IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOLLAM
DATED THIS THE 23RD DAY OF April 2018
Present: - Sri. E.M.Muhammed Ibrahim, B.A, LLM. President
Sri. M.Praveen Kumar,Bsc, LLB ,Member
CC.No.30/2014
Shaila.B : Complainant
W/o Felix Cyril
Joy Sadanam
Kodu vila, East Kallada
Kollam
[By Adv.B.Byju, Kollam]
V/S
1. Anand Kumar K.V : Opposite parties
Agency Code – 391326
Amsure Insurance Agency Ltd
C/o Amway India Enterprises
Sree Sadtha, Kripa Complex
Near Krishna Hospital
Thiruvananthapuram – 695010
2. The Branch Manager
Max Newyork Life Insurance Co.Ltd
Branch Office , II nd Floor
Varinjam Tower, Chinnakkada,
Kollam
3. Managing Director & CEO
Max Newyork Life Insurance Co.Ltd
11th Floor, DLF Square, Jacaranda Marg
DLF Phase II, Gurgaon – 122002
[By Adv.Sujith Chandran.H, Kollam]
ORDER
SRI. M. PRAVEEN KUMAR, MEMBER
The case is based on a complaint filed by Shaila.B against the 3 opposite parties seeking to refund the premium amount from 10/06/2011 onwards and also seeking compensation to the tune of Rs.25,000/- and cost of the proceedings.
(2)
Complainant case is that on 25/06/2011, the 1st opposite party approached the complainant and explained the features of the life insurance policy named “ Life Gain Plus 20 Participating Plan” introduced by the third opposite party and also he caused to convince the complainant that the said policy plan is for Rs.99,999/- (Rupees Ninety Nine Thousand Nine hundred and Ninety Nine Only) and it is a single premium policy and will mature after 20 years and the complainant will get an amount of Rs.7,62,421/- at that time and also the said plan is having 20 years life insurance coverage . Believing the words of the 1st opposite party who is the agent of the 2nd and 3rd opposite parties on 30/06/2011 the complainant joined the “ Life Gain Plus 20 Participating Plan” vide policy No.575503032 and entrusted an amount of Rs.99,999/- (Rupees Ninety Nine Thousand Nine Hundred and Ninety only ) to the 1st opposite party by Demand Draft bearing No.594254 dated 30/06/2011of Canara Bank, Kadappakkada Branch.
All the papers and application forms in relation to the said insurance policy was filled by the 1st opposite party later. The complainant was permitted to put the signatures in blank application forms on the relevant places pointed out by the 1st opposite party. After the payment of the said premium amount the 1st opposite party never contacted the complainant and failed to inform regarding the status of the said policy taken by the complainant. On several occasions the complainant contacted the first opposite party and enquired about the status of the said policy. On that occasions the 1st opposite party willfully abstained from answering the queries. Lastly he replied that now he is not doing the business of the second and third opposite party and advice the complainant to contact to the branch office of the third opposite party at Kollam ie the 2nd opposite party.
On 02/12/2013 the complainant approached the branch office of the 3rd opposite party at Kollam and required about the present status of her life insurance policy. Then the 2nd opposite party informed the complainant that the policy taken by the complainant is not a single premium policy and it was an annual policy and as the complainant made default in remitting the remaining premiums the policy
(3)
was already cancelled and hence so the complainant is not entitled to get any amount. Then the complainant got knowledge that she was totally cheated by all these opposite parties. According to the complainant this is an unfair trade practice on the part of the opposite parties because the 1st opposite party is an authorized agent of the 2nd and 3rd opposite parties. The 1st opposite party willfully abstained from informing answering the queries and suppressed the materials facts from the complainant. So all the opposite parties are jointly and severally liable to compensate the complainant.
On 16/12/2013, the complainant approached the 2nd opposite party, the branch office of the third opposite party at Kollam and demanded the premium amount which she already deposited . But the 2nd opposite party rejected the said claim of the complainant. Hence the complainant is compelled to approach this Forum to redress her grievance.
Opposite party 1’s notice return as party left. But the complainant failed to produce correct address of 1st opposite party hence the case against 1st opposite party stands dismissed. Opposite party 2 and 3 entered appearance and filed version. On their version they contended that the complainant had applied for the insurance policy after understanding the features of the policy, terms of the payment of premium and return etc. However , after availing benefits of the insurance policy for the period of insurance the complainant wants to take undue advantage by making false and concocted allegations. Complainant herself is a distributor of a leading brand this she is well aware of the pros and cons of signing of the blank forms. Thus she cannot be expected to sign blank proposal form for taking insurance policy. The complainant did not make payment of premium as per terms and conditions of the policy and therefore the policy got lapsed . The welcome letter of the policy and terms and condition s of the policy also provide that if the complainant has any grievances with respect to the terms of the policy he can approach the opposite party by writing a letter to the opposite party for the
(4)
same . Thus the law and policy contract clearly provides that terms of the policy can be assailed only within 15 days of the receipt of policy document.
Based on the information provided in the proposal form and on the basis of declaration made in the proposal form and after receipt of the initial premium amount under the policy the opposite party issued the policy bearing No.575503032 on 30/06/2011. Upon insurance of the policy, the policy documents including welcome letter, policy schedule containing various charges being levied under the policy, terms and conditions of the policy and copy of proposal form sent to the complainant at the address given in the proposal form on 08/07/2011. The policy benefits and the premium paying terms were specifically mentioned in the schedule of the policy .
Complainant was required to send request for cancellation of policy within 15 days of receipt of the policy document, however despite clear instruction regarding method, means and time period of cancellation of policy the complainant did not sent any request for cancellation of the policy within 15 days of receipt of the policy .
Complainant cannot take advantage of his own wrong by making false and baseless allegations after availing benefit of life insurance for the period before lapse of the policy and ask for refund of his amount given as premium . It is submitted that the opposite party has dealth with the terms and conditions of the policy , therefore there is no negligence or deficiency in services by the opposite party and consequently the complaint is liable to be dismissed outright .
In view of the pleadings the points that would arise for consideration are :-
(1). Whether complainant is entitled to get the premium amount of Rs.99,999/- with interest @ 9% per annum from opposite parties?
(2).Whether there is any deficiency in service or any unfair trade practice on the part of opposite parties?
(5)
(3)Whether the complainant is entitled to get the reliefs as claimed in the complaint?
(4) Reliefs and costs?
Evidence on the side of the complainant consists of the oral evidence of PW1 and Exts P1 to P5 documents Mr.Suraj.K.Rajan working as Assistant Manager (Operations ) representing opposite parties 2 and opposite party 3 has been examined as DW1 and got marked as Ext.D1 and D2 documents .
Though sufficient opportunity was given the counsel appearing for the opposite parties has not advanced any argument nor filed any notes of argument . Counsel for the complainant advanced argument and filed notes of argument.
Point No.1 to 3:-
For avoiding repetition of discussion of materials these 3 points are considered together . Admitted case of the parties is that complainant had joined the “Life Gain Plus 20 participating Plan ” vide policy No. 575503032 and entrusted an amount of Rs.99,999/- through Demand Draft No.594254 dated 30/06/2011 drawn on Canara Bank, Kadappakkada Branch . According to PW1 the complainant had joined the policy by believing the words of the opposite parties that said policy is a single premium policy and will mature after 20 years and the complainant will get an amount of Rs.7,62,421/- on maturity . But later it is came to know that the said policy was an annual policy and the 3rd opposite party has cancelled the same due to nonpayment of regular premium. According to opposite party 2 and 3 , complainant joined the policy after understanding the features of the policy and relied on Ext.D1 proposal form. Counsel for complainant argued that the complainant was unaware of the features of the policy and the complainant put signature only on the 3rd page which stands only verification and declaration and the said signed pages having no such conditions. Ext.D1 is admittedly a photocopy . No signature on the 1st or 2nd page which contain relevant entries. If the original of Ext.D1 it can be ascertained whether the 3rd page where of
(6)
Ext.D1 is continuation of page No.1 &2 . In the circumstances the entries shown in the photocopy of page No.2 of Ext.D1 cannot be relied up on especially when the complainant has not admitted the same. In the circumstances we are of the view that complainant’s case that he was having no knowledge with regard to the fact that premium has to be paid annually is believable and acceptable.
It is clear from the materials available on record that there is gross negligence, deficiency in service and unfair trade practice on the part of opposite parties 2 and 3 . Therefore complainant is entitled to get the premium amount Rs.99,999/- along with reasonable interest.
According to complainant , due to the negligence ,deficiency in service and unfair trade practice of opposite parties she has sustained mental agony another losses we are the opinion that Rs.10,000/- shall be sufficient compensation and Rs.2500/- shall be sufficient costs.
In the result, complaint stands allowed in the following terms. Opposite parties 2 and 3 are directed to pay an amount of Rs.99,999/- with interest @ 9 % per annum from 30/06/2011 till realization, Rs.10,000/- as compensation and Rs.2500/- as costs of the proceedings to the complainant within 45 days from today failing which the complainant is entitled to realize an amount of Rs.1,09,999/- with interest @12% per annum from 30/06/2011 till realization along with costs of the proceedings from the opposite parties 2 and 3 jointly and severally and from their assets .
Dictated to the Confidential Assistant Smt.Vijimole.G transcribed and typed by her corrected by me and pronounced in the Open Forum on this the 23rd day of April 2018.
E.M.Muhammed Ibrahim:Sd/-
M.Praveen Kumar: Sd/-
Forwarded/by Order
Senior Superintendent
(7)
INDEX
Witnesses Examined for the Complainant
PW1:-Shila
Documents marked for the complainant
Ext.P1:- Policy certificate
Ext.P2:- Postal receipts (3 nos )
Ext.P3:- Notice copy
Ext.P4:- Notice returned with cover
Ext.P5:- Acknowledgment card
Witnesses examined for the opposite parties
Ext.DW1:- Suraj.K.Rajan
Documents marked for the opposite parties
Ext.D1:- Copy of proposal form
Ext.D2:- Welcome letter , terms and condition marked .
E.M.Muhammed Ibrahim:Sd/-
M.Praveen Kumar: Sd/-
Forwarded/by Order
Senior Superintendent
