medical test(s)] to be done from the company’s empanelled center.

Fasting Blood Sugar [medical test(s)] to be done from the company’s empanelled center.

MEF (medical examination report) & RUA (Routine urine analysis) (medical test(s)] to be done from the company’s empanelled center.

Diabetes questionnaire to be answered by life to be assured with signature and date”.

On perusal of the documents, the complainant had failed to produce cogent evidence to prove that Mr.Afroz Pasha had submitted the documents to OP/Company.   Hence, on the above facts, it is clear that the proposal form was not accepted by the OP and there is no conclusion of contract between the OP and the husband of the complainant late Mr.Afroz Pasha.  Moreover, there is no issue of policy and the same does not give a right to the complainant to claim the policy benefit.  Further, though the acceptance of half yearly premium does not mean that the proposal of the complainant was accepted by the OP. 

11.     Further, the OP in his written arguments has stated that the contract of insurance is concluded only when party to whom offer has been made accepts unconditionally and communicates his acceptance to person making offer and mere receipt and retention of deposit to be adjusted against the first premium even until after the death of the applicant or mere preparation of the policy document is not acceptance since the acceptance must be signified by some acts agreed on by the parties.  The Ops further submitted that the said principle is also reiterated by the Hon’ble Apex Court in the matter of Life Insurance Corporation of India Vs. Raja Vasireddy Komalavalli Kamba and Ors (1984) 2SCC719 as under:

“The mere receipt and retention of premium until after the death of the applicant or the mere preparation of the policy document is not acceptance.  Acceptance must be signified by some act or acts agreed on by the parties or from which the law raises a presumption of acceptance”

On the above discussion and based on the judgment, we are of the opinion that there is no deficiency in service on the part of Ops.  Hence,  we answer the above points accordingly and proceed to pass the following:-

-:O R D E R:-

The complaint filed by the complainants is hereby dismissed. No order as to costs.

Communicate the orders to the parties.

(Dictated to the stenographer, transcribed and typed by him, then corrected and pronounced in the open Forum on this the 17^th Day of  FEBRUARY 2017).

       Sd/-                                                                   Sd/-

LADY MEMBER                                                            PRESIDENT