PRESIDENT, DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

Consumer Complaint No.-236/2023

Present-Dr. Ramakanta Satapathy, President,

  Sri. SadanandaTripathy, Member,

Tikelal Kumbhar,

S/o-Late MuktiKumbhar,

Permanent R/O-Dudukidadar, PO-Bijadhol, Ps-Jharbandh, Dist-Bargarh

Present R/O- Om Nivas, House No. A-1, Shanti Nagar, PO-Budharaja,

Ps-Ainthapali, Dist-Sambalpur, Odisha                             ……….......Complainant.

Vrs.

1. The General Manager, Reliance Noppon Life Insurance Company Limited (Formerly Known As Reliance Life Insurance Company Limited),

Corporate Office- Reliance Nippon Life Insurance Company Limited,

Western Express Highway, Santacruz Reliance Centre off East,

Mumbai-400055

2. The Branch Manager, Reliance Nippon Life Insurance Company Ltd.

(Formerly Known As Reliance Life Insurance Company Limited),

Budharaja, Sambalpur-768004, Odisha.      ..…....……….Opp. Parties

Counsels:-

1. For the Complainant         :- Sri. R.C. Dash & Associates
2. For the O.P.s                       :- Nitu Roy & Associates.

Date of Filing:18.12.2023,  Date of Hearing :17.09.2024,  Date of Judgement :29.10.2024

Presented by Dr. Ramakanta Satapathy, PRESIDENT

1. The case of the Complainant is that the complaint availed a policy from the O.Ps since 13.03.2012 bearing policy No. 19862454 and paid premium of Rs. 20,217.18p. Yearly premium was paid since 2012 and could not pay in March-2017. In March 2018 the Complainant deposited premium of Rs. 40,438/- vide receipt No. WC 0033692101 dated 26.03.2018 for the year 2017 and 2018 but the O.Ps rejected the policy on 13.04.2018 and refunded the amount. The O.Ps were asked to refund total amount of Rs. 1.00 lakh but only Rs. 38,000/- was refunded. The O.Ps were approached several times for refund of Rs. 62,000/- but it was in vain. A pleader notice was sent on 27.02.2020. The Complainant waited till date but no amount was refunded. Due to Covid-19 situation the Complainant could not file the complaint earlier. The O.Ps are deficient in their service and liable to refund the amount of Rs. 62,000/- with interest and compensation.
2. The O.Ps in reply submitted that the Complainant vide proposal form No. D.378824 submitted the proposal on 22.02.2012. After acceptance policy NO. 198624546 was issued on 22.02.2012 and policy bond was delivered withdrawal/cancellation of the policy option exist for 15 days (Free look period) from the day of receiving the policy bond. As per terms and condition of the policy survival benefit amount of Rs, 38,750/- was given to Complainant vide cheque No. 772543 dated 08.03.2016.

The Complainant failed to pay the 6^th renewal premium which was due in 2017 within the grace period. As per clause 7 of the policy the policy turned into a paid-up status. Till 13.03.2017 it was not paid. Thereafter again failed to renew for the year 2018 which was due ton 13.03.2018. On 26.03.2018 payment was made, but by that time policy has already been lapsed. The O.Ps informed to reinstate the policy and undergo a fresh medical test. After that the O.Ps were to take decision for reinstatement of the policy. On 26.03.2018 the O.Ps received the filled and signed DHH form dated 26.03.2018 along with premium. At level two of medical test the Complainant diagnosed with high blood sugar. The O.Ps declined the reinstatement of the policy vide letter dated 12.04.2018.

The O.Ps refunded Rs. 40,438.31P. vide cheque No. 93459 dated 21.04.2018. Again Rs. 38,750/- was paid vide cheque NO. 772543 dated 08.03.2016 for survival benefit. After two years the O.Ps received the legal notice dated 27.02.2020 and vide letter dated 25.03.2020 reply was given. After a gap of 3 years from date of reply notice complaint has been filed, which is barred by limitation.

The Complainant is not entitled for any relief as claimed for.

3. The Complainant filed the following documents:

1. Policy document contract No. 19862454 dated 13.03.2012.
2. Pleader notice dated 27.02.2020 with postal registration receipts.
3. Premium collection receipt against lapsed policy dated 26.03.2018.
4. Complaint dated 22.06.2018 for refund of deposit amount.
5. First premium receipt dated 13.03.2012.
6. Policy Schedule of Reliance case flow plan dated 13.03.2012.

The O.Ps filed the following documents:

1. Policy documents:
2. Policy bond details.
3. Diagnostics report of Ishita Diagnostics, Sambalpur dated 27.03.2018.
4. Letter dated 12.04.2018.
5. Letter dated 25.05.2018.
6. Reply of Mahesh Kumar to pleader notice dated 25.03.2020.
7. Pleader notice of the Complainant.
8. Declaration of State Health form dated 26.03.2018.
9. Laboratory test request form dated 23.02.2012.
10. Sales Manager Moral hazard report dated 21.02.2012.

Taking into consideration the pleadings and documents the following issues are framed:

ISSUES

1. Whether the complaint is barred by limitation?
2. Whether the policy documents submitted by the O.Ps are manipulated?
3. Whether the policy of the Complainant after lapse can not be revived?
4. What relief the Complainant is entitled to get?

Issue No.1 Whether the complaint is barred by limitation?

It is the admitted case of both the parties that on 27.02.2020 the Complainant issued a pleader notice to the O.Ps. The O.Ps replied through reply notice dated 25.03.2020. The complaint was filed on 18.12.2023.

The hon’ble Supreme Court in Suomotu W.P. (C)  No. 3/2020 has taken cognizance for extension of limitation due to Covid-19 pandemic . From 15.03.2020 to 28.02.2022 the period has been excluded for the purpose of limitation which are prescribed under any general or special laws in respect of all judicial or quasi-judical proceedings.

In the present complaint after exclusion of the period 15.03.2020 to 28.02.2022 this complaint was filed on 18.12.2023 within the period of limitation when the reply notice to the pleader notice was given on 25.03.2020. Accordingly the complaint is within time. The complaint is maintainable.

Issue No. 2 Whether the policy documents submitted by the O.Ps are manipulated?

Both the parties filed the first premium receipt. In the first premium receipt No. 84554048 dated 13.03.2012 issued to the Complainant the next premium due on 13.03.2013, whereas the documents submitted by O.Ps reflects the next premium due date as 13.03.2017, which is a clear manipulated documents submitted by the O.Ps.

Secondly in the said premium receipt issued to Complainant basic sum assured is Rs.1,55,000/- whereas the O.Ps reflected the basic sum assured Rs. 20,865.33P. The contents of the premium receipt differs to gain unlawfully the O.Ps have manipulated the documents which is unfair in trade practice. The same manipulation has been made by the O.Ps in reliance cash flow plan in the policy schedule.

From the above documents it is clear that the O.Ps have maupulated the documents. The issue is answered in favour of the Complainant.

Issue No. 3 Whether the policy of the Complainant after lapse can not be revived?

The O.Ps submitted that risk under the policy commenced from 13.03.2012 and premium was to be paid by 13^th of March every year. The 6^th and 7^th annual premium was due on 13.03.2017 and 13.03.2018 but the same was not paid in time and it was attempted to be paid on 26^th March, 2018 while the risk coverage under the policy was discontinued since 13^th March 2017.

From the policy conditions and privileges within referred to the policy it reveals that:

“clause 5: Lapse: if less than three years premium have been paid and a premium is not  paid before the end of the grace period the policy will lapsed and no benefit will be payable and all premiums paid will be retained by the company”.

This condition is applicable to the policies where premiums have been paid less that three years. In the present complaint the Complainant has paid premium from 2012 to 2016, five years premium has been paid.

Now the question arises relating to grace period. In clause 6 reinstatement conditions have been reflected.

“Clause 6: Reinstatement: If the policy has lapsed the policy holder may apply to the company to reinstate it during the life time of the Life Assured and before the date of maturity, on terms and conditions to be quoted by the company at that time.”

The life assured at any time before maturity of policy and during his/her life time can reinstate the policy. In the instant case as per submission of O.Ps on 26.03.2018 the Complainant paid the renewal premiums for two years which was due on 13.03.2017 and 13.03.2018 but the O.Ps sort for fresh medical test and after receipt of report decided declined to reinstatement of policy citing the medical examination report dated 27.03.2018. The O.Ps vide letter dated12.04.2018 declined the request of the Complainant. The Complainant submitted that the O.Ps first collected the renewal premium of Rs. 40,438.31 on 26.03.2018 and issued renewal receipt. On 26.03.2018. After receipt of the amount medical test was done and on 21.04.2018 the amount was refunded vide cheque No. 93459. On 25.05.2018 the O.Ps sent a letter and mentioned that reinstatement policy was rejected on 10.04.2018. The date of rejection of policy is different. The letter dated 12.04.2018 and 25.05.2018 the rejection dated are different. Only for lapsed policy the life assured has to undergo for fresh medical tests which is not applicable in the case of Complainant.

From the contention of the parties the following observations are made:

1. The policy premium has been paid for more than three years and accordingly the Complainant has every right to reinstate the policy before the date of maturity.
2. The O.Ps accepted the defaulted premium and later made the medical examination; which is not as per law. The policy is for more than five years. Further after acceptance of reinstatement premium rejection of the policy is illegal. Once premium is accepted it means policy is revived. Prior to receipt of the premium the O.Ps had to make the medical test.
3. The policy became a paid up policy and the sum assured shall be reduced. The paid up sum assured plus vested bonus are payable on the earlier of the maturity date and death of the life assured. The procedure followed by the O.Ps are not in consonance with the terms and conditions of the policy guidelines
4. To debar the Complainant to get his legitimate claim the documents are manipulated.

From the Supra discussion it is clear that the rejection of the policy of the Complainant is not proper. The O.Ps have violated the contract. Issue is answered against the O.Ps.

Issue No. 4 What relief the Complainant is entitled to get?

The Complainant is entitled for relief as discussed Supra. Accordingly, it is ordered:

ORDER

The complaint is allowed on contest against the O.Ps. The O.Ps are directed to pay Rs. 62,000/- with 7 % interest P.A. from the date of filing complaint. In case of non-payment within one month the amount will carry 12% interest P.A. till realisation. O.Ps are to pay compensation of Rs. 25,000/- and litigation expenses of Rs. 10,000/- to the Complainant.

Order pronounced in the open court on 29^th day of Oct. 2024.

Supply free copies to the parties.