| ORDER | DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA CC.No.554 of 21-11-2011 Decided on 30-03-2012
Parkash Kaur, aged about 64 years wife of Major Singh Gaidu, Old Post Office Street, Ward No.11, Tehsil Bagha Purana, District Moga (Punjab). .......Complainant Versus
Aviva Life Insurance Company India Limited, Branch Office, The Mall, Bathinda, through its Manager. Aviva Life Insurance Company India Limited, Registered Office 2nd Floor Prakashdeep Building 7 Tolstoy Marg, New Delhi, through Managing Director & CEO Sh. Gaurav Malhotra Manager. Aviva Life Insurance Company India Limited, Aviva Tower, Sector Road, Opp. Golf Course, DLF Phase-V, Sector 43, Gurgaon through its M.D. ......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986
QUORUM
Smt. Vikramjit Kaur Soni, President Sh. Amarjeet Paul, Member Smt. Sukhwinder Kaur, Member Present:- For the Complainant: Sh. Gurpreet Singh, counsel for the complainant For Opposite parties: Sh. Varun Gupta, counsel for opposite parties
ORDER
Vikramjit Kaur Soni, President:-
The present complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended up-to-date (Here-in-after referred to as an 'Act'). The brief facts of the complaint are that on the allurement of the opposite parties, the complainant purchased one Insurance Policy bearing No.WLG1455643 in the year 2007. The complainant paid three annual installments to the tune of Rs.10,000/- each as premium w.e.f. 14.02.2007 to 14.02.2009. At the time of taking the above said policy, the complainant fulfilled all the formalities of the opposite parties. The opposite parties have not issued any terms and conditions to the complainant. The complainant has alleged that in the month of May, 2010 when the complainant approached the office of the opposite parties with the request that due to financial problem, she is unable to continue the said policy and asked them to refund the amount of Rs.30,000/- along with interest, the opposite parties arbitrarily auto foreclosed the policy of the complainant and sent a cheque No.356681 dated 08.06.2010 for a sum of Rs.10,000/- to her and have not paid the remaining amount. She approached and requested the opposite parties many times to pay the balance due amount to her, but to no effect. Hence, the complainant has filed the present complaint seeking direction of this Form to the opposite parties to refund the amount of premium i.e. Rs.20,000/- along with interest, cost and compensation. The opposite parties filed their joint written statement and pleaded that they had issued a policy in question on the basis of the Proposal Form submitted by the complainant. The Insurance contract was entered into between the parties upon the agreed terms and conditions. Moreover, the complainant was also issued the policy schedule and key feature documents which clearly explained the charges applicable on the policy and “Right to Reconsider” notice which states that “You have the right to review the policy terms and conditions and cancel her policy within a period of 15 days from the date of receipt of the policy document. If you cancel your policy, the premium you have paid will be refunded after adjusting for adverse movement in unit prices less charges incurred on account of stamp duty and medical expenses, if any.” The complainant had the option to review and seek refund of the premium if she disagreed with the terms and conditions of the policy within 15 days of the receipt of the policy document. The opposite parties have further pleaded that the complainant approached the opposite parties for purchase of the Insurance Policy. The Proposal Form bearing No.NUP10591654 dated 07.02.2007 was received by the opposite parties which was duly filled and signed by the complainant after going through the 'key feature document' sample illustration of the maturity value and understanding the scope, meaning and contents of the Proposal Form. At the time of submitting the Proposal Form, the complainant had also signed a Consumer Declaration and on the basis of the above said Proposal Form and Declaration, the opposite parties issued Life Unit Linked Policy bearing No.WLG1455643 to the policyholder. The policy documents were dispatched to the complainant on 26.02.2007 vide Speed Post bearing No.EE807329226IN which included policy documents, the Right to Reconsider notice, the Standard Terms and Conditions, copy of proposal Form and First Premium Receipt. As per the “Right to Reconsider” Notice, the complainant has the option to get the policy cancelled within 15 days of receipt of policy documents in case she was not satisfied with any of the terms & conditions of the policy but she did not do so. The opposite parties have further pleaded that the complainant had paid 2 more premiums under the above said policy without raising any dispute with regard to the features of the policy for more than 3 years. The policy was lapsed twice and the complainant duly reinstated the same which shows that she was fully aware of the procedure of reinstatement. On 16.04.2010 i.e. after more than 3½ years of the commencement of the policy, the same was auto foreclosed as per Article 15.3.1 and 15.3.3.2 of the Standard Terms & Conditions as the fund value fell below first years premiums and accordingly, the surrender value was paid to the complainant vide letter dated 16.06.2010. The opposite parties have further pleaded that the above said policy was lapsed and reinstated various times i.e. firstly on 14.03.2008 and reinstated on 03.04.2008 and again lapsed on 14.03.2009 and reinstated on 19.05.2009 as such the complainant had full knowledge of the terms and conditions of the said policy. Thereafter, the said policy was again lapsed on 14.03.2009 due to non payment of the premium but she failed to reinstate the said policy and the same went into “Inforce Notice Period” on 22.03.2010 and later on auto foreclose mode on 16.04.2010. Accordingly, on 16.06.2010, the opposite parties sent a auto foreclosure cheque for a sum of Rs.10,000/- through speed post AWB EH140644179IN to the complainant. The opposite parties have pleaded that they have never allured any person including the complainant to purchase the policy in question rather she purchased the said policy of her free will after understanding all the terms and conditions of the policy. The opposite parties have provided best services to the complainant. It has been pleaded that the policy name itself denotes that the said policy is not short term policy. Further Key Features Documents of 'Life Long' policy makes it clear that 'Policy Term' will continue till policy holder attains the age of 85 years and accordingly, the term of the policy would be determined. Thus the proposer filling the proposal form is not required to write terms of the said policy which is according to the age of the proposer. Parties have led their evidence in support of their respective pleadings. Arguments heard. Record alongwith written submissions submitted by the parties perused. The learned counsel for the complainant submitted that the complainant purchased one policy No. WLG1455643 in the year 2007 from the opposite parties through their agent on the allurement that it is best plan and there is no maturity date and if he did not want to continue the said policy after paying three premiums, the amount paid by her would be refunded alongwith interest. The complainant paid three annual installments of Rs.10,000/- each against the said policy. Thereafter, the complainant has not paid the 4th installment. On approaching the opposite parties, they told the complainant that she has not deposited the 4th installment of her policy on due date, as such her policy has been foreclosed. The complainant alleged that there was no term and condition to apply for cancellation or auto foreclosure of policy due to non-payment of 4th installment. The opposite party has sent cheque of Rs.10,000/- against the said policy to the complainant but has not paid the remaining amount. The opposite parties withheld the remaining amount of Rs.20,000/- against the policy alongwith interest and other benefits of the complainant. The learned counsel for the opposite parties has submitted that the Insurance contract was entered between the parties upon the agreed terms and conditions as detailed in the Standard terms and conditions. The complainant was also issued the Policy Schedule and Key Feature Documents which clearly explained the charges applicable on the Policy and Right to Reconsider notice as detailed in the written reply. According to which, the complainant had option to review and seek refund of the premium, if he disagreed with the terms and conditions of the policy within 15 days of the receipt of the policy documents. The Standard Terms and Conditions and Key Feature Documents of the Life Long Unit Linked Policy was explained to the complainant in detail and thereafter that she opted for the said policy. The Unit Linked Product/Policy are Market linked policies and are dependent on the market fluctuations, the investment risk is borne by the Policyholder. Depending upon the performance of the Unit Linked fund chosen by the policyholder to achieve gains and losses on his/her investments. The learned counsel for the opposite parties has further submitted that the complainant filled the Proposal Form dated 07.02.2007 which was duly filled and signed by her after going through the Key Feature Document, sample illustration of the maturity value and understanding the scope, meaning and contents of the Proposal Form. The complainant has also signed the Consumer Declaration incorporated thereunder. On the basis of Proposal Form and declaration, the opposite parties issued a Life Long Unit Linked Policy bearing No.WLG1455643 to the Policyholder. The salient features of the policy is as stated below :- Policy No.WLG1455643 (a) Commencement date 14th February, 2007 (b) Sum Assured Rs.1,00,000/- (c) Premium Frequency Annual (d) Regular Premium Amount Rs.10,000/- (RP) (e) Premium paid till date Rs.30,000/- (f) Status of Policy Auto-Foreclosed The Policy documents were dispatched to the complainant on 26.02.2007 vide Speed Post bearing Nos.EE8073292261N and the policy documents included policy schedule, “the Right to Reconsider” Notice, the Standard Terms and Conditions, copy of Proposal Form and First Premium Receipt. Sh. Gaurav Malhotra, Manager – Authorized Signatory of Aviva Life Insurance Company India Limited has deposed in his affidavit Ex. R-12 :- “ 22. That thereafter, the complainant duly paid 2 more premium under the policy without raising any dispute with regard to the features of the policy for more than 3 years. The policies also lapsed twice and the complainant duly reinstated the policies which show that he was fully aware as to the procedure of reinstatement. duly paid premiums for 3 years. 23. That on 16th April, 2010 i.e. after more than 3 and half years of the commencement of the policy, the same was auto foreclosed in accordance with Article 15.3.1 and 15.3.3.2 of the Standard Terms and Conditions as the fund value fell below first years premiums and the surrender value in accordance with the terms and conditions was paid to the complainant vide letter dated 16th June, 2010. The opposite parties have placed on file Aviva Standard Terms and Conditions Ex. R-11. These terms and conditions are not signed by any of the parties or by the complainant which means that these terms and conditions are never supplied to the complainant. However, Article 14 of the aforesaid terms and condition i.e. Surrender Value is reproduced hereunder :- “14.1 Subject to Article 17, with effect from the commencement of the fourth Policy Year the Policyholder is entitled to receive a surrender value upon termination of the policy (other than the death of the insured) provided that all Regular Premium due have been paid for atleast two full policy years.” “14.2 The surrender value is equal to the surrender value of initial Units, which is equal to the value of all initial Units less a Surrender Charges on Initial Units as specified in the Schedule and the value of all Accumulation Units in respect of Regular Premium less a Surrender Charge on Accumulation Units in respect of Regular Premium as specified in the Schedule.” The complainant as well as the opposite parties have not placed on file the insurance policy in question. Due to non-payment of 4th installments of the premium, the opposite parties foreclosed the aforesaid insurance policy of the complainant, hence the complainant is not entitled to any other benefit or interest. The opposite parties have submitted that the policy was auto foreclosed in accordance with Article 15.3.3.2 of the Standard Terms and Conditions as the fund value fell below first years premiums and the surrender value in accordance with the terms and conditions was paid to the complainant vide letter dated 16th June, 2010. Since terms and conditions were not signed by the complainant as well as the opposite parties, these terms and conditions are deemed to be neither supplied nor conveyed to the complainant and as such, opposite parties are not entitled to make deduction by taking shelter of such terms and conditions which were never conveyed to the complainant. Hence, there is deficiency in service and unfair trade practice on the part of the opposite parties in not refunding the premium amount to the complainant and the complainant is entitled for the remaining amount of premium. In view of what has been discussed above, this complaint is accepted with Rs. 5,000/- as compensation and cost. The opposite parties are directed to pay to the complainant remaining amount of premium i.e. Rs. 20,000/-. The compliance of this order be made within 45 days from the date of receipt of copy of this order. In case of non-compliance within the stipulated period, the aforesaid premium amount of Rs. 20,000/- will yield interest @9% P.A. from the date of deposit of last premium against policy till realization. A copy of this order be sent to the parties concerned free of cost and file be consigned for record.
Pronounced in open Forum 30-03-2012 (Vikramjit Kaur Soni) President
(Amarjeet Paul) Member
(Sukhwinder Kaur) Member | |
