Delhi

East Delhi

CC/103/2014

SUNIL KUMAR - Complainant(s)

Versus

BAJAJ ALLIANZ LIFE INS - Opp.Party(s)

17 Feb 2017

ORDER

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

C.C. NO. 103/14

Shri SUNIL KUMAR SINHA

302, PRANGAN APTT., PLOT NO. B9/10

SECTOR 62, NOIDA 201 301,

•  

                                                                                                                             ….Complainant

 

•  

 

BAJAJ ALLIANZ LIFE INSURANCE Co. Ltd.,

G-85, 1^ST FLOOR, MAIN VIKAS MARG, PREET VIHAR-MADHU VIHAR,

PREET VIHAR, EAST DELHI,

1448859.  

 

                                                                              ….Opponent

Date of Institution: 25.01.2014

Judgment Reserved for: 17.02.2017

Judgment Passed on: 14.03.2017

CORUM:

Sh. SUKHDEV SINGH                  (PRESIDENT)

Dr. P.N. TIWARI                          (MEMBER

Ms. HARPREET KAUR CHARYA (MEMBER)

ORDER BY: HARPREET KAUR CHARYA (MEMBER)

JUDGEMENT

1. Present complaint has been filed by the complainant Shri Sunil Kumar Sinha, against Bajaj Allianz Life Insurance Co. Ltd., praying for refund of the entire premium for a sum of Rs.90,000/-, Rs.50,000/- for legal expenses, Rs.3,00,000/- for damages, and Rs.2,50,000/-  for compensation, physical pain and mental agony.
2. Briefly stated facts are that on 28/02/2007, the complainant issued a cheque bearing no. 574324 for Rs.30,000/- for which policy no. 0041987625 was issued to him by OP. The said policy was Unit Gain with annual premium of Rs. 30,000/- payable for 15 years. The date of commencement being 12/03/2007, so premium was to be paid on 12^th of March every year. The complainant paid second premium on 04/03/2008 which receipt no. 0130803165 was issued. The policy documents were misplaced by the complainant in March 2009, while shifting from Delhi to Rajkot and it was only in Aug 2010, after tracing the policy details, he paid 3^rd premium for which he issued cheque no. 0351146404 dated 03/08/2010 drawn on ICICI Bank for which receipt dated 25/11/2010 was issued. It is stated in the complaint that the said premium was returned in the complainant’s account on 28/12/2010 without informing him. It is further stated that on 09/08/2010 the complainant was advised to undergo certain medical tests, with the empanelled doctor of OP, which the complainant complied with. Again on 06/12/2010 the complainant was informed by OP that the status of the policy was in “Lapse Status and for revival”, the complainant was required to undergo computerized treadmill test from Cardiologist at the complainant’s cost, the complainant could not undergo the said test as he had met with a major accident on 04/10/2010, due to which he had suffered fracture of Ribs & Shoulder. On 11/12/2010, the complainant paid Rs.30,000/- as the installment of premium, which was not accepted by the OP. A termination letter dated 12/09/2011 was issued to the complainant without notice on the ground of non-payment of premium during revival period. It is also stated that the complainant had already paid the premium, which the OP did not accept. A cheque bearing no. 059943 dated 12/09/2011 for Rs.13,988/- as the surrender value of the policy was issued to the complainant., which the complainant did not accept. Instead of reviving the policy, the OP vide letter dated 20/12/2010 postponed the revival of the complainant’s policy for a period of one year i.e. until 20/12/2011. It is further stated that the complainant issued a cheque dated 28/12/2011 bearing no. 0202690 for Rs.30,000/- as 5^th premium, which was duly encashed by OP on 09/01/2012, despite that the policy of the complainant was not revived. The policy was again terminated vide letter dated 04/04/2012 after paying a sum of Rs.12,618/- with the reason that the complainant had failed to pay regular premium during the revival period of 2/3 years from the due date of the last unpaid premium. Letter dated 03/09/2012, seeking revival of the policy was written to the OP, which was not answered. Further the complainant lodged a complaint on 30/07/2012 with IRDA. The complainant has alleged that the OP has acted in arbitrary manner by terminating his policy, on 04/04/2012. The complainant has annexed policy, premium receipts, letters by OP to complainant, letter by complainant to OP dated 11/12/2010, OP’s termination letter dated 04/04/2012, letters of correspondence between complainant and OP, and Ombudsman’s letter dated 28/03/2013.
3. OP was served with the notice of the complaint, thereafter written statement was filed by them where they stated that the complainant had not complied with the mandatory requirements of medical tests, despite that as a good will gesture OP had granted onetime special opportunity to complainant for revival of policy after the complainant complied with the requirements. It was further stated that the amount of Rs. 30,000/- which was deposited by the complainant on 25/11/2010 was kept in the company’s suspense account for want of certain medical requirements, policy was not revived due to adverse medical health conditions of the complainant and finally the contract of insurance was terminated due to nonpayment of premiums in accordance with terms and conditions. A cheque dated 12/09/2011 of Rs.13,988/- was issued to the complainant. Again Rs.30,000/- were refunded to the complainant vide cheque no. 899104 dated 10/01/2012, which was deposited by the complainant. On 06/01/2012, OP referred to Clause 5(C) (ii) (d) “Revival of the policy is subject to the policy holder paying all unpaid regular premiums due & such other information & documentation as may be requested by the company. The company reserves the right to disallow the revival of the policy on original terms and conditions.” It was stated that revival of the insurance policy cannot be treated as a matter of right. Thus, payment of partial amount does not entitle the complainant for revival without OP’s consent. It was also stated on behalf of OP that as per terms and conditions the surrender charge, in case where three full years regular premiums were not paid, was 100% of the value of the capital units. As the revival period of two years from date of first unpaid premium expired on 12/03/2011, thus permissible surrender premium value amounting to Rs.13,988/- was issued to complainant. The amount deposited by the complainant on 06/01/2012 was refunded on 10/01/2012, as per strict compliance of terms and conditions of the contract.
4. Rejoinder to the written statement was filed on behalf of the complainant where he reiterated the contents of the complaint and that of the written statement were denied.
5. The complaint examined Shri Sunil Kumar Sinha, the complainant himself who stated the contents of the complaint on affidavit. Reliance was placed on Ex. C-1- the copy of policy, Ex. C-2 and Ex. C-3- receipts of the payment of 1^st and 2^nd premium respectively, Ex. C-4 is the copy of receipt issued by OP dated 25/11/2010. Ex. C-5 is the letter dated 11/12/2010, Statement of Account is Ex. C-6, letter by OP dated 09/08/2010 & 06/12/2010 are Ex. C-7 & Ex. C-8, letter dated 20/12/2010 issued by OP is Ex. C-9, termination letter dated 12/09/2011 Ex. C-10, reports pertaining to medical tests is Ex. C-11, medical opinion- Ex. C-12, termination letter dated 04/04/2012 is Ex. C-13, correspondence between complainant & OP are Ex. C-14 to Ex. C-16. Letter written to IRDA dated 30/09/2012 is Ex. C-17, proceedings with insurance ombudsman are Ex. C-18 & C-19 respectively.
6. The OP examined Shri Devender Kumar, Divisional Operational Head, Bajaj Allianz Life Insurance Co. who stated on oath the contents of the written statement filed on behalf of OP and exhibited proposal form of the policy as Ex. OP-1 (colly), Ex. OP-2 (colly) are letters dated 09/08/2010, 06/12/2010, 20/12/2010, 12/09/2011 & 04/04/2012.
7. We have heard the Ld. Counsels for the complainant & OP. Perusal of the documents placed on record reveal that the complainant had a policy bearing no. 0041987625 for a term of 15 years, for which premium of Rs.30,000/- was payable on 12^th March  every year. It is also not disputed that complainant paid first and second premium on time. The complainant had defaulted in payment of 3^rd & 4^th premium, and paid only 3^rd premium on 03/08/2010 which became due on 12/03/2009 and paid 4^th premium on 11/12/2010 instead of 12/03/2010. The complainant cannot deposit the premium as and when he desires to, if he was in default of 3^rd & 4^th premium then he should have cleared the dues in one go.
8. Both the parties are bound by the terms and conditions of the contract of insurance, if OP is expected to be bound by the terms and conditions the same holds true for the complainant as well. It is admitted that OP has refunded so called 3^rd premium and refused to accept 4^th premium. Now, the dispute remains to 1^st, 2^nd & 5^th premium. The complainant is not entitled to refund of 1^st & 2^nd premium as he has enjoyed the insurance cover for that period. The OP has accepted the 5^th premium, even after the termination of the said policy, which OP was not entitled to receive. Thus, we direct OP to refund Rs.30,000/- along with 9% interest from the date of receipt of premium by OP till its realization. OP is also directed to refund the surrender value, if any on the policy in dispute. We further award Rs.7,500/- as compensation for mental agony and this is inclusive of cost of litigation.   

Copy of this order be sent to both the parties as per law.

 

 

(P.N. TIWARI)                                                                              (HARPREET KAUR CHARYA)              

   MEMBER                                                                                                      MEMBER

 

                                                     (SUKHDEV SINGH)

                                                             PRESIDENT