Orissa

Cuttak

CC/35/2024

Sujan Kumar Roy Choudhury - Complainant(s)

Versus

Aegon Life Insurance Company - Opp.Party(s)

K Roy Choudhury & associates

22 Aug 2024

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C.No.35/2024

 

Sujan Kumar Roy Choudhury,

s/o: Bijan Bihari Ro6y Choudhury,

R/o: Arunodaya Nagar,Near High Court Colony,

Badambadi, Cuttack-753012.                                ... Complainant.

 

          Vrs.

 

1.        AEGON LIFE INSURANCE COMPANY’                                                                                                                                                  At:A-201,2nd Floor,Leela Business Park,

Near Airport Road Metro Station,

Andheri Kurla Road,Andheri(East),

                   Mumbai-400059.

 

2.        Office of the Insurance Ombudsman,

Bhubaneswar, At:62, Forest Park,

Bhuaneswar-751009, Odisha.                               ….Opp. Parties

 

.

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    31.01.2024

Date of Order:  22.08.2024

 

For the complainant:          Mr. K.Roy Choudhury,Adv. & Associates.

For the O.P No.1       :          Mr. R.Pati,Adv. & Associates.

For the O.P No.2       :               None.

 

Sri Debasish Nayak,President          

Case of the complainant as made out from the complaint petition bereft unnecessary details in short is that he had opted for one Life Insurance policy from the O.P No.1 on 31.3.2014 vide policy No.140314091624 where the sum assured was of Rs.1,00,000/- with the annual premium of Rs.13,713/-.  The premium was to be paid for 12 years whereas the policy term was for 17 years.  Thus, the date of maturity of the said policy was on 31.3.2031.  Smita Mohanty the agent of O.P No.1 was collecting the premiums from the residence of the complainant but during the pandemic Covid-19 the said agent had not turned up to collect the yearly premiums and in this context when the complainant had made correspondence with the O.P No.1, he was shocked to know that no premium is to be collected through any agent of O.P No.1.  According to the complainant, a sum of Rs.95,991/- alongwith interest thereon @ 18% is with the O.P company and in order to get return the said amount he had issued legal notice to the O.P Company on 7.9.2021.  The complainant had also approached the Insurance Ombudsman vide complaint no.BHU-L-001-2122-0440.  An award was passed by the Learned Insurance Ombudsman on 2.3.2022 vide Award No.IO/BHU/A/LI/0161/2021-2022 wherein the Learned Ombudsman had requested for regularising the policy of the complainant.  The complainant had also raised the said issue before the Zonal Office of O.P No.1 company accusing the agent of it but no fruitful result had yielded.  The complainant had visited the CAMS office and had paid Rs.40,803/- towards his arrear premiums so as to regularise his policy as per the direction of the Learned Insurance Ombudsman.  But, even after elapse of three years, the said amount has neither been credited nor his policy has been restored.  The complainant could know that on 27.1.2024 the name of the policy is changed and the sum assured amount is reflected to be of Rs.40,000/- with total premium due to be of Rs.13,601/-.  But on 31.3.2023 while the same is Rs.40,000/- was the assured amount, the total premium due was of Rs.54,404/-.  Thus, the complainant has come up with his case before this Commission seeking direction to the O.P to pay him a sum of Rs.5,00,000/- alongwith interest thereon @ 18% and also to pay him Rs.4,00,000/- towards deficiency in service.  He has also demanded from the O.P his litigation expenses to the tune of Rs.50,000/- and further with a prayer for any other order as deemed fit and proper.

          Together with the complaint petition, the complainant has annexed copies of several documents in order to prove his case.

2.       Out of the two O.Ps as arrayed in this case, having not preferred to contest this case, O.P no.2 has been set exparte vide order dated 18.3.2024.

          However, O.P No.1 has filed it’s written version wherein it is stated that the case of the complainant is not maintainable which is liable to be dismissed with cost.  The complainant has filed this case with an oblique motive.  O.P No.1 admits about the policy bearing no.140314091624 where the assured sum was of Rs.1,00,000/- was issued in favour of the complainant for a term of 17 years which was effective from 31.3.2014 where the annual premium was of Rs.13,713/- and the annualised premium was of Rs.13,302/- which was to be paid for 12 years.  The maturity date of the said policy was 31.3.2031.  It is urged by O.P No.1 that the agent has no right to collect any premium or make any transaction with the Insurance Company.  Rather, the insured was to make payment of the premiums directly to the Insurance Company.    The complainant had paid the premiums upto 2019 but had failed to deposit the yearly premiums from 2020 onwards.  In the year 2022, the complainant had claimed that the agent of the Insurance Company had not collected the yearly premiums from him.  Due to non-payment of the premiums, the policy of the complainant had lapsed being discontinued. The complainant had approached the Insurance Ombudsman in this context wherein the learned Ombudsman had directed the Insurance Company to make arrangement for revival of the policy by accepting the arrear premiums from the insured.  Accordingly, the insured/complainant had deposited an amount of Rs.40,803/- on 28.3.2022 at CAMS office for revival of his policy and to maintain the continuity of the policy.  The O.P Company thereafter had requested the complainant to provide Certificate of Insurance Form being duly filled up which is a mandatory step for rectifying the policy details but the same was not furnished by the complainant.  Thu, there was no deficiency in service on the part of the O.P as alleged by the complainant since because they had returned the premium amount received for revival of the said policy.  It is thus prayed by the O.P No.1 through it’s written version to dismiss the complaint petition with cost it being not maintainable.

          Together with the written version, the O.P No.1 has annexed copies of several documents in order to prove it’s stand.

          The complainant has filed evidence affidavit here in this case but on perusal of the same it appears to be a reiteration of the complaint petition as filed by him.

          The O.P No.1 has also filed evidence affidavit through one Nikunja Chikani working as Associate Vice President-Legal for the O.P Company.  Quite strangely the contents of the evidence affidavit of the said Mr. Nikunja Chikani when perused, it appears to be a reiteration of the written version as filed by O.P No.1 and nothing else.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written version of O.P, this Commission thinks it proper to settle the following issues in order to arrive at a proper conclusion here in this case.

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.Ps?

iii.        Whether the complainant is entitled to the reliefs as claimed by him?

Issue no.ii.

Out of the three issues, issue no.ii  being the pertinent issue is taken up first to be considered here in this case.

After perusing the complaint petition, the written version, the written notes of submission as filed from both sides as well as from the copies of documents available in the case record, it is noticed that infact the complainant had obtained one Life Insurance policy from O.P No.1 wherein the assured sum was of Rs.1,00,000/- and the policy was effective from 31.3.2014 for 17 years.  The complainant alleges that one Smita Mohanty the agent of O.P No.1 who was collecting the yearly premiums from him had failed to collect the premiums during the pandemic Covid-19.  In this context, it is the contention of O.P No.1 that it is the insured who has to pay the premiums directly to the O.P No.1 company and there is no provision for collecting the yearly premiums through any agent. No agent is authorised to make any transaction on behalf of any insured.  O.P No.1 has urged that due to non-deposit of the yearly premiums the policy of the complainant had lapsed for which the complainant had approached the learned Insurance Ombudsman and by virtue of the award of the learned Ombudsman, the O.P Company was instructed to revive the policy of the complainant by receiving the arrear premiums from the complainant.  It is further contention of O.P No.1 that accordingly the insured/complainant had deposited an amount of Rs.40,803/- on 28.3.2022 at the CAMs office but he had not provided the Certificate of Insurance Form which was a mandatory step for reviving his lapsed policy even though they had requested him for the same.  To support such contention, the O.P has not filed any scrap of document so as to apprise this Commission that infact the O.P No.1 had communicated to the complainant in this regard for filing the Certificate of Insurance form (COI).  In absence of any iota of evidence in that regard this Commission cannot jump into a conclusion that the complainant had not filed the COI as desired to which he was aware of and which is a mandatory step in order to renew/revive his lapsed insurance policy.    As it is noticed that the O.P Company had not challenged the award of the learned Insurance Ombudsman rather, had received the arrear premium of Rs.40,803/- from the complainant on 28.3.2022 obeying to the award as passed by the learned Insurance Ombudsman.  But they had returned the said amount to the complainant through NEFT on 27.6.2020.  The O.P Company also do not dispute but have admitted to have received the premiums of the complainant towards his policy bearing number 14031409162 upto 2020 from 2014.  In this regard, the complainant has stated that an amount of Rs.95,991/- has been paid by him to the O.P Company towards the yearly premiums for his policy and this statement of the complainant is also not disputed by the O.P Company.  Thus, considering the facts and circumstances of this case, this Commission comes to a conclusion that infact the O.P No.1 is found to be deficient in his service by not intimating the complainant regarding the mandatory step of COI which he was to file so as to revive his lapsed insurance policy.  Accordingly, this pertinent issue undoubtedly goes in favour of the complainant.

 

 

Issues no.i & iii.

From the discussions as made above, the case of the complainant is definitely maintainable and he is entitled to the reliefs as claimed by him from the O.Ps here in this case.  Hence it is so ordered;

ORDER

The case is decreed on contest against the O.P. no.1 and exparte against O.P no.2.   The O.P no.1 is thus directed to refund Rs.95,991/- with 8% interest thereon to the complainant effective from 27.6.2022 since when the O.P Company had returned the premium to the complainant till the total amount is quantified.  The O.P no.1 is also directed to pay the complainant an amount of Rs.2,00,000/- as compensation for his mental agony and harassment as well as to pay a further sum of Rs.50,000/- towards the cost of his litigation.  This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on this the 22^nd day of August,2024 under the seal and signature of this Commission.         

                                                                                      

                                                                                      Sri Debasish Nayak

                                                                                              President

 

 

                                                                                          Sri Sibananda Mohanty

                                                                                                      Member