This revision petition has been filed by the petitioner Reliance Nippon Life Insurance Co. Ltd. & anr. against the order dated 21.02.2018 of the State Consumer Disputes Redressal Commission, West Bengal (in short ‘the State Commission) passed in First Appeal No.A/413/2016.
2. Brief facts of the case are that the respondent/complainant filled the proposal form for policy named (Reliance Guaranteed Money Back Plan) on 28.10.2011. The petitioners/opposite parties vide letter dated 01.11.2011 requested the respondent/complainant to go through the medical tests as advised by underwriters of the company in order to decide whether the policy should be issued or not. On 12.11.2011, the petitioner Company’s underwriters took a decision to waive off the medical requirements and issued the policy bearing No.19434598 with risk commencing from 12.11.2011. This policy was dispatched on 14.11.2011 and was received by the respondent/complainant on 16.11.2011. On 15.10.2012, petitioner Insurance Company issued policy renewal premium reminder notice. The case of the respondent/complainant is that the complainant was requesting the Insurance Company to refund the premium paid by him and after receiving the letter dated 15.10.2012, he wrote letter dated 06.11.2012 demanding refund of the first premium paid. Petitioner company denied the refund of premium on the ground that the policy was issued and no request was made within the “free look period of 15 days” for cancellation of the policy. Aggrieved by the refusal for refunding the premium, the complainant filed the consumer complaint bearing no.284 of 2013 before the Consumer Disputes Redressal Forum, Unit-I, Kolkata, (in short the “District Forum”). The complaint was resisted by the petitioners/opposite parties by filing the written statement before the District Forum. The opposite parties denied all the allegations and stated that no request was made in the “free look period of 15 days”, therefore, the premium cannot be refunded. The District Forum vide its order dated 15.04.2016 dismissed the complaint.
3. The respondent/complainant preferred an appeal bearing no. No.A/413/2016 before the State Commission and the State Commission allowed the appeal and set aside the order of the District Forum vide its order dated 21.02.2018 and the Insurance Company was directed to refund Rs.49,999.73 to the complainant along with simple interest @9% p.a. from the date of filing of the complaint before the District Forum till full and final payment is made.
4. Heard the learned counsel for both the parties and perused the record. Learned counsel for the petitioners stated that the State Commission has not correctly appreciated the fact that complainant had filled the proposal form to get the policy and when the policy was issued to the complainant, the complainant cannot take a plea that he was apprehensive that the Insurance Company may refuse the claim as they had asked for the medical tests. When the policy has been issued to the complainant, in fact, the contract has been completed. There is a special clause in the policy that if the insured is not satisfied with the policy, the same may be requested for cancellation and refund of premium can be sought within the “free look period of 15 days.” In the present case, the assertion of the complainant is that he was requesting the Insurance Company for refund of the premium for quite some time is not supported by any evidence because the first letter for refund of the premium has been sent on 06.11.2012. Thus, the complainant sent the letter for refund of premium after enjoying the policy for about full one year. If the complainant had any doubt about the genuineness of the policy or about the letter asking for medical tests, he should have clarified from the Insurance Company by sending letter to the Insurance Company, however, the complainant enjoyed the policy for full one year and when he received the notice for renewal premium, he took this opportunity to seek refund of the first premium. The State Commission has not agreed with the observation of the District Forum that the Insurance Company waived off the requirement of the medical tests and issued the policy. The State Commission has observed that no clarity was given by the Insurance Company, therefore, it was not possible for the complainant to read the mind of the insurer. The learned counsel for the petitioners stated that there was no question of reading the mind of the insurer because the policy was already issued as per the proposal form and it only meant that the proposal was accepted and the contract of insurance was complete by issuance of the policy. Moreover, if the complainant had any doubt, he should have clarified from the Insurance Company.
5. On the other hand, learned counsel for the respondent/complainant stated that there was 30 days’ time given in the letter dated 01.11.2011 for completing the medical tests. The agent of the insurance company did not assist the complainant in getting these medical tests organised. It was argued that the complainant could not get the medical tests done and could not submit reports to the Insurance Company, however, the Insurance Company issued the policy within that period of 30 days, therefore, the complainant was not sure whether the requirement of the medical tests was waived off because there was no communication from the Insurance Company along with policy document or separately. There was a genuine doubt in the mind of the complainant that if any claim is generated within the currency of the policy, the Insurance Company may repudiate the claim on the ground that the medical test report was not submitted. The complainant was under the genuine impression that the policy would have been cancelled because medical tests’ reports were not submitted to the underwriters of the company. In the letter dated 01.11.2011, it is clearly mentioned that if the medical tests are not completed, the proposal will not be accepted. Though the complainant was pursuing the refund of the premium amount with the opposite parties, however, the complainant was surprised to receive the renewal notice and then he thought it necessary to send the request in writing for refund of the first premium amount. Before that, the complainant was under the impression that, as he did not submit the medical tests report, the policy would stand cancelled and he will get the refund of the premium in due course. The State Commission has rightly appreciated the concern of the complainant and has rightly decided the appeal and complaint of the complainant.
6. I have carefully considered the arguments advanced by the learned counsel for both the parties and have examined material on record. It appears to me that both the parties in the present case have been negligent. The opposite parties reversed decision within the time period of 30 days given vide letter dated 01.11.2011 for medical tests to be submitted and issued the policy on 14.11.2011. Even though the policy was sent to the complainant, no clarificatory letter was issued by the opposite parties stating that the requirement of medical tests has been waived off by the insurer. Thus, the opposite parties were negligent in not sending this intimation to the complainant. It was obvious on the part of the complainant to have become confused whether he was required to proceed with the medical tests or the matter was over as he had received the policy. The negligence on the part of the complainant is also there because after the completion of 30 days and after receiving the policy, he did not try to seek any clarification from the Insurance Company whether his policy was cancelled or was it continuing. The complainant took the advantage of the confusion and enjoyed the policy for about a year. Perhaps both the parties were relying on the possible interpretation of the circumstances in their favour. The opposite parties may be relying on the possible interpretation that if a claim arises, they can always say that as the medical test report was not supplied, the claim may not be admissible under the policy. The complainant may be relying on the fact that if a claim arises, he can always insist that the claim was admissible under the policy as he had received the policy without medical tests. In my view, clearly opposite parties have been negligent in issuing the policy pre-maturely within the period of 30 days mentioned in the letter dated 01.11.2011 for submitting the medical tests without giving any clarificatory communication to the complainant that the insurer has waived off requirement of the medical tests. There is also contributory negligence on the part of the
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complainant that he did not object to the issuance of the policy and did not make any effort to clarify his doubts from the Insurance Company after the period of 30 days was over and he enjoyed the policy for roughly full one year. In these circumstances, the complainant is not eligible to get the refund of full premium amount, however, in the circumstances, I deem it fit that 50% premium amount may be refunded to the complainant. 7. Based on the above discussion, the revision petition no.1304 of 2018 is partly allowed and the petitioner Insurance Company is directed to pay Rs.25,000/- (rupees twenty five thousand only) to the complainant along with interest @6% p.a. from the date of filing of the complaint before the District Forum till actual payment. Accordingly, the order dated 21.2.2018 of the State Commission stands modified. This order be complied with by the Insurance Company within a period of 45 days from the date of receipt of this order.