State Consumer Disputes Redressal Commission
Sh. Rajinder Singh Negi. vs Icici Prudent Life Insurance Co. Ltd. on 25 May, 2016
H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
SHIMLA.
First Appeal No.: 42/2016
Date of Presentation: 23.02.2016
Date of Decision: 25.05.2016
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Shri Rajinder Singh Negi,
Son of Shri Jagat Singh Negi,
Resident of H.No.22/8,
Cinema Street, Paonta Sahib,
Himachal Pradesh.
... Appellant.
Versus
ICICI Prudential Life Insurance Company Limited,
Through its Manager at Vinod Silk Mills Compound,
Chakaravarthy Ashok Nagar,
Ashok Road, Kandival (E),
Mumbai, Maharastra.
...Respondent
...........................................................................................
Coram
Hon'ble Mr. Justice Surjit Singh, President.
Hon'ble Mrs. Prem Chauhan, Member.
Hon'ble Mr. Vijay Pal Khachi, Member.
Whether approved for reporting?1
For the Appellant: Mr.Ashok Tyagi, Advocate.
For the Respondent: Mr. Jagdish Thakur, Advocate
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O R D E R:
Justice Surjit Singh, President (Oral) Appellant has preferred this appeal against the order dated 18.09.2015, of learned District Consumer Disputes Redressal Forum, Sirmaur at Nahan, whereby his complaint, under Section 12 of the Consumer Protection Act, 1986, 1 Whether reporters of the local papers may be allowed to see the order? Rajinder Singh Negi Versus ICICI Prudential Life Insurance Co. Ltd.
(F.A. No.42/2016) which he filed against the respondent, has been dismissed.
2. Appellant filed a complaint, under Section 12 of the Consumer Protection Act, 1986, against the respondent, alleging that in the year 2010, he had purchased a health saver policy, per which, premium at the rate of `10,000/-, was required to be paid. He alleged that he had paid the premium regularly and the premium for the year 2012, was paid on 13.04.2012. He alleged that on 20.06.2012, he received a letter, copy Annexure 'A', acknowledging that amount of `10,000/-, on account of premium, had been received, but the policy required to be revived, for which he was called upon to submit personal health declaration, duly filled in and signed, at the nearest ICICI PRU Life Branch. He received another letter dated 01.08.2012, copy Annexure 'B'. He was intimated that for the revival of policy, he should submit Medical Examination Report, Electro Cardio Gram (ECG), Routine Urine Analysis, HBAIC, Complete Blood Count and combination of 12 tests, within thirty days and the 2 Rajinder Singh Negi Versus ICICI Prudential Life Insurance Co. Ltd.
(F.A. No.42/2016) expenditure, on the aforesaid examination and tests, was to be borne by him.
3. Appellant felt aggrieved and filed a complaint, under Section 12 of the Consumer Protection Act, 1986, before the learned District Forum, seeking a direction to the respondent to accept the premium of `10,000/-, and to treat the policy, as having not lapsed or to revive it, without insisting upon medical examination report and test reports, referred to hereinabove.
4. Complaint was contested by the respondent. It was pleaded that due date for payment of premium, for the year 2012, was 12.01.2012 and that the premium could have been paid within thirty days after 12.01.2012, as the policy provided for thirty days grace period. It was stated that premium was not only not paid by the due date, but it had also not been paid within thirty days grace period and, hence, the policy stood lapsed. It was stated that in accordance with the terms & conditions, appellant was required to submit medical examination report and also to get certain pathological tests done on himself and to submit the reports. Learned 3 Rajinder Singh Negi Versus ICICI Prudential Life Insurance Co. Ltd.
(F.A. No.42/2016) District Forum has accepted the respondent's plea and dismissed the complaint.
5. We have heard learned counsel for the parties and gone through the record.
6. Terms & conditions of the policy are available on record as Annexure OP-2. Clause-9 of the terms & conditions, pertains to revival/re- instatement of lapsed policy. Clause 9(f) read as follows:
The company may subject all the
Insured Person(s) to medical
examination before taking a decision on the revival of the Policy. The Policyholder shall have to furnish, at his own expense, satisfactory evidence of health as required by the Company.
7. A bare reading of the above reproduced clause shows that when the policy lapses and the insured seeks its revival, insurance company, has the right to call upon the insured to submit medical examination report, at his own expense. Admittedly, in this case, the policy had lapsed on account of premium having not been paid by the due date and also within the 4 Rajinder Singh Negi Versus ICICI Prudential Life Insurance Co. Ltd.
(F.A. No.42/2016) extended period of grace. Now, once the policy had lapsed, respondent in exercise of the right, reserved by it to itself, vide aforesaid clause 9(f), was within its right to ask the appellant to submit medical examination report. So, the respondent cannot be said to have committed an act of deficiency in service.
8. However, we do feel that when the policy has not been revived, on account of non- submission of medical examination report and some other repots, the respondent cannot retain the amount of `10,000/-, paid by the appellant, in the month of April, 2012, towards the premium for the year 2012. So, we dispose of the appeal with the direction to the respondent to refund the aforesaid amount of `10,000/-, if not already refunded. Learned counsel representing the appellant says that premium for the year 2013 and 2014 has also been paid by the appellant to the respondent. Though, there is no material on record to support his submission, we direct that in case any amount of money has been paid by the appellant towards the premium, in respect of policy, in question, for the period subsequent to 5 Rajinder Singh Negi Versus ICICI Prudential Life Insurance Co. Ltd.
(F.A. No.42/2016) the year 2012, the same shall also be refunded by the respondent to the appellant.
9. A copy of this order be sent to each of the parties, free of cost, as per Rules.
(Justice Surjit Singh) President (Prem Chauhan) Member (Vijay Pal Khachi) Member May 25, 2016.
GAURAV) 6