O R D E R

Sri. P. Satheesh Chandran Nair (President):

                   The complainant filed this complaint u/s.12 of the C.P. Act 1986 for getting a relief against the opposite parties.

                   2. The case of the complainant is stated as follows:  The complainant is the consultant of 1^st opposite party and he worked as a consultant from 2006 to 2009.  According to her petition, the 1^st opposite party has to pay Rs.3,600/- as the commission amount for her work with the opposite parties.  She again stated that she joined in 2 policies with the 1^st opposite party.  The 1^st policy is for Rs.10,000/- and 2^nd policy is for Rs.20,000/-.  She stated that all together Rs.20,000/- has been remitted by her to the Rs.10,000/- policy and she remitted Rs.20,000/- lumpsum amount for the above said Rs.20,000/- policy.  She again stated that due to her illness she was under treatment for so many years and subsequently she did not work for the company and was unable to remit the premium as scheduled by the insurance company.  She informed all these details to 1^st opposite party in time.  The complainant again approached the 1^st opposite party for continuing her consultation work with the company after her recovery. But the company did not allow her to work there and directed the complainant to the effect that only after passing further examination her demand can be considered.  The complainant again stated that the limitation period of the premium is over hence the company was not in a position to receive the premium again.  The company also informed the complainant that she has not been eligible for the remitted amount and the commission as alleged by her.  According to the complainant, she believed the company but the company cheated like anything and as an unmarried person, a person below poverty line and as a patient the company has not done any justice to her.  The petitioner requested this Forum to direct the opposite parties to realize the commission amount of Rs.3,600/- and the remitted policy amount Rs.40,000/- with interest to her.  The complainant filed the above petition before this Forum along with documents. The Forum peruse the complaint and document then issue notice to opposite parties for their appearance.

                   3. The 1^st opposite party appeared before this Forum and filed version.  It is seen that though 2^nd opposite party received notice he has not turned up before this Forum as on 13.01.2015 the complainant filed a petition as I.A.No.4/15 for deleting 2^nd opposite party from party array.  Since the 1^st opposite party raised an objection the I.A was allowed and 2^nd opposite party is deleted from the party array.  

                   4. The contents of the version of the 1^st opposite party is as follows:  According to this opposite party, the complainant worked as a consultant with this opposite party and denied the demand of Rs.3,600/- as commission amount from 1^st opposite party.  In order to prove the pleadings regarding the payment of commission amount the opposite party has furnished a scheduled details as follows:

           5. The opposite party admitted that the complainant has taken 2 policies from the opposite parties.  But denied remittance of premium amount of Rs.10,000/- and Rs. 20,000/- as alleged by the complainant.  The opposite party has not accepted the plea of sickness of the complainant and her unableness of the subsequent payment and her reemployment after the recovery of the alleged deceased.  The opposite party denied the plea of the complainant regarding the alleged unjustice act of the opposite party against the complainant.  The opposite party subsequently referred the policy details of the complainant as follows:

                   6. According to the opposite party, the terms and conditions of the policy towards non payment of regular premium is part and parcel of the insurance policy law.  The opposite party again stated that as a result of non payment of regular premium as per the terms and condition of the scheme the complainant has committed deficiency in service and intentionally the complainant suppressed this fact in her complaint.  The opposite party again submitted that this is a false complaint without any valid grounds and merits and only stories and miscellaneous statement with the intention of making unlawful gain.  According to this opposite party, if the complainant feel any kind of differences of opinion regarding the terms and condition of the policy the complainant can opt 15 days ‘Free Look Period’ for her grievances.  As per Sec.6(2) of the IRDA 2002 the insurer can approach the insured for the cancellation etc. of the policy.  In this case, the complainant has not approached for any options as stated above.  1^st opposite party again pointed out that since the complainant has submitted any written application for revival of the policy she could not have claim any of the relief as per this complaint.  According to the opposite party, the terms and condition of the insurance is binding on both the parties and as per the condition this policies are comes under ‘Unit Linked Insurance Policy’.  The risk of investment of the market has to be borne by the policy holder.  In this case the complainant is not a laymen and she is an educated person and is aware of insurance law and other policy conditions.

                   7. In the version of the opposite party he quoted decision reported by our Hon’ble Supreme Court as ‘SSC 66(2000)1 between Ravneet Singh Bagga Vs.KLM Royal Dutch Air Lines’.  The dictum of the case is as follows:- “The deficiency in service has to be distinguished from the tortuous acts of the respondent.  In the absence of deficiency in service the aggrieved person may have a remedy under the common law to file a suit for damages but cannot insist for grant of relief under the Act for the alleged acts of commission and omission attributable to the respondent which otherwise do not amount to deficiency in service.  In case of bonafide disputes no willful fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance in the service can be informed (sic).  If on facts it is found that the person or authority rendering service had taken all precautions and considered all relevant facts and circumstances in the course of the transaction and that their action or the final decision was in good faith, it cannot be said that there had been any deficiency in service”.

                    8. According to this opposite party, the complainant has not entitled for any of the relief and the opposite party is entitled to get cost of this case from the complainant.  In Para 26, 27 and 28 of the version are also the repetition of the version of Para 24.  Hence the opposite party prayed to dismiss the complaint with explanatory cost with interest of justice and equity.  Apart from the above contention the opening portion of the version the opposite party stated that 2^nd opposite party is not at all a necessary party of this proceedings of this case.  Hence he should be deleted in the party array.  The opposite party in Para 1 to 13 of his version referred certain ruling in favour of the company in connection with this kind of complaints and totally denied the right of the complainant to file a case before this Forum seeking relief.

                   9. On the basis of the complaint, version and the records produced by the complainant we raise the following issues:

1. Whether the complaint is maintainable before this Forum?
2. If it is maintainable, whether the complainant succeed to prove her case?
3. Regarding relief and Cost?

         10. Point Nos. 1 to 3:- For the sake of convenience we are considering Point No. 1 to 3 together.  In order to prove the case of the complainant, the complainant herself examined as PW1 and marked Exts.A1 to A4.  Ext.A1 is the policy certificate No.0048248498 dated 28.03.2007 for Rs. 20,000/-. Ext.A2 is the default intimation receipt No.0027268913 dated 28.10.2006 for Rs. 10,000/-. Ext.A3(1)  is the Renewal Premium receipt dated 20.05.2008 for Rs. 5,000/-. Ext.A3(2)  is the Renewal Premium receipt dated 09.04.2008 for Rs. 5,000/-.  Ext.A4 is the Photocopy of the Proposal form for Life Insurance.  After closure of evidence, complainant and opposite party heard.

          11. On the side of the opposite party they have not adduced any oral evidence but on the basis of the version, the counsel for the opposite parties cross examined the complainant PW1.  When PW1 is examined before this Forum she deposed in chief, “ആദ്യകാലങ്ങളില് ഞാൻ ഒ.പി. സ്ഥാപനത്തില് ജോലി ചെയ്തിരുന്നു. ടി സമയത്ത് ആണ് 10,000/þ രൂപയുടേയും, 20,000/þ രൂപയുടെയും രണ്ട് പോളിസികള് എടുത്തിരുന്നത്. 20,000/- രൂപയുടെ പോളിസി സർട്ടിഫിക്കേറ്റ് നം. 0048248498 തീയതി 20.03.2007 ആണ് ഞാൻ ഹാജരാക്കുന്നത് .  Marked as Ext.A1.  Policy No.0027268913 dated 28.10.2006 ആണ് എന്ന് ഈ രേഖ- കൊണ്ട് കാണാവുന്നതാണ്.”  Marked as Ext.A2.  When we peruse the relevant Ext.A1 and A2 it is came to our notice that Ext.A1 policy commence from 28.03.2007 and the sum assured is Rs. 2 lakhs and the regular premium is Rs. 20,000/-.  Ext.A2 is a default intimation of Policy No.0027268913.  When we go through Ext.A2, it is found that the date of commencement of the said policy was on 28.09.2006 and the sum assured is Rs.50,000/- and the instalment premium is for Rs.5,000/-.  When we peruse the petition of the complainant it is seen that she has taken a policy of Rs.10,000/- and of Rs.20,000/- respectively.  It is to be understood that 1^st opposite party admitted that the complainant has taken two policies of Rs. 2 Lakh and Rs. 50,000/- respectively as per his version.  If we analyze the petition her testimony in chief examination as PW1 and the exhibit already described above, it is seen that there is no co-relation regarding the sum assured by the complainant.  Anyway, considering the nature of the case and considering the version of the opposite party we are not give much importance to the defect noted above.  In order to comply natural justice we are considering and referring the Ext.A1 and A2 are the policies taken by the complainant and we would like to discard the other contradictions stated above.  As per Ext.A3(1) and A3(2) it is seen that the complainant remitted a renewal premium amount of  Rs.5,000/- each to Ext.A2 policy.  As per Ext.A1 policy, it is clear that she remitted Rs.20,000/- as the 1^st premium amount for Ext.A1 policy of Rs. 2 lakhs.  As per the available records it is to see that the complainant remitted Rs. 15,000/- to Ext.A2 policy (payment on commencement Rs.5,000/- and Rs.5,000/- each as per Ext.A3(1) and A3(2) respectively) that the complainant remitted an amount of Rs. 35,000/- for both the policies.  When we peruse the petition it is seen that she deposited Rs.5,000/- each to Ext.A2 policy in 4 times.  It is true that the complainant is failed to produce the original insurance certificate of the policy for the sum of Rs.50,000/-.  Anyway, through Ext.A3(1) and A3(2) we can come to a conclusion that the complainant has taken the Ext.A2 policy for a sum of Rs.50,000/-.  Hence the case of remittance of Rs. 5,000 x 3 can be accepted.  However, on the basis of this calculation we are arrive a conclusion of remittance of Rs.35,000/- for both the policies.  The main contention of the opposite party in this case is that the 2 policies of the complainant are lapsed and the said policies are also foreclosed for non-payment of renewal premium.  It is seen from Ext.A3(1) and A3(2) that the complainant renewed the Ext.A2 policy and Ext.A1 shows that she paid the 1^st premium premium of Rs.20,000/- to the opposite party.  The opposite party has a definite case that the petition is barred by limitation.  The plea of limitation may not affect this case because as per Ext.A1 and A2, the maturity period of the policies are on 28.03.2027 and 28.10.2016 respectively.  Hence the plea of limitation cannot be sustainable against the complainant. At the time of cross-examination, the counsel appearing for the opposite party cross-examined PW1 in detail but we feel that the grievances of the PW1 are genuine and it has to be redressed. When we consider the available evidence before this Forum it is to see that the terms and condition of the policy are not exhibited by the opposite party.  We do admit that at the time of cross-examination the counsel raised a question, “Ext.A1 & A2-ലെ terms and condition അറിയാമായിരുന്നുവോ? Sales & Manager-ല് നിന്നാണ് ഞാൻ വിവരങ്ങള് അറിഞ്ഞിരുന്നത്. ഇപ്പോള് നല്കുന്ന insurance policy-ക്ക് 15 ദിവസത്തെ ‘free look period’ ഉണ്ട് എന്നുള്ള വിവരം അറിയാമോ?  അറിയില്ല”.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

       12. Anyway, PW1 given a negative reply regarding the above questions before the Forum.  At the time of cross examination, “താങ്കള് എടുത്തിരുന്ന policy കുറഞ്ഞത് 3 വർഷമെങ്കിലും തുടർച്ചയായി premium അടച്ചാല് മാത്രമെ policy surrender ചെയ്യാൻ പറ്റൂ എന്ന് പറയുന്നു? അതിനെക്കുറിച്ച് എനിക്കറിയില്ല”.  If a mandatory condition of continuous remittance of 3 years of premium is a necessity it is seen that, that portion of terms and condition has to be produced before us for perusal.  The complainant has a request before this Forum, to direct the opposite party for an amount of Rs.3,600/- as the commission of her work in the opposite parties firm.  We do admit that this is a matter connected to labour dispute and this Forum has no jurisdiction or right to entertain to the above said request.  The complainant submitted before this Forum that she remitted her hard earned money for this insurance scheme and though she failed to remit the subsequent premium by reason of illness she want a repayment of the remitted amount from the opposite parties.  When considering the evidence before us, we find no reason to retain the remittance amount of Rs.35,000/- in the hands of 1^st opposite party.  Though the complainant demanded the repayment of the said remittance amount, the opposite parties were in deaf ears in respect of her demand.  The attitudes of this opposite parties are to be considered as a deficiency in service on their part.

                   On the basis of the above finding Point No.1 to 3 are found in favour of the complainant. 

          In the result, we pass the following orders:

1. The opposite party is directed to pay an amount of Rs.35,000/- (Rupees Forty Thousand only) to the complainant with interest of 10% per annum till realization from the date of receipt of this order.
2. A compensation of Rs.10,000/- (Rupees Ten Thousand only) is allowed in favour of the complainant from the opposite party with an interest of 10% per annum till realization from the date of receipt of this order.
3. The cost of Rs.2,000/- (Rupees Two Thousand only) awarded in favour of the complainant from the opposite parties with an interest of 10% per annum till realization from the date of receipt of order. (If the amount ordered is paid within 1 month of the date of receipt of this order, the opposite parties need not pay any interest as stated above).

Declared in the Open Forum on this the 31^st day of July, 2015

                                                                                               (Sd/-)

                                                                              P. Satheesh Chandran Nair,

                                                                                           (President)

Smt. K.P. Padmasree (Member – I)           :     (Sd/-)

Smt. Sheela Jacob (Member – II)              :     (Sd/-)

Appendix:

Witness examined on the side of the complainant:

PW1  :  Annamma Varughese

Exhibits marked on the side of the complainant:

A1 :  Policy certificate No.0048248498 dated 28.03.2007 for Rs. 20,000/-.

A2 :  Default intimation receipt No.0027268913 dated 28.10.2006 for

        Rs. 10,000/-.

A3(1)  : Renewal Premium receipt dated 20.05.2008 for Rs. 5,000/-.

A3(2)  is the Renewal Premium receipt dated 09.04.2008 for Rs. 5,000/-. 

A4 : Photocopy of the Proposal form for Life Insurance.

Witness examined on the side of the opposite parties:  Nil

Exhibits marked on the side of the opposite parties:  Nil.

                                                                                               (By Order)

                                                                                                   (Sd/-)

                                                                                    Senior Superintendent.

Copy to:- (1) Smt. Annamma Varghese, Manakkalettu Veedu,

                    Kadamankulam.P.O., Kallooppara, Thiruvalla,

                    Pathanamthitta Dist.                                                    

2.  Branch Manager, Bajaj Allianz Life Insurance Co. Ltd.,

 Pathanamthitta, Office Mannil Regency, Pathanamthitta.

3.  Tapan, Singhel, M.D & CEO, Bajaj Allianz General Ins. Co. Ltd.,

           GE Plaza, 1^st Floor, Air Port Road, Yerawada, Pune,

           Pin – 411 006.

     (4)  The Stock File. -