DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA.
CC.No.423 of 30-08-2012
Decided on 14-02-2013
Lt.Col Harmail Singh Chahal, aged about 69 years r/o H.No.3335/21003, St.No.2, Power House Road,Bathinda.
........Complainant
Versus
1.Aviva Life Insurance Company India Pvt.Ltd., The Mall Road, Near Axis Bank, Bathinda, through its Branch Manager.
2.Aviva Life Insurance Company India Pvt.Ltd., 5th Floor, JMD Regent Square Gurgaon, Mehrauli Road, Gurgaon, through its Managing Director.
.......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.Arvinder Singh, counsel for complainant.
For Opposite parties: Sh.Varun Gupta, counsel for opposite parties.
ORDER
VIKRAMJIT KAUR SONI, PRESIDENT:-
1. The complainant has filed the present complaint under section 12 of the Consumer Protection Act, 1986 as amended upto date (Here-in-after referred to as an 'Act'). The brief facts of the complaint are that on the assurance of the agent of the opposite parties, the complainant has purchased the Pension Plus Regular Unit Linked policy bearing No.NPG1226842 dated 23.3.2006 and the said agent told him that as per the said policy, he will be required to deposit the premium amounts quarterly for the period of 3 years and after the completion of the term of the said policy he shall get the refund of the total amount alongwith upto date interest and other benefits and he was also assured regarding the refund of the total maturity value at the time of completion of the term. At the time of selling the said policy, the said agent did not disclose the maturity clause of the said policy rather assured that after the expiry of the term of the same, he will get the refund of the total maturity value. The complainant has been regularly depositing the premium amount with the opposite parties well in time and also paid the last premium by the due date i.e. 21.4.2009, in total he has paid Rs.65000/- and the said policy matured on 23.3.2011. After the maturity of the said policy, the complainant has been approaching the opposite party No.1 with a request to refund the total maturity value of the said policy but their officials did not give any response. The complainant wrote a letter dated 18.6.2012 to the opposite parties for the refund of the total maturity value as he was in need of money but no reply was given to the said letter. The complainant again visited the office of the opposite party No.1 and their officials told him regarding sending the reply dated 26.6.2012 to him and also told him that the said letter has been sent through Overnite Express Limited although he never received the same and then he enquired about the said letter from Overnite Express Limited who told him that the same was delivered to one Mr. Rahul at No.225522 on 30.6.2012 although he has no concern with any such person namely Mr.Rahul and further is also residing at the same address till date and has not changed his address and intimated the opposite party No.1 about the abovesaid fact. Thereafter the opposite parties delivered the letter dated 26.6.2012 to the complainant on 12.7.2012. The opposite parties stated in the said letter that under the abovesaid policy, the refund of the total maturity value is not possible as they have been sending the claim intimation letter to the complainant prior to the maturity date but he never received any such claim intimation letters from them. The complainant again wrote a letter dated 13.7.2012 to the opposite party No.1 with a request to refund the total maturity value of the said policy but to no effect. Despite repeated requests of the complainant, the opposite parties have failed to pay the maturity amount to him. Hence the present complaint.
2. Notice was sent to the opposite parties. The opposite parties after appearing before this Forum have filed their joint written statement and pleaded that they floated the insurance schemes for the public in general after prior approval of the Insurance Regulatory & Development Authority (IRDA) and all the terms & conditions of the respective insurance policies are set by the I.R.D.A constituted under the I.R.D.A Act, 1999 and Insurance Act, 1938. The said policy was due for maturity on 23.3.2011 and as per the terms and conditions of the said policy, the maturity value is payable as per Article 4. The complainant was well aware of the terms & conditions applicable to the said policy. The opposite parties admitted the fact that the said policy is a pension policy and there is no scheme of the consolidated payment of the pension and they have not denied its liability to pay the same as per the terms & conditions of the said policy. No dispute was raised by the complainant during the free look period of 15 days. The receipt of the said policy is not denied hence the complainant cannot dispute the terms and conditions which have been accepted by him. The complainant himself shown his interest to purchase a Life Insurance Plan of the opposite parties, he got the entire information about all the insurance plans. After understanding all the terms & conditions and benefits of all the plans, he opted to purchase Pension Plus Unit Linked Plan of the opposite parties and filled a Proposal Form bearing No.PP8330916 on 9.3.2006. The complainant opted to pay Rs.20,000/- as annual premium for the term of 5 years with quarterly frequency, opted fund option as pension Unit Linked Fund as Pension Balance Fund 100%. Moreover there is specific note i.e. in Unit Linked Plans, the investment risk in investment portfolio is borne by the policyholder. The proposer should be satisfied with the details of the product and must pay the specific attention to the additional information and 'your comment' sections in the key features brochure of the product. Before signing the proposal form, the complainant made a declaration and signed the same. The opposite parties had issued the insurance policy bearing No.NPG1226842 on 23.3.2006 and sent the policy documents alongwith its all the terms and conditions through Overnite Courier vide Airway bill No.506659991 to the complainant on the given address and the same was duly received by him which is in his possession. The actual payment of benefits in the said policy will vary, based on the actual performance of the Investment Fund(s) chosen by the policyholder. The Unit Price of any Investment Fund may increase or decrease as per the performance of the financial markets. The past performance of these or other Investment Funds offered by the company do not indicate the future performance of these Investment Funds. This plan is entirely different from the traditional Insurance Plans. The opposite parties admitted that the complainant paid the amount of Rs.65,000/- to them against the said policy. As per the terms and conditions in pension policies, full refund of the maturity value is not possible and refund can be taken in the form the annuities and under this plan he can withdraw 1/3 of the total policy amount and reinvest 2/3 of the amount in the annuity either with the opposite parties or any other Indian Insurance Company as per his own wish and for getting the abovesaid benefits the assured must under the obligation to give the information to them in written but he did not do so till date. The opposite parties also admitted that they have received a letter on 18.6.2012 and they have sent the reply of the same to the complainant which was received by him. To support their version the opposite parties have referred various authorities.
3. The parties have led their evidence in support of their respective pleadings.
4. Arguments heard. The record alongwith written submissions submitted by the parties perused.
5. Admitted facts of the parties are that the complainant has purchased the Pension Plus Regular Unit Linked policy bearing No.NPG1226842 dated 23.3.2006 and the maturity was due on 23.3.2011.
6. The disputed facts between the parties are that at the time of issuance of the said policy, the complainant was assured that he will be required to pay the premium amount quarterly for the period of 3 years and after the completion of the term of the said policy, he shall get the refund of the total amount alongwith upto date interest and other benefits and he was also assured regarding the refund of the total maturity value at the time of completion of the term. The complainant was assured by the agent of the opposite parties that the total maturity value will be refunded to him. Accordingly, the complainant has paid the last premium due on 21.4.2009, in total he has paid Rs.65000/- and the said policy matured on 23.3.2011. The complainant requested the opposite parties to pay the maturity value but no response was received by him. The complainant wrote a letter dated 18.6.2012 to the opposite parties for the refund of the total maturity value but no reply was given to the said letter. The complainant again visited the office of the opposite party No.1 and their officials told him that the reply has been sent to the above mentioned letter on dated 26.6.2012 through Overnite Express Limited but this reply was never received by the complainant and the same was delivered to one Mr. Rahul at No.225522 on 30.6.2012. The complainant has no concern with any such person namely Mr.Rahul. Thereafter the opposite parties delivered the letter dated 26.6.2012 to the complainant on 12.7.2012. In this letter the opposite parties mentioned that the refund of the total maturity value is not possible and they have been sending the claims intimation letter to the complainant prior to the maturity date but he never received any such claim intimation letters from them. The complainant again wrote a letter dated 13.7.2012 to the opposite party No.1 and requested to refund the total maturity value of the said policy but to no avail.
7. On the other hand the submissions of the opposite parties are that the maturity date of the said policy was 23.3.2011 and as per the terms and conditions of the said policy, the maturity value is payable as per Article 4 of the said policy and the complainant has duly signed the declaration while signing the proposal form to the effect that he understands and agrees to the said policy and it shall be deemed to have been delivered and received by him in course of ordinary post.
8. The complainant was well aware of the terms & conditions applicable to the said policy. The opposite parties admitted the fact that the said policy is a pension policy and there is no scheme of the consolidated payment of the pension and they have not denied its liability to pay the same as per the terms & conditions of the said policy. The complainant was given the option of the free look period of 15 days but he has neither disputed the terms & conditions of the said policy nor applied for the cancellation of the policy nor applied for the refund of the premium within the free look period. The complainant himself opted to purchase Pension Plus Unit Linked Plan policy and filled a Proposal Form bearing No.PP8330916 on 9.3.2006. The complainant opted to pay Rs.20,000/- as annual premium for the term of 5 years and frequency quarterly also opted fund option as pension Unit Linked Fund as Pension Balance Fund 100%. The complainant has signed the declaration also which is reproduced:-
“a) I fully understand the meaning and scope of the proposal form and the question in it and am submitting the complete proposal on my accord and I confirm that I have not been induced by anyone to make the proposal.
b) The statement, declarations and material facts herein shall be the basis of a contract between me and the Company and if any untrue statement, declaration and material facts be contained herein, the company shall have the right to cancel the policy, if issued, and I may forfeit any payments made.
c) If any future premium or other payments due to the company are made by me through an Adviser, then the company shall not be liable unless the amount are received and realized by the company within the time the company stipulates for receipt of the payments by the company.
d) I confirm that the company may increase the sum insured and premium by an indexation increase at each, policy anniversary after sending me notice of such an increase in advance. I shall have the opportunity to decline any such increase if I so desire and shall inform the company at least 5 days before the policy anniversary.
I understand and agree that if the policy is sent by post it shall be deemed to have been delivered and received in the ordinary course of the post within three business days of posting.”
The maturity value is payable to the complainant as per Article 4 that is reproduced as under:-
“Article 4 Maturity Benefit:-
1. If the policyholder is living on the Maturity date, the fund value as at that date (and if the With Profits Fund is opted, together with any final bonus in relation to the With Profits Fund that the Company may declare), shall be applied in one of the following ways at the option of the Policyholder:-
a) 100% towards the purchase of an annuity (on his own life or jointly with his spouse) with the Company or any other Indian Insurance Company.
b) UP to (one third) 1/3rd towards cash lump sum and the balance towards the purchase of an annuity (on his own life or jointly with his spouse) with the Company or any other Indian Insurance Company.”
The policy documents alongwith its all the terms and conditions through Overnite Courier vide Airway bill No.506659991 was sent to the complainant on the given address and the same was duly received by him which is in his possession. The actual payment of benefits in the said policy will vary, based on the actual performance of the Investment Fund(s) chosen by the policyholder. In this Unit Price of any Investment Fund may increase or decrease as per the performance of the financial markets. The complainant has deposited Rs.65,000/- in total and as per the terms and conditions in pension policies, full refund of the maturity value is not possible and refund can be taken in the form the annuities and under this plan he can withdraw 1/3 of the total policy amount and reinvest 2/3 of the amount in the annuity either with the opposite parties or any other Indian Insurance Company. To avail the abovesaid benefits the assured must under the obligation to give the information to them in written but he did not do so till date.
9. The terms & conditions are not disputed by the complainant Moreover the complainant was fully aware of the plan. The complainant has himself placed on file Ex.C2 i.e. the Policy Schedule in which the following details are given:-
“Number:NPG1226842 Plan Name: Pension Plus Regular-Unit Linked Option: Pension Plus Balance Fund: 100% Pension Plus Secure Fund
Plan Code: NPG Investment Fund: Unit Linked N/A Pension Plus Growth Fund: N/A
Policyholder Insurance Details
Name: Harmail Singh Chahal Commencement Date: 23/3/2006
Date of Birth: 31/3/1943 Regular Premium Amount: Rs.5000/-
Sex : Male Frequency : Quarterly
Address : 3335, Gali No.2, Power Policy Term : 5
House Road
Premium Paying Term : 5
Date of Maturity :23.3.2011
Allocation Rate (%) :106
Distt.Bathinda 151001 Final Premium Payment :23.12.2010
Punjab, India
Age Admitted: N Nomination Details (Under section 39 of Insurance Act 1938)
Name: Harmel Kaur Chahel
Name: N/A
Name:N/A
Appointee (In case of minority of the Nominee)
Name:N/A
Beneficiaries(In case of Insurance under MWP Act)
` Name: N/A
Name:N/A
Name:N/A
Charges | Current | Maximum Limit |
Purchase selling price Spread | 5.00% | 5% |
Annual Management Charge | 5% per annum deductible monthly | 5% per annum deductible monthly |
Regular Management Charge | 1.0 % per annum deductible monthly | 2% per annum deductible monthly |
Monthly Administration Charge | Rs.47 per month for regular premium policies and Rs.28 per month for single premium policies and paid up policies | As per Article 12 (8) of Standard Terms and Conditions |
_____ Fee | First Switch in a policy year is Nil. On subsequent switches in a policy year 0.50% of amount switched subject to a minimum of Rs.100/- | No review |
Premium allocation rate | Less than 5 Lac:103% 5 lacs and above: 104% | N/A” |
The complainant requested the opposite parties vide Ex.C3 to pay the full maturity amount. The reply of this letter has been given by the opposite parties on 26 June, 2012 vide Ex.C4. The relevant portion of Ex.C4 is reproduced as under:-
“This is in regards to your complaint dated 18.6.2012 regarding the above-mentioned policy bearing No.NPG1226842 with us.
Please accept our sincere apologies for the inconvenience cause to you.
We understand from your complaint that, you want full refund of the maturity value.
We wish to inform you your policy is 'Pension Plus Unit Linked' and as per the terms and conditions of the policy in pension policies full refund of maturity value is not possible and refund can be taken in the form of annuities.
We wish to highlight you that we had on various occasion had sent the claims intimation letter prior to maturity date but same was returned to us due to your non-contability.
We also failed to understand about non-receipt of your concern about surrender refund prior to maturity date.
Further, the following annuity option is available in pension policy:-
. 1/3rd and 2/3rd-The customer can withdraw 1/3rd amount and reinvest 2/3rd of the amount in the annuity either from AVIVA or any other insurance company as per his wish.
. 100%-The customer can reinvest 100% of the amount in the annuity either from AVIVA or any other insurance company as per his wish.”
10. Thus from the facts, circumstances and evidence placed on file this Forum concludes that the complainant was aware of the terms & conditions of the said policy at the time of purchasing the said policy and he is entitled to get the benefits as per Article 4 of the policy in question.
11. Therefore in view of what has been discussed above this complaint is accepted with Rs.2000/- as cost and the opposite parties are directed to pay the benefits to the complainant as per the Article 4 of the said policy. The compliance of this order be done within 45 days from the date of receipt of the copy of this order.
12. A copy of this order be sent to the parties concerned free of cost and file be consigned to the record room.
Pronounced in open Forum:- Vikramjit Kaur Soni
14-02-2013 President
Amarjeet Paul Sukhwinder Kaur
Member Member
