The complainant is the holder of a Reliance Life Insurance money Multiplier Plan with new critical condition (25) Rider Policy bearing no 50657316 for sum assured Rs. 4,12,427/- ( Four lakh twelve thousand four hundred twenty seven). He paid first two installments of premium for the policy but could not pay the third installment of premium because of his financial stringencies (vide annexure- 1,2 & 3). Meanwhile he received a telephone call from OP no 3 through cell phone no- 8017464880 and after some conversation she requested the complainant to pay the third installment of premium by two installments & accordingly sent a representative namely Mr. B. Ghose who collected Rs. 20,000/- (Twenty thousand) in cash issuing a receipt (vide annexure- 4). Thereafter the complainant tried to collect the balance amount for third premium. But in the meantime to his utter surprise received a new life insurance policy in his name from ‘Future Generali India Life Insurance Company Ltd.’, of which the premium was Rs. 20,000/- (Twenty thousand).
Contact being made with OP no-3 it could be ascertained that said policy has been issued inadvertently. The complainant was asked to send back the policy with an assurance of getting refund of said Rs. 20,000/- (Twenty thousand) in due course.
The complainant sent back the policy. He denied to pay the entire amount of third installment of premium for his existing policy & asked for adjustment of said Rs. 20,000/- (Twenty thousand).
Till date said Rs. 20,000/- (Twenty thousand) has not been adjusted with the amount for third installment of the premium for his existing policy though assured by OP no 3.
The complainant submits that he wants to continue his existing policy by paying the balance amount of the third premium with an adjustment of Rs. 20,000/- (Twenty thousand) that he paid to the representative send by OP no-3. Alleging adoption of unfair trade practice & fraud by the OPs the present complaint has been filed praying for relieves mentioned in the complaint itself.
Having denied all the material allegations and contention of the complainant and denying that OP no 3 is their employee and that Mr. B. Ghose has any connection with them the OP no 1 & 2 have contested by filling a written version contending inter alia that the complainant has cooked up the present story of OP no 3 only with the sole motive to regularized his existing policy which has lapsed by this time for third premium being not paid. The OP no 3 being not their employee, any amount paid to her through her representative Mr. B. Ghose has no concerned with part payment of premium for the policy in question. Pleading that there is no cause of action and that petition of complaint is not maintainable, prayer for dismissal of the same has been made.
Only point for consideration is whether the complainant is entitled to the relieves prayed for or to what other relief he is entitled?
Decision with reasons
Admittedly the complainant is the holder of a ‘Reliance Life Insurance money Multiplier Plan with new critical condition (25) Rider Policy’ issued by OP no 1 & 2 which commenced on and from 7th January 2013. Premium is to be paid annually. The complainant has paid premium for two years. Third installment was due on 7th January 2015. Statedly the complainant because of his financial stringency could not pay the same. In the meantime OP no 3, who has been described to be an employee of OP no 1 & 2, through cell ph bearing no-8017464880 contacted the complainant and in course of conversation convinced the complainant to make part payment of third installment of premium by making payment of Rs. 20,000/- in case to a person namely Mr. B. Ghose to be sent to the complainant by said OP no 3. According to the complainant he paid Rs. 20,000/- in case to said Mr. B. Ghose who issued a receipt vide annexure 4.
It is further stated by the complainant that to his utter surprise he found that instead of crediting said Rs. 20,000/- as part payment of third premium of his existing policy, a policy from ‘Future Generali India Life Insurance Company Ltd.’ was sent to him, premium of which was also Rs. 20,000/-. Contact being made with OP 3 the complainant was asked to sent back the policy which was told to have been sent inadvertently, with an assurance to adjust said Rs. 20,000/- as part payment of third premium for his existing policy issued by OP 1 & 2 undisputedly said adjustment has not been made.
Basic defence is that the OP no 3 is neither an employee nor an agent of OP no 1 & 2. So any act or omission done or assurance given by her is not binding upon OP no 1 & 2. The complainant described the OP no 3 as an employee of OP no 1 & 2 which has been flatly denied by OP no 1 & 2. What appears on record is statement versus statement on oath. There is no further document or evidence to resolve this counter claims. To resolve the dispute, detail evidence is required which is time consuming and is beyond the scope of the beneficial legislation provided in the C P Act, 1986. Leaving this issue to be decided in some subsequent attempt let us now concentrate our aim to find what relief the complainant is entitled at present. This observation is made specially because prima-facie the complainant appears to have not only been misguided and misled but also fraud has been practiced upon him by said OP no 3 either in the capacity of an employee of OP no 1 & 2 or in her personal capacity for which she may be proceeded against which is not the task of this forum in the present proceeding.
The moot prayer of the complainant is revival of his existing policy on payment of third premium with an adjustment of Rs. 20,000/- which he claims to have paid to said Op no 3. Since the payment of Rs. 20,000/- to OP no 3 through her stated agent, if at all made, appears to be unauthorized payment, that amount can not be taken as part payment of third premium of his existing policy until and unless it is proved that said OP 3 received the money as an agent and or employee of OP no 1 & 2 so as to bind OP no 1 & 2 accordingly.
It has been argued with reference to different citations that:-
- The Complainant is not entitled to any relief because of the binding force of the terms and condition of the policy which is an outcome of a contract and it is not for the court to make a new contract by imposing or deleting certain terms however reasonable it may be, if the parties have not made it themselves.
- The terms of contract have to be construed strictly without altering the nature of contracting as it may affect the interest of the parties adversely.
We have given our anxious thought and consideration over the entire fact and circumstances in the case. We have no reason to believe that the complainant who has secured a policy by making payment of two annual premia will not make payment of third premium unless he was under extreme financial crises specially when it was not unknown to him that the policy may laps provided third premium is not paid. We are also convinced that the complainant was mislead by OP no 3 and paid Rs. 20,000/- to her representative on a receipt (annexure 4 ) which on simple comparison with annexure 2 & 3 appears to be fake for which we are provided with no evidence to hold the complainant responsible. But unless said Rs. 20,000/- is credited in favour of the complainant as part payment of third premium he can not be favoured with an order for adjustment of said amount against payable amount of third premium.
The complainant has prayed for revival of his policy since admittedly lapsed. We find from clause 12 of policy conditions and privileges that “ Policy holder may revive lapsed or paid up policy during the revival period by paying the areas of premiums along with interest at the prevailing rate of interest. If the basic plan is revived, rider benefits can be revived by paying the areas of premiums under the riders with interest at prevailing rate of interest. The revival of the policy and riders, if any, will be subject to satisfactory medical and financial underwriting. The revival period is a period of two years from the due date of first unpaid regular premium or date of maturity of the basic policy which ever is earlier. The current rate of interest is 9 % p.a.
The first unpaid regular premium is that which fell due on 7th January 2015. Regard being had to the date of filling of the case or at best the date of delivery of this judgment we find that the complainant has enough time to revive his policy by making payment of due amount of premium with current rate of interest for the defaulting period. There is also provision of paying premium installment.
We are convinced to hold that by allowing the complainant to revive his policy no new term of contract is added or no new existing term of contract is deleted. By allowing the complainant to do so there is nothing which will pre judicially and adversely affect the interest of OP no 1 & 2.
Obviously the complainant after getting a new policy, which he never intended to have, should have rushed to the office of OP no 1 & 2 for his personal verification and satisfaction as to why such a new policy was issued to him on his payment of Rs. 20,000/- to the agent of OP no 3 which he actually paid as part payment of third annual premium of his existing policy. He does not appear to have done so which a man of ordinary prudence should have done. On the other hand he has filed this case without taking the issue with OP no 1 & 2. In this perspective we are constrained to opine that he is not entitled to any compensation and litigation cost.
Therefore, having regard to the entire facts and circumstances of the case we are of the clear view that an innocent consumer has a right to protect his interest and the forum acting under the spirit and object of C P Act, 1986 must come to the aid of such kind of consumers who has been misguided, mislead and tempted to pay in cash a some of Rs. 20,000/- believing it to be a part payment of his third annual premium for his existing policy specially when such kind of misguidance was extended by a person described to be an employee of OP no 1 & 2(subject to verification and confirmation in a separate and appropriate legal proceeding by the complainant if so advised. )
In view of the findings above the petition of compliant is liable to be allowed to the extent as mentioned in the body of the judgment.
Hence,
ORDERED
that the petition of complaint be and the same is allowed on contest against OP no 1 & 2 and ex-parte against OP no 3 but without any cost.
OP no 1 & 2 is directed to accept the due amount of third annual premium together with interest at the existing rate of interest from the complainant for his existing policy in two equal installments, first of which has to be paid within a month from the date of this order and the second installment within a month there after, if so paid to the office of OP 1 & 2 by account payee cheque.
This order shall become executable provided the complainant acts strictly in terms of this order but the OP 1 & 2 declines to carry out the same.
Let a copy of this judgement be supplied to the parties free of charge.
