ORDER

05.11.2024

Sh. Sanjay Kumar, President

1. The factual matrix of the present case is that the respondent is engaged in the business of Life Insurance in the name of “BIRLA SUN LIFE INSURANCE CO. LTD.”, form the above mentioned addresses and offers life insurance policies to the customers all over the India in the same way a policy was sold to the complainant by the executive of respondent.
2. It is stated that complainant paid a sum of Rs.80,000/- to the respondent and the present policy (No.001712401) was issued by the respondent after receiving the said amount. It is further stated that the respondent issued a policy namely, Birla Sun Life Gold Plus II insurance policy, Numbered 001712401 issued on 16 May 2008 with a maturity date of 16.05.2016, on Annual policy premium basis with flexible option of reducing the Annual premium to minimum of Rs.10,000/- annually and the minimum prescribed time for the annual premium was of three year, (lock in period, including the first premium) and the complainant has to pay Rs.20,000/- for the next two years.
3. It is stated that while issuing the above mentioned policy the executive of the respondent revealed that the further annual payment for the subsequent second and third year can be made at one time along with a covering letter for reducing of the premium amount for second and third year. It is further stated that the complainant made the payment for annual premium installment on 02.12.2010 to the respondent by cash payment of Rs.20,000/- vide receipt no.15220694 along with a covering letter for reducing the annual premium for second and third year on the same day which was duly received by the executive of the respondent. It is stated that the complainant rest assured that the minimum annual premium payment of the policy was made by him and the policy will continue and will get the assured amount on its maturity.
4. It is stated that in the month of August 2014 the complainant was in need of money and he went to the office of the respondent to surrender of the above policy but the complainant was shock to hear that the said policy was terminated by the respondent’s company without giving any notice for the same even no intimation was given for the same by the respondent. It is further stated that when the complainant inquired about the reason for policy termination the executive of the respondent revealed that your policy had lapsed due to non-payment of annual premium. It is stated that no notice of termination was ever given to the complainant by the respondent at any point of time.
5. It is stated that the complainant was baffled to hear this as he had already paid the premium of Rs.20,000/- for the subsequent periods to the respondent which was duly received by them for second and third year respectively and issued the receipt for the same. It is further stated that at the time of receiving of the second and third year premium the respondent not objected anything or did not tell that the policy lapsed due to non payment. It is stated that as the respondent received the premium from the complainant and kept the complainant in dark by stating the existence of the policy. It is stated that thereafter the complainant many time visited the office of the OP to verify the state of affairs, but the OP kept on assuring the complainant that they will reinstated the policy or the company will return the amount, however till date nothing has been done.
6. It is stated that the complainant was keep on visiting the office of the respondent for his hard earn money and finally on 30.12.2014 the brother of the complainant visited the office of the respondent on that the respondent clearly states that we cannot do anything for you amount and will not return anything to you hence the present complaint. It is stated that respondent had committed criminal breach of trust without intimated the complainant about the termination of the above mention policy and kept the amount of the complainant with them and using the same for making profits illegally, for three years and further kept the complainant in dark by not intimated him about the termination of the policy and further receiving the premium for the subsequent period and further despite receiving the full premium from the complainant terminated the policy of the complainant. It is further stated that due to the act of the respondent the complainant is in great shock and when he needed the hard earn money which was deposited with them in the above mentioned policy was terminated and not released on time when the complainant was in need of the same.
7. Complainant is seeking direction against OP to pay Rs.1,00,000/- being the principle amount, paid by complainant to OP and 24% p.a. interest on the said principle amount from date of allotment, till realization, to pay Rs.1,50,000/- for criminal breach of trust without intimated the complainant about the termination of above mention policy, to pay Rs.2,00,000/- for harassment, humiliation, mental and physical agony, cost  of proceedings and any other which deems fit and proper.
8. OP has filed detailed WS and taken preliminary objections that present complaint is not maintainable as there is no cause of action in favor of complainant and present complaint is barred by limitation. It is stated that the policy was purchased in the year 2008 and due to non payment of the renewal of premium, the policy got into lapse status and there was failure on the part of complainant to provide necessary documents post lapsation such as certificate of insurance and banker’s attestation. Therefore, the policy was terminated in accordance with terms and conditions of the policy contract. It is stated that present complaint is liable to be dismissed under section 24 A of CP Act, 1996.
9. It is stated that complainant policy is an unit linked policy and law is well settled that such policy are speculating in nature and the same are taken for investment purposes and as such the policy holder of such policy are not consumer and dispute relating to such policies are not maintainable before consumer forum. It is stated that complainant has raised serious allegations of criminal breach of trust against OP insurance company and this forum has no jurisdiction to examine the matter which involves complex issues with criminal allegations. OP relied on judgment of Harbans & Co. Vs. State of India II (1994) CPJ 456, M/s Singhal Swaroop Ispat Ltd. Vs. United Commercial Bank 1994 1 CLT 334 (NC), Oriental insurance company Ltd. Vs. Muni Mahesh Patel 2006 (2) CPC 668 (SC), Reliance Industries Ltd. Vs. United insurance company 1998 CPJ 13 and Jayantilal Keshavlal Chauhan Vs. The National Insurance Co. Ltd. 1994 (1) CPR 396 (NC).
10. It is stated that present complaint has been filed with ulterior motive and malafide intention because harassment and prejudice to OP and claim amount is arbitrary without any basis and is an abuse of process of law, therefore, complaint is liable to be dismissed under section 26 of CP Act, 1986. It is further stated that complainant failed to make out a case of deficiency of service on the part of OP insurance company. It is stated that insurance is a contract between insurer and insured and both parties are bound by the terms of policy. The OP relied on judgment of Suraj Mal Ram Niwas Oil Mills Pvt. Ltd. Vs. United India Insurance Co. Ltd. 2010 (10) SCC 657, Reliance Life Insurance Co. Ltd. Vs. Madhavacharya RP No.211/2009, Polymat India Pvt. Ltd. & Anr. Vs. National Insurance Co. Ltd. & Ors. and Ravneet Singh Bagga Vs. K.L.M Royal Dutch Airlines 2000 (1) SCC 66.
11. It is stated that complainant has come with malafide and dishonest intention and also twisted and distorted the facts for his convenience and mislead the hon’ble forum. It is stated that complainant has not acted in good faith and approached the hon’ble forum with unclean  hands. It is stated that one who seeks equity must come with clean hands but complainant deserves dismissal of the complaint.
12. The OP  insurance company stated the facts that complainant being the policy holder and life assured had applied for insurance policy through application no.A8997359 and policy plan no.001712401, unit link investment plan was issued. It is stated that proposal form no.A8997359 dated 14.05.2008 was submitted and policy issued on 16.05.2008 with sum assured of Rs.4,00,0000/-, premium amount Rs.80,000/-, policy tenure eight years, premium frequency annually and total premium paid Rs.80,000/- the present status of policy is terminated.
13. It is stated that complainant is well educated person and after understanding the features of policy plan and the contents signed the proposal form and specific declaration. The proposal form filed on record. It is further stated that OP insurance company believed on the material facts like age, occupation, health status, annual income, profession, family history etc as provided by complainant and after due diligence of the documents and information provided therein the OP issued the policy in question. The complainant also shared his mobile no. and email id. The OP insurance company issued policy alongwith welcome kit which includes free look letter, first premium receipt, copy of proposal form and policy terms and conditions in favor of complainant/life assured which was duly received by complainant and the photocopy of policy terms and conditions filed on record.
14. It is stated that OP insurance company adhered with the provisions of section 6 (2) IRDA Regulations 2002 according to which the policy holder/proposer can withdraw/return the policy within 15 days of receipt of the policy document i.e under “free look period”. It is stated that in the present case admittedly complainant has not approached OP insurance company within the free look period that apparent deemed admitted that complainant/life assured agreed with the terms and conditions of the policy. It is stated that OP insurance company also provided copy of duly filled proposal form under provision of section 4 (1) of IRDA Regulation 2002 to the complainant for checking and confirming information provided under the duly filled proposal form.
15. It is stated that as per policy the premium was Rs.80,000/- per annum which the complainant was required to pay annually on due dates or during the grace period. It is further stated that complainant made the payment of Rs.80,000/- of the premium in the first year i.e at the time of submitting of proposal form but later on due to his own wrong and negligence failed to give the subsequent premium, therefore, allowing the policy to go on lapsed status on 26.05.2009. It is stated that OP insurance company vide letter dated 26.06.2009 sent a lapsation notice and apprised the complainant of the lapse status of the policy and asked to pay outstanding premium of Rs.80,000/- to reinstate the policy before the validity period which was 26.07.2009. It is stated that despite that complainant failed to make the payment viz-a-viz the premium allowing the policy to be lapsed status. The lapsation notice dated 26.06.2009 filed on record.
16. It is stated that late in December 2010 the complainant made a request of reduction of premium and sent a cheque of Rs.20,000/- in lieu of the said reduced premium. It is stated that the OP relied vide letter dated 10.12.2010 whereby complainant was asked to submit the required documents within 35 days to reinstate the policy failing which OP insurance company would be forced to process the refund of the amount received post  lapsation. It is stated that OP insurance company sent a reminder notice/letter dated 22.12.2010 asking the complainant to submit the required documents within 20 days but complainant failed to do the needful for the restoration of the policy as a result OP sent a cheque of Rs.20,000/- having no.157034 dated 17.03.2011 to the registered address of complainant but same was returned back undelivered. The copies of letter filed on record. It is stated that subsequently due to failure on the part of complainant to reinstate the policy within two years of the lapsation, the policy was terminated on 16.05.2011.
17. It is stated that the complainant on his own fault, negligence and non performance of contractual obligation has failed to do the needful and consequently the policy was terminated. It is stated that the complainant very blatantly has put the blame on the OP insurance company for his  own fault in the  instant frivolous complaint, therefore, complaint is liable to be dismissed.
18. On merit all the allegations made in the complaint are denied and contents of preliminary objections and brief facts are reiterated.
19. Complainant filed rejoinder to the WS of OP insurance company and denied all the allegations made therein and reiterated contents of complaint. It is stated that without any  notice and inspite of premium payment and subsequent premium amount of Rs.20,000/- for next two installments which the OP insurance company has duly received and acknowledged by issuing receipts alongwith covering letter to reduce the subsequent premium amount from Rs.80,000/- to Rs.10,000/- and on the same day accepted the said amount of subsequent premium. It is stated that policy was terminated without any notice to the complainant even after receiving the total premium and subsequent premium. It is stated that no notice of laps status  was ever sent to complainant at any point of time.
20. It is stated that the OP insurance company has misrepresentated and distorted the true facts in order to mislead this hon’ble forum. It is stated that OP insurance company had terminated the policy of the complainant which caused great loss, mental agony to the complainant and which shows the deficiency of service  on the OP. It is stated that if the policy was terminated on 26.06.2009 in that case why the subsequent premium was accepted by OP on 02.12.2010, it shows the malafide intention and wrongful gain on the part of OP. It is stated that complainant is entitled for all the reliefs claimed in the complaint.
21. Complainant filed evidence by way his affidavit and reiterated contents of the complaint. Complainant relied on copy of policy as Annexure A, copy of receipt as Annexure B and copy of covering letter as Annexure C.
22. OP filed evidence by way of affidavit of Aakriti Manocha Manager Legal AR. In the affidavit contents of WS reiterated. OP relied on copy of proposal form Annexure R/A, copy of policy terms and conditions Annexure R/B and copy of lapsation notices dated 07.02.2009, 09.03.2009 and 10.03.2009 Annexure R/C (colly).
23. Written arguments filed by complainant as well as by OP.
24. We have heard complainant in person and Sh. Parkash Parakhar Saraswat proxy for Sh. Prateek Kasliwal counsel for OP. We have also gone through the record.
25. It is admitted case of the parties that complainant got issued an insurance policy and paid Rs.80,000/-. On 16.05.2008 the insurance policy was unit link investment plan having sum assured Rs.4,00,000/- and policy tenure is eight years. The premium payment frequency was annual. The OP insurance company taken the objection that present complaint is barred by limitation as filed in 2015 and cause of action arose in the year 2008. In the rejoinder complainant simply denied the fact and taken the plea that OP insurance company terminated the policy without any prior information and also received premium of Rs.20,000/- for two subsequent years.
26. Let us peruse the relevant provision of Consumer Protection Act, 1986.

                       As per section 24(A) of Consumer Protection Act, 1986 : -

1. The District Forum, the state commission or the National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.
2. Notwithstanding anything contained in subsection (1). A complaint may be entertained after the period specified in sub-section (1), if the complainant satisfies the District Forum, the state commission or the National Commission , as the case may be, that he had sufficient cause for not filing the complaint within such period: provided that no such complaint shall be entertained unless the National Commission , the State Commission or the District Forum, as the case may be records its reason form condoning such delay.

27. Now applying the above provision in the present fact and circumstances of the case. Admittedly, the policy was issued on 16.05.2008 and present complaint filed in July 2015. The complainant has not filed on record any document to show that objection was raised to the policy in question under “free look period”. As per policy the complainant was required to pay annually Rs.80,000/- premium. As per record complainant made a request in December 2010 for reduction of premium alongwith a cheque of Rs.20,000/-. The OP insurance company replied and asked to submit required documents including certificate of insurance alongwith bank attestation of verification of signatures within 35 days, thereafter, reminder was also sent on 22.12.2010 but complainant failed. Eventually the policy stands lapsed and OP insurance company sent a cheque of Rs.20,000/- dated 17.03.2011 but same was remained undelivered. The policy was terminated on 16.05.2011 the complainant has not filed any document to establish that he had completed all the formalities for reduction of premium as issuance of cheque of Rs.20,000/- does not automatically continued the policy and stand reduction of premium amount. As per material on record lastly the cause of action was arosen on 16.05.2011 when policy was terminated. As per limitation period complainant would have approached this commission within two years i.e. April 2013. However, present complaint filed in July 2015 after delay of more than two years, the complainant has not discloses any sufficient cause for delay. The complainant did not comply the requisite formalities for reduction of premium and reinstatement of policy, therefore, in these circumstances complainant failed to establish deficiency of service on the part of OP insurance company.
28. On the basis of above  observation and discussion present complaint is dismissed as barred by limitation and also complainant failed to establish deficiency of service against OP insurance company.
29. Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving an application from the parties in the registry. The orders be uploaded on www.confonet.nic.in.

Announced in open Commission on  05.11.2024.

SANJAY KUMAR                                                             RAJESH

       PRESIDENT                                                                  MEMBER