SMT. RAVI SUSHA: PRESIDENT
This complaint has been filed U/S 35 of Consumer Protection Act 2019 for getting an order directing the 1st opposite party to renew the policy of complainant with past seniority and to receive his premium, or pay a compensation of 50% of the sum insured alleging deficiency in service on the part of opposite parties.
The facts of the complaint is that the complainant have taken a group Insurance policy from Cigna TTK Health Insurance (OP No.1) Co.Ltd. with effect from 07/09/2018, with policy No.100200089901/01/00 and consumer ID 1151293 and got renewed up to 25/09/2020. For further renewal, when the complainant approached both the opposite parties, it was intimated that 2nd OP Unimoni Financial Service Ltd. has not renewed the relationship with the 1st OP Cigna TTK Health Insurance (OP No.1) Co.Ltd. However, they instructed the 1st OP for migrating the group policy to retail with continuing benefits. After many approach and verbal communications the 1st OP agreed to migrate the policy with a condition for a fresh medical checkup. As per the above instruction complainant paid the renewal premium amount Rs.14,069/- and undergone the medical checkup. After long days of medical checkup the 1st OP informed him verbally that there is a problem in his ECG and the premium amount was refunded on that ground. Denial of policy renewal was an irresponsible act on the part of the OPs. It is a deficiency of service imparted by the OPs. Hence this complaint.
After receiving notices, OPs entered appearance and filed their version separately. Both OPs denied the contentions of the complaint. It is stated by OP No.1 that the complainant submitted a proposal form dated 24/09/2020 along with portability form for issuance of an individual Prohealth Insurance Policy migrating from his earlier group policy. The complainant had declared in the proposal form that the proposal form is subject to the Board approved underwriting policy of the insurance company. The complainant had approached the 1st OP for porting the policy only the day prior to the expiry of its earlier policy. The complainant had also signed a portability consent form. The complainant had declared in Exhibit B3, portability consent form that “the application for portability to Manipal Cigna Health Insurance company Ltd. is to be made at least 45 days before the policy renewal date of current insurance policy. As in this case, the application has been submitted to Manipal Cigna Health Insurance Co. Ltd at a date much closer to the expiry date of current policy, there may be break in the insurance.” The complainant had also declared in the portability consent form that the acceptance of coverage under pro Health Insurance will be subject to the company’s underwriting policy including pre-policy medical tests. The complainant had also declared that he was fully aware that in the event of the portability proposal being rejected due to any of the above reasons the insurance cover may cease if the grace period for renewal has lapse. In such a situation all continuity benefits shall cease. The complainant as admitted by him had undergone, medical checkup and the completed report was received by the 1st OP on 20/10/2020. Since the ECG of the complainant was abnormal, the 1st OP decided not to issue the policy to the complainant. The complainant himself was aware and had submitted the proposal form and the portability consent agreeing that the issuance will be subject to the underwriting policy and pre-policy medical tests. It is more important to state here that the company had requested him to undergo pre-policy medical examination on 27/09/2020 and reminded him through letters dated 5th October, 2020 and 11th October 2020. However, the complainant completed the medical checkup only on 20th October, 2020. Since the 1st OP did not issue any policy to the complainant, the premium paid by the complainant was refunded to the complainant to the account provided by the complainant in the proposal form. Further submitted that the 1st OP has the discretion to accept or deny the fresh policy according to the underwriting policy of the 1st OP. There has been no deficiency in service or unfair trade practice on the part of the OPs. Hence prayed for dismissal of complaint.
Contention of OP No.2 is that the complainant was informed about the non renewal of the policy between Unimoni (Erst while UAE exchange) and Manipal Cigna TTK Health Insurance Co. Ltd.. Still all efforts were made by this answering OP to request Cigna TTK Health Insurance Co. Ltd. to migrate the insurance policy to retail policy from the existing group policy and based on the requirement from 1st OP Cigna TTK Heath Insurance Ltd, it was appraised to the complainant that there could be a medical checkup for taking an individual health policy. There is no deficiency of service from this OP in the matter of migrating the group insurance policy to retail policy. Hence prayed for the dismissal of complaint.
At the evidence time, complainant has filed chief affidavit and documents. He has been examined as Pw1 and the document marked Ext.A1 to A5. Ext. A1 is the copy mail issued by OP No.2 to OP No.1, Ext.A2 and A3 are insurance certificated. Ext.A4 policy details and Ext.A5 copy of email. Pw1 has been subjected to cross examination of OPs 1 and 2. From the side of OPs, the manager of the 1st OP at their office at Kannur Mr. Akhil Gopinathan has filed chief-affidavit and submitted documents. He was examined as Dw1, and the documents were marked as Ext.B1 to B6. Ext. B1 is the copy of Medical examination report Ext.B2 lab report, Ext.B3 proposal form, Ext.B4 copy of the portability consent form, Ext.B5 series copy of letters (3 in Nos.) and Ext.B6 copy of letter dated 21/10/2020. Dw1 was cross-examined by complainant.
After that the complainant and the learned counsel for OPs have filed their respective written argument notes.
The undisputed facts are complainant had taken a group insurance policy from OP No.1 from 07/09/2018 till 25/09/2020. Further complainant’s renewal application was rejected by OP No.1 because the ECG of the complainant into the medical checkup showed abnormality. Further during filing of the renewal application, there was no business relationship between OP No.1 and OP No.2. OP No.2 is the master policy of the group insurance policy in which complainant had joined.
Complainant’s case is that he had to apply renewal application due to the non-renewal of business relationship between OP Nos 1 and OP No.2. Complainant alleged that he had to take medical checkup also due to the same reason. According to complainant denial of policy renewal even after paid the renewal premium of Rs.14,069/- was an irresponsible act on the part of the OPs and the said action amounts to deficiency in service from the side of OPs.
OP No.1 submitted that they had not agreed to the complainant to migrate the policy with a condition for a refresh medical checkup. The averment of the complainant that they agreed to migrate the policy with a condition for a fresh medical checkup is denied. OP No.1 contended that the complainant submitted a proposal form dated 24/09/2020 along with portability form for issuance of an individual pro-health Insurance policy migrating from his earlier group policy. OP submitted as per the condition of policy, the application for portability to Manipal Cigna Health Insurance company Ltd is to be made at least 45 days before the policy renewal date of current insurance policy. But the complainant has submitted application of portability at a date much closer to the expiry date of current policy ie only the day prior to the expiry of his earlier policy. OP No.1 also submitted that in the portability consent form (Ext.B3) it is declared that the acceptance of coverage under pro health Insurance will be subjected to the company’s underwriting policy including pre-policy medical test. Further in the event of the portability proposal being rejected due to any of the reasons including pre-policy medical test, the insurance cover may cease if the grace period for renewals has lapsed. In such a situation all continuity benefits shall cease. Further complainant had given the medical checkup report to OP No.1 only on 20/1/2020 even after requested to under medical examination on 27/09/2020 and sent remainder letters dated 05/10/2020 and 11/10/2020 (Ext. B5 series). On perusal of Ext.B5 series OP No.1 informed the complainant to submit medical examination report within the period in order to process the renewal proposal. According to OP No.1, since they did not issue any policy to the complainant; the premium paid by the complainant was refunded to the complainant. Further contended that OP No.1 has the discretion accept or deny the fresh policy according to the under writing policy of the 1st OP.
It is to be noted that during cross-examination of Pw1, for OP No.1 complainant totally dined the signature seen in Ext.B3 and B4 (renewal proposal form and portability consent form). According to Pw1 he had not given such renewal proposal form and portability consent form and signatures seen in those documents are not belonged to him. Further he denied the receipt of Ext.B5 series letter from OP No.2. But Pw1 admitted the refund of renewal premium from OP No.2 and also the lab report with ECG Ext. B2 series. Though complainant denied Ext.B3, B4, during cross-examination by him to Dw1, complainant put questions that if OP No.2 had renewed the business with OP No.1, complainant could have renewed his policy without port to individual policy and need not taken medical checkup. From the said question itself, the fact that complainant had given Ext.B3 and B4 to OP No.2, is evident.
It is well established that the renewal of a policy amounts to a new contract, a fresh declaration is to be taken at the time of renewal of the policy and the insurance company will accept the proposal form based on the policy terms and conditions including the health status of the proposer. The insurance company has the discretion to accept the fresh policy according to the conditions of the policy. Here from Ext.B1 and B2 it has been established that the ECG of the complainant was abnormal. The learned counsel of OP No.1 submitted a citation of Hon’ble apex Court in Life Insurance corporation of India V/s Raja Vasireddy Komalavalli kamba (1984) 2SCC719, has held that mere receipt and retention of premium until after the death of applicant or the mere preparation of the policy document is not an acceptance.
Here also there is no evidence that renewal premium was accepted by OP No.2. After obtaining medical checkup report of the complainant, OP No.2 repudiated the proposal form of complainant through ext.B6 letter stating the reason that the rejection of proposal is purely on the basis of health status of the complainant and further the premium amount collected, shall be refunded. Since an insurance is a contract entered between the parties in “almost good faith” rejection of proposal form as pre the terms and conditions of the policy, Insurance company is entitled to reject.
Here complainant raised another contention that both OPs colluded each other and discontinued their business of issuing policy.
For the said contention no piece of evidence is before us. More over during cross-examination Dw2 deposed that the group policy is not being renewed by some master policy holder.
OP No.2 submitted that from Ext.A5 communication it is clear that there is no business relationship between the OP No.1 and the OP No.2 at the time of the renewal application from the complainant and also stated that as an insurance agent, they have no authority to decide to whom an insurance can be provided and still all efforts were made by them to request OP No.1 to migrate the insurance policy to retail policy from the existing group policy through Ext.B1 series. It is also evident that complainant has deposed that there is no deficiency of service from the part of OP No.2.
We therefore from the aforesaid facts and circumstances of this case, opinioned that there is no deficiency in service on the part of OPs 1 and 2. So complainant is not entitled to get relief as prayed in the complaint.
In the result complaint fails and hence the same is dismissed. No order as to cost.
Exts.
A1- Mail copy issued from OP2 to OP1
A2- Copy of insurance certificate dated 07/09/2018 to 08/09/2019
A3- Copy of insurance certificate dated 26/09/2019 to 25/09/2020
A4- Copy of policy details
A5- Copy of policy Gmail
B1- Copy of medical examination report (already marked through complainant)
B2- lab report (already marked through complainant)
B3- Proposal form
B4- Copy of portability consent form
B5(series)- Copy of letters dated 27/09/2020, 05/10/2020 and 11/10/2020(3 in numbers)
B6- Copy of letter dated 21/10/2020
Pw1-Complainatn
Dw1- Akhil B G- Witness of OP
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Assistant Registrar
