1. This is case a relating to deficiency in service made by the O.Ps Insurance Company and agent Mrs. Babita Kumari Das, as alleged by the Complainant. On the pursuation of the O.P. No.1 & 3 the Complainant took a policy “Smart Investment Super” after payment of premium of Rs. 25,000/- for sum assured Rs. 5.00 Lakhs dated 30.03.2010. The O.Ps accepted the 1^st premium on 31.03.2010 in respect of policy no. 777601089.

It is further allegation of the Complainant that he received letter dated 30.04.2010 regarding cancellation of policy no. 777601089 and transferred the payment to policy no. 777601394 without consent and approval of the Complainant. The Complainant after some days received the policy document in policy no. 777601394 for Rs. 5.00 lakhs sum assured with annual premium of Rs. 25,000/- for 15 years term and the date of maturity is 03.05.2025. The Complainant paid the yearly premium of Rs. 25,000/- for the year 2010,2011 and 2012, the O.P.s granted receipt there for.

During May 2013 when this Complainant went for payment of insurance the O.P. No.1 told that his policy has been surrendered. The Complainant has not given his consent to surrender. The Complainant requested thereafter to receive the payment but it was in vain.

2. The O.Ps after receipt of notice from the court appeared, filed their version whereas the O.P. No.3 set ex-parte. The answering O.Ps challenged the maintainability of the case. On the request of Complainant this policy dated 24.10.2010 ‘Smart Investment Pension Super’ was changed to ‘Max Fortune Builder’ vide letter dated 27.10.2010, Policy no. 777601394 and policy document sent to Complainant. The Complainant has not received the policy within 15 days. The termination of policy has been intimated vide letter dated 18.06.2013. The Complainant violated the terms and condition of the policy, stopped making premiums, upon termination of the policy an amount of Rs. 25,000/- through cheque was sent and subsequent premium not accepted. The O.P.No.1 & 2 stated that they have replied to the letter dated 22.06.2013 (The Complainant alleged to communicate on 22.06.2013). The claim of the Complainant is malicious, vexatious and incorrect and prayed for dismissal of the Complaint.
3. After perusal of the Complaint petition, version of the O.Ps and documents filed by the parties, the following issues are framed:

1. Whether the Complainant deliberately stopped making payment which caused termination of the policy No. 777601394?
2. Is there any deficiency on the part of the O.Ps in service?
3. What relief the Complainant is entitled to get?

ISSUE NO.1: Whether the Complainant deliberately stopped making payment which caused termination of the policy No. 777601394?

From application dated 27.04.2010 of the Complainant and reply dated 27.04.2010 of the Complainant and reply dated 30.04.2010 of the O.Ps it reveal that on the request of the Complaint policy no.777601089 changed to policy no. 777601394. It is admitted by both the parties that the Complainant has paid an amount of Rs. 75,000/- to-wards premium for the years 2010, 2011 and 2012.

The allegation of the O.Ps is that the Complainant failed to pay the premium of 2013 and for which the policy was terminated and an amount of Rs. 25,000/- has been refunded through cheque (which was refused by the Complainant). In the other hand the Complainant alleged that when he went to the office of O.Ps his policy had already been surrendered. A Complaint was lodged bearing No.11304248. Kishu Sharma was the Redressal officer, no any relief was granted by the Redressal officer.

From letter dated 18.06.2013 of the O.Ps it reveals that the O.Ps informed the Complainant about cancellation of the Policy and refund of Rs. 25,000/- through cheque.

From the policy Documents it is apparent that (Clause 14) the policy can be terminated

1. On the death of life insured
2. The date on which we receive your surrender request
3. On the maturity date
4. If the surrender value reaches an amount equal to first year ATP as per section 12
5. On the expiry of revival period as described in section 12 unless the cover continuance option is opted.

In the present case the O.Ps have not filed any surrender request of the Complainant or option opted. As per clause 13 of the policy if at all a policy is lapsed, the revival period is 36 months. The due date of premium for 2013 was May 2013, whereas the O.Ps issued letter dated 18.06.2013 about cancellation of the policy. The O.Ps have not followed due procedures of the policy clause no. 12.2, clause 13 or clause No. 14 by giving opportunity to receive the policy if any. On the other hand from Complaint dated 22.06.2013 it is very clear that the Complainant made a grievance to the Grievance Redressal Office, whereas the O.Ps are totally silent on the matter and not uttered a single word on the point. Accordingly the allegation of stopping payment by the Complainant is not acceptable.

The issue is answered against the O.Ps

ISSUE NO.2: Is there any deficiency on the part of the O.Ps in service?

From the foregoing issue it is established that before cancellation of the policy No. 777601394 of the Complainant, reasonable opportunity has not been given to the Complainant and for monetary gain automatically shown the policy surrendered, failed to file any surrender letter of the Complainant.

Accordingly, the O.Ps are deficient in their service. The O.P No.3 is an agent and part of the Insurance Company, who is equally liable.

ISSUE NO.3: What relief the Complainant is entitled to get?

For the deficiency in service of the O.Ps, the Complainant sustained financial loss, mental agony and harassment and ultimately dragged to litigation. Hence it is ordered:

The Complaint is allowed on contest against the O.Ps. The O.Ps are jointly and severally liable for the deficiency in service and directed to pay a sum of Rs. 75,000/- to the Complainant to-wards his premium deposit for non observance of procedures, a compensation of Rs. 40,000/- to be paid and litigation expenses of Rs. 5000/- within thirty days from the day of order. In case non-payment all the total amount will carry 9% interest P.A. w.e.f. 31.03.2010 till payment.

Order pronounced in open court on this 25^th April 2022.

Free copy of the Judgement be supplied to the parties.