BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.219 of 2020
Date of Instt. 07.08.2020
Date of Decision: 28.10.2022
Pawan Kumar Gogna aged about 29 years, son of Shiv Kumar, R/o House No.313, Sitla Mandir Street, Post Office Road Nakodar, Jalandhar. (M) 98765-48121.
..........Complainant
Versus
1. Manager/Incharge Max New York Life Insurance Social and rural Distribution Nakodar Jalandhar.
2. Manager/Incharge Max New York Life Insurance Co. 11th Floor, DFL Square, DFL Phase III Gurgaon PIN 122002.
3. Chairman Max New York Life Insurance Registered Office Max House 3rd Floor 1 Dr. Jhina Marg Okhla New Delhi PIN 110020.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member) Sh. Jaswant Singh Dhillon (Member)
Present: Sh. H. S. Grewal, Adv. Counsel for the Complainant. Sh. Nitish Arora, Adv. Counsel for OPs No.1 to 3.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the complainant has purchased a Max New York Life Insurance policy in the name of complainant. On dated 21 Aug 2009, the complainant was approached by the OP for the purpose of selling the policy by the name of Life maker premium Investment Plan, after completing all the required formalities and documentation to the satisfaction of the OP, the complainant had duly deposited the sums of Rs.5000/- as already attached. The aforesaid amounts were deposited as per the instructions of the concerned official of the OP as premium Deposit and against new policy number 750681009. As such, the complainant is a consumer of the Opposite Party as covered under the Consumer Protection Act. At the time of aforesaid amounts, the depositing concerned officer of the OP has informed the complainant that the complainant shall have to pay premium for 5 years and after 10 years sum assured shall be 200000/- and the annual target premium shall be 20000/- and in case of any partial withdrawal first 6 partial withdrawals shall be free of cost by the Opposite Party. It shall be pertinent to mention here that the maturity date of the policy shall be 21 Aug 2019. It shall be valuable to mention here that after the maturity of the said policy the company has refused to pay the assured and stated that the policy has been expired and lapsed for the reason that last premium was not paid. The OPs have not cooperated with the party, have not cooperated with the complainant for the sum assured of the policy despite the premium was deposited in time by the complainant till date, despite of giving false assurances to the complainant. The Opposite party have miserably failed to adhere the genuine request of the complainant and remained lingering on the matter for want of time on one pretext or the other without assigning any cogent and plausible reasons thereof. The complainant had on number of occasions visited the office of the OP No.2 to know the status of his application, and further for the redressal of his grievances is being inordinately delayed due to which the complainant has to suffer in his work. It is pertinent to mention here that the deliberate delay being caused by the OP is resulting into financial losses to the complainant as it is the only source of income of the complainant. The complainant has made several requests to the concerned officer for the withdrawal of the said policy however, the OPs have failed to address the genuine grievances of the complainant and remained dilly delaying the matter on one pretext or the other. The act and conduct of the OP of not addressing the genuine request of the complainant within the stipulated time limit as advertised on their website and publicized as per the policy is violative of the rules and regulations and tantamount to deficiency in service and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to repay the policy amount, immediately. Further, the OPs be directed to pay Rs.25,000/- as compensation for causing mental tension and harassment to the complainant and Rs.10,000/- as litigation expenses.
2. Notice of the complaint was given to the OPs, who filed joint written reply and contested the complaint by taking preliminary objections that the answering OPs have rightfully lapsed the said policy due to the non-payment of the due premium amount in accordance with the terms and conditions of the policy. The complainant had showed his interest to take the Life Insurance Policy, thus signed duly filled proposal form after understanding the terms & conditions of the policy which were explained fully by the officials of OP No.1. On 07.08.2009, the said duly filled and signed proposal form was received by the OP. Pursuance to the said request, OP No.3 issued insurance policy bearing no.750681009 dated 21 AUG 2009 with sum assured of Rs. 2,00,000/-to the complainant. The said policy document along with the terms and conditions was sent to the complainant. It is further averred that the above said insurance policy was Life Maker Premium Unit Linked Investment Plan, which had a 2020 option of cancelation which is known as free look cancellation. This term along with other terms and conditions was fully brought to the knowledge of the complainant. However, the complainant never requested for any cancellation of the policy and started paying the premium amounts. The complainant failed to make the payment of the premium amount of Rs. 5,000.01 which was due on May 21, 2010 which the complainant failed to pay and as per the terms and condition the policy was lapsed and the intimation of the same was sent to the complainant on June 21st, 2012. Along with the intimation the opportunity to reinstate the policy was also given to the complainant by paying the overdue amount immediately. However, the complainant never reinstated the policy by paying the amount due and thus has failed to comply with the terms of the policy in relation to the payment of the premium amount. It is noteworthy that the complainant himself had on one instance sent the request for reinstatement of the insurance policy on 31.03.2012 stating reasons that he was out of country which makes it clear that he was very much familiar with the terms of lapsation and subsequent reinstatement. However, even after this knowledge he failed to pay the overdue amount of Rs.5000/- and the policy was rightfully lapsed. It is further averred that the Respondent/ OP further seeks the leave of this Commission to refer and rely upon the proposal, policy documents with annexure, the correspondence exchanged between the Complainant and the Respondent/ OP along with all forms and declarations submitted by the Complainant at the time of inception of the policy and any other relevant documents. Contrary to the stand taken by the complainant of non-performance/ deficiency in service, the respondent/OP claims this opportunity to apprise the Commission of the fact that complainant had submitted it's duly signed proposal form after fully understanding & deliberating upon the terms and conditions of the policy concerned. The terms and conditions of the policy are in strict adherence to norms set by IRDA and were duly communicated to the complainant. The Respondent/ OP has taken all the necessary precautions and has kept the complainant adequately informed of his policy terms and obligations. It is further averred that the complainant has termed their negligent and callous acts, as non-performance/ deficiency in service by the Respondent/ OP. No cause of action has arisen in favor of the Complainant to file the present case. It is submitted that the Respondent/OP has acted strictly on the basis of the terms and conditions contained in the policy. The complaint has been filed by the complainant with the mala fide intention, and further to grab the public money. Hence, the present complaint is liable to be dismissed. It is further averred that the complainant has approached this Commission with unclean hands by not disclosing and misrepresenting material facts. The present complaint is false, frivolous, misconceived and vexatious in nature and has been filed with the sole intention of harassing the OPs. The complainant has knowingly and intentionally concealed the true and material facts from this Commission. The present complaint is a gross abuse of the process of law and is liable to be dismissed with costs. The present complaint is the misuse of the legal process. It is further submitted that the present complaint was filed only with the motive to harass the opposite parties. The complainant has no locus-standi and cause of action to file the present complaint. On merits, the factum with regard to purchase of the policy by the complainant is admitted, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
3. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
4. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
5. We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.
6. The complainant purchased the policy from the OPs on 21 August, 2009 with the sum assured of Rs.2,00,000/-. The copy of the insurance policy has been proved as Ex.C-1 and the premium paid was Rs.5000/-. It has been alleged by the complainant that he was informed that the complainant shall have to pay premium for five years. The complainant has proved on record the policy documents Ex.C-2, which have been proved by the OPs also as Ex.OP-1. Ex.OP-2 has been proved as proposal form. So this fact is not disputed that the policy was purchased by the complainant on 21, August, 2009. It has been alleged by the complainant that the OPs refused to pay the sum assured after the maturity of the said policy on the ground that the same has expired and lapsed due to non-payment of last premium.
7. The OPs have relied upon the condition No.16 of insurance policy terms and conditions, which says that if the due annual target premium have been paid for at least three consecutive years and if subsequent annual target premiums are unpaid then opportunity will be given to the consumer/customer to revive the policy within the revival period mentioned in clause 17 which is a period of 30 days and during the revival period the policy shall remain continue.
8. In the present case, the OPs have alleged that there is a lapse on the part of the complainant as he failed to pay the premium which was mandatory and even in the revival period, he did not make it possible to get the same revived after depositing the money, whereas the contention of the complainant is that he never made any reinstatement request to the OP for revival of the policy. More so, the revival letter itself shows that the document is false one. As per the written statement, the defence of the OP is that the complainant failed to make the payment of premium amount of Rs.5000/- which was due on May 21, 2012 which the complainant failed to pay, an intimation was sent to the complainant on June, 21 2012. They have produced on record the documents in support of their case. Ex.OP-3 has been proved as the renewal premium notice, this was issued on 31.03.2011 and the policy lapse intimation was given on 21.06.2012. This document shows that the last due date for the payment of the premium was 21 May 2012 and intimation is being sent to the complainant regarding the lapse of the policy on 21.06.2012. The OP has also relied upon the document Ex.OP-5 which is the alleged document of reinstatement request and this document is dated 03.03.2012 and in column of reason for lapse, it has been mentioned out of country and this document bears the signature of the complainant, the date has been mentioned as 31.03.2012. The document itself proves that this document is not correct document, it is wrong and false document as the stamp of receipt of this reinstatement request is dated 03.03.2012 on the first page of this form whereas on the last page of this form, the date has been mentioned as 31.03.2012, meaning thereby that the form was filled on 31.03.2012, which was received much prior to its signing and filling in i.e. on 03.03.2012. More so, as per the defence of the OP and as per the documents the due date for depositing the premium was May, 2012 and the policy was lapsed and an intimation was sent on 21, June 2012, whereas the request letter is showing the date 31.03.2012/03.03.2012, meaning thereby that prior to its lapse the reinstatement request was allegedly made by the complainant, when the policy was still alive. During the alive period of the policy, the complainant could have not made any request for its reinstatement and the reason for lapse has been mentioned as out of country, which is itself wrong on the face of it. The complainant has categorically alleged that at the time of purchasing the insurance policy, his signatures were obtained on number of blank papers, which is evident from Ex.OP-5. So, this document is wrong and the action of the OP is also wrong. This shows the negligence and unfair trade practice on the part of the OPs and as such, the complainant is entitled for the relief.
9. In view of the above detailed discussion, the complaint of the complainant is partly accepted and OPs are directed to repay the policy amount i.e. Rs.2,00,000/- to the complainant after deducting the amount of premium, if any due towards the complainant. Further, OPs are directed to pay a compensation of Rs.10,000/- for causing mental tension and harassment to the complainant and Rs.5000/- as litigation expenses. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
10. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
28.10.2022 Member Member President
