BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.: 202 of 2016.
Date of Institution: 09.09.2016.
Date of Decision: 25.04.2019.
Sajjan Singh son of Shri Harphoool Singh, resident of village Barsi Jatan, Tehsil Bawani Khera and District Bhiwani.
..….Complainant.
Versus
1. Bajaj Allianz Life Insurance Co. Ltd. Dalal Complex 1st Floor, Opposite Liberty Cinema, Delhi Road, near Bajrang Bhawan, Rohtak, District Rohtak through its Manager.
2. Sarva Haryana Gramin Bank, Milakpur (Bhiwani) through its Branch Manager.
…...Opposite Parties
COMPLAINT UNDER SECTIONS 12 AND 13 OF
THE CONSUMER PROTECTION ACT, 1986.
Before: - Hon’ble Mr. Manjit Singh Naryal, President.
Hon’ble Mr. Parmod Kumar, Member.
Hon’ble Mrs. Saroj Bala Bohra, Member.
Present: Complainant in person.
Shri J. P. Tanwar, Advocate for the OP No. 1.
Shri Sanjay Sheoran, Advocate for the OP No. 2.
ORDER:-
PER MANJIT SINGH NARYAL, PRESIDENT
The case of the complainant in brief, is that he has taken KCC facility having account No.80408800004020 and also having a saving Bank account No.80400100060537 with OP No. 2. It is alleged that on assurance of the Manager of OP No.2, the complainant has taken policy No.0119486435 on 16.6.2010 under Swayam Shakti Suraksha Scheme and the OP No. 1 has issued the certificate of insurance and complainant is having membership No.3122 and paid the premium of Rs.10,000/- on 16.6.2010, Rs. 10,000/- on 12.7.2011, Rs.10,000/- in September, 2012, Rs. 10,000/- in September, 2013 and Rs.10,000/- on 5.7.2014 with the OP No. 1. It is further alleged that the complainant has deposited total amount of Rs.50,000/- and the 5 year period of the policy completed in June, 2015 and as per the terms of the policy the OP No. 1 had to pay Rs.64,000/- as maturity amount. It is further alleged that the complainant has requested many times to the OPs for the payment of maturity amount, but to no effect. Hence, there is deficiency in service on the part of OPs. Hence, the present complaint.
2. On appearance, the OP No. 1 filed written statement alleging therein that no cause of action has arisen in favour of the complainant against the answering OP, as the membership bearing No.0312271154 of the complainant stands already matured & terminated on the date of maturity i.e. 30.6.2015 and permissible maturity value i.e. Rs.39,439/- vide cheque No.680879 dated 21.9.2015 already paid by answering OP to complainant strictly in accordance with terms & conditions of the membership/master policy, as only 4 yearly premiums received by the OP till date of maturity. It is further alleged that the payment was made in accordance with the terms & conditions of the certificate of insurance as well as Group Master Policy administered by Haryana Gramin Bank and the complainant received the amount as full & final claim under the membership without raising any dispute, thus, nothing more is liable to be paid to him, as per the terms of the contract. It is further alleged that the complaint is not legally maintainable as the complainant has already received the full and final payment under the policy without any protest, hence, in view of law laid down by the Hon’ble National Commission in case titled as M. L. Kathuria Vs OIC & Anr. 2013 CPJ 586 NC has held that “once party accepts the payment as full and final satisfaction without any protest, the party cannot put forward claim before Consumer Fora – Complainants had accepted amount while accepting claim voluntarily and without any coercion exercise on upon him – No illegality, irregularity or jurisdictional error in impugned order – dismissed”. It is further alleged that the complainant himself opted to be enrolled as member of the “Swayam Shakti Suraksha” Group Master Policy bearing No.0119486435 administered by Haryana Gramin Bank and opted for premium payment and benefit term of 5 years and accordingly he was enrolled as a member of the said master policy with membership number 0312271154 and date of commencement as 30.6.2010 and date of maturity as 30.6.2015 for a sum assured Rs.2,50,000/- and yearly premium of Rs. 10,000/- was stipulated to be paid by the insured member to enjoy the benefits under the policy. It is further alleged that certificate of insurance was accordingly issued to him containing coverage detail and other relevant terms & conditions of the membership, which was duly received by him and he neither disputed the terms & conditions of the Master Policy administered by Haryana Gramin Bank nor he ever challenged the terms & conditions of the Certificate of Insurance. It is further alleged that the complainant was continued to pay the yearly premiums for 4 years without ever disputing the terms of the membership and enjoyed risk cover to the tune of Rs.2,50,000/- apart from Accidental Rider to the tune of Rs.2,50,000/- and other Rider benefits without ever disputing the terms & conditions of the master policy or certificate of insurance. It is further alleged that the OP has recalculated the maturity amount treating all the 5 yearly premiums as paid and the answering OP is willing to pay the balance amount of Rs.5016/- (Rs.4488/- as balance maturity amount + interest of Rs.528/- for delayed payment). It is further alleged that the maturity value under the membership comes to Rs.43,924/- if all the 5 years premiums are treated to be received. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of answering OP and as such, the complaint of the complainant is liable to be dismissed with costs.
3. On appearance, the OP No. 2 filed its separate written statement
alleging therein that the complainant had purchased a Group Master policy for 5 years for a risk cover of Rs. 2,50,000/- and certificate of insurance was accordingly issued to him by OP No. 1 containing coverage details and other relevant terms & conditions, which was duly received by him. It is further alleged that the complainant never disputed the terms & conditions of the Master Policy nor he ever challenged the terms & conditions of the Certificate of Insurance received by him. It is further alleged that the complainant enjoyed risk cover to the tune of Rs.2,50,000/- + Accidental Rider to the tune of Rs. 2,50,000/- and other Rider benefits, without disputing the terms & conditions of the master policy and certificate of insurance. It is further alleged that the complainant paid the premium amount continuously, which indicates that he was fully satisfied with the terms of the policy and has filed this complaint with malafide intention. It is further alleged that the policy stands matured and the maturity amount as per the master policy was to be paid to complainant by OP No. 1 and, thus, there is no fault on the part of the answering OP and the complainant has dragged the answering OP in unnecessary litigation. Hence, there is no deficiency in service on the part of answering OP and the complaint is liable to be dismissed with costs qua it.
4. Ld. Counsel for the complainant has placed on record the documents Annexure C1 to C7 in evidence and closed the evidence.
5. Ld. Counsel for the OPs has failed in producing any evidence on record in support of their case and their evidence has been closed by court order vide order dated 27.2.2019.
6. We have heard both the parties at length and have gone through the case file carefully.
7. Ld. counsel for the complainant reiterated the contents of the complaint. Ld. counsel for the complainant submitted that the OPs have wrongly deducted the amount and not paid the total maturity amount of the policy in question.
8. Ld. Counsel for the OPs also reiterated the contents of written statement. Ld. counsel for the OPs has argued that payment of Rs.39,439/- has already been made to the complainant towards the maturity amount of the policy in question and now they are ready to pay the remaining amount of Rs.5016/- (Rs.4488/- as balance maturity amount + Rs.528/- as interest of the remaining maturity amount). Ld. counsel for the OP No. 1 has further submitted that the maturity value of the policy was Rs.43,924/- and not Rs. 64,000/-. Ld. counsel for the OP No. 1 has further argued that the OP No. 1 is still ready to pay the remaining amount Rs.4488/- together with interest.
9. After hearing learned counsel for both the parties and having gone through the material available on record, we are of the considered view that the complaint of the complainant deserve acceptance as there is deficiency in service on the part of OP No. 1. It is the admitted fact that the complainant has taken the policy from OP No. 1 under Swayam Shakti Suraksha Scheme. It is also admitted fact that complainant has deposited 5 years premium of Rs.10,000/- each. It is also not disputed that the OP No. 1 has paid Rs.39,439/- to the complainant towards maturity value of the policy in question. The complainant has taken the plea that he is entitled to a sum of Rs.64,000/- being maturity value of the policy in question and placed on record copy of pamphlet as Annexure C1, whereas the OP No. 1 has taken the plea that complainant is entitled to Rs.43,924/- and out of Rs.39,439/- has already been paid to him and placed on record copy of policy. From the perusal of pamphlet Annexure C1, it is found mentioned that Rs.64,000/- as after maturity approx, whereas from perusal of policy, it is found mentioned in clause No.4 (b) “On an individual member being alive on the Maturity Date, the Account Value shall be paid to the policy holder as maturity benefit and the individual account for that member shall be closed. The minimum maturity guarantee is the total Net Premiums paid till Maturity date less sum of Scheme Administration Fee deducted till Maturity Date, provided all due premiums have been paid by the policy holder for the respective member”. The complainant has placed on record copies of receipt and copy of pass book as Annexure C2 to C5 and Annexure C7 to show the payment of premium amount. The OP No. 1 has also admitted the fact of payment of all the premiums by the complainant. The OP No. 1 has taken the plea that the complainant was not regular in making the payment of premium, this plea of the OP No. 1 is not tenable, because no copy of notice issued to complainant for payment of overdue premium has been placed on record. Moreover, the complainant is farmer and poor person, so it is the duty of the OP No. 1 to issue notice for the payment of premium in time, but the OP failed to do so. It is established on record that the complainant has deposited a total sum of Rs.50,000/- towards the payment of premium of the policy in question and the OP No.1 paid only Rs.39,439/- to him towards maturity amount of policy in question. Further the OP No.1 has calculated an amount of Rs.43,924/- as maturity amount and is ready to make the payment of remaining amount of Rs.4488/-, but it is not understood that as to how the calculation has been made by the OP No.1. In our view, the OP No. 1 should at least pay the total amount deposited by complainant i.e. Rs.50,000/- alongwith interest, but the OP No. 1 failed to do so. So, it is clearly proved on record that insurance company is deficient of not making the payment of the total maturity amount to the complainant, because the complainant has fully proved his case by placing on record certain documents Annexure C1 to Annexure C7. Therefore, by not making payment of total maturity amount to the complainant, the OP No. 1 has indulged in highly unfair trade practice and it amounts to deficiency in service on the part of the OP No.1.
10. As regards quantum, complainant has claimed Rs. 64,000/- as maturity value of the policy in question along with interest @ 18% pa, but as per the Clause No. 4 (b) of the policy, the complainant is only entitled to get back his total amount deposited as premiums of the policy. Therefore, in such circumstances, in our view, it would be appropriate, if complainant is awarded Rs. 10,561/- (Rs.50,000/- less Rs.39,439/- already paid) being the amount deposited towards the policy in question. Therefore, the complaint is partly allowed against OP No. 1 and OP No. 1 is directed: -
i) To pay Rs.10,561/- (Ten thousand five hundred sixty one only) along with interest @ 9% p.a. from the date of filing of this complaint till its final realization.
ii) To pay Rs.5000/- (Five thousand only) as compensation on account of mental agony, physical harassment & hardship, due to deficiency in service & mal trade practice on the part of OPs and punitive damages, counsel fee as well as litigation charges.
The compliance of the order shall be made within 30 days from the date of the order. Certified copies of the order be sent to parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: - 25.04.2019.
(Saroj Bala Bohra) (Parmod Kumar) (Manjit Singh Naryal)
Member. Member. President,
District Consumer Disputes
Redressal Forum, Bhiwani.
