Chandigarh

DF-I

CC/507/2023

GURMEET SINGH CHAWLA - Complainant(s)

Versus

AEGON RELIGARE LIFE INSURANCE COMPANY LIMITED - Opp.Party(s)

NEERAJ SHARMA

01 Aug 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                                     

Consumer Complaint No.	:	CC/507/2023
Date of Institution	:	15/10/2023
Date of Decision	:	01/08/2024

 

Sh. Gurmeet Singh Chawla son of late Sh. R S Chawla, aged 62 years, resident of House No.628, Sector 33-B, Chandigarh (Old Address House No.1165, Sector 33-C, Chandigarh).

… Complainant

V E R S U S

Aegon Religare Life Insurance Company Limited (through Manager/Director/A.S), GYS Infinity, 2^nd Floor, Pranjpe (B) Scheme, Subash Road, Near Garware House, Vile Parle (East), Mumbai-400057.

… Opposite Party

 

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

 

 

                                                                       

ARGUED BY	:	Sh. Neeraj Sharma, Advocate for complainant
	:	Sh. Rahul Makkar, Advocate for OP (through VC)

 

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Gurmeet Singh Chawla, complainant against the aforesaid opposite party (hereinafter referred to as the OP).  The brief facts of the case are as under :-

1. It transpires from the allegations, as projected in the consumer complaint, that in the year 2012, representative of OP had approached the complainant and informed him about the policy product namely “Aegon Religare iTerm Plan” (hereinafter referred to as “subject policy”) and by believing said representative, complainant agreed to purchase the subject policy (Ex.C-2) which commenced w.e.f. 10.10.2012 with policy and premium payment term of of 23 years, date of maturity 9.10.2035 and sum assured of ₹50.00 lacs.  As per the policy document, death benefit, maturity benefit, terminal illness benefit and surrender benefit were provided.  The complainant continuously paid annual premium of ₹22,000/- to the OP from 10.10.2012 to 10.12.2021 i.e. for ten years without any delay.  The last annual premium was due on 10.10.2022, having grace period till 10.11.2022, and as the complainant had undergone serious family crisis in the month of September, October and November 2022, he could not make the payment by due date. It was only on 16.11.2022 that the complainant could check the message dated 11.11.2022 (Ex.C-3 & C-4) and he immediately tried to make the payment of annual premium to the OP, but, the email ID in the master record of the OP was old one, which became defunct. The complainant made a lot of communications with the OP for updation of his email ID and only after updating the same he could send the required COI form and other documents on 28.11.2022 (Ex.C-9) to the OP.  However, the documents (Ex.C-12) were resubmitted by the complainant on 9.12.2022 and had also sent the pathology report on 19.11.2022 to the OP.  However, to the utter shock of the complainant, he received regret email from the OP on 16.12.222 (Ex.C-13) through which the OP had declined the revival of the insurance policy in view of the medical history of kidney stone and fatty liver of the complainant.  Thereafter complainant again approached the OP by sending reply (Ex.C-14) with the request to revive the subject policy, but, the said request was again turned down by the OP.  Not only this, even the complainant submitted detailed representation with additional documents (Ex.C-16) on 24.12.2022 with the OP, but, the OP vide email (Ex.C-18) again regretted to revive the policy.  In fact, the OP had declined the request of the complainant on the basis of mere surmises by ignoring the medical and other record submitted by the complainant as the ultrasound scan and reports qua fatty liver (Ex.C-21) had categorically ruled out any fatty liver of the complainant.  Not only this, even clause 6 of the subject policy schedule provides that policy holder can apply for reinstatement of lapsed policy within two years from the due date of the first unpaid policy premium and after satisfactory evidence of insurability of the life assured, the lapsed policy could be reinstated.  As complainant had fulfilled all the requirements, OP has wrongly not reinstated/ revived the subject policy of the complainant despite of the fact that the annual premium was regularly received by it for the last more than 10 years.  Moreover, when the complainant is medically fit, not having fatty liver and kidney stone, OP was bound even as per the terms and conditions of the subject policy to revive the lapsed policy, but, it failed to do so. In this manner, the aforesaid act of the OP amounts to deficiency in service and unfair trade practice. OP was requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.
2. OP resisted the consumer complaint and filed its written version, inter alia, taking preliminary objections of maintainability, cause of action and concealment of facts.  However, it is admitted that the complainant had obtained the subject policy from the answering OP and had been paying the premium since 3.10.2012 and had not paid the last premium due upto 10.11.2022, as a result of which the subject policy lapsed w.e.f. 10.11.2022. Copy of certificate of insurability (COI) was submitted by the complainant alongwith the COVID questionnaire (Annexure OP-4) and thereafter the complainant was further asked to submit medical reports in order to see his health condition.  Even in the medical record submitted by the complainant, it was found that he was having fatty liver and stone in the kidney and accordingly his request for revival of the policy was declined as per the terms and conditions of the policy schedule.  On merits, the facts as stated in the preliminary objections have been reiterated. The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
3. In rejoinder, complainant re-asserted the claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.

2. In order to prove their case, parties have tendered/proved their evidence by way of respective affidavits and supporting documents.
3. We have heard the learned counsel for the parties and also gone through the file carefully, including written arguments.
   1. At the very outset, it may be observed that when it is an admitted case of the parties that complainant had obtained the subject policy (Ex.C-2) from the OP after getting himself medically examined in the year 2012 and the subject policy commenced w.e.f. 10.10.2012 and due to non-payment of the annual premium amount by the complainant which was payable upto 10.11.2022 i.e. within the grace period, the subject policy lapsed and despite of the repeated requests and submission of the Certificate of Insurability (COI) alongwith the medical record by the complainant, the OP refused to revive the subject policy on the ground that the complainant was having fatty liver and stone in the kidney, the case is reduced to a narrow compass as it is to be determined if the OP is unjustified in not reviving the subject policy and the complainant is entitled to the reliefs prayed for in the consumer complaint, as is the case of the complainant, or if the OP has rightly not revived the subject policy and the consumer complaint of the complainant, being false and frivolous, is liable to be dismissed as is the defence of the OP.
   2. In the backdrop of the foregoing admitted and disputed facts on record, one thing is clear that the entire case of the parties is revolving around the documentary evidence placed on record by them and the same is required to be scanned carefully in order to determine the real controversy between the parties.
   3. Perusal of email (Ex.C-9) clearly indicates that the OP had acknowledged the receipt of email from the complainant and sought online COI and COVID questionnaire form with medical record from the complainant.  Ex.C-10 is another copy of email sent by the OP to the complainant intimating him that his request is being evaluated and the decision will be shared by the OP with him shortly. Ex.C-12 is copy of email sent by the complainant to the OP alongwith the documents including diagnostic reports as had been asked by the OP. Ex.C-13 is copy of email sent by the OP to the complainant intimating him on 16.12.2022 that the OP has decided to decline his request in view of his personal medical history of kidney stone and fatty liver. Ex.C-14 is copy of the email sent by the complainant to the OP requesting it to keep his case open and not to close the same.  Ex.C-21 is copy of email sent by the complainant to the OP alongwith medical record obtained by him from the diagnostic centre indicating that the liver of the complainant is normal with no stone in the kidney.
   4. Learned counsel for the complainant contended with vehemence that as it stands proved on record that the OP has illegally and wrongly declined to revive the subject policy despite of the fact that the complainant was not having any kidney or liver problem at the time of request for revival, the consumer complaint deserves to be allowed as prayed for.
   5. On the other hand, learned counsel for the OP contended with vehemence that as it stands proved on record that the complainant was having kidney stone as well as fatty liver at the time when he approached the OP for revival of the subject policy, as a result of which his request was declined, the consumer of the complaint deserves to be dismissed.
   6. There is no force in the contention of learned counsel for the OP as perusal of Ex.C-12 with Ex.C-21 clearly indicates that the liver and kidney of the complainant were found normal even by the diagnostic centre in their reports. Moreover, the latest report dated 14.1.2023 submitted by the complainant (attached with Ex.C-21 at page 158) clearly indicates that Dr. Sodhi’s MRI & CT Scan Centree, Chandigarh, while conducting the USG abdomen, had found the liver and kidney of the complainant normal and no stone was seen.  The relevant portion of the said report is reproduced below for ready reference :-

                “LIVER

                Liver is normal in size and shows normal echotexture with Grade – 1 Fatty change in it.  The surface is smooth. 

                No mass seen.  No dilated intrahepatic biliary radicles seen.

                Pvein & CBD are of normal caliber.  No ascites seen.

xxx           xxx           xxx

                        Kidneys RT Kidney measures 10.3 cm LT Kidney measures 10.5 cm

                        Both Kidney are of normal size, shape and position.  Echogenicity is normal

                        Cortico-medullary demarcation is normal.  No stone seen.

xxx           xxx           xxx”

 

7. Not only this, even clause 6 of the policy schedule itself provides right to the policyholder to apply for reinstatement of the lapsed policy within two years from the date of first unpaid policy premium, subject to certain satisfactory evidence of insurability of the life assured and payment in full of an amount equal to the policy premium due and the said clause is reproduced below for ready reference :-

 “6. Reinstatement of the policy

The Policyholder can apply for reinstatement of the lapsed Policy within two years from the due date of the first unpaid policy premium (“Reinstatement period”). The re-instatement shall be subject to the following conditions:

• Satisfactory evidence of insurability of the Life Assured and
• Payment in full of an amount equal to all the Policy Premiums due but unpaid till the Effective Date of Reinstatement.

The Effective Date of Reinstatement is the date on which the above requirements are fulfilled and communicated by the Company to the Policyholder."

8. In view of the foregoing, it is clear that despite of the fact that the complainant was having normal liver and kidney and had also approached the OP within two years from the date of first unpaid policy premium (reinstatement period), OP has illegally and wrongly declined to revive the policy, knowing fully well that he had already paid premium for last 10 years regularly without any delay/break, and the said act of the OP certainly amounts to deficiency in service and unfair trade practice on its part and the present consumer complaint deserves to succeed.

4. In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and the OP is directed as under :-

1. to revive/reinstate the subject policy on payment of due premium(s) by the complainant, but, without levying any additional charges.
2. to pay ₹25,000/- to the complainant as compensation for causing mental agony and harassment;
3. to pay ₹10,000/­- to the complainant as costs of litigation.

5. This order be complied with by the OP within a period of 45 days from the date of receipt of certified copy thereof, failing which the amount mentioned at Sr.No.(ii) above shall carry penal interest @ 12% per annum (simple) from the date of expiry of said period of 45 days, till realisation, over and above payment of ligation expenses.
6. Pending miscellaneous application(s), if any, also stands disposed of accordingly.
7. Certified copies of this order be sent to the parties free of charge. The file be consigned.

01/08/2024	Sd/- [Pawanjit Singh] President
	Sd/-
	[Surjeet Kaur] Member
	Sd/-
	[Suresh Kumar Sardana] Member