MR LAXMI NARAYAN PADHI, PRESIDENT… The fact of the complaint is that, the complainant on dt. 16.04.2012 on the persistent instances of the O.P.3 who is an agent of O.P.1 and 2 opted to subscribe the policy of Bajaj Allianz Super Gain Policy, with payment of annual premium of Rs. 48,683/- and as against the first premium payment the O.P.3 provided her the Policy bearing No. 264978398. The Complainant subsequently paid the next annual installments on dt. 24.04.2013 and 25.07.2014 as 2nd and 3rd installments. She also as per the terms of the policy got refunded a sum of Rs. 60,000/- on dt. 30.04.2015. But owing to financial hardship, the Complainant finding here self unable to pay the subsequent premiums, on dt. 01.10.2015 intimated the O.P.1 in his office at Jeypore, personally through writing, and also the same request letter intention to surrender the policy was posted to both the O.P.1 and O.P.2 through registered post. And as per the instruction f the O.P.3 she submitted him the filled in forms for surrendering the policy, along with all requisite documents. But till the date of filing there was no response from either of the O.P.s to refund her the surrender value of the policy, as the amount was highly necessitated for the medical treatment of her husband, and without which she had to suffer financial hardship along with mental agony, for which she has filed this complaint demanding the accrued sum under the policy, along with a compensation of Rs. 50,000/- and Rs.5,000/- as cost of litigation.
The Complainant has filed the copies of the policy papers, copies of the letters submitted to the O.P.1 and O.P.2.
2. Observing Prima facie the negligence in rendering service by the O.P.s, the Complainant was admitted and Notice along with copy of complaint sent as per provisions of the CP Act-1986 to the O.P.s to file their counters. On dt. 17.03.2016 the O.P.1 and O.P.2 filed counter denying the allegations of the Complainant. They contended that, the policy in question is Non Linked Regular Premium “super cash Gain” with premium payment of 7 years and benefit term of 12 years. Hence no maturity claim falls due nor the complainant submitted any request for surrender value under the policy. The survival benefit of Rs.60,000/- i.e 20% of the sum assured was paid to Complainant on dt. 30.04.2015. And in absence of any request for surrendering the policy, auto cover runs on as per the terms of the policy and as thus making any further payment to the Complaint under the policy does not arise. They further contended that, the O.P.3 is not their agent, but independent contractors licensees by IRDA, hence any commitment made by him for any assured return cannot bind the O.P. Company. After the premium is received by the O.P. Company, policy was send to Complainant by speed post, on dt. 26.04.2012 and remaining silent for more than four years has assumed the acquiescence of the Complainant to the terms and conditions of the Policy and then after filing the complaint is barred by limitation. If she had any objection, she could have return the policy within 15 days of receipt of the policy. As the Complainant has paid 3 years premium, it has been converted in reduced paid u8p policy, thus the complainant may opt to surrender the policy as per the terms and conditions of the policy. That they are willing to process the surrender value as per the terms and conditions of the policy provided a written request for Surrender Value along with the requisite documents are submitted by the Complainant. The questions of refunding the premiums or any interest under life insurance policy does not arise and the demands raised by the Complainant if met would amount to rewriting the contract of insurance. They further contended that, under the special surrender of policy the Complainant can avail Rs. 41,565/- provided she submits written requests along with mandatory requisites.
The O.P.1 and O.P.2 except these counters did not supply any other papers in support of their contentions.
3. The O.P.3 choosed to abstain from appearing before the forum or file anything in his defense, hence the forum proceeded to decide the complaint on merit with available documents, submissions.
4. Primarily the cause of action to the present com plaint arouse with failure on the part of the OP.s to provide service to complainant to reimburse his funds under the policy accepting the surrender request. It is admitted by both the parties that the complainant had purchased the policy under dispute which was a 7 years regular premium payable and maturable for sum assured is 12 years.
5. As per the terms and condition of policy, the insured has right to surrender the policy at any time after payment of 3 years regular premature and redeemed of her surrendered value after such standard deducting which includes the survival benefits if any paid to the policy holder. But, contradictory to the guidelines prescribed by IRDA, from time to time, the insurer is obligated to mention all these riders, deductions, costs and accrual of all bonus and interests in contingencies of such surrender, in the policy conditions, communicated to the insured, we did not find any such prescriptions in the policy document provided by the OP company, stretched to twenty pages. The conditions which are mentioned with abbreviations/ terms through technically viable, but far from reach of understandings of any common man, having no deep knowledge of insurance business. Further, the regulations of 2002 (Protection of interest of policy holders) has mandated the insurers to keep the policy holder informed periodically on the requirements to be fulfilled by the insured. Here in the present case, the OP.s having failed to do so, and specifically denying of any obligations to have any such, in his counter, res ipsa loquittur assumes deficiency in service on his part.
6. From the copies of the letter of complainant dt.01.10.2015, addressed to the OP.1, it is clear that, she had opted for surrender of policy, hence, the contentions of the OP.s that, there was no communication from complaint to that effect is false and intended to veil their inactions redressing the grievance of the policy holder.
7. The complainant has filed this complaint on dt.04.12.2015, and the same was communicated to the OP.s. But still the OP.s did not come up to action communicating the complaint to file the requisites to redress her grievance or process the surrender, leaving the complainant to legate her grievance for last 10 months, deprived of her legitimate claim under the policy.
8. The contentions of the OP.s that, they are not obligatory to the part of acts of the agent but strictly to the contracts conditions laid in the policy documents. But IRDA Reg (Protection of interest of policy holders) 2002, has never relieved the insurer of the obligation, but has cast obligations on insurer or agent or intermediary jointly or severally. The contentions of OP.s to that extent that, the agent was not authorized by them, but independent contractor licensed under IRDA also does not hold any ground, as though the present OP.3 is licensed under IRDA to act as an insurance agent, he is further codified and registered under the OP company, bearing it’s agent code and identity, bearing FSC code 1000908658 of OP.1.
9. Though we are not inclined to apply our efforts to go to detailed arithmetical calculation of the amount, the complainant is entitled on surrender of the policy, the contentions of the OP.1 & 2 that, she is entitled to Rs.41,565/- holds to be correct, provided backed by a detailed calculation sheet rationalizing the OP.s contention to arrive on such an amount.
As thus, we allow the complaint against all the OP.s.
ORDER
i. The OP.s are directed to provide all the information about the requisites, detailed calculation of amount payable to the complainant on surrender of the policy No.0264978398 and the requisite forms to enable her to apply for such surrender within 15 days of receipt of this order And, on receipt of the forms and requisites all completed, the OP.s shall, complete the process of surrender, within 30 days hence receipt of such application.
ii. The OP.s are further jointly & severally directed to pay a compensation of Rs.40,000/- (Rupees Forty thousand) and Rs.5,000/- (Five thousand) as cost of litigation to the complainant.
iii. All the directions above shall be complied within 45 days of receipt of this order, failing which the total awarded sum will carry 12% interest per annum till its realizations.
Sd/- Sd/-
MEMBER PRESIDENT, DCDRF,
NABARANGPUR.
