Haryana

Panchkula

CC/405/2019

RAM KANWAR. - Complainant(s)

Versus

MAX LIFE INSURANCE CO.LTD. - Opp.Party(s)

COMPLAINANT IN PERSON

10 Jan 2024

ORDER

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PANCHKULA.

 

                                                       

Consumer Complaint No	:	405 of 2019
Date of Institution	:	09.07.2019
Date of Decision	:	10.01.2024

 

 

Ram Kanwar, aged 66 years, son of Shri Tika Ram, resident of House No.509, Ratpur Colony, Pinjore, Tehsil Kalka, District Panchkula.

                                                                          ..….Complainant

Versus                                                                  

Max Life Insurance Co. Ltd. (earlier known as Max New York Life), 3^rd Floor, Operation Centre, 90-A, Udyog Vihar, Sector-18, Gurugram- 122015(Haryana).

                                                                        ……Opposite Party

COMPLAINT UNDER SECTION 35 OF THE CONSUMER PROTECTION ACT, 2019

 

 

Before:              Sh. Satpal, President.

                        Dr. Sushma Garg, Member.

                        Dr. Barhm Parkash Yadav, Member. 

 

 

For the Parties:   Complainant in person.

                        Sh.Nitesh Singhi, Advocate for OP.

 

                       

ORDER

(Satpal, President)

1.The brief facts, as alleged, in the present complaint, are that the complainant is a senior citizen, having no income, except the meager pension amount of Rs.2,000/- per month, to meet his day to day expenses. The complainant received a telephonic call from the executives of the Opposite party(hereinafter referred to as OP), in the month of 2004, informing him that the OP had launched a cash flow plan, wherein the life risk was covered and premium in the said policy was half yearly i.e. Rs.2,743/- per month. It was also assured that the complainant would receive the 30% of the sum insured before 5 years and 35% of the sum assured before the two years of maturity and the remaining amount was to be paid alongwith bonus on the completion of the tenure of the policy. It is stated that the complainant is only a matriculate and simple person and came under the clever talks of the executives of the OP and accordingly, agreed to opt for the policy and thereafter, the executive of the OP visited the residence of the complainant and obtained the signature on blank performa and received the initial premium of Rs.2,743/-. The policy bearing no. 240432898 with commencement of date 22.06.2004 was issued by the OP. The complainant kept on making regular payment of the premium amount without any default. In December, 2019, it was disclosed by the OP that the premium amount was enhanced from Rs.2,743/- to Rs.2,771/- due to levy of taxes. It is stated that an amount of Rs.2,743/- as half yearly premium was to be paid as per policy till December 2018 but the premium, was enhanced by the OP and last premium  paid by the complainant was Rs.2,805/-. The OP had given 30% to 50% of sum assured as per the terms and conditions of the policy to the complainant. It is averred that till the end of the policy i.e. date of last premium the complainant had paid an approximate amount of Rs.85,000/- in total to the OP. It is further averred that the OP had made the payment of Rs. 49,128/- at the time of maturity of the said policy and thus, in total, the OP had made the payment of sum of Rs. 83,831/- against the payment of Rs.85,000/- made by the complainant to it. It is stated that the OP has not paid the full amount, which was paid by the complainant and so, the OPs are liable to pay balance amount of Rs.1,169/- along with bonus on the amount of Rs.85,000/-, which was paid by the complainant against the said policy. A letter dated 29.06.2019 was sent by the complainant to OP seeking the release of the balance amount along with bonus but to no avail.  Due to the act and conduct of OP, the complainant has suffered a great deal of financial loss and mental agony, harassment; hence, the present complaint.

2.Upon notice, the OP appeared through counsel and filed the written statement, raising preliminary objections that the Consumer Commission, Panchkula has no jurisdiction to try and decide the present complaint; the complainant has not approached the Commission with clean hands. The OP has acted strictly in accordance with the terms and conditions as contained in the policy. 

                On merits, it is submitted that the complainant/policy holder, with his own sweet will and without any pressure, had approached  the OP for purchasing  the insurance policy and after  going through different insurance plans, he had opted for the insurance plan, namely, “Max Life Stepping Stones” for the sum assured of Rs.50,000/-. The policy was issued to the complainant on the basis of proposal form no.240432898 and the declaration which the complainant himself had submitted with the OP. The policy was sent to the complainant on 22.06.2004 but no objection was ever raised qua the terms and conditions of the policy by the complainant either within the free look period or thereafter. It is submitted that the change in the premium had occurred due to change of service tax and GST. It is submitted that the complainant has been paid the entire amount as admissible under the policy and thus, no relief is liable to be granted now to the complainant; hence, there is no deficiency in service on the part of the OP; as such, the complaint is liable to be dismissed.

3.The complainant has tendered affidavit as Annexure C-A along with documents Annexure C-1 to C-8 in evidence and closed the evidence by making a separate statement. On the other hand, the learned counsel for the OP has tendered affidavit as Annexure R-A along with documents Annexure R-1 to R-13 in evidence and closed the evidence.

4. We have heard the complainant as well as the learned counsel for the OP and gone through the entire record available on file, minutely and carefully.

5.During arguments, the complainant has reiterated the averments as made in the complaint as also in his affidavit(Annexure C-A) and contended that a payment of total sum of Rs.85,000/- was  made by him(complainant) to the OP whereas a payment of Rs. 83,831/- was released to him(the complainant) against the payment  of Rs.85,000/-. The complainant also argued that the amount was enhanced from Rs.2,743/- to Rs.2,805/- against the terms and conditions of the policy and thus, the complaint is liable to be accepted by grating the relief as claimed for in the complaint.

6.On the other hand, the learned counsel on behalf of the Ops has reiterated the averments as made in the written statement as also in the affidavit(Annexure R-A) and contended that the entire amount alongwith bonus as admissible as per the terms and conditions of the policy has already  been paid to the complainant. It is contended that no objection, whatsoever, was ever raised by the complainant after the receipt of the policy papers by him within the free look period. It is further contended that both the parties to the insurance contract i.e. the insured  as well as insurance company are bound by the terms and conditions of the insurance policy and none of them is permitted to travel beyond the explicit terms and conditions as contained in the policy. Reliance has been placed on the case law titled as Suraj Mal Ram Niwas Oil Mills(P) Ltd. Vs. United India Insurance Company & Anr. 2011 (1) CLT 485(SC).

7.As per the rival contentions raised by the complainant on one hand and the learned counsel for the OP on the other hand, it emerges that the complainant has expressed his grievances against the OP on the following two counts:-

1. That the OP has not made the payment of bonus as assured vide schedule(Annexure C-6) appended with insurance policy (Annexure C-7).
2. That the premium amount was enhanced from Rs.2,743/- to Rs.2,805/- contrary to the schedule and policy documents.

8.We have perused the schedule(Annexure C-6), wherein under the column of sum insured the amount i.e.Rs.50,000/- and accrued bonus has been mentioned. The Ops, as per the complainant’s own case as mentioned in Annexure C-1 has released the payment of total amount as under:-

 

The complainant has contended that he has received short payment i.e. of Rs.1,169/- as he had made the total payment of Rs.85,000/-, whereas he had received the payment of Rs.83,831/-. The insured sum, as per schedule(Annexure C-6) was Rs.50,000/-, whereas the OP had made the payment of Rs.83,831/- to the complainant. It means that the OP had made the payment of Rs.33,831/- on account of bonus. However, the OP has not provided the breakup of the bonus vis-à-vis the assured sum despite the specific averments of the complainant made in para no.9 and 10 qua the non release of bonus. In view of the specific averments of the complainant qua the non-payment of the complainant in para no.9 and 10 of the complaint, it was binding upon the OP to place on record the exact breakup of the payment of amount Rs.83,831/- showing separately amount of the bonus; thus, the OP has acted negligently.

ii.Coming to the second grievance of the complainant qua the enhancement of the premium amount from Rs.2,743/- to Rs.2,805/-, itis found that as per schedule(Annexure C-6)appended with policy documents(Annexure C-7), the model premium was Rs.2,743/-. The OP in para no.4 of merits of its written statement has justified the enhancement in the premium due to change in service tax and GST but we find no such term and condition in the entire policy documents, which had empowered the OP to enhance the premium. As per well settled legal position, none of the party is permitted to travel beyond the specific and explicit terms and conditions of the policy documents. The premium as per Schedule(Annexure C-6) and policy documents (Annexure C-7) was Rs.2,743/- &thus, same was not to liable to enhancement in the absence of any clause of the terms and conditions of the policy authorizing and empowering the OP in this behalf; therefore, the OP has been found deficient while rendering service to the complainant.

9.As a sequel to above discussion, we partly allow the present complaint with the following directions:-

1. The OP is directed to refund the amount as taken by it on account of premium in excess of Rs.2,743/-, which was initially fixed vide policy bearing no.240432898 dated 22.06.2004 along with interest @9% per annum (S.I.) w.e.f. the date of enhancement of the premium from Rs.2,743/- till its realization.
2. The OP is directed to pay a sum of Rs.5,000/- to the complainant on account of mental agony and harassment suffered by him.
3. The OP is directed to pay a sum of Rs.5,000/- as litigation charges.

 

10.  The OP shall comply with the order within a period of 45 days from the date of communication of copy of this order failing which the complainant shall be at liberty to approach this Commission for initiation of proceedings under Section 71/72 of CP Act, 2019 against the OP. A copy of this order shall be forwarded, free of cost, to the parties to the complaint and file be consigned to record room after due compliance.

Announced on: 10.01.2024

 

 

 

     Dr.Barhm Parkash Yadav           Dr.Sushma Garg          Satpal

                  Member                        Member                         President

 

Note: Each and every page of this order has been duly signed by me.

 

                                             Satpal

                                            President