SMT. RAVI SUSHA: PRESIDENT
Complainant filed this complaint U/s 12 of Consumer Protection Act 1986 against OP for getting an order directing OP to pay Rs.1,74,838/- towards premium paid with bonus.
The facts of complaint are that the complainant availed Life Insurance Policy No.296423395 from the OP on 10/10/2006 Biannual Premium is Rs.7,799.85/-. The maturity period is attaining the age of 100 years ie on 10/10/2059 or death of the life insured. Sum assured is Rs.3,32,588/-+Bonus. The agent of the OP assured after completion of 10 years the policy can be surrendered and the complainant is entitled to get premium paid for the 10 years including the bonus. Believing him policy was taken and the first installment premium paid. Thereafter original policy was delivered through registered post. By the time of completing 10 years period as per the document issued by the OP complainant paid premium of Rs.1,41,680.01/- Bonus of Rs.4624.97 for October 2009, Rs.3,170.90/- for October 10, Rs.4,008.88/- for October 2011, Rs.4,839.15 for October 2012, Rs.5941.10 for October 2013, Rs.6,832.47 for October 2014 and Rs.7,749.81 for October 2015. A total of Rs.1,74,838/- (including paid premium +Bonus declared). Complainant approached the OP with all relevant documents. According the OP this complainant is entitled to receive only Rs.83000/-, since it is premature surrender and the maturity period is attaining 100 years of age. Conditions stated in policy are against principles of natural justice. Hence filed this complaint for getting the relief as prayed in the complaint.
After receiving notice, OP entered appearance through counsel and filed written version resisted the allegations of the complainant raised against them. It is submitted that the complainant after completely understanding the terms and conditions of out product “Max Life Whole Life Participating” plan had voluntarily applied for a Policy by voluntarily filling up the Proposal Form. On the basis of the information provided by the complainant a Policy bearing No.296423395 was issued on 10/10/2006 stipulating for an annual premium of Rs.14,999.72 against the sum assured of Rs.3,32,588/- for a premium paying term of 53 years. Thereafter all the policy terms and conditions were sent to the complainant, which has been admittedly received by the complainant. That the welcome letter clearly stated that in case the complainant had any objections with respect to any terms and conditions of the Policy, he is entitled to request for the cancellation of the Policy within the free look period of 15 days. However it is pertinent to mention that the OP never received any complaint with respect to the said policy from the complainant within the free look period. Thus, it was presumed that a legally valid contract was concluded between the parties. That the complainant under the said policy has paid 19 half yearly (ie. For 9.5 years) premium amounting to a total sum of Rs.1,49,968.24/-. That the complainant as per the terms of the Policy contract is entitled to surrender the policy and will receive the surrender value in accordance with the terms of policy contract. The surrender Value as on August, 2017 was Rs.84,271.64/-. It is submitted that as the contract of insurance is a contract of uberrime fide and the OP has performed its part of the contract by providing services and covering the risk from the date of commencement of the policy. The complainant is only talking about the refund of the Premium and forgetting the insurance part. It is submitted that the OP has also given insurance under the policy and have been providing coverage to the complainant from the time of issuance of the Policy. It is submitted that every communication to the complainant is made as per the contract of insurance. The OP has engaged its time and money in giving the insurance cover to the complainant. In case, the complainant would have died within those periods of coverage, the OP would have paid the entire sum assured to the nominee of the complainant. Thus the complainant has availed the services of the OP for all these years and is now claiming refund of the amount, for which service has already been provided by the OP. Since, the OP have performed all part of the contract by providing our services and there is no deficiency of service and as such the complainant is stopped from challenging the contract a such at such a belated stage. Hence prayed for the dismissal of the complaint.
Evidence in this case consists of chief-affidavit in lieu of evidence of complainant. Ext.A1 to A3 were marked. No oral evidence in the side of OP. Ext.B1 to B3 were marked from the side of OP. Ext. A1 is the policy in question. Ext.A2 is the premium receipts and Ext.A3 is bonus details. Ext. B1 is the policy, B2 is terms and conditions, and Ext.B3 is proposal form.
The averment of complainant is that after getting the policy document complainant realized the policy condition that the maturity period is attaining the age of 100 years ie on 10/10/2059 or death of the life insured. It is also alleged that the agent of the OP assured that after completion of 10 years the policy can be surrendered and the complainant is entitled to get premium paid for 10 years including the bonus. Complainant stated that believing the words of agent, policy was taken and premium paid. Hence he has to get Rs.141680.01(premium paid + 32542 bonus. On the other hand, OP has produced policy in dispute with terms and conditions and stated that complainant after completely understanding the terms and conditions of the policy and had voluntarily applied for the policy by voluntarily filling up the proposal form. It is also contended that if the complainant had any objection with respect to any terms and conditions of the policy, is entitled to request for the cancellation of the policy within the free look period of 15 days. But complainant had not made any complaint. According to OP1 as per the terms of the policy contract, complainant is entitled to receive only the surrender value as Rs.84271.64 and there was no deficiency in service on their part.
On perusal of Ext.A1 (Ext.B1) policy duration of coverage as to age 100 is specifically mentioned. Complainant contended that he came to understand the duration of coverage as to age 100 only after getting policy with schedule after remitting the 1st premium amount Rs.7799.85. Then also complainant believed the words of the agent through him complainant taken the policy. There is also specific condition that if the complainant wants to cancel the policy after knowing its terms and condition, he is at liberty to cancel within 15 days from date of receipt. Here complainant does not have a case that he exercised the said option. Here OP says that the complainant has paid premium only for 9 ½ years, So he is entitled to get surrender value as per the terms of the policy contract was Rs.84271.64.
But we can see that OP had issued Ext.A2 and Ext.A3. Ext.A3 is the premium paid certificate for a period from 10/10/2006 to 11/02/2016 which shows the total premium received by them was 1,41,680.01 and Ext.A3 is the bonus details for the policy till 10/10/2015 amount to Rs.32542/-. Issuance of Ext.A2 and Ext.A3 means on 10/10/2015 complainant is entitled to get Rs.32542 bonus. Here, OP has not produced any calculation statement as how they arrived Rs.83000/-as surrender value. Further OP does not have a contention that the complaint was a defaulter in paying the insurance premium till 11/02/2016. Therefore as per the Ext.A2 and Ext.A3 complainant is entitled to refund of amount as Rs. 1,41,680 + 32,542 bonus ie total Rs.1,74,838/-. Without paying eligible amount to complainant amounts to deficiency in service on the part of OP.
In view of the above facts, the complainant was entitled to get Rs.1,74,838/- from OP.
In the result complaint is allowed in part. Opposite party is directed to pay Rs. 174838/- as surrender value and Rs.10,000/- as cost to this complaint to the complainant within one month from the date of receipt of this order. Failing which Rs. 1,74,838/- carries interest @ 9% per annum from the order date till realization. Complainant can realize the amount by filing execution application against OP as per the provisions of Consumer Protection Act 2019.
Exts.
A1 - Policy in question
A2 - Premium receipts
A3 - bonus details
B1 - the policy document
B2 -Terms and conditions of policy
B3 - proposal form
PW1 - Complainant
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Assistant Registrar
