CC No:183/2014

 Filed on 27.01.2014

Disposed on 13.04.2016

BEFORE THE III ADDITIONAL BANGALORE URBAN DISTRICT

CONSUMER DISPUTES REDRESSAL FORUM,

BANGALORE – 560 052

DATED THIS THE 13^th DAY OF APRIL 2016

CONSUMER COMPLAINT NO.183/2014

PRESENT:

Sri. H.S.Ramakrishna,  B.Sc., LL.B.

                                    PRESIDENT

                        Smt. L. Mamatha, B.A., (Law), LL.B.

                        MEMBER

                                                        V/S

ORDER

BY SRI H.S. RAMAKRISHNA, PRESIDENT

1.         This is a complaint filed by the Complainant against the Opposite Party under Section-12 of the Consumer Protection Act, 1986, praying to pass an order directing the Opposite Party to pay a sum of Rs.1,00,000/- to the Complainant.

2.         The brief facts of the Complaint can be stated as under:

In the complaint, the Complainant alleged that in the year 2005, the Complainant took Bajaj Pension Policy bearing No.07477241, paid the first premium a sum of Rs.11,074/- on 02.03.2005, the second premium on 07.03.2006, the third premium on 08.02.2007, the fourth premium on 23.02.2008 and the fifth premium on 31.01.2009.  The first pension was due on 17.03.2010.  The Opposite Party did not pay the first pension inspite of reminders.  Insisting on the original bond, the Complainant complained to IRDA, Hyderabad on 11.11.2010.  The Opposite Party instead of paying annual pension of Rs.7,790/-, paid a sum of Rs.18,629/- i.e. 33% of the sum assured on 13.04.2011 in violation of fundamental right, in violation of first option in MBF dt.18.01.2010.  His option for full pension and not for Rs.18,629/- refund of which is unlawful.  The Opposite Party illegally issued in the policy for a sum of Rs.37,823/- and deleted the first policy in the computer without the consent of the Complainant, the Opposite Party issued new policy.  According to the new policy, the first pension is due on 05.05.2012, inspite of request and demands, the Opposite Party fails to pay the pension.  Hence, this complaint.

            3.         In response to the notice, the Opposite Party put their appearance through their counsel and filed their version.  In the version, the Opposite Party pleaded that all the allegations made in the complaint are false, the complaint is not maintainable either in law or on facts.  The complaint is mis-conceived one.  The Complainant is not seeking any relief in the present complaint.  The Complainant has surrendered his policy to the Opposite Party and has realized the entire amount available under the policy as such the relationship between the Complainant and the Opposite Party is closed as on the date of the complaint, hence, the Complainant do not fall within the definition of the Consumer and on this ground alone, the complaint is liable to be dismissed.  The insurance company on receipt of the proposal form, verified the same if the details and documents provided by the proposal fulfill the company’s requirement, then the insurance policy is issued if there are ambiguity in the proposal or any additional details or documents are rejected, then the same is informed to the Proposer, who has to comply with the same filing which the insurance company has got right to reject the proposal and refund the amount of the premium paid by the proposal.  The contract of insurance is only concluded when the policy holder receives the copy of the insurance policy.  The Complainant has made a declaration that he has read the application and answers he entered in the application is full, complete and true.  The Opposite Party company believing them to be such, will rely and act on them, otherwise the proposed application becomes void.  Thereafter, both the policy holder and the company are bound by the terms and conditions of the insurance policy which is issued by the insurance company.  The Complainant had availed the policy in question after agreeing to abide with the policy terms and conditions and as declared by him in the proposal form submitted to the Opposite Party for issue of the said policy.  The Complainant is well aware of the terms and conditions of the said policy and also well aware of the benefits which the Complainant was entitled as described in the policy agreement.  The Complainant policy was a pension policy, wherein the Complainant was under an obligation to pay the renewal premiums regularly to keep the insurance policy alive and avail the benefits of the insurance policy.  The Complainant paid the premium and then surrendered the policy in question and has realised the full amount as a special case.  As such there exists no relationship between the Complainant and the Opposite Party as on the date of the complaint, the Complainant does not fall within the ambit of the definition of Consumer as defined under the Consumer Protection Act, 1986.  The policy was issued to the Complainant only after the Complainant agreed and accepted the terms and conditions of the policy and upon agreeing the same, the Complainant has paid the policy premium amount to the Opposite Party.  The Complainant is under misconception that he was entitled to get pension of Rs.3,895/- as on 17.03.2010 and a sum of Rs.3,895/- as on 17.03.2011, though in reality the Complainant is not entitled to any amount.  Furthermore, as per the terms of the policy once the policy taken by the policy holder is matured then the policy holder has to either reinvest the entire 100% amount or 2/3^rd amount in the pension policy either in the Opposite Party Company or any other insurance policy.  The Complainant in the present case invested 2/3^rd amount of Rs.37,823/- in the Opposite Party Company and as such 1/3^rd amount of Rs.18,639/- was refunded to the Complainant.  But the Complainant was not satisfied with the policy and hence lodged a complaint.  The Complainant had the option to go through the terms of the policy bond and if the same was not acceptable to him, then the Complainant was provided with the option of 15 days free look period from the date of receipt of the policy.  As per the policy bond and in accordance to the provision of Sec.6(2) of the IRDA, 2002 regulation, to approach the Insurer for cancellation of the policy stating the reason, which the Complainant has failed to do so.  The said option is also provided by the Insurance Regulator in its guidelines.  However, the Complainant is at no point in time raised any grievance before the Opposite Party for more than 5 years in the absence of any such steps being taken, the Complainant is barred from raising any grievance about non awareness or acceptance of the policy terms.  The Complainant is merely made allegations against the Opposite Party which are not at all true and seems to be made by the Complainant only with the malafide intention.  The Complainant took the policy after fully understanding the policy condition, moreover, the Complainant is not a layman, the Complainant is an educated person and is aware of insurance and other policy conditions.  The Complainant is not entitled for any relief claimed in the complaint. Hence, prays to dismiss the complaint.

4.         In support of the complaint, the complainant has filed affidavit by way of evidence.  For the Opposite Party one Sri M. Aravinda, South Zonal Legal Manager of the Opposite Parties has filed his affidavit by way of evidence.  Heard the arguments of both the parties.

5.         Now the points that arise for consideration are:-

1. Whether the Complainant has proved the alleged deficiency in service by the Opposite Parties?
2. If so, to what relief the Complainant is entitled?

6.         Our findings on the above points are:-

                        POINT (1):-  Negative

                        POINT (2):-As per the final Order

REASONS

7.         POINT NO. 1:-         As looking into the averments made in the complaint and also the version filed by the Opposite Party, it is not in dispute that the Complainant took a Bajaj Pension Policy in the year 2005 bearing Policy No.07477241 for 5 years and paid a premium of Rs.11,074/- on 02.03.2005, 07.03.2006, 18.02.2007, 23.02.2008 and 31.01.2009 respectively.  The first pension was due on 17.03.2010 and the Opposite Party did not pay the pension.  This fact is not denied or disputed by the Opposite Party.  This contention of the Complainant is clear as looking into the policy Allianz Bajaj Swarna Vishranti Policy.  By looking into this, it is in the name of the Complainant bearing Policy No.0007477241, commencement date 17.03.2005, frequency of premium payment annually for 5 years and risk covered 17.03.2005, date of commencement of annuity 17.03.2010, due date of premium 17^th March every year and the premium amount total is Rs.11,075/- p.a.  So from looking into this document, it is very clear that the Complainant has obtained a policy Allianz Bajaj Swarna Vishranti Policy from the Opposite Party.  He is regularly paid the premium amount of Rs.11,075/-.  Therefore, it is proper to accept the contention of the Complainant.  It is the further case of the Complainant that the first pension was due on 17.03.2010, the Opposite Party did not pay the first pension despite of reminders, but insisting on the original bond.  The Complainant complained to IRDA, Hyderabad on 11.11.2001.  The Opposite Party inspite of paying only pension of Rs.7,790/-, paid a sum of Rs.18,629/- i.e. 33% of the sum assured in violation of the terms of the bond.  The Complainant optioned for full pension exercises in maturity benefit form and illegally issued a new policy for a sum of Rs.37,823/- and deleted the first policy in the computer without the consent of the Complainant, the Opposite Party issued a new policy according to the new policy, the first pension is due on 05.05.2012.  Inspite of requests and demands, the Opposite Party fails to pay the pension.  To substantiate this fact, the Complainant in his affidavit evidence reiterated that he accepted a sum of Rs.7,790/- second pension as the Ho'ble IRDA,  but Bajaj has refunded a sum of Rs.18,629/- in violation of his first option in maturity benefit form dt.18.01.2010 for full pension payment.  In support of this, the Complainant produced a letter dt.11.02.2010.  As looking into this letter, it is dt.11.02.2010.  This letter is addressed by the Complainant to the Branch Supervisor, Bajaj Allianz LIC Ltd., Yerawada, Pune.  In this letter, he clearly mentioned that he acknowledged the letter dt.30.12.2009 from the Opposite Party along with the enclosures i.e. discharge form, machine No.0485615, maturity benefit dt.18.01.2010 and electronic payment mandate and also clear from this letter, he is now returning the abovesaid documents duly complied in all respect and also signed and he read and opted for first option pension guarantee fee, ROC Rs.3,895/- yearly annuity payable.  So from this document, it is very clear that after maturity of Allianz Bajaj Swarna Vishranti Policy, the Opposite Party by addressing a letter dt.30.12.2009 itself send the relevant papers along with electronic payment mandate to the Complainant.  The Complainant returned the abovesaid documents as per this letter.  On the other hand, there is no evidence to show that the Complainant repaid the electronic payment made by the Opposite Party.  If at all the Complainant refund the amount sent by the Opposite Party through cheque payment mandate, to that effect, the Complainant ought to have produced evidence, but there is no such evidence.  On the other hand, he has only addressed this letter and returned the other papers.  Further, by looking into the discharge form dt.30.12.2009 sent by the Opposite Party in favour of the Complainant, this document is with reference to the policy No.0007477241.  Under this document, the Complainant acknowledged the receipt from the Bajaj Alliance Company a sum of Rs.50,452.09.  This maturity benefit payment due on 17.03.2010.  So by looking into this document, the Complainant has received a sum of Rs.56,452.09 from the Opposite Party, but stated earlier the Complainant return back this amount to the Opposite Party by addressing a letter dt.11.02.2010, absolutely there is no evidence.  Further, as looking into the maturity benefit it is dt.18.01.2010, this is also with respect to the policy No.0007477241.  Under this document also, the Complainant acknowledged the receipt from the Opposite Party a sum of Rs.56,452.09, maturity benefit payment due on 17.03.2010.  Further as looking into this document i.e. maturity benefit, it reveals that total maturity value is Rs.56,452.09 and the first option annuity with mark up 2%, purchase price is Rs.56,452.09 and second option amount available after withdrawal of 33% of maturity value available for withdrawal Rs.18,629.46, purchase price Rs.37,823.44.  By looking into this document, they put a right mark for the first option as the contention taken by the Complainant.  But to substantiate this fact, except this right mark, there is no other cogent evidence.  On the other hand, it is the defence of the Opposite Party that Complainant has sworn his policy to the Opposite Party and has realized his entire amount available under his policy and also take a defence that insurance company on receipt of the proposal form, verifies the same if the details and documents provided by the proposal fulfills the company requirement then the insurance policy is issued.  If there are any ambiguities in the proposal form or if any additional details or documents are required, then the same is informed to the Proposer who has to comply with the same, availing which insurance company has right to reject the proposal and refund the amount of premium paid by the propser.    The contract of insurance is only concluded when the policy holder receives the copy of the insurance policy.  The Complainant has made declaration that he has read the application and answers, he entered in the application is full, complete and true.  The Opposite Party company believing them to be such, will rely and act on them, otherwise the proposed application becomes void.  The Complainant availed the policy in question after agreeing and abide with the policy terms and conditions and has deprived by him in the proposal form.  In support of this, Sri M. Aravinda, South Zonal Legal Manager of the Opposite Party filed his affidavit and in his affidavit he reiterated the same.  Further to substantiate this fact, he produced the copy of the insurance policy and the proposal form.  As looking into the proposal form, it is very clear that the Complainant affixed the signature after going through the proposal form and also declaring that all the facts are true and correct and particularly this Complainant is an literate man, so knowing fully well about the worldly knowledge and after making such declaration, he has no right to go back as per his undertaking i.e. by signing the proposal form.  Further, they also produced the Allianz Bajaj Swarna Vishranti Policy.  As looking into this, it is very clear that the life assured may receive lumpsum upto maximum of 33% of the sum assured plus accumulated Bonuses on the vesting date.  The balance amount will be used to purchase from the company an immediate annuity for the life assured, at the immediate annuity rates of the company prevailing at that time or from any other institution in the open market as chosen by the life assured.  The policy holder has to exercise this option at least 6 months before the vesting date.  So from this clause of the policy, it is very clear the Complainant has agreed to receive the 33% of the sum assured with accumulated bonus and the balance amount will be reinvested for purchase of immediate annuity for the life assured.  It is further supported by as looking into the Bajaj Allianz Pension Guarantee.  This document is in the name of the Complainant with respect to Policy No.0217163480 and the date of commencement of the policy is 05.05.2011.  The purchase price Rs.37,823/-, annuity commencement date 05.05.2012.  So as per this document, the Opposite Party has issued a new Bajaj Allianz Pension Guarantee to the Complainant after making payment of 33% i.e. a sum of Rs.18,629.46 out of Rs.56,452.09.  While Opposite Party issuing this Bajaj Allianz Pension Guarantee also addressed a letter to the Complainant, it is dt.14.06.2011.  As looking into this document, this letter is addressed to the Complainant informing that they issued new policy as per seizure form No.2619839 informing that they offered 15 days free look period as per the clause on free look period under this policy.  Any application for free look cancellation will be made after lapse of the referred 15 days shall not be entertained.  So by looking into this document, it is very clear that the Opposite Party has issued a new policy on 05.05.2011 for a sum of Rs.37,823/-.  This amount after deducting the previous policy maturity benefit of Rs.56,452.09 and by deducting 33% i.e. Rs.18,629.46.  Further this fact is supported by the letter dt.02.11.2010.  This letter is addressed by the Opposite Party Life Insurance Company to the Complainant about the maturity of the policy No.0007477241.  By addressing this letter, the Opposite Party give an opinion to the Complainant informing maturity of the Allianz Bajaj Swarna Vishranti Policy No.0007477241 will be due on 17.03.2010 and also they informed as per the policy condition on the vesting date.  The sum assured and accumulated bonus declared if any will be used to purchase immediate annuity.  There is also an option to take lump sum, the policy holder will have an option to receive the lump sum of 33% of the sum assured + accumulated bonus on the vesting period.  So as soon as the policy bearing No.0007477241 of the Complainant matured on 17.03.2010, the Opposite Party addressed a letter to the Complainant informing that the sum assured plus accumulated bonus will be reinvested by purchasing immediate annuity and also there is an option of receiving lump sum up to 33% of the sum assured + accumulated bonus.  So on this basis only after the maturity period, the Opposite Party transferred 33% of the sum assured along with accumulated bonus to the Complainant through cheque payment of sum of Rs.18,629/- and the balance amount was invested for immediate maturity and issued new policy i.e. policy bearing No.0217163480 and furthermore, if the Complainant is not interested to receive and accept the abovesaid new policy, he has right to exercise to cancel the same within 15 days from the date of receipt of the new policy as per letter dt.14.06.2011.  But the Complainant being an literate man, he has not exercise this option, on the other hand, now he has filed this complaint without assigning proper and valid reason.  Therefore, as the defence taken by the Complainant, it is proper to accept their defence that the Complainant know the facts and after obtaining the consent of the Complainant, they issued a new policy, but on the other hand, absolutely there is no evidence to believe in the contention of the Complainant that the Opposite Party have issued new policy without his consent.

            8.         In the evidence of the Complainant, he clearly stated that the Complainant opted for second option for refund of Rs.18,623/-, but opted for refund of Rs.56,452/-.  To substantiate this fact, as stated earlier, maturity benefit letter dt.18.01.2010, in the said maturity benefit except put right mark for the first option, there is no other evidence.  If really he is not opted for refund of Rs.18,629/-, why the Complainant accepted a new bond and if he not interest in accepting the new bond, he ought to have return the bond to the Opposite Party requesting for cancellation of the bond within 15 days from the receipt of the bond, but he has not did so.  Further by looking into the proposal form and the terms and conditions of the policy, it is crystal clear that the Complainant accepted the proposal and first bond by the terms and conditions of the Opposite Party and as per the terms and conditions of the Opposite Party as per the first bond, the sum assured along with accumulated bonus, out of which 33% will be paid in lump sum and the balance amount will be invested in purchase of immediate annuity.  On that basis only, the Opposite Party have issued a new policy.  Therefore, it falsifies the contention of the Complainant.

            9.         Further as looking into the evidence of the Complainant at para-4 mentioned that the Opposite Party forcefully against his consent refunded a sum of Rs.56,452/- in violation.  So from this evidence of the Complainant itself, it clearly goes to show that the Complainant has received maturity amount of Rs.56,452/-, but according to the Complainant, he received the said amount since the Opposite Party forcefully to receive the same.  But there is no evidence on record to show that the Opposite Party forcefully refunded the said amount of Rs.56,452/-.  If at all as the contention of the Complainant that Opposite Party has forcefully refunded the maturity amount of Rs.56,452/- what is necessary to the Complainant to accept the same instead of protesting, but there is no such protest or resistance made by the Complainant, thereby, it falsifies the contention of the Complainant that the Opposite Party forcefully refunded the same.

            10.      So as looking into the evidence placed by the parties, the Complainant fails to place any sufficient evidence to show that there is deficiency in service on the part of the Opposite Party.  The Complainant argued before me that under what authority the Opposite Party issued a new policy dt.05.05.2011 without any proposal declaration.  But as looking into the proposal form of the Complainant, at the time of taking the first policy i.e. No.0007477241 he declares that he accepted all the terms and conditions of the terms of the policy and further as looking into the terms and conditions of the first policy itself, it clearly reveals that the life assured may receive lump sum up to maximum of 33% of the sum assured plus accumulated bonus on the vesting date.  The balance amount will be used to purchase from the company an immediate annuity for the life assured.  So on this basis and on the basis of the first proposal itself, the Opposite Party issued a second policy bond and before issuing the second insurance policy bond, the Opposite Party by addressing a letter informed for the reinvestment of the maturity benefit amount after deducting 33%, the balance amount will be invested for repurchase of immediate annuity bond.  Thereby, for issuance of second policy, the Complainant has given a consent if at all he has not interested and he has not consent about this, there is also an option for the Complainant to cancel he said policy bond within 15 days, but even after receiving second bond, the Complainant did not exercise his option for cancellation of the bond within 15 days, thereby, the argument of the Complainant that without his proposal and declaration, the Opposite Party has issued second policy falsifies to the ground.  So by looking into the material evidence on record, the Complainant miserably fails to prove that there is a deficiency in service on the part of the Opposite Party.  Hence, this point is held in the negative.

11.      POINT NO.2:-          In view of the finding on Point No.1, we proceed to pass the following;

ORDER

The Complaint is dismissed.  No costs.

 Supply free copy of this order to both the parties. 

(Dictated to the Stenographer, got it transcribed, typed by her/him and corrected by me, then pronounced in the Open Forum on 13^th day of April 2016).

       MEMBER                                                                               PRESIDENT

CC. NO.183/2014

LIST OF WITNESSES AND DOCUMENTS

Witnesses not examined, but affidavit of the witnesses is filed, as follows;

1. Sri Kuntumalla Gangaya has filed his affidavit for Complainant.

1. Sri M. Aravinda, South Zonal Legal Manager filed his affidavit for the Opposite Party.

List of documents filed by the Complainant :

1. Copy of the letter dt.31.03.2011.
2. Copy of the Jeevan Suraksha Policy
3. Copy of the IRDA Circular.
4. Copy of the letter dt.11.02.2010.
5. Copy of the maturity benefit.
6. Copy of the Bajaj Allianz Pension Gurantee.
7. Copy of the letter dt.19.04.2010, 26.02.2011, 08.03.2010.
8. Copy of the Bajaj Allianz Life Insurance Company Discharge Form.
9. Copy of the letter dt.02.07.2011, 28.02.2012, 02.11.2010
10. Copy of the addendum to the policy bond.
11. Copy of the letter dt.05.06.2013, 18.12.2013 from Insurance Ombudsman.
12. Copy of the letter dt.02.07.2011, 22.09.2011, 02.09.2011, 02.07.2013, 16.09.2011, 20.10.2011, 11.11.2011, 20.05.2011, 20/21.11.2011, 20.12.2011, 11/12.01.2012
13. Copy of the insurance discharge form dt.29.11.2010.
14. Copy of the letter dt.29.11.2010, 02.09.2013, 29/30.09.2013, 11.11.2013, 11.06.2013, 29.07.2013.

List of documents filed by the Opposite Party :

NIL

MEMBER                                                                               PRESIDENT