Chandigarh

DF-I

CC/548/2023

JANKI DEVI - Complainant(s)

Versus

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

JATIN KHULLAR & ROHIT KHULLAR

05 Jul 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                                     

Consumer Complaint No.	:	CC/548/2023
Date of Institution	:	20/11/2023
Date of Decision	:	05/07/2024

 

 

Janki Devi age 46 years W/o Late Sh. Mahipal Lal resident of House No.150/1, Sector 30/B, Chandigarh (being nominee and 1^st class legal heir of Mahipal Lal).

… Complainant

V E R S U S

1.     Aegon Religare Life Insurance Company SCO No.2417-2418, 2^nd Floor, Sector 22/C, Chandigarh through its Manager.

2.     CAMS Service Centre, Deepak tower, SCO 154-155, 1^st Floor, Sector 17, Chandigarh through its Service Manager.

3.     Aegon Religare Life Insurance Company Ltd. Regional office at Building No.3, Third Floor, Unit No.1, Nesco IT Park, Western Express Highway, Goregaon (E) Mumbai-400063 through its Regional Manager.

4.     Aegon Religare Life Insurance Company Ltd. Registered office at A-201, 2^nd Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai-400059 through its Managing Director Satishwar Balakrishnan.

… Opposite Parties

 

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

 

                                                                               

ARGUED BY	:	Sh. Jatin Khullar, Advocate for complainant(through VC)
	:	Sh. Rahul Makkar, Advocate for OPs 1, 3 & 4
	:	None for OP-2

 

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Smt.Janki Devi, complainant against the aforesaid opposite parties (hereinafter referred to as the OPs).  The brief facts of the case are as under :-

1. It transpires from the allegations, as projected in the consumer complaint, that, in the month of April 2016, husband of complainant namely Sh.Mahipal Lal had received a call from the representative of OPs namely Sh. Deepak Sharma requesting him to purchase a policy with benefit of money back insurance plan.  By believing the words of the said representative, who came to the house of complainant and explained the features of the policy, complainant and her husband had purchased the policy namely “Ageon Life Regular Money Back Insurance Plan” (hereinafter referred to as “subject policy”) on payment of ₹95,000/- in cash for one time only on 19.4.2016. It was assured to the complainant and her husband by the representative of the OPs that the insured would get 10 times sum assured of the premium i.e. ₹9,50,000/- on completion of tenure of the subject policy of seven years.  On 25.5.2016, when complainant and her husband received policy document (Annexure C-3), they were shocked to see that the features of the policy, which were explained to them by the agent of the OPs, were totally different in the said document. Immediately after that i.e. on 27.5.2016, complainant and her husband visited the office of OPs and submitted the policy bond alongwith the letter of cancellation (Annexure C-4) of the subject policy with the request to return back the first premium amount of ₹95,000/-. On 8.6.2016 (Annexure C-5), husband of the complainant had received one letter alongwith the policy bond from the office of the OPs in which it was clearly mentioned that the OPs would not cancel the subject policy and directed him to consult the agent of OPs. On 9.6.2016, complainant and her husband again approached the office of OPs and met aforesaid Deepak Sharma and he was made aware of the different features of the policy, but, he assured that they would get the maturity amount of ₹7,18,216/-.  Unfortunately, during the COVID-19 pandemic, husband of the complainant died due to corona disease on 7.5.2021 and copy of his RTPCR test report and death report are Annexure C-1 and C-2. The complainant being nominee of the deceased insured Sh. Mahipal Lal (hereinafter referred to as “DLA”) brought the said fact to the notice of the OPs and they were requested to pay the maturity amount of ₹7,18,216/-, as agreed upon through the subject policy.  After waiting for two months when the complainant did not receive any claim amount from the OPs, she again approached the OPs with the request to release the claim amount, but, nothing was done. The complainant again requested the OPs through letters 1.9.2023 (Annexure C-6) and 22.9.2023 (Annexure C-8) to release the claim amount, but, the OPs refused to release the same by sending reply dated 13.10.2023 (Annexure C-9).  In this manner, the aforesaid act of the OPs amount to deficiency in service and unfair trade practice. OPs were requested several times to admit the claim, but, with no result. Hence, the present consumer complaint.
2. OPs resisted the consumer complaint and filed their separate written versions.
3. In their written version, OPs 1, 3 & 4 inter alia, took preliminary objections of maintainability, concealment of facts, locus standi and cause of action.  However, it is admitted that the husband of the complainant/DLA had obtained the subject policy from the answering OPs and he opted for payment of annual premium of ₹95,000/-. The relevant details of the policy are as under :-

Policy No.	160414665880
Plan	Aegon Life Regular Money Back Insurance Plan
Policy Term and Premium Payment Term	10 years
Sum Assured	Rs.7,18,216/-
Premium Amount	Rs.95,000
Premium Payment Mode	Yearly
Policy Issuance Date/ Risk Commencement Date	29.04.2016

 

It is further alleged that, in fact, after payment of the first premium, DLA had not paid any installment despite of the fact that an amount of ₹95,000/- was payable annually as premium for 10 years and the installment was due on 29^th of April every year till 29.4.2025. Since DLA has failed to comply and pay any premium after payment of the first premium, as such, the policy went into discontinuance status w.e.f. 29.4.2017 with no benefits as per the terms and conditions of the policy. It is further admitted that the copy of intimation letter dated 1.9.2023 (Annexure OP-4) was received from the complainant and thereafter the claim was rightly repudiated vide letter dated 13.10.2023 (Annexure OP-5). On merits, 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.

4. In its written version, OP-2, inter alia, took preliminary objections of maintainability, cause of action and also that the complainant has not approached the Commission with clean hands.  However, it is admitted that the subject policy was obtained by the DLA and the complainant had made request for its cancellation on 27.5.2016 which was rejected by the OP vide letter dated 8.6.2016 and thereafter the complainant had lodged claim through letter dated 1.9.2023 and the said letter was forwarded by the answering OP to OP-1 for taking appropriate action. 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.
5. In separate replications, 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 complainant and OPs 1, 3 & 4 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 the husband of the complainant i.e. the DLA had obtained the subject policy with total policy and premium payment term of 10 years with sum assured of ₹7,18,216/-, on payment of annual premium of ₹95,000/- commencing w.e.f 29.4.2016 and on receiving the policy document , DLA had approached the OPs for its cancellation vide letter dated 27.5.2016 (Annexure C-4) and the said request was rejected by the OPs vide letter dated 8.6.2016 (Annexure C-5) and the DLA had died on 7.5.2021 during the COVID-19 pandemic and thereafter the complainant, being nominee of the DLA had approached the OPs for the release of the claim amount vide letter dated 1.9.2023 (Annexure C-6) and the OPs had repudiated the claim vide letter dated 13.10.2023 (Annexure C-9), the case is reduced to a narrow compass as it is to be determined if the OPs/insurers are unjustified in repudiating the genuine claim of the complainant and she is entitled for the reliefs prayed for in the consumer complaint, as is the case of the complainant, or if the OPs/insurers have rightly repudiated the claim of the complainant and the consumer complaint of the complainant, being false and frivolous, is liable to be dismissed, as is the defence of the OPs.
   2. Learned counsel for the complainant submitted that after payment of the first premium amount by the DLA and on receiving the policy document on 25.5.2016, when the complainant and her husband/DLA had found that the features explained by the agent of the OPs were quite different  as were referred in the policy document, they immediately approached the OPs with the request to cancel the subject policy by moving application dated 27.5.2016 (Annexure C-4) and the OPs vide letter dated 8.6.2016 (Annexure C-5), refused to cancel the subject policy and since the OPs have failed to release the claim amount i.e. maturity amount of ₹7,18,216/- or the premium amount of ₹95,000/- to the complainant, till date, the consumer complaint deserves to be allowed as prayed for.
   3. On the other hand, learned counsel for OPs submitted that as the policy was not cancelled by the OPs, as per the request made by the DLA in the year 2016, and thereafter the DLA has not paid any installment of premium, the policy benefits were discontinued after 29.4.2017 with no benefits as per the policy terms and conditions, the consumer compliant deserves to be dismissed.
   4. There is no force in the submission of the learned counsel for the OPs as it is clear from the letter dated 27.5.2016 (Annexure C-4) through which the DLA had made request for cancellation of the subject policy within the free look period of 15 days on receipt of the subject policy document, especially when the OPs have failed to prove on record with cogent evidence that the DLA could not approach the OPs for cancellation of the subject policy within the free look period. 
   5. Not only this, the subject policy itself provides that the policy holder can opt to cancel the policy within 15 days from the date of its receipt and even in the year 2016 when the OPs had conveyed to the DLA vide letter dated 8.6.2016 (Annexure C-5) that he has not approached them for the cancellation of the policy within the free look period, it appears that, even at that time, OPs had wrongly rejected the request of the DLA for cancellation of the policy and had not refunded the premium amount, especially when it has come on record that the insurer had approached the OPs for cancellation of the subject policy within the free look period on the receipt of the policy documents.
   6. However, so far as the case of the complainant that she is entitled to the maturity amount of ₹7,18,216/- is concerned, when even the said policy does not provide that on payment of only single premium of ₹95,000/-, the insured or his nominee will get the maturity amount, rather it is clear from the subject policy that annual premium of ₹95,000/- was payable by the insured for 10 years, which has admittedly not been paid by the insured to the OP in the present case, it is unsafe to hold that the complainant is entitled to the maturity amount of ₹7,18,216/-.
   7. In view of the above discussion, it is safe to hold that OPs 1, 3 & 4 were certainly bound to have refunded the premium amount of ₹95,000/- to the DLA immediately upon receiving request for cancellation of policy from him and non-payment of the same certainly amounts to deficiency in service and unfair trade practice on their 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 OPs 1, 3 & 4 are directed as under :-

1. to pay ₹95,000/­- to the complainant alongwith interest @ 9% per annum (simple) w.e.f. 8.6.2016 (i.e. the date of cancellation of request by the OPs) onwards.
2. to pay ₹15,000/- 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 OPs 1, 3 & 4, jointly and severally, within a period of 45 days from the date of receipt of certified copy thereof, failing which the amounts mentioned at Sr.No.(i) & (ii) above shall carry penal interest @ 12% per annum (simple) from the date of expiry of said period of 45 days, instead of 9% [mentioned at Sr.No.(i)], till realisation, over and above payment of ligation expenses.
6. Since no deficiency in service or unfair trade practice has been proved against OP-2, the consumer complaint against it stands dismissed with no order as to costs.
7. Pending miscellaneous application(s), if any, also stands disposed of accordingly.
8. Certified copies of this order be sent to the parties free of charge. The file be consigned.

05/07/2024 hg	[Pawanjit Singh] President
	[Surjeet Kaur] Member
	[Suresh Kumar Sardana] Member