Chandigarh

StateCommission

A/139/2015

Harinder Singh - Complainant(s)

Versus

Aviva Life Insurance - Opp.Party(s)

S.S.Virk & Devinder Kumar, Adv.

13 Jul 2015

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

First Appeal No.	139 of 2015
Date of Institution	17.06.2015
Date of Decision	13.07.2015

Harinder Singh son of Sarabjeet Singh resident of Village Adhoi, Tehsil Barara, District Ambala.

                                        …..Appellant/Complainant.

                                Versus

Aviva Life Insurance through its Branch Manager, Showroom No.180-182, Sector 9, UT, Chandigarh.

                                        …..Respondent/Opposite Party.

BEFORE:    JUSTICE SHAM SUNDER (RETD.), PRESIDENT

                SH. DEV RAJ, MEMBER

                MRS. PADMA PANDEY, MEMBER

 

Argued by:

Sh.S.S.Virk, Advocate alongwith Sh.Devinder Kumar, Advocate for the appellant.

Sh.Sanjeev Goyal, Advocate alongwith Sh.Gaurav Bhardwaj, Advocate for the respondent.

 

PER PADMA PANDEY, MEMBER

                This appeal is directed against the order dated 01.06.2015, rendered by District Consumer Disputes Redressal Forum-I, UT, Chandigarh (hereinafter to be called as the District Forum only), vide which, it disposed of Consumer Complaint bearing No.505 of 2014, filed by the complainant, with the following directions:-

“Henceforth, judged from every angle and in view of the foregoings, we have no hesitation to conclude that the complainant has not been able to prove his case of alleged deficiency on the part of Opposite Party. However, we dispose of the present Complaint, with a direction to the Complainant to exercise his preference with the Opposite Party to choose between the two annuity options available to him as per the terms & conditions of the policy within fifteen days from the date of receipt of certified copy of this order. Thereafter, the Opposite Party shall process the case of the Complainant forthwith and release the pending installments of the pension to him, within 30 days. The parties are left to bear their own costs. “

2.             The facts, in brief, are that the complainant, who is a handicapped person, with the financial assistance of his friends, purchased one Insurance Policy from the Opposite Party by paying a premium of Rs.1,00,000/- on 08.09.2006 vide First Premium Receipt (Annexure C-1) and as per the Policy, the date of maturity was 08.09.2013. It was stated that after the date of maturity, when the complainant approached the Opposite Party, it refused to pay the sum due and further directed him to reinvest the said amount in some other Policy, whereas, there was no such condition mentioned in the said Policy, and, as such, he (complainant) did not agree. Ultimately, the complainant sent a legal notice to the Opposite Party on 01.01.2014 (Annexure C-2), which was duly replied to by it (Opposite Party) on 07.02.2014 (Annexure C-3), showing its inability to pay the amount by making false and baseless excuses and, as such, clearly refused to pay the due amount to him in lumpsum. It was further stated that the Opposite Party was deficient, in rendering service, as also indulged into unfair trade practice.  When the grievance of the complainant was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the “Act” only), was filed.

3.             In its written statement, the Opposite Party, admitted that the complainant took the Insurance Policy i.e. ‘Pension Plus Single Premium’ bearing No.OPG1334678 dated 08.09.2006 by paying a single premium of Rs.1,00,000/-. It was stated that all the Policy documents alongwith terms and conditions were supplied to him (complainant), as such, he was fully aware about all the terms & conditions and benefits of the same. It was further stated that after receipt of the Policy, the complainant did not exercise the option, during the free look period of 15 days, either for cancellation thereof or modification of the terms and conditions thereof, as per Regulation 6(2) of the Insurance Regulatory and Development Authority (Protection of Policyholders Interests) Regulations, 2002.  It was further stated that the Policy matured on 8.9.2013 with maturity value of Rs.1,38,214/- and as per the standard terms & condition of the Policy, the complainant had the option to choose between two annuity options, mentioned in para No.2 of its written statement. It was further stated that the Opposite Party sent a number of intimation letters through ordinary post on 29.05.2013, 28.06.2013, 31.07.2013 and 12.03.2014 respectively, informing the complainant about the maturity of the Policy and to choose between the two annuity options, as per terms and conditions of the Policy but he did not submit the required documents and rather insisted for full maturity value, which was not possible being contrary to the terms & conditions of the Policy.  It was further stated that the replying Opposite Party was neither deficient, in rendering service nor indulged into unfair trade practice.

4.             The parties led evidence, in support of their case.

5.             After hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, disposed of the complaint, as stated above. 

6.             Feeling aggrieved, the instant appeal, has been filed by the appellant/complainant.

7.             We have heard the Counsel for the parties, and have gone through the evidence and record of the case, carefully. 

8.             The Counsel for the appellant/complainant submitted that the respondent/Opposite Party placed on record only Annexure R-2 (proposal form) alongwith its written statement and no terms and conditions of the Policy were placed on record by it. In the said proposal form, no such terms and conditions were written, which bound him to further reinvest the amount. He further submitted that at the time of taking the premium, Opposite Party only issued Annexure C-1 and in the said document, no such terms and conditions were written. He further submitted that the Opposite Party concealed the maturity amount. He further submitted that in its written statement, the Opposite Party alleged that as per records, Policy had matured on 08.09.2013 with maturity value of Rs.1,38,000/- but it did not place on record any document, formula and calculation to show that how the amount of Rs.1,00,000/- became Rs.1,38,000/- after 7 years. He prayed for allowing the appeal and modification of the impugned order.

9.             The Counsel for the respondent/Opposite Party submitted that, the complainant took the Policy from the Opposite Party and paid a single premium of Rs.1,00,000/-. He further submitted that the complainant was fully aware about the terms and conditions of the Policy, because the Policy document alongwith terms and conditions were supplied to him. He further submitted that the complainant failed to exercise the option for cancellation within stipulated period. He further submitted that the Policy had matured on 08.09.2013 with maturity value of Rs.1,38,214/- and the same is intact and freezed on that date and maturity value as on 30.06.2015 was also Rs.1,38,214/-. He further submitted that the complainant was having two options (a) to purchase an annuity plan as per Article 4 of the Policy for the entire sum of Rs.1,38,214/- (b) to take lumpsum cash of Rs.46,071.33 and purchase an annuity plan for balance amount of Rs.92,142.67 but he (complainant) failed to exercise the said options. He further submitted that the requisite forms for exercise of the options were sent to him (complainant) but he failed to accept the same.

10.           After giving our thoughtful consideration, to the submissions, raised by the Counsel for the parties, and the evidence, on record, we are of the considered opinion, that the appeal is liable to be partly allowed, for the reasons, to be recorded, hereinafter.

11.           The first question, that falls for consideration, is, as to whether, the Policy documents alongwith terms and conditions were supplied to the complainant or not. Annexure C-1 is a copy of the First Premium Receipt dated 08.09.2006. From this document, it is proved that the complainant took the Policy i.e. ‘Pension Plus Single Premium – Unit Linked’ bearing No.OPG1334678, from the Opposite Party, by paying single premium of Rs.1,00,000/-, and the date of commencement of the Policy was 08.09.2006 and date of maturity was 08.09.2013. As per the allegation of the appellant/complainant, the Policy documents alongwith terms and conditions were not supplied to him, whereas, according to the Counsel  for the Opposite Party, the Policy documents alongwith terms and conditions were supplied to him. He further submitted that the complainant submitted a proposal form bearing No.NNU-10492333 for purchasing the aforesaid Policy, submitted the relevant documents and he thumb marked the proposal form after admitting the contents thereof to be correct. On the basis of the proposal form, Policy bearing No.OPG1334678 was issued, which contained Policy Schedule, first premium receipt standard terms and conditions, copy of the proposal form and the right to reconsider notice. If he (complainant) had disagreed with any of the terms and conditions of the Policy, then he could have cancelled the same within 15 days from the receipt of the Policy document but despite the receipt of the Policy, he did not opt to cancel the Policy, meaning thereby he was aware and accepted each and every term and condition of the Policy. Moreover, the allegation of the appellant/complainant, at this stage, for non receipt of the Policy documents alongwith terms and conditions, has no value, at all because he took the Policy in the year 2006 and the said Policy had matured in the year 2013. After about seven years he had raised an objection regarding non receipt of the Policy documents alongwith terms and conditions. Even the complainant failed to produce on record any document/letter, which could show that he made repeated requests for supply of the Policy documents alongwith terms and conditions but the Opposite Party did not supply the same.

12.           The next question, that falls for consideration, is, as to whether, the complainant is entitled to the lumpsum deposited amount alongwith interest or not. As per the Policy of the complainant, the date of maturity was 08.09.2013 and when he approached the Opposite Party, after the maturity of the Policy, it refused to pay the sum due and rather directed him to re-invest the said amount in some other Policy, which he did not agree. As per the Opposite Party, the Policy of the complainant had matured on 08.09.2013 with maturity value of Rs.1,38,214/-. It is pertinent to note none of the parties placed on record copy of the Policy alongwith terms and conditions, before the District Forum. Therefore, this Commission directed the Counsel  for the respondent/Opposite Party to submit duplicate copy of the Policy alongwith terms and conditions thereof. The Counsel  for the respondent filed copy of the Policy Schedule and standard terms and conditions on 29.06.2015. The Counsel  for the Opposite Party drew our attention to the standard terms & conditions of the Policy, in which, the complainant had the option to choose between following two annuity options, as per Article 4 ‘Maturity Benefit’ (at page No.17 of the file), and the same reads 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 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.

(2) x x x x x x x x”

From the afore-extracted Article, it is clear that the appellant/complainant is not entitled to the refund of the lumpsum deposited amount alongwith interest. It is also proved that the Opposite Party sent many intimation letters dated 28.05.2013, 26.06.2013, 29.07.2013 and 07.03.2014 (page No.35, 37 to 39 of the District Forum file) to exercise the option but he failed to choose the same.

13.           At the time of arguments, the Counsel for the Opposite Party filed the calculation, in which, it has been mentioned that maturity value of the Policy as on 08.09.2013 was Rs.1,38,214/- and the same is intact and freezed at that date and maturity value as on 30.06.2015 was also Rs.1,38,214/-. It was further mentioned that the complainant was having the two options (a) to purchase the annuity plan as per Article 4 of the Policy for the entire sum of Rs.1,38,214/- and (b) to take lumpsum cash of Rs.46,071.33 and purchase an annuity plan for balance amount of Rs.92,142.67. It is pertinent to note that the Opposite Party failed to file any calculation, before the District Forum, as to how much amount, the complainant was entitled, as per the annuity options mentioned in Article 4(a) & (b) of the terms and conditions of the Policy. Without the bifurcation of the amount of Rs.1,38,214/-, how the complainant could came to know as to which option was suitable to him. So, we are of the considered opinion that the District Forum erred in disposing of the complaint and, as such, the appeal filed by the complainant is liable to be partly allowed.

14.           In view of the above discussion, the appeal filed by the appellant/complainant, is partly accepted, with no order as to cost. The order of the District Forum is modified, and the appellant/complainant is directed to choose between the two annuity options, as per Article 4 of the terms and conditions of the Policy, within a period of 30 days, from the date of receipt of a certified copy of this order and after exercising one of the options, the respondent/Opposite Party shall process his case within the period of further 20 days from the date of receipt of the same (option) and grant him benefit, as per that option.

15.           Certified Copies of this order be sent to the parties, free of charge.

16.           The file be consigned to Record Room, after completion.

Pronounced.

13.07.2015                                                 Sd/-                 

[JUSTICE SHAM SUNDER (RETD.)]

PRESIDENT

 

Sd/-

 (DEV RAJ)

MEMBER

 

Sd/-

(PADMA PANDEY)

        MEMBER