Before the District Consumer Dispute Redressal Commission [Central], 5th Floor ISBT Building, Kashmere Gate, Delhi
Complaint Case No. 303/17.08.2016
Raj Kumar Chhabra, T-1095, Bhagat Singh Nagar
Punjabi Basti, Opp. Filmistan Cinema
Karol Bagh, New Delhi-110005 ...Complainant
Versus
OP1- Max Life Insurance Co. Ltd.
Aggarwal Complex Tower, 4th Floor,
Plot No. 23, Rajender Place, New Delhi-110008
OP2- Yamini AroraR/o C-28, Main Road,
Near Prem ViharJagatpuri, Delhi-110051 ...Opposite Parties
Date of filing: 17.08.2016
Date of Order: 07.07.2023
Coram: Shri Inder Jeet Singh, President
Ms. Shahina, Member -Female
Shri Vyas Muni Rai, Member
Inder Jeet Singh, President
ORDER
1.1 The complainant bought ‘Max New York Life-Siksha Plus (Basic Policy) policy bearing no. 770709251’ from OP w.e.f. 17.03.2010 for 18 years having annual premium of Rs. 24,000/- through agent/OP2 that complainant would receive Rs.15 lakhs to Rs.18 Lakhs after 18 years . The complainant has been depositing the annual premium regularly. The policy was under market link plan. However, the OP never sent any statement. After five years the complainant was apprised that the fund value was Rs. 87,200/- against paid premium of Rs. 1,20,000/-. After seven year the amount deposited was Rs.1,68,000/- having fund value of Rs. 1,05,000/-. Whereas, the OP failed to explain that he has been depositing the premium regularly, the amount deposited is more than the fund value of Rs. 1,05,000/- advised by the OP. The complainant was constrain to continue the policy and to pay the annual premium, apprehending that his policy will lapse in case the annual premium is not deposited. Simultaneously, in case he continues to pay the premium regularly ultimately the fund value will go on deflating. That is why, the complaint to refund amount of Rs. 1,68,000/- and to compensate the complainant the losses happened of Rs. 5 to 6 lakhs, which ought to have been earned on the policy, besides damages of Rs. 2,00,000/- on account of mental agony. And to get the matter investigated from IRDA.
When the OP sells the policy it makes tall claims and in the name of risk factor or market plus, fund value if shown on lower side. When policy is to be got net asset value (NAV) are shown on higher side and OP always desire that units never mature so that money may not be returned.
1.2. The complaint is accompanied with policy, certificate/document, payment receipts from time to time as complainant paid amount of Rs. 1,68,000/- for seven year, the copy of application dated 09.04.2016 written to Ombudsman , final order dated 23.05.2016 by insurance Ombudsman.
1.3. It is relevant to mention that the complaint has been filed in Hindi (देवनागरी स्क्रिप्ट ) and the same is also written manually. Moreover, the evidence and arguments were also filed in Hindi. The complainant has been prosecuting the complaint in person.
2.1. The OP1 opposed the complaint vehemently that on the basis of proposal form, declarations, insurance policy document and other material, the complaint is liable to be dismissed. The complainant is taking the stand of non-performance, whereas, the circumstances are contrary to it. The complainant took the policy after filling in the proposal form, the terms & conditions of policy were knowing to the complainant, which are in terms of norms set by IRDA and the same were communicated to the complainant. The clause 6 (2) of the IRDA (Protection of Policyholders’ Interest) Regulation, 2002 provides free look period of fifteen days from the date of receipt of policy to seek review of terms & conditions, if there are reservation but the complainant never raised any grievances in respect of terms of the policy bearing no. 770709251, for sum insured of Rs. 4,80,000/-, which was issued to him on 17.03.2010. The complainant wrote first time on 18.08.2015 about his grievances through email and making call on customer care that he had been mis-sold the policy and wanted to cancel the policy and refund of his premium amount. The complainant was replied that his request is declined with reasons. There is no cause of action for the present complaint, since the policy opted by the complainant and issued was subject to market link and risks. The complainant was made aware that unit linked policy plan and face value as also the surrendered value is based on market fluctuations and the same cannot be fully controlled by the opposite party.
2.2. There are many charges to be levied under the policy, which were also narrated in policy and those charges includes Premium Allocation Charge (as a % of ATP and Top-up Premium), Fund Management Charge, Policy Administration Charge, Switching Charge, Redirection Charge, Surrender Charge, Partial Withdrawal Charge, Mortality Charge, etc. Moreover, the complainant had also filed complaint before the office of Ombudsman, and independent quasi judicial body, to resolve the issue as a cost effective, efficient and in impartial manner, however, that complaint was dismissed by insurance ombudsman after examining it after merits.
2.3. The OP1 also denies other allegations of the complaint and it denies that the complainant would get Rs. 15-18 lakhs at the end of 18 years, however, the projection, if any were tentative and subject to share market. The complaint deserves dismissal.
Reply is accompanied with case summary, proposal form, copy of insurance policy with schedule, reply to email, statement of account and copy of order by insurance ombudsman.
2.4. There is no appearance of OP2 and for want of appearance OP2 was proceeded ex-parte vide order dated 22.11.2016.
3. The complainant filed rejoinder under the titled of evidence and denied each and every allegations of the reply that there is no substance in the case of OP, since the complainant was shown material and also demonstrated as to how money will go on increase under the unit linked plan. The NAV of Rs. 28/- has been increased to Rs. 48/- but fund value has been shown deflated, how is it possible?. The replication re-affirms the complaint that there is substance in the complaint and he is entitled for the relief claim.
4.1 The complainant filed his affidavit of evidence, which is reiteration of the complaint as well as substance of replication.
4.2. OP1 led evidence by filing affidavit of Sh. Gurinder Singh Talwar, Manager Legal and it is replica of written statement.
5.1 Both the sides have filed their written arguments on the lines of their cases. The parties were given opportunity to make oral submission, the complainant himself argued the case, however, on the other side, Sh. Samarjeet Deo, Advocate along-with Ms. Deerghika Dixit, Advocate argued for OP1.
During the course of argument it was also supplemented on behalf of OP that parties are bound by terms & conditions of policy as held in United India Assurance Co. Ltd. Vs. Harchand Rai Chandal Lal 2005 ACJ 570. Further, reliance is also placed that unit linked policy are at market risks and the same are speculative in nature and held in Ram Lal Aggarwala Vs. Bajaj Allianz Life Insurance Co. Ltd. 2013 SCC Online NCDRC 399.
5.2 During the course of submissions, it was enquired from the complainant as to what relief he is seeking against OP2, the complainant responded that OP2 is an agent of OP1 and as such no relief is claim against OP2.
6. The contentions of both sides are considered keeping in view the material on record. There are rival contentions as the complainant claims that he is entitled for the relief claim against OP1 but according to OP there is no relief made out. By taking in to account stock of totality of circumstances on record, the following conclusions are drawn:-
(i) The terms & conditions of policies on record are not disputed by the parties.
(ii) The complainant had not approached the OP after fifteen days of receipt of policy or prior to five years after issue of the policy, as he keep on paying the premium annually.
(iii) The complainant has not invoked the fifteen days free look period, if he had grievances against the terms & conditions of the policy.
(iv) The complainant has also not disputed nor he has grievances about the policy Max New York Life-Siksha Plus (Basis Policy), consequently he is bound by the terms & conditions of the Policy.
(v) The clause no. 15 is general conditions of the policy and it enumerates that it is unit linked life insurance plan subject to investment risks, the complainant has consented thereto.
(vi) The clause no. 2 of the policy is of certain charges and the complainant had consented for those charges being linked units investment policy, therefore, it could not be construed to deficiency in service.
(vii) The present complainant is having a single policy, which is under consideration and the feature of present case are distinguishable from the feature of Ram Lal Aggarwala Vs. Bajaj Allianz Life Insurance Co. Ltd. case (supra) since in that case number of policy were taken for commercial gain and the same got cancelled from time to time. It is settled case that in material facts dipper, then case would not be applicable.
However, the policy opted by the complainant is subject to market investment risks as well as the charges to be levied under the policy.
7. The circumstances established, and the conclusion drawn in paragraph 6 above, are not leaning in favour of the complainant and the complaint could not be proved by him. Therefore, the complaint is dismissed.
8: Announced on this 7th July, 2023 [वैशाख 25 , साका 1945]. Copy of this Order be sent/provided forthwith to the parties free of cost as per rules for necessary compliance.
[Vyas Muni Rai] [ Shahina] [Inder Jeet Singh]
Member Member (Female) President
