Kerala

Idukki

CC/27/2021

Jomy George - Complainant(s)

Versus

ICICI Prudential Life Insurance Co Ltd - Opp.Party(s)

Adv:K M Sanu

01 Apr 2023

ORDER

DATE OF FILING : 4.2.2021

IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, IDUKKI

Dated this the   1^st   day of  April, 2023

Present :

SRI. C. SURESHKUMAR                   PRESIDENT

SMT. ASAMOL P.                             MEMBER

SRI. AMPADY K.S.                           MEMBER

CC NO.27/2021

Between

Complainant                                         :       Jomy George,

                                                                    Thekkekkara House,

                                                                   Kaliyar P.O.,

                                                                   Vannappuram.

         (By Adv: K.M. Sanu)

 And

Opposite Parties                                   : 1. The Manager,

                                                                   ICICI Prudential Life Insurance Co. Ltd.,

                                                                   Velloorkkunnam P.O.,

                                                                   Muvattupuzha.

      2.  ICICI Prudential Life Insurance Co. Ltd.

                                                                   Represented by its Branch Manager,

                                                                   Muvattupuzha Branch,

                                                                   Velloorkkunnam P.O.

 (Both by Advs: Saji Isaac &Lissy M.M.)

 

O R D E R

 

SRI. C. SURESHKUMAR, PRESIDENT

 

1. This case originates from a complaint filed under Section 35 of the Consumer Protection Act of 2019 (the Act, for short).  Complaint averments are briefly discussed here under :

 

Complainant resides at Vannappuram, within the local limits of this Commission.  1^st opposite party is manager of ICICI Prudential Life Insurance Co. Ltd., Muvattupuzha branch.  2^nd opposite party is the same manager in his capacity as representing the insurance company as such.  Complainant had applied for ICICI Prudential Health Saver Policy in 2009 as he was made to believe by the agent, namely, Theruvumkunnel Annie, that the policy had several advantages.  Complainant need to pay annual premium of Rs.15,000/- for 5 years continuously and there upon he will get medical coverage from the date of remittance of 1^st premium till 2050.  That it was a familyfor spouses and two children.  Each LA will have coverage for Rs.2 lakhs each for inpatient treatment.  Apart                                                                                                 (cont....2)

• 2  -

from that, expenses involved for purchasing medicines for outpatient treatment, expenses for dental ailments and for those not covered by policy, complainant will be entitled to take  requisite amount from Fund Value accumulated in the policy.  That minimum fund value to be maintained was Rs.16,500/-.  Whenever it falls below this limit, the complainant has to pay only the balance, instead of paying premium.  Upon enquiry, all those representations, assurances were confirmed from the 1^st opposite party branch.  Accordingly, on 5.11.2009, complainant had submitted a proposal form after paying Rs.15,000/- yearly, initially.  Complainant was issued a policy bearing No.12860996 and given health card for all members of family (which was 3 in total at that time) showing that the policy was live till 11.11.2050.  In 2011, 2^nd child was born.  This child was also included as LA without paying any additional premium, for remaining 4 years.  While so, in 2016, 3^rd child was born to him.  Hospital expenses amounting to Rs.22,000/- were recouped from  fund value as allowed by opposite parties.  At that time, fund value was more than Rs.75,000/-.  Thereafter complainant had gone to Thodupuzha Cathelic Syrian Bank in connection with some transactions.  Bank officials there, had attempted to canvass him for subscribing to the same policy, i.e., ICICI Prudential Health Saver, complainant had informed them that he is already holding the policy.  Bank officials had after verification, informed him that there is no such policy presently live in his name.  On 18.1.2021, complainant had gone to 1^st opposite party branch in person and made enquiries.  At that time, he was informed that, in 2017, fund value was only Rs.16,300/-.  Since balance of Rs.200/- was not remitted by complainant within 6 months of due date, policy has been foreclosed.  Subsequently, a letter dated 19.1.2021 was issued by opposite parties to him, informing about the foreclosure.

 

Complainant submits that opposite parties had never informed him that the fund value was low by Rs.200/-.  He was not informed that in case balance is not remitted, policy will be foreclosed.  When premium amount was demanded, complainant had paid it correctly.  Opposite parties were bound to inform the complainant in writing with regard to intended foreclosure or other contingencies as he had already paid premium for 5 years.  Opposite parties were deducing premium allocation charges, health insurance charges, policy administration charges from each annual premium and only Rs.12,000/- was being invested.  Upon deduction of charges, opposite parties were duty bound to inform the complainant with regard to remittances remaining.  Foreclosure without notice is only an attempt by opposite parties to avoid giving medical coverage as promised, after obtaining Rs.75,000/- as premium amount.  If they had informed complainant in 2017 that fund value was short by Rs.200/-, complainant would have paid the balance amount and retain the policy.  Shortage in fund value was deliberately concealed for 3 years with the only intention of cheating the complainant. Action of opposite parties amount to deficiency in service and unfair trade practice.  Complainant therefore prays for a direction against opposite parties to revive the policy after                                                                                                                          (cont....3)

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accepting Rs.200/- towards remaining fund value.  He also prays for return of Rs.75,000/-  with 18 % interest in alternate.  He seeks compensation of Rs.3 lakhs for deficiency in service and unfair trade practice from the side of opposite parties and litigation costs of Rs.10,000/-. 

 

2.  Complaint was admitted.Upon notice, both opposite parties have entered appearance and filed a detailed joint written version, which contains quotes from decisions of Hon’ble Supreme Court, National and various State Commissions.  We are avoiding reproduction of quotes here  for the sake of brevity.  Contentions raised are briefly reproduced hereunder :

 

Both opposite parties have taken a preliminary objection that foreclosure was on 18.5.2017 and therefore present complaint filed nearly 3.5 years after foreclosure is barred by limitation as per Section 69(1) of the Act.  In accordance with clause 6(2) and 4(1) of the Insurance Regulatory and Development Authority (Protection of Policyholders Interests) Regulations 2002, company had sent copy of proposal forms submitted by complainant, covering letter and policy documents on 13.11.2009 to complainant which were duly received by him.  Thereafter he had 15 days of free look period during which, if he is not satisfied with the applicable provisions of the policy, along with its terms and conditions, he was free to return the policy to the company.  In such circumstances, the company would have refunded the first premium amount, subject to certain deductions in accordance with Regulation 6(2) of the IRDA (Protection of Policyholders Interests) Regulations 2002.  However, complainant had not chosen to do so and had continued with the policy and paid premium for the next 4 years.  As policy was accepted, a legal binding contract had come into existence between  insurance company and complainant.  Both are strictly bound by its terms and conditions.  As per policy document clause 24.1, premium allocation charges are appropriated from the premium received.   As per Section 24.2, insurance charges are levied for hospitalisation insurance benefits. As per clause 24.3, policy administration charges are levied at the beginning of each policy month from the fund by cancelling units for the charge amount.As per section 24.4 fund management charges are levied as a percentage of the  value of assets and are appropriated by adjusting NAV (Net Asset Value). Atable is given in the written version with regard to percentage per annum  deductions.  Clause 24.5 of policy document allows deduction of miscellaneous charges which is a one time charge of Rs.250/-.  As per clause 26, if premium has been paid for 3 full policy years  since inception, notice will be given to policyholder,well before the total fund value reaches 110% of one full year’s premium.  Thereafter, if the fund value  falls below 110% of one full year’s premium, policy will be foreclosed. Fund value as on the foreclosure date is based on that days NAV, which can be claimed within next 5 years as health savings benefit, subject to a maximum limit of 50% of foreclosed fund value.  The maximum aggregate benefit that can be claimed over to 5 years is limited to the foreclosed fund value.                                                             (cont....4)

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As per clause 9, revival (re-instatement of lapsed policy) can be done on application for revival which is to be made within 2 years from the due date of the 1^st unpaid premium and before the covercessation date.  Revival will be based on the then applicable revival norms of the company.  Revival of the policy may be on terms different from those applicable to the lapsed policy.  In case of family floater cover, application for revival should be made for all insured persons. Nowaiting period will be applicable for any revival within 60 days from the due date of first unpaid premium.  Remaining sub-clauses of clause 9 are not germane for discussion here, hence we are not quoting those from written version.  It is also contended by opposite parties that the policy is a unit linked policy and therefore the complaint cannot be maintained before this Commission.  It is also pointed out that at the time of filling up of proposal form, the agent acts as the agent of the insured and no agent can be assumed to have authority from the insurer to promise anything beyond the terms and conditions of the subject policy.  In the present case, agent against whom complainant had raised allegations, though a necessary party, has not been impleaded in this case.

 

Opposite parties further submit that the so called Theruvumkunnel Annie is not an agent of the subject policy.  That the agent is one Ansamma Jose.  Besides, opposite parties are not privy to any communication between the agent and complainant.  An insurance agent is licensed by Insurance Regulatory and Development Authority of India and functions independently of any insurance company.  Primary function of an insurance agent is to service insurance needs of his customers and insurance agent categorically acts on behalf of a customer and not on behalf of insurance company.  Assurances which are allegedly given by agent which are not in accordance with terms and conditions of the subject policy are not binding upon the opposite parties.  No confirmation was given regarding the alleged promise or assurances given by agent from the opposite parties branch at Thodupuzha.  It is true that opposite parties had informed complainant of the fund value being above Rs.75,000/- during the initial 5 year period.  However, complainant has paid premium only for 5 years and defaulted in payment of subsequent premiums.  Opposite parties had paid hospital expenses of Rs.21,534.88/- to complainant on 11.6.2016 through NEFT.  At that time, fund value was Rs.50,799.30/- as on 31.12.2014.  Averment that it was more than Rs.75,000/- at the time of processing hospital expenses in 2016 are false.  Opposite parties admitted that the complainant had met them on 18.1.2021 and further that a foreclosure letter was issued dated 19.1.2021 to complainant by opposite parties.  Opposite parties had received premium under the policy till 11.11.2014 and due to levy of charges mentioned in clause 24 of the policy document, fund value of policy had dropped below 110% of one full years premium.  Hence policy was foreclosed on 18.5.2017 as per clause 26.  Complainant was duly informed that the policy was foreclosed and nothing is payable after foreclosure.  Complainant could have approached opposite parties for revival of his policy within a period of 2 years from the date of 1^st unpaid premium.  But he has not done so, for                                                                                                                              (cont....5)

• 5  -

reasons best known to him.  It is incorrect to say that complainant was not informed about the fall in fund value.  It is also incorrect to say that the complainant did not knew that the policy will be foreclosed when the funds fall below 110% of one full years premium and the revival period is two years from date when premium falls due.  Due to fall in fund value, policy was foreclosed on 18.5.2017.  Complainant has not paid premium for 5 years upon  requisitions or directions by opposite parties.  It is his legal duty to pay premium on due dates in accordance with policy conditions.  Due to non-payment of premium, policy had lapsed and opposite parties are not obliged to provide coverage upto 2050.  According to policy availed by complainant, premium of Rs.15,000/- was payable annually and the last date of premium payment was 11.11.2049.  In the 1^st policy year, i.e., in 2009, complainant has to pay 20% of annual premium of Rs.15,000/- towards premium allocation charges.  Thereafter he has to pay 9% each for successive 2 years and thereafter by 2% for the remaining 2 successive years for each year.  It is incorrect to say that Rs.12,000/- was invested each year out of  premium amount of Rs.15,000/-  for 5 years. Amountwas invested as mentioned above as deduction of premium allocation charges.  Complainant was duly informed about all the deductions made in accordance with terms of subject policy.  He had opted for SMS intimations, provided his contact number also, with regard to premium amount payable.  Timely SMS alerts were given to him for payment of premium on and after due date.  Complainant was well aware of the charges to be paid.  These charges are specified in the receipts also.  When fund value was not recouped, even after receipt of 5 SMS alerts, upon expiry of 6 months from the due date of policy, it had expired as such in 2017.  There is no deficiency in service from the side of opposite parties.  On 26.2.2015, complainant had approached opposite parties to change the name of his 2^nd child in policy documents.  His request was complied with upon submission of written request along with requisite documents.  He had again approached the company on 2.6.2016 for hospital expenses of 2^nd child.  As mentioned earlier, Rs.21,534.88/- was paid to him on 11.6.2016, on this count.   Complainant had approached opposite parties with a request to revive the policy only on 8.1.2021, which is after 3.5 years from the date of foreclosure of policy.  Reply was given without delay informing him that it cannot be complied with after revival period.  There was no unfair trade practice.  It is incorrect to say that opposite parties are trying to deprive the complainant of the benefits under the policy after obtaining Rs.75,000/- as premium from him. He was not cheated.  Opposite parties have worked in accordance with the Insurance Act provisions and IRDA guidelines. Complainant has pleaded that fund value should not go below Rs.16,500/-.This shows that he knew the value is to be maintained as such.  That apart, being a unit linked policy, case itself is not maintainable.  Complainant is not entitled for the reliefs prayed for.  Complaint is to be dismissed with costs. 

 

                                                                                                          (cont....6)

 

 

- 6  -

3.  After filing of written version, case was posted for steps and then for evidence.  On the side of complainant, he himself was examined as PW1 and Exts.P1 to P3 were marked.  No oral evidence was tendered from the side of opposite parties.  10 documents produced by them were marked as Ext.R1 to R10. 

 

Ext.P1 is a paper print out of the 3 photos of health cards in the names of complainant, his spouse and eldest child.  Ext.P2 is copy of letter of foreclosure dated 19.1.2021, copy of which was again marked as Ext.R8.  Ext.P3 is a letter dated 3.3.2010 issued by opposite parties to complainant with regard to incorporation of corrected date of birth of complainant as requested by him and issuance of revised policy certificate. 

 

Ext.R1 is the copy of proposal form signed by complainant.  Ext.R2 is policy document.  Ext.R3 is copy of request by complainant for change of his date of birth, dated 23.2.2010.  Ext.R4 is adding of Joseph Jomy, child of complainant, dated 13.1.2012 as LA upon request by complainant dated 5.11.2009.  Ext.R5 is personal health declaration form and related papers with regard to incorporation of Joseph Jomy as LA, which were submitted on 10.12.2011.  Ext.R6 is request for change in name of LA Milan J. Thekkekara, child of complainant, dated 26.2.2015.  Ext.R7 is medical benefit claim form of Jomy George, dated 2.6.2016 for LA Somy Jomy.  Ext.R8 is copy of Ext.P2.  Ext.R9 is unit statement from 11.11.2009 to 24.2.2021.  Fund value is shown as ‘0’ as on 24.2.2021.  Ext.R10 is a letter with regard to servicing of Ext.R6 request sought by complainant.  Both sides were heard.  Opposite parties have filed argument notes which are quite similar to the written version filed by them earlier.  We have heard the learned counsel for complainant in reply also.  Now the points which arise for consideration are :

1)  Whether complaint is barred by limitation ?

2)  Whether there was any deficiency in service or unfair trade practice from the side of opposite parties ?

3)  Whether there is lack of inherent jurisdiction to entertain this case ?

4)  Whether complainant is entitled for the reliefs claimed ?

5)  Final order and costs ?

 

4.  Point Nos.1 to 4 are considered together :

 

          According to complainant, he was not informed in writing with regard to intended foreclosure of policy, on account of not remitting a mere amount of Rs.200/-, so as to bring the fund value for the year 2014 to the required minimum of Rs.16,500/-.  Admittedly, Rs.15,000/- is the yearly premium.  Fund value for an year is 110% of premium amount which is Rs.16,500/-. 

 

                                                                                                                   (cont....7)

 

• 7  -

          Complainant would contend that as he had paid Rs.75,000/- as premium for 5 years, that the policy is  live till 2050 in the light of representations made by the insurance agent which  were later confirmed by the branch also .

 

          Opposite parties had contended in their notes that insurance company cannot be made liable for any irresponsible statements  or representations of agents which are not in accordance with terms and conditions of the policy.  Agent is appointed as per the provisions of Insurance Act and IRDA Regulations.  Individual agents act in their own  capacity and therefore company cannot be made liable for such acts.  To buttress these contentions, opposite parties have referred to a decision of National Commission in the matter of Prema and other Vs. Life Insurance Corporation of India [IV (2006) CPJ 293 (NC)].  Though a copy of same was not made available, we have searched and found the decision uploaded in the net.  That was a case where claim for compensation with regard to death of husband of complainant was repudiated by LIC on the ground that insured deceased had suppressed material facts of his previous ailments. District Forum had allowed the complaint.  Both parties went in appeal, the complainant alleging inadequacy and company claiming dismissal of claim.Both appeals were decided by a common order whereby complaint was dismissed.  Matter thereafter came up before  the National Commission which had upheld the order of State Commission observing that contract of insurance is uberrimaefidei and therefore if any party fails to observe his utmost good faith, contract can be avoided by  others.  This decision does not consider the question regarding extent of liability of insurance company for the acts done by the agent.  Further that, the appointment of any individual agent is in accordance with the provisions of Insurance Act and IRDA Regulations, nevertheless insurance agent is an agent of the insurer and hence we cannot accept the contentions that the agent does not act in the interests of insurance company while canvassing for the policy. 

 

However, in the present case, though pleadings are addressed by complainant that he was made to believe that benefits of the policy which would be live till 2050 upon payment of mere 5 years premium as expounded by the agent, Theruvamkunnel Annie, said Annie is not made a party to the complaint.  Opposite parties have taken a contention that there is no such agent and that as per the policy proposal from , which is Ext.R1, agent is one Ansamma Jose.  Though it is further contended that branch had confirmed the representations made by agent, no specific name or designation of the official of the company who had purportedly confirmed the representation is   mentioned in the complaint. Agent who made misrepresentations and official who confirmed those assurances were not made parties to this proceeding, though necessary parties. Therefore contentions that complainant had acted upon representation made by agent which were later confirmed from the side of company are only to be eschewed from consideration.

 

                                                                                                                    (cont....8)

 

• 8  -

2^nd contention with regard to maintainability raised by opposite parties is that the complaint itself is barred as per Section 69(1) of the Act.  Repudiation took place in the year 2017.  This is borne out from Exts.P2 and R8.  Complainant admittedly sought  revival of policy only in 2021.  He claimed to have approached the company only on 18.1.2021 whereas as per Ext.P2, policy was foreclosed on 18.5.2017.  Gap is more than of 2 years and without condoning the delay, complaint cannot be entertained.  Whereas complainant contends that Insurance company had a bounden duty to inform in writing about the intended foreclosure giving him sufficient time to recoup the fund value.  He claimed that no intimation with regard to due date of premium or short fall in the fund value which had lead to the foreclosure was intimated to him by the company. He had written information of foreclosure only on 19/01/2021 and hence time will run only from that date. Complaint filed 04/02/2021 is well within the period of limitation.

 

          In this regard, opposite parties have contended in their written version that, as per Ext.R1, complainant had chosen for receiving alerts through SMS in his contact number, which is given in the proposal form itself.  They would further submit that in fact 5 alerts were given with regard to shortage in fund value.  Paragraph 26 of the written version contains transcription of 5 alerts sent to the mobile phone number of complainant given in the proposal form.   These are with regard to premium due on 11.11.2014.  Alerts are seen issued on 11^th, 16^th and 26^th of same month and thereafter twice on 6.12.2014.  Due to non-payment of premium which had resulted in non-allocation of requisite fund value available, policy was foreclosed.  We see from the contentions taken by complainant in his complaint that he was aware that minimum fund value of Rs.16500/- which is 110% of one year’s premium is to be maintained.  Ext.R1 discloses that policy is unit linked and this admitted by complainant also during his cross examination.  We will consider the question of jurisdiction arising in this regard, in later paragraphs of this order. 

 

Reverting to the question at hand, as per the terms and conditions contained in Ext.R2 policy document, non-payment of premium will certainly, after the lapse of grace period, result in lapse of policy.  Relevant clauses are extracted in the written version which is clause 9 and 26 in Ext.R2.  The fact that the premium was due as on 11.11.2014, was informed to complainant as per SMS alerts upon his contact number.  The date, time in hours, minutes and seconds of each SMS alert is also given in the written version. Complainant has not specifically denied receipt of SMS alerts in his proof affidavit.Policy document,copy of proposal along with covering letter are to be issued to complainant upon acceptance of his proposal.  Complainant does not have a case that the original policy document was not issued to him in fact he has been admitted of having received the policy. He has not chosen to return the policy within free look in period, accepted it and paid premium for 5 years. Hence it is to be concluded that the complainant had opted for a coverage as per the terms of policy which has come into                                                                                                                 (cont...9)

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force.  That being so, he is bound by these terms and will have to act in accordance with such terms.  The terms of foreclosure contained in it were intended to be gone through by him and are binding upon him also.  He cannot shirk his responsibility by stating that he had blindly believed the insurance agent or on oral confirmation from unknown sources within the company. 

 

          As mentioned earlier, complainant was intimated with regard to the premium due for the year 2014, due date being 11.11.2014.  He has not acted upon the alerts.  If he had made timely remittances, he could have saved the policy from being foreclosed.  If he had opted for SMS alerts, he cannot claim that he is entitled for any intimation in writing with regard to foreclosure of the policy due to non-payment of premium.  It is the duty of complainant as a policyholder to ascertain and see that the premium for each year is being paid regularly.  The policy documents itself shows that the payment of premium is to be paid annuallyand the last premium date is 11.11.2049.

 

          This being a unit linked policy, complainant has to pay only the difference if any if the fund value in an year falls below 110% of the premium to be paid annually (15000 x 110% = 16500).  As far as 2014 was considered, fund value of the policy was Rs.16300/-.  Complaint submits that the difference was only Rs.200/- and if he had known, he would have recouped the shortage. These lementations are of no use as he was alerted by SMS with regard to due date of premium and the amount to be paid as premium.  There is no provision for any written intimation as claimed by complainant.  His contentions that the policy will be live till 2050 upon payment of 5 annual premium beginning from 2009 are against the policy document.  As rightly contended by opposite parties, complainant and the company are bound by the terms and conditions of the contract which is reflected from Ext.R2.  Decisions are also quoted in this regard which we do not think should be again reproduced in this order for the sake of brevity.  It is a well settled preposition.  We have already discussed the question of foreclosure and needless to say clauses relating to foreclosure contained in the policy documents are binding on the complainant.  Coming to the question of limitation, it is not date of foreclosure, but non intimation and subsequent belated information of foreclosure which the complainant claims, gives him cause of action. Deficiency in service is alleged on the premises that there was no written intimation with regard to intended foreclosure.  We have already found that there is no provision enabling the complainant or rather entitling him for a written intimation as such.  According to complainant, he had come to know that the policy had lapsed only on 18.1.20201, regarding which he got Ext.P2 on the next day.  Therefore, cause of action will accrue from that date and hence complaint is saved as such from limitation.  On the other hand, we find that he had received SMS alerts on 11.11.2014, 16.11.2014, 26.11.2014 and 6.12.2014 with regard to non-payment of premium amount which was due on 11.11.2014.  After 2 years period, there was foreclosure of policy in accordance with terms and conditions.  This                                                                                                                 (cont...10)

• 10  -

was in 2017.  To be exact on 18.5.2017.  After having received alerts regarding premium due repeatedly, he cannot claim that he was not aware of premium due to be paid. There is no obligation upon opposite parties to give him written intimation again with regard to non payment of premium.  It is his duty to alertly pay premium within time as per policy conditions and to avoid foreclosure or other consequences. It is to be presumed that he was aware of foreclosure clauses in R2 which he had receipt upon issuance of policy. Due to non payment of premium as there was no sufficient fund value, policy was foreclosed on 18/05/2017. Complaint ought to have been filed on before 17.5.2019.  It is seen filed only on 4.2.2021, well after 2 years period mentioned in Section 69(1) of the Act.  There is no application to condone delay.  Hence complaint is time barred.

 

          Next contention is with regard to lack of inherent jurisdiction.  According to opposite parties, policy is unit linked and therefore not maintainable before this Commission.  Several decisions of State Commission and that of National Commission are quoted of which decision of National Commission in the matter of Ram Lal Aggarwalla Vs. Bajaj Alliance Life Insurance Company [III 2013 CPJ 203 (NC)] is more specific and illustrative..  As rightly pointed out by opposite parties, subscribing for the policy amounts to investments made under unit linked policy, which is speculative and hence is to be considered as  a commercial purpose, as held in the decision mentioned above.   Hence the matter does not come under purview of the Act.  Complainant does not have a case that he was unable to go through the policy document and understand its contents.  Admittedly, he is a graduate and capable of reading and understanding the policy document.  The document is not in small print so as to make it unreadable by naked eye.  Hence we are of the view that the complainant having understood the terms and conditions of the policy, knowing fully well that it was a unit linked one,  had proposed to subscribe for the policy and had paid premium amount.  These being the facts, decision of National Commission will be applicable here and therefore, we are of the view that this Commission does not have inherent jurisdiction to try this case. 

 

          Three instances are subsequently referred to by opposite parties whereby complainant had sought for a change of his date of birth incorporated in the policy document,inclusion of 2^nd child to the benefits of the policyand also for medical expenses in relation to delivery of his last child.  All the 3 requests were serviced by opposite parties as is evidenced from Exts.R3 to R7.  Contentions that there was default in service or unfair trade practice owing to failure to give intimation in writing with regard to intended foreclosure are not at all tenable or supported by policy conditions.  As requested by complainant, he was given SMS alerts with regard to premium due.  Under this circumstances, we are of the view that opposite parties have not defaulted in service or are guilty of unfair trade practice.  That being so, we find that complainant is not entitled for the reliefs prayed for in the complaint.  Point Nos.1 to 4 are answered accordingly.                                                                                                     (cont....11)

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5.  Point No.5 :

 

          In the result, this complaint is dismissed, under the circumstances, without costs.  Parties shall take back extra copies, without delay. 

 

                             Pronounced by this Commission on this the    1^st   day of April, 2023

                                     

                                                                                                Sd/-

SRI. C. SURESHKUMAR, PRESIDENT

                             Sd/-

 SMT. ASAMOL P., MEMBER

                   Sd/-

SRI. AMPADY K.S., MEMBER

 

APPENDIX

Depositions :

On the side of the Complainant :

PW1        - Jomy George.

On the side of the Opposite Party :

Nil.

Exhibits :

On the side of the Complainant :

Ext.P1    -  Paper print out of the 3 photos of health cards.

Ext.P2    - Copy of letter of foreclosure dated 19.1.2021.     

Ext.P3    -  Letter dated 3.3.2010 issued by opposite parties to complainant.

On the side of the Opposite Party :

Ext.R1    -  Copy of proposal form signed by complainant. 

Ext.R2   -  Policy document. 

Ext.R3   -  Copy of request by complainant for change of his date of birth

Ext.R4   -  Letter showing adding of Joseph Jomy dated 13.1.2012 as LA.

Ext.R5   -  Personal health declaration form and related papers with regard to

       incorporation of Joseph Jomy as LA. 

Ext.R6   -  Request for change in name of LA Milan J. Thekkekara, dated 26.2.2015.

Ext.R7   -  Medical benefit claim form of Jomy George, dated 2.6.2016 for LA

        Somy Jomy.  

Ext.R8   -  Copy of Ext.P2. 

Ext.R9   -  Unit statement from 11.11.2009 to 24.2.2021.  

Ext.R10 -  Letter with regard to servicing of Ext.R6 request sought by complainant. 

 

                                                                                      Forwarded by Order,

 

 

                                                                                   ASSISTANT REGISTRAR