BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.485 of 2016
Date of Instt. 14.12.2016
Date of Decision: 02.07.2019
Gurjinder Singh aged about 37 years, son of Mohinder Singh, resident of Guru Nanak (West), Jalandhar 9988700037
..........Complainant
Versus
Birla Sun Life Insurance Co. Ltd. 23/24 Second Floor, EH 197 City Square, Civil Lines, Jalandhar.
….….. Opposite Party
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Jyotsna (Member)
Present: Sh. Gurvinder Arora, Adv. Counsel for the Complainant.
Sh. K. S. Minhas, Adv. Counsel for the OP.
Order
Karnail Singh (President)
1. This complaint has been filed by the complainant, wherein alleged that the grandfather of the complainant Sh. Rattan Singh had obtained an insurance policy No.001858010 from OP on 24.07.2008 having maturity date 24.07.2016 and the whole premium payment was three years upto 24.07.2011. While accepting the application for life insurance of Sh. Rattan Singh, the premium was paid and its receipt was issued. The complainant was nominee of insured Rattan Singh. The policy period 24.07.2008 to 20.10.2016, but unfortunately, the insured Rattan Singh was died due to natural death on 16.04.2016.
2. After that the claim settlement form was submitted by the complainant along with required documents in the office of the insurance company, but the company has delayed the payment of the genuine and just insurance claim of the policy after the death of insured Rattan Singh. Inspite of numerous visits of the complainant to the office of the OP, the OP is not ready to release the payment of the genuine claim. A letter dated 31.05.2016 was received after about 6 months of the submission of the claim form from the headquarter of the insurance company rejecting the legal claim on the ground that:-
(a) No payment of premium was paid earlier and therefore, the policy lapsed long before the death of the owner of the policy.
3. That these facts were never told to the policy holder or the nominee i.e. the complainant, who is the genuine claimant of the insured i.e. his grandfather Sh. Rattan Singh. No intimation was ever given to the insured or the nominee before the death of the insured in regard to lapse of the policy for non-payment of premium. Rather the insurance company is trying to mislead the insured and its nominee. It is clearly unfair and deceitful practice of the insurance company as well as deficiency in service and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OP be directed to pay the insured amount of Rs.2,50,000/- alongwith some further payable amount to the complainant with interest for the delayed payment and further OP be directed to pay compensation of Rs.50,000/- for causing mental tension and harassment to the complainant.
4. Notice of the complaint was given to the OP, who appeared and filed written reply, whereby contested the complaint by taking preliminary objections that the complaint of the complainant is not maintainable and is liable to be dismissed as the complainant has misguide and mislead the Forum. In fact, the complainant has suppressed the material facts from the Forum and as such, the complainant is not entitled for the relief. It is further averred that the policy in question was issued by the respondent company on the basis of information provided by the Life Assured in the proposal form. Since the policy was already terminated at the time of death of the life assured, hence the respondent company was well within its rights to repudiate the said claim of the complainant. Since, the answering respondent has acted within the four corners of the statutory provisions, no case of deficiency in service can be said to have arisen, and as such, the present complaint is not maintainable before this Forum. It is further submitted that the respondent have strictly acted as per the terms and conditions of the policy contract. It is further alleged that the policy holder had opted for quarterly premium payment towards said policy, the life assured paid the 1st annual premium as quarterly premiums. Then for the 2nd year, the life assured made a request for the conversion of the quarterly mode of the policy into annual mode and also for the reduction of the premium amount to Rs.10,000/- for 2nd and the 3rd year. As per the policy terms and conditions, the company deducted the necessary administrative and service charges. On 24.02.2015, the policy was Auto Surrendered/Terminated on account of non availability of fund in the policy to remain the policy in Active State. The complainant has submitted all the relevant documents pertaining to the death claim under the said policy on 20.05.2016. The said claim was duly examined by BSLI and it was revealed that the said policy was terminated since 24.02.2015 and Fund Value was not available in the policy. Further, an intimation was also sent to the complainant’s registered address with regard to the same. That in view of the aforesaid, BSLI has rightly acted and hence is not liable to pay any further amount of whatsoever nature to the complainant. It is further averred that the complainant has not acted in good faith with respect to subject of his complaint and has approached the Forum with unclean hands, whereas it is a settled legal preposition that “One who seeks equity must come with clean hands”. On merits, it is admitted that the insurance policy was obtained by the grandfather of the complainant, namely Sh. Rattan Singh, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
5. In order to prove his case, the complainant himself tendered into evidence his duly sworn affidavit Ex.CA alongwith some documents Ex.C-1 to Ex.C-7 and closed the evidence.
6. Similarly, counsel for the OP tendered into evidence affidavit Ex.OP1/A alongwith some documents Ex.OP/1 to Ex.OP/6 and closed the evidence.
7. We have heard the learned counsel for the respective parties and also gone through the written argument submitted by counsel for the complainant as well as case file very minutely.
8. From the pleadings of both the parties, it has become clear that the complainant has not disclosed the factum that the policy in question is covered under the Investment Plan and even the OP has miserably failed to take a plea in the written statement that the policy in question is a Unit Linked Policy, which does not cover under the Consumer Protection Act, because it is investment for loss and gain. This fact has come to our notice during the course of argument as well as from the documents placed on the file by both the parties i.e. the complainant has brought on the file one document Ex.C-6 Premium Paid Certificate and in its second page, it is categorically mentioned that this is a Unit Linked Life Insurance Policy, similar document has been placed on the file by the OP, which is Ex.OP-2 having two pages. On the first page, it is also clearly mentioned on the heading that “the investment risk is borne by the policy holder” and further on the 2nd page, it is categorically mentioned that “All Unit Links life insurance plans are different from traditional insurance plans and are subject to different risk factors. The name of the investment funds and that of this plan do not in any way indicate the quality of the plan or future returns. Investment funds are subject to investment risks associated with the capital markets and unit prices may go up or down reflecting the market value of the underlying assets. Past performance is no guarantee of future results”.
9. The above language itself make clear that the grandfather of the complainant had invested the amount for purchase of units which depends upon the risk of the market value which may go up or down and thus, the matter directly covered under the definition of ‘Commercial Purpose’. Further, we like to refer another document placed on the file by the OP i.e. Ex.OP/5, the terms and conditions of the policy, wherein specifically mentioned under the heading ‘General’, ‘This is Unit Linked Life Insurance Policy’.
10. From the above documentary evidence, it has become clear that the policy purchased by the complainant’s grandfather namely Rattan Singh was a Unit Linked Policy and whatsoever amount invested for purchase of that insurance policy is apparently considered as Investment for Commercial Purpose. We like to make it clear that the factum in regard to purchase of Unit Linked Policy did not come to the notice of our Predecessor at the time of admitting the complaint, being reason the documents produced by the OP in a later stage and as such, whenever the legal lacuna came to notice of the Forum, the same is required to be discussed and disposed off accordingly.
11. In the light of above detailed discussion, it has become clear that the policy purchased by the grandfather of the complainant was a Unit Linked Policy and the amount was invested by the insured for commercial purpose, if so, then the complainant is not a consumer and in support of this observation, we like to take advantage to refer a judgment of Hon’ble National Commission, cited in 2013 Part 3 CPJ 203 (NC), titled as “Ram Lal Aggarwalla Vs. Bajaj Allianz Life Insurance Co. Ltd. & Anr.”. On the same point, we further like to refer another pronouncement of our own Hon’ble State Commission, decided in Consumer Complaint No.96 of 2011, decided on 04.07.2014, titled as “Smt. Paramjit Kaur Vs. Aviva Life Insurance Co. India Ltd.”.
12. As an upshot of our above detailed discussion, the complaint of the complainant is not maintainable and therefore, the same is dismissed with no order of cost. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.
13. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jyotsna Karnail Singh
02.07.2019 Member President
