In the District Consumer Disputes Redressal Forum, Murshidabad
Berhampore, Murshidabad.
Case No. CC/89 /2014
Date of filing: 04/07/2014 Date of Final Order:18/11/2015
71/2, Alep Khan Mahalla Road,
Gorabazar, P.O.&P.S.- Berhampore,
Dist- Murshidabad, PIN-742101.……………………………...Complainant
- Vs-
Manager,Bajaj Allianz Life Insurance Company Ltd.
37/A, R.N.Tagore Road, Berhampore.
H.O.-Laldighi,Dist.- Murshidabad. PIN-742101. …………......................Opposite Party
Mr.SiddharthaSankarDhar, Ld. Advocate……………………………….for the Complainant.
Mr.NilabjaDatta, Ld. Advocate..............………………………………….for the Opposite Party.
Present: Hon’ble President,Anupam Bhattacharyya.
Hon’ble Member, Samaresh Kumar Mitra.
Hon’ble Member, Pranati Ali.
FINAL ORDER
Samaresh KumarMitra,Member.
This complaint has been filed by the complainant u/s- 12 of C.P. Act, 1986 praying for an order directing the OP to pay a sum of Rs.87,748/- (Principal Amount Rs.50,000/- + Interest on Invested Capital @ 9.75% p.a + Litigation Costs Rs.10,000/- + Compensation for harassment Rs.20,000/-).
The case of the complainant, in brief, is that she purchased New Unit Gain Easy Pension Policy No.0076023064 (5 Year Term) from Bajaj Allianz Life Insurance Company Ltd on 26.11.2007 and contributed Rs.50,000/-(@ Rs.10,000/- p.a.) . She was told that he could withdraw the maturity value at the end of 5 years Term. The Development Officer also assured him that a large part of his investment would be kept in Bond and the rest of Equity. The complainant was never informed either verbally or in writing aboutthe fund value and the nature of investment. Surprisingly he was not given any option to withdraw the maturity value at the end of the Policy term and he was left with no choice other than buying a “Pension Guarantee Annuity” type 5G policy at a letter dated 14.05.2013. Immediately, after receiving the Policy Document (which granted a free look period of 15 days), the complainant let the Insurer know his complete disapproval with the term and conditions of the policy and requested to return the money they held back after returning one third of the maturity value of Rs.53,913/-. The complainant’s request was turned down and the Insurer in its letter dated 30.5.13 stated that the complainant opted for “Pension Guarantee R.O.C”.
The return on capital or R.O.C that the complainant has invested for the stipulated period of 5 years has to be calculated on the basis of the then prevailing rate of interest which stood at 9.75 % for senior citizens. But the Insurer will not pay even half of the purchase price to complainant’s nominee of the complainant die even at the end of the guarantee period.
The amount, equivalent to 67% of the maturity value will not be paid to the policy holder but will be transferred to any company of the complainant’s choice for purchasing ‘similar policy’. The complainant hasalso tried to make them understand that the process of such transfer of fund cannot be unilateral and in this case it must be bilateral. The present policy of the complainant has been stated to be a continuation of the earlier policy(0076023064), but actually there is nearly six months gap between the termination of the earlier policy and the beginning of the new policy. The Insurer remained silent on this issue. The complainant’s pension should have started on and from November26,2013 instead of May14, 2014.
The complainant will be well over 69 years when the pension will start and obviously 31 years policy terms has little meaning to the complainant as she has been suffering from severe Osteoporosis, Hypertension, Hypothyroidism and diastolic dysfunction. She is unable to climb up to the 5th Floor of the office building at R.N.Tagore Road. She further averred that in estimating Complainants own investment in terms of premium value of Rs.50,000/- plus the prevailing rate of interest minus the amount of money the complainant have already received litigation costis also an important component of the claim.
The complainant took up the matter with the office of the Consumer Affairs and Fair Business Practices, Murshidabad Regional Office for amicable settlement of the case but all her efforts failed because the Insurer did not co-operate. Getting no other alternative the complainant filed the instant complaint beforethis Forum for redressal as prayed for in the prayer portion of the complaint.
The case of the OP, in brief, is that the petitioner had purchased a Bajaj Allianz New Unit Gain Easy Pension Plus RP(M) Policy being No.0076023064 on 26.11.07 and contributed Rs.50,000/- but it is absolutely untrue that the complainant was never informed of either verbally or in writing anything about the fund value and the nature of investment the insurer had been making on complainant. A copy of policy document containing the details terms and conditions of the Policy No.0076023064 was provided to the complainant where the options available. When she has accepted the terms and conditions of the policy and paid renewal premium without protest.
It is absolutely untrue that after maturity of the previous policy No.0076023064 she has then to purchase the Pension Guarantee Annuity form. The vesting benefit on the survival of the Life Assured to the vesting date will be the Regular Premium Fund Value plus Top upPremium Fund value if any, on the vesting date. The benefit may be used in one of the following ways:
The Regular Premium Fund value plus Top Up Premium Fund value, of any, as on vesting date may used to purchase an immediate annuity for the Life Assured at the immediate annuity for the Life Assured, at the immediate annuity rates of the company prevailing at that time or from any other life insurer as recognised by IRDA in the open market as chosen by the Life Assured.
And the Life assured may receive in lump sum up to a maximum one-third of the Regular Premium Fund Value plus Top Up Premium Fund Value, if any, as on vesting date. The balance amount will be used to purchase an immediate annuity for the life assured, at the immediate annuity rate of the company prevailing at that time or from any other life insurer as recognised by IRDA in the open market as chosen by the Life Assured.
The OP also stated that the complainant received the policy documents after fulfilment of the queries and after submitting the documents as well as proposal form for purchase of an immediate annuity as per option No.b. The complainant after going through the terms and conditions of the policy purchased the immediate annuity plan after having received one-third amount in lump sum. If she was not satisfied with the policy, she hadan option to exercise any of the option as available under option (a) or (b). Under no circumstances, the complainant was entitled to get refund of the entire purchase amount of the immediate annuity plan. After maturity of the previous policy No.0076023064, the complainant received the one-third of the maturity value and rest of the value was again invested to purchase an immediate annuityplan from the company in Pension Guarantee Policy, as she did not raise her choice of investment in any other company. The immediate annuity is calculated as per individual policy schedule as per immediate annuity rate available at the time of purchase of immediate annuity plan. The complainant at the time of investment had been explained in detail and after being satisfied of the annuity rate at that time, she did not raise any objection and decided to purchase immediate annuity from the Company. So the question of unfair business does not arise. It is as per mandate of IRDA that the rest 67% of maturity amount on vesting has to be necessarily invested to purchase an immediate annuity. Under no circumstances, the purchase price of immediate annuity can be returned which has to be compulsorily annuitized. The said policy has been started from 13.5.2013 just after maturity of the previous policy, so question of delay in 6 months does not arise. The complainant opted for the option “Annuity Guaranteed for 5 years & life thereafter”. Accordingly, the annuity rates were fixed and an annuity instalment for Rs.3615/- was promised to be paid annually w.e.f. 14.5.2014. The complainant has also provided NEFT details for directs transfer of annuity payable. The instant complaint is liable to be rejected with cost. The answering OP filed a few documents in connection with the Insurance policy of the complainant which are certified to be true copy by the Divisional Manager of the OP Company.
The complainant filed Evidence on Affidavit on 01.06.2015 in which she demanded that she purchased a New Unit Gain Easy Pension Plus policy being No. 0076023064 (5yr.Term) from the OP on 26.11.2007 and contributed Rs.50,000/-. During the period of investment it was told thatshe can withdraw the amount of maturity value at the end of 5 yrs term. The development officer assured her that a large part of the investment would be in bond and restamount in equity. The OP never informed her about the fund value and the nature of the investment. But she was not given any option to withdraw the maturity value at the end of policy term. So no choice was left other than buying a “Pension Guarantee Annuity” type 5G policy. Immediately after receiving the policy document the complainant informer her disapproval with the terms and conditions of the policy and she requested to return the money but her request was turned down. The OP violated the “Free Look Policy”.
The argument as advanced by the parties/agents heard in full.
From the discussion herein above, we find the following Issues/Points for consideration.
ISSUES/POINTS FOR CONSIDERATION
- Whether the Complainant ‘Mandira Sanyal’ is a ‘Consumer’ of the Opposite Party?
- Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
- Whether the O.Ps carried on unfair trade practice/rendered any deficiency in service towards the Complainant?
- Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?
DECISION WITH REASONS
In the light of discussions here in above we find that the issues/points should be decided based on the above perspectives.
(1).Whether the Complainant ‘Mandira Sanyal’ is a ‘Consumer’ of the opposite party?
From the materials on record it is transparent that the Complainant is a “Consumer” as provided by the spirit of section 2(1)(d)(ii) of the Consumer Protection Act,1986. As the complainant herein invested her money before OP Company and it is admitted by the OP Company being the service provider.
(2).Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
Both the complainant and opposite party are residents/carrying on business within the district of Murshidabad. The complaint valued within Rs.20,00,000/- limit of this Forum. So, this Forum has territorial/pecuniary jurisdiction to entertain and try the case.
(3).Whether the opposite party carried on Unfair Trade Practice/rendered any deficiency in service towards the Complainant?
The case of the complainant is that she purchased a New Unit Gain Easy Pension Plus policy being No. 076023064 (5yr.Term) from the OP on 26.11.2007 and contributed Rs.50,000/-. During the period of investment it was told that she can withdraw the amount of maturity value at the end of 5 yrs term. The development officer assured her that a large part of the investment would be in bond and rest amount in equity. The OP never informed her about the fund value and the nature of the investment. But she was not given any option to withdraw the maturity value at the end of policy term. So no choice was left other than buying a “Pension Guarantee Annuity” type 5G policy. Immediately after receiving the policy document the complainant informed her disapproval with the terms and conditions of the policy and she requested to return the money but her request was turned down. The OP violated the “Free Look Policy”. So the OP by violating the conditions of the policy adopted unfair trade practise for which the complainant took the recourse of this Forum for getting redressal as prayed for in the prayer portion of the complaint petition.
The OP denied the allegation as levelled against him by filing written version. He stated that the petitioner had purchased a Bajaj Allianz New Unit Gain Easy Pension Plus RP (M) Policy being No. 0076023064 on 26.11.07 and contributed Rs.50,000/- but it is absolutely untrue that the complainant was never informed of either verbally or in wring anything about the fund value and the nature of investment the insurer had been making on complainant. A copy of policy document containing the details terms and conditions of the Policy No.0076023064 was provided to the complainant where the options available. When she has accepted the terms and conditions of the policy and paid renewal premium without protest.
It is absolutely untrue that after maturity of the previous policy No.0076023064 she has then to purchase the Pension Guarantee Annuity form. The vesting benefit on the survival of the Life Assured to the vesting date will be the Regular Premium Fund Value plus Top up Premium Fund value if any, on the vesting date. The benefit may be used in one of the following ways:
The Regular Premium Fund value plus Top Up Premium Fund value, of any, as on vesting date may used to purchase an immediate annuity for the Life Assured at the immediate annuity for the Life Assured, at the immediate annuity rates of the company prevailing at that time or from any other life insurer as recognised by IRDA in the open market as chosen by the Life Assured.
And the Life assured may receive in lump sum up to a maximum one-third of the Regular Premium Fund Value plus Top up Premium Fund Value, if any, as on vesting date. The balance amount will be used to purchase an immediate annuity for the life Assured, at the immediate annuity rate of the company prevailing at that time or from any other life insurer as recognised by IRDA in the open market as chosen by the Life Assured.
The OP also stated that the complainant received the policy documents after fulfilment of the queries and after submitting the documents as well as proposal form for purchase of an immediate annuity as per option No.b. The complainant after going through the terms and conditions of the policy purchased the immediate annuity plan after having received one-third amount in lump sum. If she was not satisfied with the policy, she had an option to exercise any of the option as available under option (a) or (b). Under no circumstances, the complainant was entitled to get refund of the entire purchase amount of the immediate annuity plan. After maturity of the previous policy No.0076023064, the complainant received the one-third of the maturity value and rest of the value was again invested to purchase an immediate annuity plan from the company in Pension Guarantee Policy, as she did not raise her choice of investment in any other company. The immediate annuity is calculated as per individual policy schedule as per immediate annuity rate available at the time of purchase of immediate annuity plan. The complainant at the time of investment had been explained in detail and after being satisfied of the annuity rate at that time, she did not raise any objection and decided to purchase immediate annuity from the Company. So the question of unfair business does not arise. It is as per mandate of IRDA that the rest 67% of maturity amount on vesting has to be necessarily invested to purchase an immediate annuity. Under no circumstances, the purchase price of immediate annuity can be returned which has to be compulsorily annuitized. The said policy has been started from 13.5.2013 just after maturity of the previous policy, so question of delay in 6 months does not arise. The complainant opted for the option “Annuity Guaranteed for 5 years & life thereafter”. Accordingly, the annuity rates were fixed and an annuity instalment for Rs.3615/- was promised to be paid annually w.e.f. 14.5.2014. The complainant has also provided NEFT details for directs transfer of annuity payable.
Perusing the case record,documents as produced by the parties and hearing the arguments as advanced by the agents it appears that the complainant after getting the Policy Document ( Pension Gurantee-5G-Single Premium, No.0300747897) she informed the OP by a letter that she is not satisfied with the terms and conditions on a few reasons vide letter dated May27,2013,requested for the cancellation of the policy and prayed to refund the purchase price that the OP deducted from the maturity value within the Free Look Period.
But the OP took no measure to meet the desire of the complainant but remained silent after receiving the letter of the complainant. According to the version of the complainant that after receiving the policy document which granted free look period of 15 days since the date of receiving policy document, the complainant let the Insurer know complainant’s complete disapproval with the terms and conditions of the policy and requested to return the money they held back after returning one third of the maturity value of Rs.53,913/- against the investment of Rs.50,000/- for 5 yrs. The request of the complainant was turned down and the Insurer in its letter dated 30.05.2013 stated that the complainant opted for the policy,”Pension Guarantee R.O.C”.
It is well settled proposition of law that a contract of insurance is based on the principles of utmost good faith-uberrimae fidei, applicable to both the parties. The rule of nondisclosure of material facts vitiating a policy still holds the field. The bargaining position of the parties in a contract of insurance is unequal. The insured knows all the facts; the insurer is unaware of anything which may be material to the risk. Very often, it is the insured who is the sole person who has this knowledge. The insurer may not even have the means to find out facts which would materially affect the risk. The law, therefore, enjoins on the insured an absolute duty to disclose correctly all material facts which is within his/her personal knowledge or which she ought to have known had she made reasonable inquiries. A contract of insurance, therefore, can be repudiated for non disclosure of material facts.
The expression “material fact” is not defined in the Insurance Act, 1938 and therefore, as observed by the Supreme Court in Satwant Kaur Sandhu -vs- New India Assurance Company Ltd., 2013 (3) CPR 644 (SC), it has to be understood in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether she would like to accept the risk. Any fact, which goes to the root of the contract of insurance and has a bearing on the risk involved, would be “material” and if the proposer has knowledge of such fact, she is obliged to disclose it, particularly while answering questions in the proposal form. Any inaccurate answer will entitle the insurer to repudiate their liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance.
The complainant being a prudent person having sufficient knowledge to undergo the terms and condition of the policy that she accepted from the OP Company and she put her signature after going through the risk factors of the policy. After getting the 1st policy from the OP by investing Rs.10,000/- p.a. she was fully aware that the 67% of the maturity amount will be used to purchase annuity from the same company or from other company. But after the maturity of the previous policy No.0076023064 the complainant received 1/3rd of maturity value and the rest of the value was again invested to purchase an immediate annuity plan from the company in Pension Guarantee (ROC) Policy, as she did not raise her choice of investment in other company.
Dispute cropped up when the complainant raised her disapproval during the Free Look Period of the second policy which is in continuation to first policy in different reasons regarding her old age and the terms and conditions.
It appears from the letter dated 30.05.2013 of Policy No.0300747897 of the OP Company(Attachment-4) that, ‘As your immediate annuity policy is the result of a deferred annuity policy after cancellation the cheque will be released in favour of any other insurer of your choice and not in your favour. Hence, with respect to the terms and conditions of the policies, we regret to inform you that 100% refund cannot be made by our Company’.
As the policy was accepted along with its terms and conditions by the complainant by putting her signature, now the complainant cannot take shelter under such plea that she had no knowledge about the terms and conditions of the policy. Therefore, neither the OP nor the complainant can go beyond the said terms and conditions of the policy.
It is presumed that such well educated person would exercise due caution and diligence as also ensure that she is well informed of the benefits and terms and conditions before taking such policy.
Going by the foregoing discussion hence it is ordered that the complainant has failed to prove her case by adducing cogent document/evidence and therefore, the complainant fails on contest. However considering the facts and circumstances there is no order as to cost. With the abovementioned observation the complaint is thus disposed of accordingly.
4). Whether the complainant proved her case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?
The discussion made herein before, we have no hesitation to come in a conclusion that the Complainant failed to prove her case beyond any doubt so she is not entitled to get any compensation as prayed for.
ORDER
Hence , ordered that the complaint be and the same is dismissed on contest against the opposite parties, but without any cost.
Let a plain copy of this order be supplied free of cost to the parties/their Ld. Advocates/Agents on record by hand under proper acknowledgement/sent by ordinary post with A/D forthwith, for information & necessary action.
Dictated and corrected by me.
Member, Member, President,
