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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. B.C. Gupta, Presiding Member and Dr. S.M. Kantikar, Member
Omprakash Agarwal —Appellant
versus
HDFC Standard Life Insurance
Co. Ltd. and Ors. —Respondents
First Appeal No.518 of 2013
(Against the Order dated 18/03/2013 in Complaint No. 131/2009 of the State Commission Maharashtra)
Decided on 6.4.2018
Counsel for the Parties:
For the Appellant:Mr. Z. Khan, Advocate
For the Respondent Nos.1(a) (b) and 3:Mr. Joydip Bhattacharya, Advocate Mr. Hitesh Kumar, Advocate
For the Respondent No.2: Nemo
IMPORTANT POINT
Mere receipt and retention of premium does not constitute acceptance of Policy document.
Headnote:Consumer Protection Act, 1986—Sections 19 and 21(a)(ii)—Insurance—Mediclaim Policies—Treatment for cancer—Claim repudiated by OP Insurance Company on ground that same was not payable if critical illness was detected within six months of issuance of insurance policies—Complaint dismissed by State Commission—Critical illness occurred within six months of commencement of Policies and hence, extra health benefit could not be given to complainant—Mere receipt and retention of premium does not constitute acceptance of Policy document—Acceptance to be completed must be communicated to the offer, either directly or by some other act—No infirmity, illegality or jurisdictional error in impugned order passed by State Commission—Appeal dismissed. (Paras 9, 10 and 11)
Result: Appeal dismissed.
Dr. B.C. Gupta, Member—This first appeal has been filed under section 19, read with section 21(a)(ii) of the Consumer Protection Act, 1986 against the impugned order dated 18.03.2013, passed by the Maharashtra State Consumer Disputes Redressal Commission (hereinafter referred to as ‘the State Commission’) in consumer complaint No. 09/131, filed by the present appellant. The State Commission dismissed the said consumer complaint on the ground that the appellant/complainant was not eligible to get the benefit of extra health benefit, as per the terms and conditions of the insurance policies in question.
2. Briefly stated, the facts of the case are that the appellant/complainant Omprakash Agarwal had obtained two medi-claim insurance policies for a sum assured of Rs.20 lakh each from the Opposite Party (OP), the HDFC Standard Life Insurance Co. Ltd. The proposal form for obtaining the said policies were submitted on 24.03.2008 alongwith premium amount of Rs.2 lakh each vide cheques of even date. The said premium cheque was realised by the OPs on 02.04.2008, but despite receiving the premium, the appellants were not issued the policies within 15 days from the date of submission of the proposal form. The said policies are stated to have been issued on 11.05.2008 by the OP Insurance Company, taking the plea that additional information/documents regarding the financial status of the complainant were furnished to them on 08.05.2008 only. It is stated that the complainant was diagnosed for the disease of cancer on 20.10.2008, following which, he went to USA for treatment, where he was admitted at the Memorial Cancer Hospital on 04.11.2008 and discharged on 09.11.2008. On his return to India, the complainant filed claim under the medi-claim policies with the OPs on 28.02.2009, claiming a sum of Rs.30,81,800/-. However, the claim was repudiated by the OP Insurance Company on the ground that the same was not payable, if the critical illness was detected within 6 months of the issuance of the insurance policies in question. The complainant filed the consumer complaint in question, seeking directions to the OP Insurance Company to pay the amount claimed by him alongwith interest @18% p.a. from the due date till realisation and also compensation of Rs.9 lakh for mental harassment etc. and Rs.60,000/- as litigation cost.
3. The complaint was resisted by the OP Insurance Company by filing a written statement before the State Commission, in which they stated that after submitting the proposal form on 24.03.2008, the complainant was required to submit copies of the income tax returns, the balance sheet and the profit and loss account statement of his firm for the last 3 financial years. The said documents were submitted by the complainant on 08.05.2008, following which, the policies were issued on 11.05.2008. One of the pre-conditions to be fulfilled under the Policy document is that the critical illness should not have occurred within six months of the date of commencement, or the date of issue of the policies, which is later. Since the policies have commenced on 11.05.2008 and his critical illness of cancer was detected on 20.10.2008, i.e., within six months of the date of commencement of the policies, the complainant was not liable to be given any benefit under the policies.
4. The State Commission, after considering the averments of the parties, upheld the version given by the OP Insurance Company and concluded that the OP Insurance Company was justified in repudiating the insurance claim, based on the terms and conditions of the policies. The State Commission accordingly dismissed the consumer complaint in question. Being aggrieved against the order of the State Commission, the complainant is before this Commission by way of the present first appeal.
5. During arguments before us, it was contended by the learned counsel for the appellant that he had presented the proposal form before the OP Insurance Company alongwith a cheque containi
