Haryana

Yamunanagar

CC/1250/2011

Vinay Sharma S/o K.C.Sharma - Complainant(s)

Versus

Birla Sun Life Insurance Company Ltd. - Opp.Party(s)

Atul Pandey

21 Apr 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                          Complaint No. 1250 of 2011.

                                                                                          Date of institution: 21.12.2011           

                                                                                          Date of decision: 21.04.2017

 

Vinay Sharma aged about 35 years son of Sh. K.C.Sharma resident of Inderlok Street, Opp. Gaba Hospital, Yamuna Nagar, Tehsil Jagadhri, Distt. Yamuna Nagar.

   …Complainant.

                                    Versus

1. Birla Sun Life Insurance Company Limited, S.C.O. 133, 2^nd Floor, Sector-17, Near Mini Secretariat, HUDA, Jagadhri, District Yamuna Nagar through its Branch Manager.
2. Birla Sun Life Insurance Company Limited, One India Bulls Centre Tower-1, 15^th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013 through its Managing Director.

 

                                                                                                           ...Respondents

 

BEFORE:       SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                        SH. S.C.SHARMA………………………….MEMBER.

                        SMT. VEENA RANI SHEOKAND………. MEMBER

 

Present:          Sh. Atul Pandey, Advocate for complainant.

                        Respondent No.1 already ex-parte.

                        Sh. Divender Kamboj, Advocate, for respondent No.2.  

 

ORDER  (Ashok Kumar Garg, President)

 

1                       The present complaint has been filed by complainant Vinay Sharma under section 12 of the Consumer Protection Act 1986. 

2.                     Brief facts of the present complaint, as alleged by the complainant, are that complainant bought the insurance policy from the OPs and paid the first premium of Rs. 7508/- including tax and the OPs Insurance Company issued an insurance policy bearing No. 000806715 with the commencement date of 20.12.2006. Under the policy in question, the following coverage was covered i.e. (i) premium back term plan-100% plan (ii) Accidental Death & Dismemberment Rider, (iii) Critical illness Plus Rider. The complainant paid all the premium on time and nothing was due on the part of the complainant. However, when the complainant deposited his premium on 10.01.2011 vide receipt No. 20979888 of Rs. 7440/- with the OP No.1 then it came to know that his previous premium was due because he forget to deposit it and coming to know he immediately contacted the OPs and paid Rs. 8300/- vide receipt No. 20980082 dated 27.01.2011 which includes renewal charges and other charges as told by the official of the OPs. The official of the Ops assured the complainant that the said policy will continue as normal way with all the benefits. After that complainant received a cheque of Rs. 15740/- dated 01.04.2011 from the OPs as refund whereas the complainant never requested any kind of refund as he wanted to get all the benefits of the said policy for which he availed the policy in question. The complainant enquired from the local office of the Ops but nobody provided any information about the said refund cheque. After that, complainant tried very hard to know the status of his policy and at last on 07.04.2011 he came to know that such policy can be reinstated by depositing Rs. 16080/-. The complainant, to save all benefits of the said policy and for benefits of his family and risk cover, deposited Rs. 16,206/- vide receipt No. 20981130 dated 09.05.2011 and even as per assurance of the OPs provided new medical report as per schedule. The official of the OPs did not provided any basic information about the fate of the said policy as some official told the complainant that his policy is in lapsed and some officials told that policy is cancelled. The official of the OPs cheated the complainant after receiving all the premium by luring false claims and in good faith complainant paid all premium but he lost his faith by behavior and illegal act of OPs. The complainant made so many visits at Chandigarh and Delhi office and also made many e-mails to the OPs. Now, the complainant is again shocked as the complainant received a cheque bearing No. 168015 dated 12.09.2011 of Rs. 24,573/- as policy lapsed reason. It is utter surprise fact that the OPs illegally lapsed the policy of the complainant which he purchased for his family secure futures. The officials of the OPs Company harassed the complainant mentally and financially which constitute the deficiency in service and unfair trade practice on the part of Ops. Lastly, prayed for directing the OPs to refund all the paid up amount premium for the life insurance policy bearing No. 000806715 with immediate effect alongwith interest and also to pay litigation expenses and compensation etc.

3.                     Upon notice OP No.1 failed to appear despite service, hence, he was proceeded ex-parte vide order dated 26.03.2012 whereas Op No.2 appeared and filed its written statement by taking some preliminary objections such as complaint filed by the complainant is not maintainable; complainant has suppressed the material facts from this Forum and it is settled legal proposition that one who seeks justice must come to the court with clean hands; complainant has failed to disclose any legal and valid cause of action; complainant has no locus standi to file the present complaint. The true and correct facts pertaining to the present case are that Sh. Vinay Sharma had submitted an application for insurance bearing No. A4995812 dated 17.11.2006 in his own name for premium back term 100%- term 20 for sum insured of Rs. 12,00,000/-. The premium in respect of application No. A4995812 dated 17.11.2006 was assessed for Rs. 7507/-. The complainant opted for semi-annual payment of premium. On receipt of the application form and required documents policy bearing No. 000806715 was issued to the insured/complainant on 20.12.2006. Under the policy contract in question it was the obligation of the life assured/complainant to pay the semi annual premium on due dates and as per term and condition of the said policy contract failure on the part of the complainant/life assured to pay the premium in time would render the said policy to lapse. The conditions of revival of the said policy were also clearly set out in the policy contract. After paying the annual premium for 3 years only the life assured/complainant did not continue to deposit the semi annual premium of Rs. 7507/- and therefore, the said policy lapsed w.e.f. 20.06.2010. The policy in question was lapsed due to non-payment of premium. After that, the OPs Insurance company received an amount of Rs. 15,400/- from the complainant, upon which, the OPs Insurance Company have informed to the complainant vide its letter dated 07.02.2011 that since the policy has not been revived within 180 days from the date of lapsation on 20.06.2010, therefore, the complainant has to submit the certificate of insurability           ( COI). However, complainant did not submit the same and in view of the non-fulfillment as per policy standard terms and conditions, the OPs Insurance Company refunded the amount of Rs. 15740/- vide cheque No. 959728 dated 31.03.2011. After that also, the OPs Insurance Company sent a letter dated 03.05.2011 to the complainant informing that to revive the said policy amount of premium required to be paid alongwith necessary documents and again a letter dated 28.05.2011 was also sent to the complainant informing about the requirements of consent letter and extra premium due to the reason of medical cases. However, the complainant did not fulfill any requirement. The OPs Insurance Company had again received amount of Rs. 24573/- from the complainant, however, since the said amount was not sufficient amount to be paid to reinstate the said policy, the amount was refunded back to the life assured vide cheque No. 168015 dated 12.09.2011. The aforesaid amount was deposited by the complainant post lapsation without fulfilling the condition of revival/reinstatement as per terms and conditions of the said policy. Thereafter, the official of the OPs Insurance Company again informed the complainant vide letter dated 10.11.2011 requirements to reinstate the said policy and asked to submit the full medical examination report vide letter dated 15.12.2011. It was also mentioned in the said letter that said requirement should be furnished within 35 days. However, the OPs Insurance Company did not receive any revert from the complainant and refunded the amount of Rs. 25171/- vide cheque bearing No. 408134 dated 24.02.2012 and on merit it has been admitted that on payment of three year premium, the complainant as life assured enjoyed all the benefits and privileges under the policy risk on life on uninterruptedly covered and the said premium was absorbed towards the same. The payment of premium is not like a saving bank account, the premium amount cannot be refunded or returned to the insured because the same is part of the contribution creating a larger corpus out of which the claims made by the insured are settled from time to time, since it is consideration for the indemnity accepted by the underwriters. The money available with the insurers is an aggregate of premiums received from the various policy holders that constitute a corpus fund out of which the widows and orphans who are the ultimate beneficiaries of genuine death claims under these policies are paid. Rest contents of the complaint were controverted and reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint.

4.                     In support of his case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and documents such as photo copy of first premium receipt as Annexure C-1 and C-2, Photo copy of coverage information alongwith terms and conditions as Annexure C-3, Photo copy of insurance policy as annexure C-4, Photo copy of letter sending the cheque amounting to Rs. 24,573/- as Annexure C-5 and C-6, Photo copy of e-mail as Annexure C-7, Photo copy of letter sending the cheque of Rs. 15740/- as Annexure C-8, Photo copy of reinstatement quotation as Annexure C-9, Photo copy of blank performa certificate of insurability for majors as Annexure C-10, Photo copy of filled performa certificate of insurability for major as Annexure C-11, Photo copy of receipt dated 09.05.2011 as Annexure C-12, Photo copy of reinstatement quotation as Annexure C-14, Photo copy of certificate of insurability for major as Annexure C-15, Photo copy of rejection letter for accepting the revival amount of Rs. 24,593/- as Annexure C-16 and C-17 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for the OP No.2 tendered into evidence affidavit of Smt. Sreemaya Athikkat, Authorized Officer of Birla Sun Life Insurance Company as Annexure RW2/A and documents such as Photo copy of authority letter as Annexure R-1, Photo copy of proposal application as Annexure R-2, Photo copy of insurance policy as Annexure R-3,Photo copy of premium paid certificate as Annexure R-4 and closed the evidence on behalf of OP No.2.

6.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

7.                     It is not disputed that Sh. Vinay Sharma obtained an insurance policy bearing No. 000806715 on 20.12.2006 for a sum insured of Rs. 12,00,000/- and the premium was payable as semi- annual payment. It is also not disputed that after paying the annual premium for three years the complainant did not continue to deposit the semi- annual premium of Rs. 7507/- and therefore, the said policy was lapsed w.e.f. 20.06.2010 due to non-payment of premium.

8.                     The only grievances of the complainant is that he forget to deposit the one installment of June, 2010 and when this fact came to his knowledge on 10.01.2011 while depositing his installment for the month of January, 2011 vide receipt No. 20979888 of amounting to Rs. 7740/-, then he immediately paid Rs. 8300/- vide receipt No. 20980082 dated 27.01.2011 which includes policy renewal charges and other charges with the OPs and at that time the official of the OPs assured the complainant that policy will run in normal way with all benefits but the complainant was very astonished when he received a cheque of amounting to Rs. 15740/- ( 7400+ 8300) from the OPs. Further it is also the version of the complainant that he again deposited Rs. 16206/- vide receipt No. 20891130 dated 09.05.2011 for renewal of the policy in question. However, he again shocked by the OPs by sending/returning the cheque bearing No. 168015 dated 12.09.2011 amounting to Rs. 24,573/-. Lastly, it is the version of the complainant that the Ops be directed to refund all paid premium amount against the policy in question alongwith interest and also to pay compensation as well as litigation expenses.

9                      On the other hand, it is the case of the OPs Insurance Company that policy in question was lying in the lapsed condition w.e.f. 20.06.2010 the life assured cannot claim any benefits under the said policy. It has been further mentioned that once the said policy was lapsed not revived as per terms and conditions thereof, there ceased to be any privity of contract between the parties. A sum of Rs. 15740/- was returned to the complainant vide cheque No. 959728 and another sum of Rs. 24,573/- vide cheque No. 168015 dated 12.09.2011 and amount of Rs. 25171/- vide cheque bearing No. 408134 dated 24.02.2012 was returned to the complainant by the OPs Insurance Company since the aforesaid amounts were deposited by the complainant post lapsation without fulfilling the conditions of revival/reinstatement as per terms and conditions of the said policy. So, there was no deficiency in service or unfair trade practice on the part of the OPs Insurance Company and requested for dismissal of complaint.

10.                   After hearing both the parties one thing is clear that complainant had purchased insurance policy bearing No. 000806715 commencing w.e.f. 20.12.2006 and the said policy lapsed w.e.f. 20.06.2010. Meaning thereby that complainant had paid the installments against the policy in question up to 20.06.2010 w.e.f. 20.12.2006. Now, dispute between the parties is that as per version of the complainant he had paid an amount of Rs. 7440/- on 10.01.2011 and Rs. 8300/- on 27.01.2011 and again Rs. 16206/- on 09.05.2011 for revival of the policy in question but as it is the stand of the OPs Insurance Company that complainant remained failed to fulfill the requirements by submitting documents for revival of the policy in question. So, the OPs Insurance Company could not revive the insurance policy in question and returned the amount whatsoever was deposited by the complainant for reviving the policy in question. To decide the controversy between the parties, we have gone through the documents placed on file by both the parties i.e. reinstatement quotations dated 07.04.2011, 03.05.2011 and 10.11.2011 attached with premium paid certificate dated 07.04.2011 Annexure R-4. As per these quotations, the complainant was asked to deposit the amount due to revive the policies as Rs. 16080/- quotation valid up to 07.05.2011, Rs. 16225/- quotation valid up to 22.03.2011 and amount of Rs. 25,170/- quotation valid up to 10.12.2011 and as per these quotations the complainant was depositing the amount with the OPs Insurance Company but the OPs Insurance Company was returning the same to the complainant on one pretext or the other. Even, we have gone through these quotations and as per quotations complainant was asked only to deposit the amount mentioned in these letters and in addition a certificate of insurability and medical, if any. Learned counsel for the complainant draw our attentions towards the copy of e-mails dated 26.05.2011 (part of Annexure C-7) in which he has clearly mentioned that amount of Rs. 16026/- paid from my account dated 11.05.2011 and form of insurability submitted alongwith medical at local office. Meaning thereby that complainant fulfilled all the requirements as per the letters for reinstatement of the policy issued by the OPs on 03.05.2011 part of Annexure R-4. On the other hand, learned counsel for the OPs has totally failed to convince this Forum that why the OPs Insurance Company has not re-instatement the insurance policy in question of the complainant. So, after going through the facts of the case and replies submitted by the OPs Insurance Company, we are of the considered view that the OPs Insurance Company was not playing fairly and returning the reinstatement premium deposited by the complainant on one pretext or the other due to the reason best known to the official of the Ops Insurance Company. Hence, we have no option except to partly allow the complaint of complainant.

11.                   Resultantly, we partly allow the complaint of complainant and direct the OPs Insurance Company to revive/reinstate the insurance policy in question of the complainant after receiving the due installments as per terms and conditions of the revival of the insurance policy as the policy in question is having a maturity date up to 20.12.2026. OPs insurance company is also directed to pay Rs. 10,000/- as compensation for mental agony and harassment and further to pay Rs. 10,000/- as litigation expenses.

             If the OPs Insurance Company is not in a position to revive the policy in question due to lapse of considerable time then the Ops Insurance Company is directed to refund the entire amount deposited by the complainant alongwith interest at the rate of 7% per annum from the date of lapse of policy i.e. 20.06.2010 till its realization and further to pay Rs. 5500/- as litigation expenses. Order be complied within a period of 30 days after preparation of copy of this order failing which complainant shall be entitled to invoke the jurisdiction of this Forum as per law. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court.21.04.2017.

                                                                                    (ASHOK KUMAR GARG)

                                                                               PRESIDENT

                                                                               DCDRF,YAMUNANAGAR

 

 

(VEENA RANI SHEOKAND)                            (S.C.SHARMA)

 MEMBER                                                              MEMBER