Complaint taken on file:14.02.2017
Order delivered on: 14.10.2022
BEFORE THE HON´BLE DISTRICT CONSUMER DISPUTES REDRESSALCOMMISSION, ARIYALUR
PRESENT:
Dr.V.Ramaraj M.L, P.hd : President
Mr.N.Balu B.A, B.L : Member - I
Mrs.V.Lavanya B.A., B.L :Member - II
Consumer Complaint (RBT) No.31/2022
Friday, the fourteenth day of October, 2022
Jitendra Shukla
E-4, 6th Main Road, Thiruvalluvar Nagar,
Thiruvanmiyur, Chennai – 600 041 ... Complainant
-Vs-
1.Max Life Insurance Co. Ltd,
Rep. by its Director,
Plot No.90-A, Sector 18,
Gurgoan, Haryana
2. Max Life Insurance Co. Ltd,
Rep. by its Branch Manager,
II Floor, Adayar Bakkery Building,
Sardar Patel Road, Adayar, Chennai – 600 020 ... Opposite Parties
Counsel for Complainant: Mr.T.Ravikumar
Counsel for Opposite Parties: Mr.S.Dhakshnamoorthy
On perusal of records in this case, we delivered the following
ORDER
Pronounced by Mr.N.Balu: Member-I
Adopted by Dr.V.Ramaraj: President and Mrs.V.Lavanya: Member-II
1. The Complainant has filed this case as against the Opposite Parties claiming a refund the extra premiums of Rs.21,172/- with interest, to credit July, 2015 bonus to complainant’s account, to have accident rider clause without the age restriction of 60 years and to pay a sum of Rs.10,00,000/- as damages for mental agony and caused to complainant because of the unfair trade practice of the Opposite Parties.
The facts of complaint in brief:
2. The complainant has taken a Life Insurance policy from the 2nd opposite party on 15.07.2015 with accident rider vide Policy No.225544337 with a coverage up to Rs.10,00,000/- with coverage up to 100 years of age, the sum assured would be paid by the opposite parties on death or on maturity. The half yearly premium of Rs.13,249.60 was usually paid with an additional Rs.351/- towards personal accident coverage.
3. As per the terms of the policy, the complainant obtained a loan of Rs.25,429/- on 27.12.2005 from the opposite parties assigning the policy. He continued to pay the premiums regularly. He settled the loan with interest on 27.01.2012 by paying Rs.48.453/- to the 2nd opposite party. At the request of the complainant, the mode of premium was converted from Half yearly mode to Quarterly mode in 2007 and the complainant started to pay Rs.6,932 from March, 2017 in Quarterly mode.
4. The opposite parties informed that as there are some technical glitches in the original policy, on 15.12.2015 they assigned a new number to the policy and the new number is 278704507. They also assured that the new policy would have continuity from 15.07.2002 and all the conditions that prevailed in the previous policy No:225544337 would be retained in the new policy. This information was intimated to the complainant by e-mail on 21.10.2015 which declared the old policy in No:225544337 as null and void. The 2nd opposite party on 05.03.2016 informed complainant’s wife that their previous policy had expired in2005 itself, shocked by this statement the complainant sent an e-mail to the 2nd opposite party on 09.03.2016 with the details as to how worse the opposite parties maintain their accounts.
5. The complainant was shocked to receive a reply mail from the opposite party on 29.03.2016 stating that he had to pay an amount of Rs.2,94,493.52 for revival of the (New) Policy bearing No:278704507 followed by a letter from the 2nd opposite party dated 19.03.2016 containing the same content found in the e-mail. The complainant was constrained to approach the Insurance Ombudsman. He sent a petition to the Insurance Ombudsman on 12.04.2016. The opposite party appeared for enquiry before the Ombudsman’s Chennai office along with the complainant. The opposite party submitted before the Ombudsman that the amount was inadvertently typed as Rs.2,94,49.52 in the notice and e-mail. They regretted their mistake before the Ombudsman and reduced their demand from Rs.2,94,493.52 to Rs.49,332.70 to renew the lapsed new policy and informed this to complainant by e-mail on 06.06.2016.
6. The 2nd opposite party sent a letter dated 02.08.2016 to the complainant to pay Rs.29,957.96 to renew the policy. They have again reduced their demand from Rs.49,332.52 to Rs.29,957.96 but they have not given any calculation as to how they arrived at the various amounts. At last they stated in their demand notice dated 02.08.2016 that the complainant had to pay the premiums for the 3 quarters (April, July and October, 2012). But this demand is also wrong because as per their demand all the 3 premiums put together, it comes around Rs.21,000/- only whereas the opposite parties demand to pay Rs.29,957.96.
7. Even though the complainant had already paid the premiums for the demanded quarters of April, July and October, 2012, the complainant paid the demanded amount of Rs.29,957.96 to the 2nd opposite party on 17.08.2016. This amount was adjusted for the pending 3 quarters and the current July, 2016 premium. But the demand letter and the receipt contradict each other. The complainant has paid premiums for April,2012 due on 15.04.2012 (Rs.7057.51 vide Receipt No:225544337/2012-13/01), July,2012 due on 22.07.2012 (Rs.7057.51 vide receipt no.225544337/2012-13/01 and October,2012 due on 15.10.2012 (Rs.7057.51 vide receipt no.225544337/2012-13/01). The complainant has paid all the premiums properly in time but the opposite parties have collected excess premium amounts for the above 3 quarters. The complainant has dealt with various branches of the opposite party such as Chennai, Lucknow and Surat branches and since there is no uniform system between the branches, the accounts and the payments have not been properly updated in a centralized network which has led to these discrepancies.
8. The new policy No:278704507 is not the same that of the old policy No: 225544337 because in the new policy, there is a restriction clause which contains accident benefit to 60 years whereas the old policy provided the benefits up to the age of 100 years. The opposite parties have violated the terms and conditions and have broken the mutual trust. The opposite parties have intentionally terminated the old policy and created the new policy only to cheat the complainant. Hence, the complainant has filed this case against the Opposite Parties claiming a refund of the extra premiums of Rs.21,172/- with interest, to credit July, 2015 bonus to complainant’s account, to direct the opposite parties to maintain true and correct accounts of the premiums collected from their customers, to add accident rider clause in the new policy without the age restriction of 60 years and to pay a sum of Rs.10,00,000/- as compensation for the mental agony caused to complainant because of the unfair trade practice of the Opposite Parties.
The facts of written version of 1st Opposite Party:
9. The complainant himself opted for the whole life participating Life Insurance plan of the opposite party with an annual premium of Rs.26,499/- on 15.07.2002. The complainant paid the half yearly premiums regularly. As he requested for a loan of Rs.25,000/- against the policy on 27.12.2005, it was discharged assigning his policy with the company and he repaid it with interest on 27.01.2012. At the request of the complainant on 18.02.2012, an amount of Rs.1,01,000/- was transferred to complainant’s account towards paid up additions-bonus. The complainant approached the opposite party on 25.03.2013 requesting them to change the bonus option and accordingly his bonus option was changed and it was communicated to the complaint on 26.03.2013. As per the request of the complainant, another Rs.39,046/- was transferred to his account on 17.12.2013 towards paid up additions. The complainant did not pay any premium after July, 2014. The opposite parties did not terminate the policy at all. The opposite parties have not committed any deficiency of service or have not done any unfair trade practice.
10. The complainant in the month of October, 2015 called opposite party company’s helpline number and raised 2 grievances that total declared bonus was Rs.20,587/- but his account shows the bonus as Rs.13,513/- and that in spite of his settling the entire loan with interest that he obtained against the policy, a balance amount of Rs.3,703/- in the loan was still reflecting in his account statement. The company sent a mail to the complainant on 21.10.2015 stating that the policy number was changed because the system files had become corrupt and was continuously reflecting an outstanding loan amount in complainant’s accounts statement and it was not done willfully but in spite of much efforts, the system could not be corrected and it continued to reflect that the complainant had some outstanding balance in his loan.
11. As the complainant again sent a mail to the opposite party company on 03.05.2016 addressing the same grievances, the company on 01.04.2016 sent a reply letter in which it was inadvertently mentioned that the dues against the policy by the complainant was Rs.2,94,493/-. As the complainant filed a petition before the Ombudsman, Chennai, the opposite party appeared before them and submitted all required documents and substantiated their stand that the amount stated in the letter was only a mistake, it was stated inadvertently without any ulterior motive. The Ombudsman accepted the reply submitted by the opposite party and recording the same dismissed the report filed by the complainant. The complainant had failed to revive the policy. The opposite party did not terminate the policy at all. Hence, the opposite parties have not committed any deficiency of service or have not done any unfair trade practice and therefore they are not liable to pay to the complainant any compensation much less than Rs.21,172.53 being the extra premium amounts received by the opposite parties or any cost as prayed by the complainant. They have prayed to dismiss the complaint in total.
12. Points to be considered:
1). Has the Opposite Party committed deficiency in service and unfair trade practice as alleged by the complainant? If yes, what is the relief the complainant is entitled to?
2). Whether compensation and cost can be awarded to the complainant?
3). What are the other reliefs the complainant is entitled to?
Points 1 and 2:
13. The 2nd opposite party is the branch office of the 1st opposite party. The complainant has purchased his policy from the office of the 1st opposite party on 15.07.2002 with half yearly premium paying option and later he has changed to quarterly premium mode. The complainant used to pay the premiums at various branches of the 1st opposite party like Lucknow, Surat, Chennai, etc. His loan of Rs.25,429/- on 27.12.2005 from the opposite parties assigning the policy. He continued to pay the premiums regularly. He settled the loan with interest on 27.01.2012 by paying Rs.48.453/- to the 2nd opposite party.
14. The opposite parties have informed the complainant on 15.12.2015 that due to some technical glitches in their system, they have assigned a new number to his policy and the new number is 278704507. They also assured that the new policy would have continuity from 15.07.2002 and all the conditions that prevailed in the previous policy No:225544337 would be retained in the new policy. This information was intimated to the complainant by e-mail (Ex. A-3) on 21.10.2015 which declared the old policy in No:225544337 as null and void. The complainant’s contention that the new policy No:278704507 is not the same that of the old policy No: 225544337 because in the new policy, there is a restriction clause which contains accident benefits to 60 years whereas the old policy provided the benefits up to the age of 100 years. The opposite parties have violated the terms and conditions and have broken the mutual trust. The opposite parties have intentionally terminated the old policy and have created the new policy only to cheat the complainant. The opposite parties refuse this contention of the complainant and say that al the terms and conditions in the old policy and new policy are the same.
16. The complainant has sent an e-mail to the 2nd opposite party on 09.03.2016 stating that the opposite parties do not maintain proper accounts. The complainant was shocked to receive a reply mail from the opposite party on 29.03.2016 stating that the complainant had to pay an amount of Rs.2,94,493.52 for revival of the (New) Policy bearing No:278704507 followed by a letter from the 2nd opposite party dated 19.03.2016 containing the same content found in the e-mail. The complainant was constrained to approach the Insurance Ombudsman. He sent a complaint to the Insurance Ombudsman on 12.04.2016. The opposite parties have appeared for enquiry before the Ombudsman’s Chennai office along with the complainant. The opposite party submitted before the Ombudsman that the amount was inadvertently typed as Rs.2,94,49.52 in the notice (Ex.A-8) and e-mail (Ex.A-7) and substantiated their stand with necessary documents that the amount stated in the letter was only a mistake, it was stated inadvertently without any ulterior motive. The Ombudsman has accepted the reply submitted by the opposite party and recording the same they have dismissed the complaint filed by the complainant.
17. The complainant has received a letter from the Ombudsman (Ex.A-5). The opposite parties have regretted their mistake before the Ombudsman and reduced their demand from Rs.2,94,493.52 to Rs.49,332.70 in their demand notice (Ex. A-6) to renew the lapsed new policy and informed this to complainant by e-mail and by a letter (Ex. A-6) on 06.06.2016. Again the 2nd opposite party sent a letter dated 02.08.2016 to the complainant to pay Rs.29,957.96 to renew the policy again reducing their demand from Rs.49,332.52 to Rs.29,957.96 but they have not given any calculation as to how they arrived at the various amounts. At last they stated in their demand notice with statement (Ex. A-7) dated 02.08.2016 in which on page 2 they have admitted that the bonus amount Rs.20,587.35 declared in July, 2015 was adjusted towards the premiums for April, July and October 2012. But on page 3, it is stated that the complainant had to pay the premiums for the 3 quarters (April, July and October, 2012). But the 3 receipts (Ex. A-8) issued by the 2nd opposite party on 15.04.2012, 22.07.2012, 15.10.2012 show that the opposite parties have received the 3 premiums from the complainant in cash from the complainant on respective dates. The opposite parties have not denied or not even stated anything about these receipts (Ex. A-8) in their written version, affidavit or in their written arguments.
18. Hence, it is clearly proved that they have received those 3 premiums already from the complainant in cash on respective dates. Therefore, this commission finds that the opposite parties have collected 3 premiums (April, July and October, 2012 premiums) twice from the complainant. Since the complainant approached the Ombudsman, the opposite parties have changed their stand and have reduced their demand from Rs.2,94,493.52 to Rs.49,332.70 in their demand notice (Ex. A-6) and when the complainant questioned this amount also, they again send a demand notice asking him to pay Rs.29,957.96 (Ex. A-7). The stand taken by the opposite parties that the demand notice was sent inadvertently and was corrected later is unacceptable. Had the complainant not approached the Ombudsman, he would have had to pay the amount of Rs.2,94,493.52 which is truly unethical.
Point No.3:
19. Therefore this commission concludes that the opposite parties have practiced unfair trade and have committed deficiency in their service by receiving 3 premiums extra from the complainant and by sending a false notice demanding the complainant to pay a sum of Rs.2,94,493.52 and suddenly reducing it to Rs.49,332.70 and again reducing it to Rs.29,957.96 without any calculation. The opposite parties should be held liable for their deficiency and unfair trade practice. Therefore, this commission feels that the opposite parties may be directed to refund the extra amount of Rs.21,172.53 received from the complainant with interest and to pay a compensation of Rs.5,00,000/- as compensation for the mental agony and the physical hardships caused to the complainant. Points No. 1 and 2 are answered accordingly.
The complainant has proved his case. He has approached the Ombudsman and then has filed this case and thereby has incurred a reasonable cost. He is eligible to get a cost from the opposite parties. This commission comes to the conclusion that Rs.10,000/- can be awarded as the cost of this litigation payable to the complainant by the 1st and 2nd opposite parties.
As result this Commission passes the following ORDER:
(i). The 1st and 2nd opposite parties are directed to pay to the complainant a sum of Rs.21,172.53/- with interest at the rate of 9% per annum from the date of this complaint till the date of payment towards the balance amount of the insurance claim.
(ii). The 1st and 2nd opposite parties are directed to pay to the complainant a sum of Rs.5,00,000/- towards compensation for the mental agony.
(iii). The 1st and 2nd opposite parties are directed to pay to the complainant a sum of Rs10,000/- towards cost of this litigation.
The 1st and 2nd opposite parties should pay all these amounts within a period of 2 months from the date of this order.
This Order was dictated by me to the steno today the fourteenth day of October, 2022, was taken notes in short-hand and then typed in computer and corrected by him and was pronounced by us in the open court today.
President
Member - I
Member -II
Witness examined by the Complainant: Jitendra Shukla (Complainant)
Witness examined by the Opposite Parties: Astha Arora (Operations Manager of O.P-1)
Exhibits marked by the Complainant:
S.No | Date | Details of Document | Remarks |
| A-1 | 15.07.2002 | Policy Document No: 225544337 | Xerox copy |
| A-2 | 15.12.2015 | Policy Document No: 278704507 | Xerox copy |
| A-3 | 21.10.2015 | E mail sent by complainant to opposite party | Xerox copy |
| A-4 | 29.03.2016 | E mail sent by opposite party demanding Rs.2,94,493.52 for revival of policy | Xerox copy |
| A-5 | 19.04.2016 | Demand Letter sent by opposite party | Xerox copy |
| A-6 | 06.06.2016 | E mail sent by opposite party demanding Rs.49,332.70 for revival of policy | Xerox copy |
| A-7 | 02.08.2016 | Statement with clarification and demand letter from the opposite party | Xerox copy |
| A-8 | Various Dates | Receipts issued by opposite party for payment of 3 premiums (April, July and October, 2012) | Xerox Copy |
| A-9 | 20.09.2016 | Legal Notice | Office Copy |
| A-10 | 06.10.2016 | Reply Notice | Xerox Copy |
| | | | | |
Exhibits marked by the Opposite Party:
S.No | Date | Details of Document | Remarks |
| B-1 | 19.04.2016 | Letter sent to the complainant | Xerox copy |
| B-2 | 02.08.2016 | Letter with clarifications and statement sent to the complainant | Xerox copy |
| | | | | |
President
Member - I
Member -I
