Haryana

Fatehabad

CC/301/2015

Amrit Lal - Complainant(s)

Versus

Max Life Insuranc - Opp.Party(s)

J. S Bhati

19 Aug 2016

ORDER

BEFORE THE DISTT.CONSUMER DISPUTES REDRESSAL FORUM; FATEHABAD.

Complaint Case No.301/2015.

Date of Instt.:  17.11.2015.

Date of Decision: 19.08.2016.

Amrit Lal aged 33 years son of Madan Lal, caste Rebari, resident of village Ayalki, Tehsil and District Fatehabad.

 

..Complainant.

     Versus

1. Anirudh Gautam agent code No.349880 Max Life Insurance Ltd. resident of Aggarwal Colony Bhattu Road, behind Indane Gas agency, Fatehabad, Tehsil and District Fatehabad.

 

2. Max Life Insurance Ltd., Operation Centre, 90-A Udhyog Vihar Sector 18, Gurgaon- 122015, District Gurgaon.

 

..Opposite parties.

Before:                 Sh.Raghbir Singh, President.

                             Smt. Ansuya Bishnoi, Member.

 

Present:       Sh. J.S. Bhatti, counsel for the complainant.

                   Sh. Rajesh Sharma, counsel for opposite party no.1.

                   Sh. P.S. Sandha, counsel for opposite party No.2.

ORDER     

 

                   Amrit Lal -complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties.

2.                Briefly stated the facts of the present case are that opposite party no.1 who is an authorized agent of opposite party no.2 who insures the persons on behalf of opposite party no.2. The opposite party no.1 assured the complainant that if the life insurance policy of the complainant is run properly for three years, then the same will not be cancelled and on the assurances of the opposite party no.1, the complainant obtained life insurance policy bearing No.807069653 on 30..4.2010 and deposited first installment of Rs.4689/- with the opposite party no.2 through op no.1. It is further averred that second installment of Rs.4690/- was deposited by him on 12.12.2010 and third installment of Rs.4690/- was deposited on 28.5.2011. The fourth installment of Rs.4710/- was deposited on 22.12.2011, fifth of Rs.4690/- was deposited on 11.7.2012, sixth installment of Rs.4960/- was deposited on 30.7.2012 and seventh installment of Rs.4963/- was deposited by him with the opposite party no.2 on 7.10.2013. In this way, the complainant has deposited total amount of Rs.33,662/- with the opposite party no.2 so far. It is further averred that now the opposite parties are not taking installments and after closing the insurance policy of the complainant, they have sent a cheque of Rs.245/- in lieu of Rs.33,662/- to the complainant whereas either he is entitled to the above said amount of Rs.33662/- deposited by him alongwith interest from the opposite parties or he is entitled to continue his policy. It is further averred that opposite parties cannot stop the above said policy without intimating him, without surrender and without his consent as the complainant has not surrendered his policy to the opposite parties and so they cannot terminate the policy of the complainant. It is further averred that complainant visited the opposite parties many times for refund of the amount of Rs.33662/- deposited by him alongwith interest @18% per annum and has completed all the formalities as per the instructions of the opposite parties but they are not paying the above said amount to him. The complainant has also got served a legal notice dated 19.2.2015 upon the opposite party no.2 but op no.2 has not given any reply and has not refunded the above said amount. Thus, the opposite parties have caused deficiency in service towards the complainant and he has suffered financial loss and mental harassment. The complainant is entitled to the above said amount of Rs.33,662/- alongwith interest @18% per annum from the opposite parties besides compensation of Rs.10,000/- for harassment. Hence, this complaint.

3.                Upon notice, opposite parties appeared and resisted the complaint by filing written statement taking preliminary objections that no cause of action ever arose to the complainant to file the present complaint; the complaint does not fall under the purview and jurisdiction of this Forum as the mere reading of complaint makes it very clear that the complaint was filed for the recovery of the amount and nothing more than that and as such, this Forum has no jurisdiction to try and decide the present complaint and that complainant has concealed the true and material facts from this Forum. It has been submitted that on 30.4.2010 complainant filled and signed the proposal form, on 6.5.2010 policy documents were sent to him and on 25.2.2010 (it should be 25.2.2015) a legal notice was received, which was duly replied. On 3.6.2015, complainant had filed an application in Permanent Lok Adalat, Fatehabad regarding mis-selling of the policy, which was duly replied. On merits, it has been submitted that op no.1 never assured that the complainant will be entitled for benefits under the policy after completion of 3 years or the complainant need to pay the premium for 3 years and the policy will never be lapsed. It is noteworthy that complainant will be entitled for benefits under the policy only as per terms and conditions of the policy. It has been further submitted that the complainant himself approached the ops with the intention to purchase insurance plan and met with the representative of op no.2 and different insurance plans were explained to the complainant by authorized representative of op no.2. After going through different insurance plans of the ops, the complainant opted for Max Life Pay Money Back, whereby the complainant had to deposit Rs.8,912.67/- as annual premium and the sum assured under the policy was Rs.1,00,500/- as per the terms and conditions of policy in question. The duly signed proposal form No.807069653 dated 30.4.2010 alongwith the declaration was submitted by the complainant himself after being fully satisfied from the terms and condition of the policy. On the basis of said proposal, the policy pack was delivered to the complainant and all the terms and conditions of the policy are clearly mentioned in the contract. It has been further submitted that complainant is making baseless allegations to plead ignorance. The policy documents were sent to the complainant well within time and if he was having any objection then he would have raised the same within 15 days i.e. free look period and he had option to cancel the policy within that free look period. It has been further submitted that complainant never raised any objection with regard to miss-selling nor he ever visited to the office of ops with regard to any complaint. All the terms and conditions were explained to the complainant very well at the time of inception of the policy. It has been further submitted that opposite parties refunded Rs.245/- as excess premium. The opposite parties will not be able to cancel the policy and refund the complete amount as it is very much outside the free look period and same is against the terms and conditions of the policy contract as the same are the base of the insurance contract and have paramount importance in the eyes of law and as such both the parties can neither go nor claim beyond the terms and conditions of the insurance contract. Therefore, the complaint is liable to be dismissed on this ground also. It has been further submitted that all the renewal intimations and lapse intimation were sent by the ops through Indian post at the mailing address of the complainant as mentioned in the policy documents. It has also been submitted that it is correct that the answering ops received a legal notice which was duly replied by the ops. In reply to the legal notice, all the technicalities were fully explained. Moreover, any legal notice does not entitle the complainant to claim the relief, which is over and above the terms and conditions of the insurance contract. The complainant is not entitled to any relief as alleged. With these submissions, dismissal of the complaint has been prayed for.

4.                Both the parties then led their respective evidence. Complainant has tendered in evidence his affidavit as Annexure C1 and documents as Annexures C12. On the other hand, the opposite parties have tendered into evidence affidavit of Sh. Gurvinder Singh Talwar, Manager (Legal) as Annexure R2/A and documents as Annexures R1 to R5.

5.                We have heard learned counsel for the parties and have gone through the case file carefully.

6.                There is no dispute that the complainant obtained an insurance policy from opposite party No.2 through its agent i.e. opposite party no.1 on 30.4.2010 and for the purpose of obtaining the insurance policy he filled proposal form dated 30.4.2010, copy of which has been placed on file as Annexure C12. The complainant has also placed on file copies of premium receipts as Annexure C4 to C10 which go to show that complainant deposited a total sum of Rs.33,662/- in seven half yearly installments from 30.4.2010 to 7.10.2013. From the proposal form placed on file by the complainant as Annexure C12 and then by the opposite parties as Annexure R1, it is evident that complainant intended to purchase money back policy with duration of coverage of 16 years for which he was required to pay half yearly premium of Rs.4564.39/- each on 30^th of April and October of every year and upon maturity he was to receive an amount of Rs.1,00,500/- and also personal accident benefit of Rs.1,00,000/- for which he was required to pay extra premium of Rs.70.2/- with the above said amount of Rs.4564.39/-. As such, he was required to deposit total premium of Rs.4689/- half yearly with the opposite party no.2. The complainant has deposited first premium of Rs.4689/- on 30.4.2010, then second premium of Rs.4690/- on 12.12.2010, third premium of Rs.4690/- on 28.5.2011, fourth premium of Rs.4710/- on 22.12.2011, fifth premium of Rs.4960/- on 11.7.2012, sixth premium of Rs.4960/- on 31.7.2012 and then seventh premium of Rs.4963/- was deposited on 7.10.2013 as is evident from the premium receipts Annexures C4 to C10. The life insured i.e. complainant was to receive 10% amount of sum insured after four years, 20% amount after eight years, 30% amount after 12 years and 50% amount after 16 years as is evident from the terms and conditions of the policy.   

7.                The grievance of the complainant is that opposite party no.1 assured him that if his insurance policy is continued for three years, then it will not be cancelled. But now nor the opposite parties are getting installments from him nor refunding the above said amount of Rs.33,662/- to him and he is entitled to the above said amount alongwith interest. The opposite parties have come up with the plea that they never assured the complainant that he will be entitled to the benefits under the policy after completion of three years or he need to pay the premium for three years and thereafter the policy will not be lapsed. In this regard we see substance in the contention of the opposite parties. As mentioned above, the above said policy was obtained by the complainant for a period of 16 years as mentioned in the proposal form and there is no stipulation in the terms and conditions of the policy that after three years the insured will be entitled to full benefits under the policy or that he can get full amount of premiums deposited by him after three years. There is also no condition in the policy that after paying premiums for three years, the policy will not be lapsed/ terminated. If the complainant was not satisfied with the terms and condition of the policy, he could have get the policy cancelled within free look period of 15 days of receipt of policy documents which were sent to him on 6.5.2010 i.e. just within six/seven days of obtaining the policy in question. There is no substance in the contention of the complainant that after depositing of seven installments by him, the opposite parties are not getting further installments. The complainant has wrongly averred that after terminating his policy, a cheque of Rs.245/- in lieu of the amount of Rs.33,662/- has been sent to him. The said cheque of Rs.245.44/- has been sent to the complainant towards short premium vide letter dated 25.2.2014 placed on file as Annexure C11. In the said letter, it has not been mentioned by the opposite parties that policy of the complainant has been cancelled. The complainant sent legal notice Annexure C2 to the opposite parties only on 19.2.2015 i.e. after more than a period of one year and four months of deposit of last installment of premium which was deposited on 7.10.2013. The eighth half yearly installment was to be paid by the complainant in the month of April, 2014.  However, there is nothing on file to suggest that after the month of April, 2014 and prior to 19.2.2015 the complainant moved any application to the opposite parties  requesting them either to get installment which was due from him or to refund the amount deposited by him. It seems that complainant himself does not want to continue the policy and wants to reimbursement of the full amount of premiums deposited by him with the opposite parties. Moreover, it is not the case of the opposite parties that policy has been cancelled and cannot be revived. There is specific provision in the policy that if the policy is lapsed, same can be revived within three years by applying for revival of the policy in writing. It is pertinent to mention here that complainant also filed an application under Section 22-C of the Legal Services Authority Act, 1987 before the Permanent Lok Adlat for Public Utility Services, Fatehabad in the year 2015 on the same facts as is evident from the copy of application in this regard placed on file by the opposite parties. The opposite parties have also placed on file copy of notice issued by Permanent Lok Adalat to respondent as Annexure R5 whereby the respondent i.e. opposite party No.2 in this case was directed to appear before the Permanent Lok Adalat on 3.6.2015 but the complainant has failed to disclose the factum of filing of application before Permanent Lok Adalat and result thereof. It seems that after losing the matter from that authority, the complainant has filed the present complaint on 17.11.2015. As we do not know what happened in that proceedings whether said application has been withdrawn or dismissed as the opposite parties have also not placed any copy of the final order of that authority, but in this case the fact remains that the complainant has failed to prove on record that he is entitled to the reimbursement of the premiums amount of Rs.33,662/- deposited by him as per any terms and condition of the policy in question.

8.                However, keeping in view the fact that there is clause of Cash Value in the terms and conditions of the policy in question according to which the policy will acquire cash value if it has been in force for at least three years and provided all the premiums that have fallen due have been received and in this case the policy has run for more than three years and complainant has deposited seven half yearly installments, therefore, we are of the considered view that complainant is entitled to cash value of the policy. Therefore, the opposite parties are directed to release cash value/ surrender value as per the terms and conditions of the policy to the complainant alongwith interest @6% per annum from the date of filing present complaint till actual realization. This order should be complied within a period of one month. The present complaint stands disposed of accordingly. Copy of this order be supplied to both the parties free of cost.  File be consigned after due compliance.

Announced in open Forum.

Dated: 19.08.2016.

                                                                   

                                                                   (Raghbir Singh)

                                                                   President

                                                                   Distt.Consumer Disputes

                                                                   Redressal Forum, Fatehabad.

 

(Ansuya Bishnoi)                                                              

                    Member