(Date-27.04.2016) As per :-Hon’ble Mrs. Rupali D.Ghatage, Member
JUDGEMENT
Facts giving rise to this complaint may be stated, in brief, as follows:-
[1] The present complaint is filed under section–12 of Consumer Protection Act, 1986 by the Complainant against the Opponent Nos.1, 2 and 3.
[2] The notices are served to the Opponent nos.1 to 3. The Opponents are filed their written version. The documents submitted by the both partied on record; the Forum may pleas e to pass an order in the interest of justice.
[3] The Complainant is the consumer in respect Life Insurance Policy of Opponent nos.1 and 2 and given information and instructions by Authorized Agent i.e. Opponent no.3. The Opponent no.1 Company about SBI Life Maha Anand Plan and believing upon it and in good faith the Complainant entered into transaction with Opponent no., only upon the oral instructions and information given by the Opponent no.3 i.e. the Authorized Agent. The Complainant was regularly paying the monthly installment of Rs.500/-. But after payment of some installment the Opponent no.3 i.e. the agent have not approached the Complainant for receiving the monthly installment, the suddenly in the month of October, 2013, the complaint received Lapsed Terminated Refund Letter dt.07.10.2013 against Policy No.34018555503 with cheque no.502315 worth Rs.3,602.93paise in which the Complainant shocked very much.
[4] According to the Complainant, the Complainant never failed to pay the monthly installment amount. The Complainant’s Policy is alleged to be terminated by the Opponent no.1-Company. The Opponent nos.1 and 2-Company are legally bound to issue notice to the Complainant before terminated of Policy. But the Opponent nos.1 and 2 –Company failed to issue such notice to the Complainant. In such circumstances the Opponent no.1-Company took the undue disadvantage of negligence of Opponent no.3 agent and caused heavy loss to the Complainant without issuing legal notice to that effect. That the Complainant is and was ready to continue the policy and ready to pay the installments. In the above circumstances, the Complainant issued notice, dated, 28.12.2013 to Opponent no.1 to 3 respectively. The Opponent no.1-Company received the Complainant’s notice on 01.01.2014, the Opponent no.1 given reply to the Complainant’s notice and in such reply the Opponent no.1 –Company deny the all contents of Complainant’s notice and mentioned that the Opponent nos.1 and 2 Company has received premium under the Complainant policy till August, 2011 and the policy of the Complainant lapsed due to non-payment of renewal premium due since 18th September, 2011. They further contended in their reply that the same has been intimated to Complainant vide Opponent no.1 Company lapse intimation letter, dated 8th November, 2011. The Complainant had not received any kind of intimation about his policy from the Opponent nos.1 and 2, in their reply dated, 10.02.2014, is totally illegal, against the Public Policy and against the Principles of Natural Justice. The Complainant say’s and submit that he is not in any kind of negligence in respect of his policy. The Opponents have been grossly negligent and deficient in their service and thus caused injury (In Monetary Terms), Mental Agony to Complainant and also harassed him. Aforesaid reasons, the Complainant filed the complaint in this Forum. The Complainant’s complaint be allowed with costs, the Opponents are directed to pay amount of Rs.12,000/- which is paid by the Complainant to the Opponent nos.1 and 2 by way of installment under the policy with interest @18% per annum till realization and amount of Rs.10,000/- as damages for mental agony and harassment and costs of proceeding of this compliant of Rs.5,000/-.
[5] The Complainant has produced on 02.07.2014 the list of documents at Sr.no.1-the lapsed terminated letter issued by Opponent nos.1 and 2 to the Complainant. At Sr.No.2-the refund cheque no.502315 for an amount of Rs.3,602.93paise issued by the Opponent nos.1 and 2 to the Complainant. At Sr.No.3- the Legal notice issued by the Complainant through his advocate to the Opponent nos.1 to 3. At Sr.No.4- The reply notice to the notice of Complainant’s advocate by the Opponent nos.1 and 2. At Sr. no.5- the return RPAD notice to the notice of Complainant’s advocate by Opponent nos.1 and 2. At Sr.No.6- the statement of account of Complainant policy with Opponent nos.1 and 2-Company. The Complainant has produced on affidavit on 02.06.2015.
[6] On 04.09.2014, the Opponent nos.1 and 2 submitted and reply to the complaint of the Complainant. According to the Opponents, they are carrying on Life Insurance Business as licensed by IRDA under the provision of the Insurance Act, 1938. The Complainant is not a consumer as defined under Consumer Protection Act, 1986, as the dispute raised pertains to a unit linked policy. The investment made by the complaint was to gain profit and it was invested for commercial purpose. That the Opponents had received a proposal form for SBI Life Maha Anand Plan vide proposal form no.34309199, dated, 12.09.2009 in the name of Mr.Raghunath Yashwant Lashkare along with initial proposal deposit of Rs.500/-, benefit illustration duly signed by the Complainant with other documents and opting for regular monthly mode of premium payment for a term of 10 years and sum assured of Rs.30,000/-. The proposal was sourced by the Insurance Agent-Mr.Amarsingh Balasaheb Sawant.
[7] According to the Opponents, the proposal form is the basis of the contract of insurance. Under the Doctrine of Utmost Good Faith, the insurer can rely on the information given in the Proposal Form and assess the risk and issue the policy. The Opponents had issued the policy in good faith bearing no.34018555503 with date of commencement as 18.09.2009 for a term of 10 years and sum assured of Rs.30,000/-. The premium payable under the policy was Rs.500/- per month during the term of the policy. The Complainant was required to pay the monthly premium of Rs.500/- on 18th of every month during the term of the policy.
[8] The policy lapsed due to nonpayment of premium since due date 18.09.2011. The policy holder had an option to revive the policy within two years from the first unpaid premium. But the policy holder did not opt for the same. The policy got terminated at the end of revival period i.e. on 18.09.2013. The dates for payment of premium, provisions regarding consequences of non-payment of premium, lapsation revival, etc. of the policy are clearly stated in the policy documents issued to the Complainant. The Opponents are not under any contractual obligation to give lapse or revival intimation to the policy holder. But as matter of routine, as policy lapsed due to nonpayment of premium since the due date 18.09.2011, the Opponents issued a lapse intimation letter dated, 04.10.2011 and lapse revival notice dated, 18.03.2013. The policy lapsed due to nonpayment of premium, since 18.09.2011. The Complainant did not revive the policy within the stipulated revival period of two years. Hence, the policy got terminated i.e. on 18.09.2013 and the surrender value of Rs.3,602.93paise, payable as per the terms and conditions of the policy was paid to the Complainant vide cheque no.502315, dated, 30.09.2013 and receipt of the same has been acknowledged by the Complainant. According to them, the terms and conditions of the policy and nothing more is payable, which is just and legal and all the obligations as per the agreed terms. The complaint is liable to be dismissed as there is no deficiency in service. The complaint is thus vicious and sinister in nature. Hence the complaint is not maintainable and deserves to be dismissed in limine. Hence, it is humbly prayed that this Hon’ble Forum be pleased to dismiss the complaint with costs to the company.
[9] The Opponent no.1 and 2 have produced on 04.09.2014 the list of documents. They are chronologically, copy of proposal form, copy of benefit illustration policy document, copy of the policy document, copy lapse intimation and revival letter, copy of Unit Statement, copy of Legal notice and reply and dated, 15.07.2015 the affidavit of Neelam Singh, Legal Manager of SBI Life Insurance Company Ltd.
[10] We have gone through the complaint, written version of the defence, affidavits, documents and written arguments. We heard arguments of both parities advocates.
[11] Complainant enter into transactions with Opponent no.1 only upon oral intimation and information given by Opponent no.3 i.e. Authorized Agent. Opponent no.1 and 2 received proposal form and according, Complainant initially deposited Rs.500/- benefit illustration duly singed by Complainant with other documents and opting for regular monthly mode of premium for a term of 10 years and sum assured of Rs.30,000/-. The Opponent nos.1 and 2 received 24 monthly premiums from 15.09.2009 to 20.09.2011.
[12] The Complainant alleged that he was regularly paying the monthly of Rs.500/- to the Opponent no.3 and continued it. But after payment of some installment the Opponent no.3 i.e. agents have not approached to him for receiving the monthly installment. On 07.10.2013 Lapse Terminated refund letter along with cheque of Rs.3,602.93paise was received. The Complainant alleged that he never failed to pay the monthly installment amount. It was due to negligence of Opponent no.3, policy is terminated. The Opponent nos.1 and 2 failed to issue notices before termination of policy. It caused heavy loss to the Complainant. Thus the Opponents have been grossly negligent and deficient in their services.
[13] For that issue Forum perused the documents which are filed by both the parties. According to policy, documents issued to Complainant, the Complainant required to pay monthly premium of Rs.500/-. Opponents admitted in their written statement that they received 24 monthly premiums from 15.09.2009 to 20.09.2011. The policy lapsed due to non-payment of premium since 18.09.2011. The Complainant stated in his affidavit that after payment of some installment the Opponent no.3 i.e. agent have not approached to him receiving the money installment. So due to the negligence of the Opponent no.3 his policy is alleged to be terminated. The agent is licensed by the IRDA to Source the insurance business. But in this case, the documents which are produced on record itself shows that maximum premium paid by Complainant has been received by Opponent nos.1 and 2 through Online. Opponent nos.1 and 2 issued policy based on proposal form duly signed and submitted by Complainant. The Hon’ble National Commission in 10.10.1994, LIC India Versus M.Gouri and others. Clearly held that “while filing up proposal form an agent acts as an agent of insured for whole benefit the insurance is to be obtained”. Thus the agent is not responsible for collection of premium from policy holders. Thus, if the Insurance Agent violates any code of conducts prescribed by IRDA or commit any fraud into his transaction, that he alone has been held liable or responsible of his act of commission. In this particular case, Complainant is failed to produce any documentary evidence on the record which shows that agent has committed any fraud during the whole transaction. The payment of premium is the responsibility of policy holder as policy holder signed the proposal form. The policy holder is required to pay premium regularly to enjoy the benefits of plan taken by him.
[14] The policy had lapsed due to non-payment of premium since due date 18.09.2011. The Complainant produced documents along the complaint at sr.no.6 details of payment schedule which shows that the Complainant paid premium upto date 23.01.2010. The Policy of the Complainant lapsed with the effect from 11.09.2011 due to the nonpayment of the premium. Thus it shows that Complainant has not been regular in paying the premium. The Opponent produced on record Annexure-D copy lapse intimation and revival letter dated, 04.10.2011. In such case, policy within two years from the first unpaid premium. But the document itself shows that the policy holder i.e. Complainant did not options for the same. On the contrary, the Complainant alleged in the complaint that the Opponent nos.1 and 3 failed to issue to notice to him. But the date of payment of premium, provisions regarding consequences of nonpayment of premium, lapsation revival, etc. of the policy is clearly stated in policy document which are issued to the Complainant. The Complainant admitted that Agent have not approached him for receiving the monthly installment. So it is responsibility of policy holder / Complainant to pay the premium, if Agent was not approached to him. In such case, policy holder / Complainant had options to revive the policy within two years from the first unpaid premium. But the documents its produced on record, itself shows that Complainant /Policy Holder did not option for the same. So the policy got terminated at end of revival period on 18.09.2013.
[15] While considering, the rival contention, the contention raised by the Opponent that the investment made by the Complainant was to gain profit and it was invested for commercial purpose. For that issue Forum, perused copy of benefit illustration policy documents at Annexure nos-B and C, which shows that this is unit linked product and is different from a traditional life insurance product. In this policy, the investment risk in the investment portfolio is borne by the policy holder. It shows that the policy which was taken by the Complainant from the Opponent is unit linked policy i.e. to gain profit.
Revision PetitionNo.658/2012 N.C., New Delhi, Ram Lal Aggrawal Versus Bajaj Allianz Life Insurance Co.Ltd.,
The petitioner /Complainant is put to strict proof of the same. Even for the sake of argument if its assumed that at the time of taking the policy the petitioner / Complainant was ignorant about the details of the policy, but after receipt of the policy certificate and the terms and condition of the policy, he could have returned the policy in the free look period of 15 days as contained in clause no.14 of the policy document. The policy being an Unit Linked policy and is dependent on the market volatility and the value may go up or may come down depending upon the market condition. The fund switching has been done strictly on the basis of the written requests of the Complainant in the prescribed forms.
The investment made by the petitioner/Complainant was to gain profit. Hence, it was invested for commercial purpose and therefore, the petitioner/ Complainant is not a consumer under the Opposite Parties. The State Commission, Odisha in First Appeal no.162 of 2010 in the case of Smt.Abanti Kumari Sahoo Vs. Bajaj Allianz Life Insurance Company Ltd., have held that the money of the petitioner/ Complainant invested in the share market is no doubt a speculative gain and the speculative investment matter does not come under the Consumer Protection Act and accordingly, the State Commission dismissed the appeal. In view of the aforesaid discussions and findings of the State Commission, we are of the opinion that the present complaint is not maintainable under the Consumer Protection Act, 1986 and as such it is dismissed being devoid of merit.
[16] By considering the documents produced on record and judgments of Hon’ble Apex Court, the Complainant did not opted for free look cancellation and so policy has been terminated. The surrender value has already been paid as per the terms and conditions of policy to the Complainant. The plan opted by the Complainant is a market related plan where in the premium amount paid by policy holder is invested in capital market after deduction of risk premium, administrative charges and other applicable charges. The benefit illustration which is duly singed by Complainant and received with the proposal form also explain benefits or expected group of growth in the funds over period of a policy term. Considering detail submission by both sides, dispute raised to pertain a Unit Link Policy. The investment made by the Complainant is for speculative gain and speculative investment matters does not came under the Consumer Protection Act, 1986, as money is invested for commercial purpose. Hence, the Forum come to the conclusion that the complaint is dismissed having no jurisdiction.
[17] In the result, we pass the following order.
ORDER
(1) The Complaint stands dismissed.
(2) No order as to costs.
(3) Certified copies of this order to be furnished to both the parties, free of costs.
