Punjab

Nawanshahr

CC/114/2015

Dharam Pal - Complainant(s)

Versus

Max Life Insurance Co. Ltd - Opp.Party(s)

Vikas Narad

23 Sep 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SHAHEED BHAGAT SINGH NAGAR.

                  

Consumer Complaint No.      :  114/2015        

Date of Decision                     :  23.09.2016

Dharam Pal aged 66 years S/o Durga Dass R/o House No.269, B-2, Teacher Colony, Nawanshahr, District Shaheed Bhagat Singh Nagar.    

                                                                    ….Complainant

Versus

1.       Max Life Insurance Company Limited, (Earlier Max New York Life Insurance Company Limited), Max House, 3^rd Floor, 1 Dr. Jha Marg, Okhla, New Delhi 110 020, India through its Managing Director. 

2.       Max Life Insurance Company Limited, (Earlier Max New York Life Insurance Company Limited), Happy Building, 2^nd Floor, Above bank of Maharashtra, Chandigarh Road, Nawanshahr District Shaheed Bhagat Singh Nagar through its Branch Manager.

                                                                    ….Opposite Parties

          Complaint under Section 12 of the Consumer Protection Act, 1986

Counsel for the parties:

For complainant            :         Sh.Vikas Narad, Advocate

For OPs                         :         Sh.Nipun Bhalla, Advocate

QUORUM:

S.BHUPINDER SINGH, PRESIDENT

S.KANWALJEET SINGH, MEMBER

 

 ORDER

S.BHUPINDER SINGH, PRESIDENT

1.       In brief the case of the complainant is that in September, 2009, he purchased two insurance policy bearing Nos.391551900 & 391551892 from OPs under the plan “Whole Life Participating to age 100” and regular paid due premiums till March 2013.  He was not able to pay the premiums of the said policies due for the month of September 2013, as he was not in India and when he came to India on 20.02.2014 and visit to OP No.2 for payment of premiums for the month of September 2013 & March 2014, he came to know that the said policies have lapsed by OPs.  He requested the officials of OP to reinstate his lapsed policies, the said officials told him that since the policies stood lapsed therefore again complainant will have to go through medical checkup/tests and thereafter the Ops will take the premiums to reinstate the lapsed policies.  He went to Raja Hospital, Nawanshahr for the medical checkup/tests and after that the officials of the OP told him that his medical checkup/tests are fine and he required to deposit due premiums and his policies will be reinstated.  On 12.03.2014, he deposited Rs.20350/- for policy No.391551892 and Rs.20490/- for policy No.391551900.  The policy bearing No.391551892 was reinstated but he astonished to know through letter dated 24.04.2014 received from OP in which they stated that “We are constrained to decline your request based on our internal assessment” and refunding the last paid premium of Rs.20490/-.  The said policies were issued in the month of September 2009 under the same plan and having same benefits and terms and conditions and medical checkup/tests for the said policies were also done but unjustly one policy was reinstated and other was not.  He left India on 08.04.2014 and he was not able to agitate the matter with OPs.  After that, he came back to India on 10.03.2015 and agitated the matter with OPs who again made him to go through the same procedure of medical checkups/tests at Raja Hospital Nawanshahr and again received premium of Rs.42703/- for reinstating the said policy but again he surprised when he received letter dated 27.03.2015 a day before when he left India on 02.04.2015 again stating “We are constrained to decline your request based on our internal assessment” alongwith cheque of Rs.42703/-.  On 03.09.2015, he came to India and again requested the OPs to reinstate the said lapsed policy but nothing has been done by OPs.  Therefore, it is prayed that OPs be directed to reinstate the policy bearing No.391551900 or to return the all amount of premium paid  towards the said policy alongwith interest @12% alongwith damages to the tune of Rs.50,000/- and litigation expenses for unfair trade practice and deficiency in service.     

2.       Upon notice, OPs appeared through counsel and filed written statement in which OPs denied all the averments and contentions made by the complainant in the complaint.  The complainant has submitted duly signed proposal form after fully understanding & deliberating the terms and conditions of the policy.  No cause of action arisen in favour of complainant.  Complainant does not fall under the definition of the consumer as per Consumer Protection Act and this Forum has got no jurisdiction.  The relief sought in the complaint is in violation of the terms and conditions of the policy.  Complainant has not come with clean hands before this Forum.  Without any prejudice to the contentions, the Ops submitted complete factual details of the policy in question as under:-

i.        On 07.09.2009, complainant filed proposal form for the policy No.391551900 and policy was issued.

ii.       On 24.09.2009, said policy was issued and policy documents were sent to the address of the policyholder as mentioned by him in the documents. 

iii.      On 15.04.2009, complainant visited the branch in order to surrender the policy.  Branch executive has explained the benefit of the product and complainant agreed to continue the policy.

iv.      On 03.04.2014, complainant submitted reinstatement request and same was declined as per the underwriting decision.

v.       On 23.04.2014, complainant has submitted reinstatement request however the request was declined.

vi.      On 12.03.2015, complainant visited the branch in order to surrender the policy.  Branch executive has explained the benefit of the product and complainant agreed to continue the policy.

vii.     On 18.03.2015, complainant submitted reinstatement request and same was declined as per the underwriting decision.

viii.    On 13.04.2015, complainant sent email asking about status of the policy and the OP had informed the details to the complainant regarding reinstatement.

            On merits, it is submitted that both the policies bearing No.391551892 and 391551900 were purchased by complainant with his own sweet will after fully understanding the terms and conditions of the policy.  It is submitted that Ops acknowledged the receipt of reinstatement request from complainant and payment of both the policies.  However, the Ops had declined the reinstatement request as per underwriting decision of the policy No.391551900, as the same was outside 180 days.  The policy No.391551892 was got reinstated as the amount was received within 180 days. Complainant himself submitted that he failed to deposit the premium as he was out of Country.  The complainant cannot take the benefit of his own wrong.  The OPs as well as complainant is bound by terms and conditions of the policy/insurance contract.  Each and every other averments of the complaint are denied and prayed for dismissal of the complaint.    

3.       In support of complaint, complainant has tendered his affidavit Ex.CW1/A alongwith photocopies documents Ex.C-1 to Ex.C-14 and closed the evidence.

4.       Learned Counsel for OPs has tendered affidavit of Sh.Gurinder Singh Talwar, Manager Legal as Ex.OP1/A alongwith photocopies of documents i.e. Ex.OP-1 to Ex.OP-15 and closed the evidence.  

5.       We have heard the learned counsel for the parties, minutely gone through the record and have appreciated the evidence produced on record by both the parties with the valuable assistance of learned counsels for the parties.

6.       From the entire record i.e. pleadings of the parties and evidence produced on record by the parties, it stands fully proved on record that complainant in September 2009 applied for and obtained two insurance policies bearing No.391551900 & 391551892 under plan “ Whole Life Participating to age 100”.  The complainant admitted that in September 2013, he was out of India and as such he was not able to pay the premiums of aforesaid policies as a result of which both the policies lapsed due to non-payment of premiums.  The complainant came to India on 20.02.2014 and then approached OP No.2 to pay premiums of both the aforesaid insurance policies due in September 2013 and March 2014.  The officials of OPs told to the complainant that as the policy lapsed due to non-payment of premium so the complainant has to get the same reinstated and for that purpose he again has to go through medical examination/tests.  Thereafter, the OP – Insurance Company shall receive the premium alongwith with other reinstatement/relevant charges.  Resultantly, complainant underwent medical checkup/tests and he produced the documents in one policy i.e. policy bearing No.391551892 and he deposited reinstatement charges in both the policy.  Consequently, the OPs considered all the facts and reinstated the policy bearing No.391551892.  However, refunded the premium and other charges regarding reinstatement of the other policy bearing No.391551900 as the complainant did not submit the medical checkup and tests reports.  Thereafter, the complainant again went out of India on 08.04.2014 as he is NRI and did not fulfill the condition for reinstatement of the second policy bearing No.391551900.  Thereafter, complainant came to India on 10.03.2015 and again approached the OPs for reinstatement of the second policy bearing No.391551900. Again, the officials of Ops told the complainant that he will have to undergo entire procedure of medical tests.  The complainant again deposited reinstatement charges alongwith premium not paid.  This time,  the Ops declined reinstatement request of the complainant regarding policy bearing No.391551900 as the same was outside/beyond 180 days because as per rules and regulation of the OPs, the policy can be reinstated if amount received within 180 days.  So the OPs-Insurance Company declined to reinstate the second policy of the complainant bearing No.391551900 and refunded the entire amount deposited by the complainant for reinstatement of this policy.  Moreover, the complainant/insured cannot claim as a matter of right to get policy reinstated which has already lapsed due to non-payment of premium by the insured.  Resultantly, we hold that the OPs was justified in not reinstating the second policy bearing No.391551900.  As such we do not find any deficiency in service on the part of OPs qua the complainant.

7.       Consequently, we hold that there is no merit in the present complaint and the same is hereby dismissed with no order as to costs.

8.       The certified copies of this order be supplied to the parties, as per rules. File be indexed and consigned to the Record Room.

Dated:  23.09.2016

                                                          (BHUPINDER SINGH)

                                                          President

         

                                                          (KANWALJEET SINGH)

                                                       Member