Date of filing : 23/08/2013
Order no. 27
The case of the complainants in brief is that one Krishna Kumar Khemka, the husband of the complainant no.1 and father of the complainant no.2 during life time of said Krishna Kumar Khemka, he was approached by the agent of o.ps. with the request of availing insurance facility provided by o.p. no.1. At the time of approach made by o.p. no.1 said Krishna Kumar Khemka was aged about 76 years and he subscribed a policy under o.p. no.1 and paid a sum of Rs.2 lakhs towards the premium of the said policy. The o.p. no.1 issued the policy certificate dt.24.8.09. After receiving the said policy Krishna Kumar Khemka came to learn that said policy is in fact in the nature of mutual fund and for payment of each of the premium he would be allotted certain number of units and at the time of foreclosure of the policy, the policy value would be the sum total of the value of those shares at the time of foreclosure. It would appear from the said policy that out of the payment of Rs. 2 lakhs made by Krishna Kumar Khemka only a sum of Rs.1,77,940/- was invested and units were allotted to him. However, no statement of account of said two premiums made in the year 2010-11 was issued and forwarded by o.ps. Krishna Kumar Khemka died on 11.11.11 leaving behind his widow Sudha Khemka, Dipak Khemka the complainant no.2 and predeceased son Bharat Khemka’s Wife Mina Khamka and his legal heirs are the proforma o.p. no.s 5, 6, 7 respectively. The complainant no. 2 with a view to obtaining the claim under the policy visited the o.p.s, but no amount of the claim was received when only o.p. no.1 told that the amount would be a very less amount and said Krishna Kumar Khemka switched over from very law risk profile to high risk profile. The complainant became surprised and wanted to know from the o.p.s regarding the prove of allegation of switching over of investment fund option, but no reply was provided by o.p. no.1. Subsequently on being approached by the complainant no.2 a meeting was held between o.p. no.1 and the complainant no.2, but fruitful result was achieved. On the basis of the complaint made by the complainant no.2 a hearing was held before ld. ombudsman and the said order was a cryptic one and the complainant did not accept the said order. On the basis of the said fact the complainants filed this case praying for direction upon the o.ps. to pay a sum of Rs.6 lakhs as well as compensation of Rs.6 lakhs and litigation cost.
The o.p. no.s 1 to 4 contested this case by filing w/v and denied all the material allegations of the complaint. It was stated that o.p. no.1 is a company doing business of life insurance in India for the last few years and they have reputation in the work of insurance sector. The life assured executed a will with regard to the assets of the life assured, the complainant has not disclosed the said will with ulterior motive. Until and unless the complainant produces the said will along with the probate before this Forum the proper adjudication will not be possible. The life assured had switched his investment to a fund where the premium was invested in blue chip shares instead of govt. security and bond sometimes in Aug. 2010. The present complaint has been filed as at the time of initiation of the complainants the performance of the market was bad. At present the market has revived and the complainants would not have raised any objection had this value was available at the time of application of the payment. The complainants have based his complaint on the basis of a certain hypothecation that his father could not have switched his investment. The complainants also made the self same complaint before the ld. ombudsman who held that the switch was justified and no relief was provided to the complainant. It was further stated that life assured Krishna Kumar Khemka submitted an application dt. 29.09.12 under the Freedom 58 Plan where he agreed to pay an annual premium of Rs.2 lakhs, accordingly the policy was issued on 24.8.09. The complainant was given detailed description about the features of the said policy and also mentioned that the said policy premium terms risk and consequences of the said policy. At the time of issuance of the policy the fund was invested in individual life income advantage. However, the life assured made a call on 20.8.10 where he requested the o.ps. to switch over its fund and allocate it to a new fund – Individual Life Maximiser. Based on the request of the assured the fund was switched and allocation request was provided to the assured. The o.p.s did not receive any complaint from the life assured with regard to switch and allocation of fund which shows that he had no objection with respect to the changes made according to his request. After receiving an application after the demise of the said policy holder o.p.s in order to settle the claim asked for certain documents viz. indemnity bond for title of claim money where there is no nominee, joint discharge receipt, etc. for settlement of the claim, but no such document was provided by the complainant. Subsequently the complainants sent further letter and o.ps. demanded those requirements. Since the complainants did not comply the request of o.ps. the request of the complainants could not be entertained. On the basis of the said fact o.p.s stated that there was no deficiency in service or unfair trade practice on the part of o.ps. and as such, o.p.s prayed for dismissal of the case.
On the basis of the pleadings of parties the following points are to be decided :
- Whether the complainants predecessor in interest had the policy with o.p.s ?
- Whether during the life time of the said policy holder he switched over to high risk profile in respect of the said policy ?
- Whether after the demise of the life assured his legal heirs provided the documents sought for by o.p.s for payment ?
- Whether there was any deficiency in service on the part of o.p.s ?
- Whether the complainant will be entitled to get the relief as prayed for?
Decision with reasons :
All the points are taken up together for the sake of brevity and avoidance of repetition of facts.
Ld. Lawyer for the complainants argued that one Krishna Kumar Khemka, the husband of the complainant no.1 and father of the complainant no.2 during life time of said Krishna Kumar Khemka, he was approached by the agent of o.ps. with the request of availing insurance facility provided by o.p. no.1. At the time of approach made by o.p. no.1 said Krishna Kumar Khemka was aged about 76 years and he subscribed a policy under o.p. no.1 and paid a sum of Rs. 2 lakhs towards the premium of the said policy. The o.p. no.1 issued the policy certificate dt. 24.08.09. After receiving the said policy Krishna Kumar Khemka came to learn that said policy is in fact in the nature of mutual fund and for payment of each of the premium he would be allotted certain number of units and at the time of foreclosure of the policy, the policy value would be the sum total of the value of those shares at the time of foreclosure. It would appear from the said policy that out of the payment of Rs. 2 lakhs made by Krishna Kumar Khemka only a sum of Rs.1,77,940/- was invested and units were allotted to him. However, no statement of account of said two premiums made in the year 2010 - 11 was issued and forwarded by o.ps. Krishna Kumar Khemka died on 11.11.11 leaving behind his widow Sudha Khemka, Dipak Khemka the complainant no.2 and predeceased son Bharat Khemka’s Wife Mina Khamka and his legal heirs are the proforma o.p. no.s 5, 6, 7 respectively. The complainant no. 2 with a view to obtaining the claim under the policy visited the o.p.s, but no amount of the claim was received when only o.p. no.1 told that the amount would be a very less amount and said Krishna Kumar Khemka switched over from very law risk profile to high risk profile. The complainant became surprised and wanted to know from the o.ps. regarding the prove of allegation of switching over of investment fund option, but no reply was provided by o.p. no.1. Subsequently on being approached by the complainant no.2 a meeting was held between o.p. no.1 and the complainant no.2, but fruitful result was achieved. On the basis of the complaint made by the complainant no.2 a hearing was held before ld. ombudsman and the said order was a cryptic one and the complainant did not accept the said order. On the basis of the said fact the complainants filed this case praying for direction upon the o.ps. to pay a sum of Rs.6 lakhs as well as other reliefs.
Ld. Lawyer for the o.ps. argued that o.p. no.1 is a company doing business of life insurance in India for the last few years and they have reputation in the work of insurance sector. The life assured executed a will with regard to the assets of the life assured, the complainant has not disclosed the said will with ulterior motive. Until and unless the complainant produces the said will along with the probate before this Forum the proper adjudication will not be possible. The life assured had switched his investment to a fund where the premium was invested in blue chip shares instead of govt. security and bond sometimes in Aug. 2010. The present complaint has been filed as at the time of initiation of the complainants the performance of the market was bad. At present the market has revived and the complainants would not have raised any objection had this value was available at the time of application of the payment. The complainants have based his complaint on the basis of a sum certain hypothecation that his father could not have switched his investment. The complainants also made the self same complaint before the ld. ombudsman who held that the switch was justified and no relief was provided to the complainant. It was further stated that life assured Krishna Kumar Khemka submitted an application dt.29.9.12 under the Freedom 58 Plan where he agreed to pay an annual premium of Rs.2 lakhs, accordingly the policy was issued on 24.8.09. The complainant was given detailed description about the features of the said policy and also mentioned that the said policy premium terms risk and consequences of the said policy. At the time of issuance of the policy the fund was invested in individual life income advantage. However, the life assured made a call on 20.8.10 where he requested the o.ps. to switch over its fund and allocate it to a new fund – Individual Life Maximiser. Based on the request of the assured the fund was switched and allocation request was provided to the assured. The o.ps. did not receive any complaint from the life assured with regard to switch and allocation of fund which shows that he had no objection with respect to the changes made according to his request. After receiving an application after the demise of the said policy holder o.ps. in order to settle the claim asked for certain documents viz. indemnity bond for title of claim money where there is no nominee, joint discharge receipt, etc. for settlement of the claim, but no such document was provided by the complainant. Subsequently the complainants sent further letter and o.ps. demanded those requirements. Since the complainants did not comply the request of o.ps. the request of the complainants could not be entertained. On the basis of the said fact o.ps. stated that there was no deficiency in service or unfair trade practice on the part of o.ps. and as such, o.ps. prayed for dismissal of the case.
Considering the submissions of the respective parties it is an admitted fact that one Krishna Kumar Khemka during his life time applied for obtaining the policy from o.p. no.1 and the policy was issued in favour of Krishna Kumar Khemka. The o.ps. raised objection with regard to the claim made by the complainants whereby o.ps. specifically stated that during the life time of said Krishna Kumar Khemka he executed a will and until and unless the probate is obtained by the executor of the said will the legal heirs cannot claim any amount left by the said policy holder, since deceased. It appears from the agreement on record that o.ps. in the w/v specifically stated that after the demise of said policy holder Krishna Kumar Khemka o.p.s demanded certain documents including indemnity bond, death certificate and other documents from the complainant no.2, but the complainant no.2 did not provide those documents to o.p. insurance company. The complainants thereafter made several letters to the contesting o.p.s and o.p.s all through wanted to have some documents from the complainant in order to settle the amount in favour of the complainants. The o.ps. also stated that Krishna Kumar Khemka during his life time switched over his fund and allocate it to a new fund –‘individual life maximiser’. The o.ps. BSLI processed his request and the same was communicated to the policy holder vide letter dt.26.8.10. During life time of the said policy holder he did not raise any objection which will fortify the claim of o.ps. that the life assured had no objection with respect to the changes made according to his request. It is found from the materials on record that the complainants made a complaint before ld. ombudsman and ld. ombudsman also held that the life assured on his own accord opted for the ‘individual life maximiser’. It is also found from the materials on record that o.ps. demanded the certain documents from the complainants, but they failed to produce those documents for which the settlement could not be arrived from the side of o.ps. and the amount could not be disbursed in favour of the complainants. It is relevant to mention here that the complainants while applied the performance of stock market was bad, but subsequently with the revival of the market the complainants would not have raised any objection. Since the policy was an equity market linked life insurance policy and Hon’ble National Commission has held that life insurance policy which is market linked will not come under the purview of Consumer Forum. On the basis of the facts and circumstances as stated above we hold that the case filed by the complainants has got no merit and the complainant will not be entitled to get any relief as prayed for. Thus all the points are disposed of accordingly.
Hence, ordered,
that the case no. CC/527/2013 is dismissed on contest without cost against the o.p.s.
Supply certified copy of this order to the parties free of cost.
