This case is fixed for hearing on the point of admission. But at the time of admission itself O.Ps were noticed to appear to say his version, if, any against the facts pleaded in the complaint.
In pursuance of notice learned counsel Sri Abhay Kumar Sinha has appeared and filed W.S. It is also stated that on 12.05.2023 preliminary objection on the maintainability of the present case and an another application was filed relating to amendment in W.S.
Both the parties are ready for final hearing on account of the facts that they have already brought the facts needed on record for adjudication of the case to its finality. But previous to final hearing it has been heard on preliminary objection relating to maintainability which is related to section 69 of CPA, 2019. As submitted by the O.P that this case has been filed after two years from the date of cause of action. In this regard he has referred the judgments reported in iv (2005) CPJ 1 (SC) as well as II (2009) CPJ 29 (SC) and also iv (2010) CPJ 27 (SC) in the application itself. Learned counsel on behalf of Complainant opposed the contention and submitted that the limitation does not arise in this case. We find to get it mentioned that this case has been filed on 10.01.2023 and the cause of action arose on 25.01.2021 while the total required amount Rs.39,500/- was deposited well within the six months period from the date of lapsation of policy. In the month of March, 2021 vide cheque no. 482958 dated 18.03.2021 for the amount as above i.e. Rs.39,500/- was returned. Therefore, from the date of return of the amount through cheques dated 18.03.2021 and also as above which tells a volume that this complaint has been brought well within the time as indicated above. In a such situation no prayer of condonation of delay was required by the District Commission. Hence, it is observed that the preliminary objection as raised by O.P is not sustainable.
So far as prayer for amendment as made in the W.S. by the O.P is concerned upon which already the order was passed on 11.05.2023 which is specific and no order is required further by this Commission relating to facts after filing of W.S.
After considering the facts as mentioned in the complaint and after hearing the parties this complaint case stands admitted. As both the parties are ready to argue this case for final hearing, therefore, they have been heard finally and accordingly, final order is passed as discussed hereunder.
The main facts mentioned in the complaint is that the policy no.005741348 was got opened by Sri Rajeev Ranjan Prasad, being the father for his minor son Kumar Saurav Complainant no.1. The policy was purchased under the plan BSLI Vision for sum assured Rs.8,50,000/-. Kumar Saurav is now major and he has also joined in this complaint as a Complainant no.1. Policy is effective from 31.08.2012. The Complainant no.2 had regularly paid the premium under the policy. But during covid-19 period the premium due since August, 31st 2020 could not be paid as there was complete lockdown in the country and the office of the insurance company was also closed. Therefore, the Complainant could not get deposited the premium on due date. The last premium was paid vide receipt no. 64898130 dated 02.09.2019. It is stated further that the Complainant no.2 had received the message on his mobile to revive the policy by paying the premium only. The last message was received on 25.01.2021. There after he had deposited the premium with interest thereon Rs.39,500/- and the same was accepted by O.P. Complainant no.2 had received message “thank you for payment of Rs.39,500/- towards your policy no.005741348”. But it is stated that after one month Complainant no.2 got information that his policy could not be reinstated due to pending requirements. But insurance company never informed the Complainants of any pending requirements. The Complainant no.2 at his level sent his person to the branch office to know about the requirements. The person of the Complainant no.2 was handed over the restatement quotation dated Feb.10, 2021 which was clearly stating about the amount received post lapsation Rs.39,500/-. No where it was shown that any amount is due required to revive the policy. Further it is stated that the quotation letter reads inter-alia as under: - “for reinstatement within 180 days lapse date, only the net amount (displayed above) is required. However, after 180 days of lapse date, you are required to pay the net amount and also fulfill other additional requirements like certificate of insurability and medicals (if any). In case there are any other further requirements, we shall intimate you of the same….” The detail mentioned in the quotation letter dated Feb.10, 2021 would show that Rs.36,582.141/- as amount due to revive the policy interest at the rate of 12% per annum on unpaid premium being Rs.1667.51 with GST Rs.823.08 and GST on interest Rs.300.14 were added. The total amount of Rs.39,500/- were required to be deposited and the quotation was valid upto 12.03.2021. The total required amount Rs.39,500/- had already been deposited on 25.01.2021 well within the six months from the date of lapsation of the policy. As per the quotation only the net amount was required to be deposited which were shown in the column “Amount Received Post Lapsation”. After receiving the quotation letter dated Feb.10, 2021 the Complainant no.2 got pursued the local office to take correct view of the matter but local office did not pay heed and kept continue to demand filing up of several forms such as certificate of insurability and Covid-19 exposure questionnaire. It is relevant to mention that in the month of March.2021 vide cheque no.482958 dated 18.03.2021 the insurance company on its own refunded the amount of Rs.39,500/- by sending the demand draft to the Complainant no.2. Finding no option Complainant no.2 had encashed it and thereafter sent his person to pursue the matter to revive the policy but no intimation was given. The second premium which was also fallen due was sent duly signed by his son Kumar Saurav Complainant no.1 as he had become major along with certificate of his insurability. It is stated the cheque for Rs.79,996.85/- was drawn by the name of Aditya Birla Sun Life Insurance Company ltd. It has also been stated that neither the Complainant no.2 nor the Complainant no.1 suffered from Covid-19 but it is relevant that while Mr. Rakesh Kumar one of the person of the Complainant went to branch office with the duly filled up forms and cheques it was not accepted. The conduct of the insurance company was beyond the understanding of the Complainant. The Complainant no.2 sent a complaint through his e-mail id justice.rrp@gmail.com on 04.07.2021 at 6.09.26 PM and made complaint regarding the revival of policy but O.P did not pay heed to which the Complainant has suffered from mental agony and monetary loss. The conduct of insurance is unfair, unjust and improper. The cause of action has been shown on 18.03.2021 as well as on 18.08.2021. While the insurance company did not accept the form signed by Complainant no.1 and did not receive the cheque of Rs.79,996.85/-. The evidence of Rakesh Kumar and Chitrasen Charan have also been furnished on behalf of the complainant in support of the facts.
It appears from the record that W.S. has been filed on behalf of O.P which is also too elaborate. But relevant facts from the W.S is taken to place here that it is an admitted fact that the Complainant no.2 being as policy purposer submitted proposal no. M.4102259 dated 31.08.2012 for issuance of life policy for his minor son namely Kumar Saurav under BSLI Vision for the sum assured of Rs 8.50lacs and paid his first premium with yearly premium frequency for the amount of Rs.37,713/- and same was to be paid for the period of 25 years. The purposer has opted for the “BSLI Waiver of Premium Rider.” Copy of proposal form dated 31.08.2012 is hereby annexed marked as annexure R/1. Copy of proposal form is also annexed along with the other documents. Photocopy of policy schedule along with terms and conditions has been hereby annexed as annexure R/2. Insurance company had issued policy bearing no.005741348 since 31.08.2012. Provision of free look period has also been mentioned therein. It is also an admitted fact that Complainant no.2 paid the annual premium for the policy of his minor son till the year 2019, but failed to pay his annual premium due on 31.08.2020 even within grace period till 30.09.2020. Hence, the policy got lapsed. Though it is also stated in W.S that Complainant had two years time to renew the policy from the date of lapsation. It is also an admitted that Complainant no.2 submitted his request along with the premium amount of Rs.39,500/- for re-instate of the lapsed policy of minor son Kumar Saurav who is Complainant no.1. It is stated in W.S that the amount as above was received by the O.P on 28.01.2021 but without certificate of insurability of life insured as per policy terms. The certificate of insurability along with Covid-19 questionnaire was raised on 30th Jan, 2021 and on 10 Feb, 2021 it was sent to the purposer to say that after lapse due to non-fulfillment of the above requisite policy could not be reinstated. Hence, the O.P has refunded the premium amount Rs.39,500/- vide cheque no.482958 dated 18.03.2021 and it was encahsed by the Complainant’s. The Complainant was also conveyed to submit for his revival application with premium amount due Rs.79,965.85/- along with certificate of insurability and questionnaire of complaint but nothing was received. It has been under I.R.D.A.I Guidelines and Insurance Act 1938 that O.P is bound to provide service but as per the terms of policy. To reinstate the policy, you must pay all unpaid installment premiums due till date plus interest thereon and to repay any outstanding policy loan balance plus interest thereon. The interest we will charge is at a rate declared by us from time to time at our sole discretion. In addition, you must provide us with evidence of insurability satisfactory to us with respect to the life insured. The effective date of reinstatement is when these requirements are met and approved by us, at our sole discretion. It is also stated that Complainants were directed to receive fresh revival application along with certificate of insurability of both the Complainants with the premium amount of Rs.79,995/-. But the cheque as stated was not in order as the correct name of the insurance company was not in order and the correct name of the insurance company was not mentioned. After 10.08.2021 the O.P never received any revival application and lastly submitted that this complaint is fit to be dismissed as there is no deficiency of service on the part of the O.P.
The main point for consideration is that whether the Complainant is entitled to a claim as prayed for revival of the policy as stated and also that whether there is deficiency of service on the part of O.P?
Heard both sides. Learned Counsel on behalf of Complainant submitted firstly that detail facts have been mentioned in the complaint in respective way but further submitted that after going through the statement as made on behalf of O.P. it is obvious that there is no denial about the insurance policy taken by Complainant no.2 in the name of his minor son Kumar Saurav. It is also not denial that the Complainant deposited the premium regularly after commencement of the policy from 31.08.2012. During Covid-19 the premium became due on 31st Aug, 2020 as same could not be paid due to lockdown in the country. Complainant while got message about the amount due paid the premium Rs.39,500/- and thereafter message was received from the O.P “thank you for payment of Rs.39,500/- towards your policy no.005741348”. But the O.P. after receiving such amount returned on account of baseless facts. Not only this as mentioned in complaint that thereafter 2nd premium amount was accrued due Rs.79996.85/- and it was also paid through the cheque signed by Kumar Saurav Complainant along with certificate of insurability and covid-19 questionnaire Complainant no.1. But O.P had ignored those facts and did not abide the due terms and made only issue without the necessary cause that he insurability certificate and questionnaire of Complainant no.2 is also required. Hence, submitted that this complaint be allowed.
Learned lawyer on behalf of O.P has made emphasis in argument that there is no fault on the part of the insurance company. Detail facts have been mentioned in the W.S on each and every aspect including the terms and conditions from which it would transpire that the O.P is not at all at fault. It has also been submitted that it is relevant that the meaning of terms and policy cannot be differentiated rather it has to be meant in accord thereto. The O.P for revival had sent message and thereafter acted upon in terms of the policy to reinstate the policy. But on behalf of Complainant no certificate of insurability and questionnaire of Covid-19 was submitted while to revive the policy it was required. O.P never obstructed rather always followed the norms and procedure. To argue more and more shall be repetitions of facts as each and every aspects have been touched in W.S which is necessary to take into considerations. After considering all it will be apparent that there is no fault on the part of O.P.
Having heard the rival contentions of both the sides as well as on perusal of the facts pleaded and the documents placed as available on record we are of the opinion that Complainant no.2 got opened the policy from the O.P vide policy no.005741348 under plan name BSLI Vision for sum assured Rs.8.50 lacs for his minor son Kumar Saurav. Thereafter regularly premium was paid and it is not denial. It is also not denial that due to covid-19 the offices were closed in the country, hence, the premium amount could not be paid timely which was due since 31st, August, 2020. But whenever the information was received from the insurance, O.P, Complainant had deposited the amount Rs.39,500/- to revive the policy. Whereupon the message was received in the following terms- “thank you for payment of Rs.39,500/- towards your policy no.005741348”. But after a month Complainant no.2 received message that your policy could not be reinstated due to pending requirement but O.P did not inform the Complainant no.2 about pending requirement. On query by the person of Complainant no.2 and from reinstatement quotation dated 10th Feb, 2021 which was showing the deposit of premium without any requirement. The required premium amount Rs.39,500/- was deposited on 25.01.2021 well within the six months period from the date of lapsation of policy even then policy was not revived. Further it appears that though the cheque amount was refunded for Rs.39,500/- and it was encashed finding no option but it is also relevant that in the mean time second premium was fallen due and the Complainant no.2 sent certificate of insurability of his major son and covid-19 (corona virus) exposure questionnaire of his son Kumar Saurav with a cheque of Rs.79,996.85/- but the cheque was not accepted. The Complainant no.2 also made complaint through his e-mail on 04.07.2021 at 06.09.26 PM but no reply was received and same has also been filed with complaint under annexure 1 series. The main question which is not at all in dispute nor it is a matter of dispute that on behalf of Complainant no.2 certificate of insurability along with questionnaire of Covid-19 was not furnished on demand of O.P and same has been unnecessarily made objectionable and put the Complainant in mental harassment. Because the cheque was furnished by the Kumar Saurav (Complainant) and at the same juncture O.P must have aware that such Kumar Saurav has become major now, who is Complainant no.1 of this case and he is one of the beneficiary as the policy was got opened by Complainant no.2 in his name while he was minor and same is an admitted fact. But now he has become major then how it would be avoidable that to file insurability certificate and covid-19 questionnaire by the Complainant no.1 alone is not acceptable. In this regard the rider available will also justify the same. Therefore, the act of the O.P is not at all appreciable rather arbitrary in nature and they have committed deficiency of service and did not follow the due norms and put the Complainant to litigation as well as in mental agony. Hence, we allow this complaint case to the extent that O.P is directed to revive the policy bearing no.005741348 after receipt of the order within fifteen days and it is specified that, if, the premium amounts are due or standing against the Complainant same have to be paid to the O.P as early as possible so that there shall not be any delay in revival of the policy. Further O.P is directed to pay Rs.15,000/- (fifteen thousand rupees only) as litigation cost and others. The payment has to be made within one month after receipt of the order. In case of non-compliance of the order and non-payment, Complainant shall be entitled to take due course of law for the compliance of the order as well as for the recovery of the amount as aforesaid.
