PER SHRI. S.S. PATIL – HON’BLE MEMBER
1) This is the complaint regarding deficiency in service on the part of Opposite Party as it did not reinstate the lapsed polices of the Complainant.
2) The facts of the complaint as stated by the Complainant are that the Complainant had obtained 19 Life Insurance Policies under Plan 110. These policies covered the life and three major diseases.
The sum insured in each policy was Rs.1 Lac. The numbers of these policies are as follows
Sr. No. |
Policy No. |
1 |
910231695 |
2 |
900252052 |
3 |
900252051 |
4 |
900252050 |
5 |
900252049 |
6 |
900252048 |
7 |
910231708 |
8 |
910231705 |
9 |
910231704 |
10 |
910231703 |
11 |
910231702 |
12 |
910231701 |
13 |
910231700 |
14 |
910231699 |
15 |
910231698 |
16 |
910231697 |
17 |
900278186 |
18 |
900278187 |
19 |
900278188 |
All the above polices were obtained by the Complainant in the year 1986. He was paying the premium regularly. But the accounts of the Complainant were frozen by Sales Tax and Income Tax and D.R.T. in the year 1999-2000. Therefore, the Complainant could not pay the premium. The Complainant has stated that the Policy No.900278186 lapsed in May, 2003. Policy No.900278187 & 900278189 lapsed in November, 2002.
3) Complainant further alleged that he approached the Opposite Party and complied with all the requirements for the revival of these polices. (Complainant has not mentioned what were the compliance for the revival of the policies & when he approached the Opposite Party ?). Then the Opposite Party vide its letter dtd.10/09/04 confirmed that the Complainant had submitted necessary form and medical papers. Opposite Party again issued another letter dtd.11/10/04 for submission of another form. The Complainant accordingly submitted another form also. But the Opposite Party did not revive the policies.
4) Again by letter dtd.17/08/06, Opposite Party asked the Complainant to submit medical reports and ultimately the Opposite Party by its letter dtd.24/08/06 rejected the medical reports on the ground that the medical reports are of 2004. The Complainant again submitted fresh medical reports in 2006 and then finally, the Opposite Party vide its letter dtd.14/09/06 informed the Complainant that it will not revive the policies at Sr.No.17 to 19 (900278186 to 900278188) without giving any reason stating that “Revival under Policy No.900278186 to 900278188 under Plan 110 has been regretted.”
5) Further it was stated by the Complainant that he had taken loan on the policies at Sr.17 to 19. But the Opposite Party, without reviving the policies, demanded the loan (letter dtd.17/08/06). Again the Opposite Party vide its letter dtd.04/10/06& 24/01/07, rejected the revival of the above said policies. The Complainant through his advocate, vide letter dtd.23/04/07 asked the Opposite Party to revive the policies. The Opposite Party vide its letter dtd.15/05/07 mentioned that, revival of a policy or a discontinuation is the right of the corporation. All policies at Sr.No.1 to 16 were revived by the Opposite Party on submission of documents and extra premium but policies at Sr.No.17 to 19 were not revived inspite of submission of documents.
6) It is the contention of the Complainant that as the Opposite Party revived the policies at Sr.1 to 16. it can also revive the policies at Sr.17 to 19 by demanding more premium which the Complainant is ready to pay. By reviving some policies and not reviving certain policies, Opposite Party can not make any discrimination which is against principals of natural justice. The Complainant has stated that, due to non revival of the said policies, he has sustained the physical and monitory loss. He has to spend Rs.20,000/- for obtaining medical report twice. The Complainant has further submitted that he is entitled for renewal of the said policies. He has prayed that a compensation of Rs.20,000/- for the loss sustained by him be granted to him by the Opposite Party due to deficiency in service on the part of Opposite Party. Therefore, the Opposite Party be directed to revive the Policies No.900278186 to 900278188 with extra premium. Opposite Party also be directed to pay a compensation of Rs.20,000/- for loss and injuries sustained by the Complainant at the time of obtaining medical reports.
7) Complainant has attached the xerox copies of the following documents alongwith the complaint.
a) Letter from Opposite Party, dtd.10/09/04.
b) Letter from Opposite Party, dtd.11/10/04.
c) Letter from Opposite Party, dtd.17/08/06.
d) Letter from Opposite Party, dtd.24/08/06.
e) Letter from Opposite Party, dtd.14/09/06.
f) Letter from Opposite Party, dtd.04/10/06.
g) Letter from Opposite Party, dtd.24/01/07.
h) Medical report of the Complainant.
i) Letter from Complainant’s advocate, dtd.23/04/07.
j) Reply from Opposite Party, dtd.15/05/07.
k) Letter from the Complainant, dtd.12/07/07.
8) The complaint was admitted and notice was served on the Opposite Party. Opposite Party filed the written statement wherein, it was submitted that revival of policies no.900278186 to 900278188 was regretted in the year 2004 by the Opposite Party vide its letter dtd.15/05/07. It is further stated by the Opposite Party that Revival is a fresh contract. Insurer is not bound to revive every policy. It is open to decline. Accordingly revival was regretted and the Complainant was informed vide letter dtd.09/09/06 and 24/01/07.
9) It is further submitted by the Opposite Party that the above 3 policies are issued under Plan No.110 i.e. ‘Ashadeep’ Policy. It is a high risk plan.
10) As per policy conditions and privileges which form the part of printed policy document, the Opposite Party reserves the right to accept or decline. The relevant policy clause 2 & 3 are printed at the back of policy document. The Opposite Party has finally averred that there is no deficiency in service on its part and the complaint be dismissed with exemplary cost.
11) The Opposite Party has attached the xerox copies of the following documents –
a)Letter from Opposite Party dtd.15/05/07.
b)One blurred copy which cannot be read.
c)Letter from Opposite Party to Complainant dtd.24/08/06, 24/01/07, 09/09/06, 04/01/07.
d)Letter from the Complainant to Opposite Party, dtd.12/07/07.
e)Letter from Opposite Party to the Complainant, dtd.03/08/07.
f)Policy document Policy No.900278186, 900278187, 900278188 valid from 20/11/1993 to 20/11/2013.
12) The Complainant then filed the affidavit of evidences and written argument wherein he reiterated the facts mentioned in the complaint. Opposite Party also filed its written argument wherein it reiterated the facts and points raised by it in its written statement.
13) We heard the Ld.Advocate for the Complainant and the Ld. Legal Manager for the Opposite Party. We also perused the documents submitted by both the parties and our findings are as follows –
The Complainant had obtained 19 insurance policies from the Opposite Party. These policies covered the life and 3 major diseases. However, the Complainant has failed to produce the policy documents and terms and conditions of these policies. It can be said that the Complainant tried to avoid to bring these policy documents before this Forum. Copies of these document policies were produced by the Opposite Party. It was also averred by the Complainant in the complaint that these polices were obtained in the year 1986. But when we carefully scrutinized the disputed polices i.e. policy bearing no.900278186 to 900278188 these policies were valid form 20/11/1993 to 20/11/2013. Therefore, it is the fact that these policies were obtained since 1993 and not from 1986 as averred by the Complainant.
14) It is also the contention of the Complainant that due to the freezing of his accounts by Sales Tax Dept. etc., he could not pay the premium of the policies and hence, the policies lapsed. It is the fact that the policies lapsed due to non payment of the premium. In November, 2002 and in May, 2003 the policies lapsed.
15) The Complainant has submitted that he approached Opposite Party for revival of the policies but he has not mentioned the date and month when he approached the Opposite Party for revival. Therefore, we have to see the letter of Opposite Party dd.10/09/04. In this letter there is a reference regarding the ECG report indicating that the Opposite Party required ECG. Letter dtd.11/10/04 does not refer the disputed policies.
16) This indicates that the Complainant has tried and requested the Opposite Party to revive the policies before September, 2004. But after considering the reports of the Complainant the Opposite Party vide its letter dtd.14/09/06 informed the Complainant that revival of policy no.900278186 to 900278188 under plan has been regretted. In other words the Opposite Party did not revive the said disputed policies. It is the contention of the Opposite Party that revival is a fresh contract and insurer is not bound to revive every policy. It is open to the insurer to decline. The policies which were not revived were issued under plan 110 which is a high risk plan. It is also vehemently stated that, the decision was taken as per the terms and conditions of the policy. Therefore, we perused the clause 3 of the policy document which states as follows -
“Clause 3 – Revival of discontinued policy – “If the policy has lapsed, it may be revived, during the life time of life assured, but within a period of 5 year from the date of the 1st unpaid premium and before the date of maturity, on submission of proof of continued insurability to the satisfaction of the corporation and the payment of all the arrears of the premium together with interest at such rate as may be fixed by the corporation from time to time compounding half yearly. The Corporation reserves the right to accept or decline the revival of discontinued policy. The revival of the discontinued policy shall take effect only after the same is approved by the corporation and is specially communicated to the life assured.”
From the above clause it is clear that, the revival is subject to the submission of proof of continued insurability to the satisfaction of the insurer. From the Opposite Party’s point of view insurability is important. The revival of a lapsed policy is subject to the satisfaction of the insurer. It appears that, though the Complainant has submitted various medical reports, the Opposite Party was not satisfied so far as the insurability is concerned. It is again very clearly stipulated in the same condition that the Opposite Party reserves the right to accept or decline the revival of the discontinued policy.
In the instant case the Opposite Party asked the Complainant to submit some medical reports to evaluate the insurability of the lapsed policies. The disputed policies under plan 110 were of high risk according to the Opposite Party and hence, it decline to revive the same. Therefore, taking into consideration, the provision of this clause 3 of the policy, refusing to revive the discontinued policy shall not amount to any deficiency in service on the part of Opposite Party.
At the same time we find, it necessary, just and proper to direct that the Opposite Party should inform the insured the ground of declining the revival of the lapsed policy. Therefore, we pass the following order –
O R D E R
i)Complaint No.288/2007 is hereby dismissed for want of merits.
ii)No order as to cost.
iii)Copy of this order be furnished to both the parties.
