C.C. No. 174/2019

Date of Institution: 22.05.2019

Judgment Reserved on: 16.04.2024

Judgment Passed on: 16.04.2024

QUORUM:

Sh. S.S. Malhotra (President)

Sh. Ravi Kumar (Member)

Ms. Rashmi Bansal (Member) On Leave

Judgment By: Shri S.S. Malhotra (President)

JUDGMENT

1. By this judgment the Commission shall dispose off the complaint of the complainant alleging deficiency in service in not refunding the full assured amount against the policy taken.
2. Brief facts as stated by the complainant in the complaint are that one Mr. Shishir Bhatnagar claiming to be the agent of OP approached him and offered him a policy by stating that complainant has to invest Rs.2,50,000/- in one time and he would get Rs.6 Lakh after 5 years alongwith Life Insurance Cover and on such assurances the complainant applied for the investment policy which was issued on paying single premium as assured and the sum assured was Rs.12.5 Lakh and after the completion of 5 years, he received only Rs.1,55,332/- instead of Rs.6 Lakh as assured, whereafter he approached the OP, but of no consequences & ultimately he issued a legal notice through his counsel which was also not complied with and he has filed the present complaint case claiming Rs.6 Lakh from the OP alongwith compensation of Rs.3 Lakh for mental pain, inconvenience & harassment alongwith litigation charges.  
3. The OP was served and has filed its written statement interalia stating that the present complaint case is without any cause of action in favour of complainant as there is no deficiency on the part of OP and it is asserted the complainant has taken the policy after fully understanding and deliberating upon the terms & conditions of the policy and accordingly he was insured with the answering respondent for the period of 5 years from 14.03.2014 to 13.03.2019 on providing the particulars i.e. name of the nominee Smt. Meenakshi Bansal, the date of commencement i.e. 14.03.2014, premium amount as Rs.2,49,917/-, policy term for 5 years, sum assured for Rs.12.5 Lakh and policy status at present (i.e. at the time of filing written statement) is matured and it is further submitted that all the terms & conditions were explained which are in strict adherence to the norms set by IRDA and after maturing of the policy, the matured value was sent to the complainant which was Rs.1,55,332/- through cheque dated 11.02.2019 . However this cheque got stale and moved to unclaimed & from unclaimed amount, last payout was made by the OP on 21.10.2020 through cheque for an amount of Rs.1,67,682/-(including unclaimed gain) and as such there is no misuse of the legal process nor there is any deficiency on the part of OP, the amount as per NAV(Net Asset Value)  has already been given to complainant & therefore complaint may be dismissed.    
4. The complainant thereafter filed the rejoinder interalia stating that the OP had failed to present any terms & conditions or the illustration which are alleged &  particulars of such details were concealed from the complainant which should have been provided as per the IRDA guidelines. It is further stated that in all the 5 years the OP has not made any single correspondence with the complainant regarding this status of the policy till the policy was automatically terminated and the terms & conditions of the policy were not provided to the complainant, which is in violation of IRDA guidelines. The concealment of facts and automated behaviour of the company for matured policy without the consent of the complainant has caused financial harm to the complainant which should be compensated. In the last 5 years, neither NAV has ever been conveyed/provided to the complainant nor it has ever been informed as to where the fund of the complainant were invested by the OP and therefore a kind of fraud was played upon the complainant for which he should be awarded with the assured amount of Rs.6 Lakh. Contents of written statement are denied & contents of complaint are reiterated.
5. Complainant has filed his own evidence by way of affidavit but OP at this stage of evidence did not appear and was proceeded ex-parte for the purpose of filing evidence. The Commission has heard the arguments and perused the record.
6. Complainant alongwith his own complaint has filed the policy thereby mentioning the terms & conditions w.r.t. benefits payable which are produced herein above…….

3) The scheme would be administered as per the scheme rules entered between master policy holder and the insurance company.

4) The Benefits Payable are as given below

a) On Death of an individual Member: On the occurrence of death of the member due to any cause subject to exclusion of suicide as mentioned hereinafter or upon the accidental permanent total/partial disability if opted, the Sum Assured, Rider benefit, if opted plus the account value in the individual account as on date of death would become payable to the Nominee through the Policyholder for the benefit of the beneficiary.

b) On Member reaching to Maturity Date: The Account Value, subject to minimum guaranteed maturity value in the individual account as on date of maturity would become payable to the Member through the Policyholder for the benefit of the beneficiary.

5) Surrender Value: After completion of one year of membership, any member may surrender his membership and the surrender value shall be the account value of the said member subject to market value adjustment as applicable on the date of such closure less surrender penalty if applicable, subject to minimum guaranteed surrender value. Surrender value would become payable to the Member through the Policyholder for the benefit of the beneficiary.

The minimum guaranteed surrender value is 70% (Single Premium less scheme administration fees charged at inception of membership less life insurance premium and rider premium, it any deducted till the date of surrender. The surrender penalty as a percentage if single premium is as follows.

7. Although the OP has not filed evidence but he has filed the written argument. It is the case of the OP in nut-shell that after issuing the policy to the complainant as per IRDA guidelines the terms & conditions were provided where ‘matured value’, ‘sum assured’ in case of death and the maturity value of the product at the time of completing 5 years first to be given to the complainant as per those guidelines and further the complainant had the advantage of having been insured for all the 5 years in this policy all these facts were clarified & even the NAV has already been given & granted to the complainant. Therefore no cause of action survives in favour of the complainant.
8. Complainant on the other hand has argued that the amount as per the assurances given by the OP has not been given & there of OP has cheated the complainant and he has put him in financial loss by just giving Rs.1,67,682/- against the premium paid Rs.2,50,000/- and he should be granted the money as per the assurance. NAV was never informed to the complainant nor any communication has ever been made w.r.t. the NAV, if that such information would have been he could have surrendered the policy as per the terms & conditions & he could have avoided his loss for such reason & since there is no communication ever made by OP to him, he has been put to financial harm therefore this amounts to deficiency in service.     
9. The Commission has perused the document i.e. NAV record and amount of NAV has already been refunded to the complainant. The Commission is also of the opinion that an oral assurance allegedly was given to the complainant, may be by the agent of the company but once the policy guidelines have been issued to the complainant which document has been filed by the complainant himself in the court file, therefore as per provision of Section 91 of Indian Evidence Act the oral assurance has to be discarded against the written document and therefore contention of the complainant that no communication was ever made after inception of the policy w.r.t. NAV is of no consequence. The complainant has not been able to prove as to who Mr. Shishir Bhatnagar is, whether he is authorised to make some statement on behalf of OP, & if yes, whether such assurance is binding upon OP, in view of the specific terms & conditions of the policy. Therefore the contention of complainant that the amount be given to him as assured & not as per NAV is not well found. If the complainant is of the opinion that he has been given lesser value than ‘NAV’, on the date of maturity, he should have filed some documents to that effect which would show that NAV was higher than given but no document has been filed. Admittedly the amount invested by the complainant was not only an investment policy but was a policy with life insurance of the complainant for 5 years which benefit has already been taken by the complainant and granted as per the policy and fortunately the complainant has survived the policy period & in case of some mis-happening the benefit might have been higher. In view of the written document it cannot be said that whatever was assured orally can be given to the complainant. Therefore this Commission is of the opinion that there appears to be no deficiency in service on the part of OP in giving the NAV amount as per calculation. Complainant case of the complainant is accordingly dismissed.    

Copy of the Order be supplied/sent to the Parties free of cost as per rules.

File be consigned to Record Room.

Announced on 16.04.2024.