As per Hon’ble President. Mr. Shekhar Muley.
- This is a complaint u/s 12 of the Consumer Protection Act against the Insurance company is regarding its deficiency in service.
2. Facts in short are that the complainant purchased 5 life insurance policies of the OP1 through agent, OP2, in the name of his grandchildren on 27/8/2013. When he received policy papers he noticed some errors in the policy No. 873989826 of Vaishnavi Sanjay Ghyar. Firstly, the date of birth of insured was wrongly mentioned and there was mistake in effective date of coverage. He, therefore, communicated with the OP1 to correct the date of birth. But despite receipt of the letter, the OP1 failed to take note of it. He then personally visited the office of OP1 and besides requesting to correct the date of birth, he also requested the OP1 to apply bonus to premium offset, so that bonus amount would be adjusted to his yearly premium and he would be required to pay only remaining amount of premium. On 23/8/2016 the OP1 informed him that bonus option in all policies was changed to off-set. Then on 29/8/2016 when he went to office of OP1 to pay deducted amount of premium, it was informed that policies of only 4 insured were entitled for change of bonus to premium off-set and the insured, Vaishnavi was not entitled for change because the effective date of coverage was 21st August, which was lapsed. Therefore, he was to pay complete premium of her policy (Rs. 3868 + Rs. 15,896/-). For other policies, he was to pay only bonus deducted amount Rs. 15,900/-. To save the policy from being lapsed he paid full premium amount. The OP1 asked him to write a request letter for changing bonus option to cash. He was told that after one year he would get bonus. This is alleged to be harassment to him to get bonus of Rs. 3868/-. Hence he has prayed to direct the OPs to pay him bonus of Rs. 3868/- with interest from 27/8/22016 and to change bonus option to premium off-set. Besides, compensation and cost are also claimed.
3. The OP1 insurance company is ex-parte, as none appeared on its behalf despite service of notice.
4. The OP2 filed reply at Ex.9 and denied being an agent of OP1. It is stated he is an Insurance Broker having granted license by IRDA. The complainant is not his consumer, though purchase of policies by the complainant through him is admitted. It is stated all allegations are against the OP1 and hence he is not liable for any error nor liable for the acts done by the OP1. Thus, denying all the allegations, it is prayed to dismiss the complaint.
5. We have heard the counsels for the complainant and OP2. Perused documents and notes of argument.
FINDINGS WITH REASONS
6. Considering the averments, the complaint is only against the OP1. There is no cause against the OP2. Secondly, the complaint is in respect of one policy only bearing No. 873989826, which is in the name of Vaishnavi. It is alleged, the date of birth of Vaishnavi in the policy was wrongly mentioned as 23/5/2005 instead of 23/6/2005. This can be seen on the policy document No.1. The complainant has filed copy of Birth Certificate of Vaishnavi wherein her date of birth mentioned as 23/6/2005. In this respect he wrote a letter to the OP1 on 17/9/2014 for correcting date of birth. There appears no cognizance of the letter by the OP1.
7. There was one more request from the complainant to change in bonus applicability for said policy. The OP1 by its letter dt. 23/8/2016 intimated him that his request for change in bonus option was accepted and it was changed to premium off-set from 21/8/2017. This change to offset was reported to have been effected in all 5 policies.
8. However, despite the communication by the OP1 regarding change of bonus option, the OP1 did not change it in so far as policy of Vaishnavi is concerned. The bonus amount Rs. 3868/- was not adjusted towards premium and he was made to pay entire amount of premium of that policy. Payment receipts are filed on record which reveal this fact. In the terms and conditions of the policy it is specifically mentioned that the insured is entitled to bonus while the policy is in force. But no bonus is payable for first two Policy years. Three options are given for applying bonus. Premium offset is one of the options which entitles the insured to offset the premium against the bonus, if any. If bonus is not sufficient, the shortfall is required to be paid by the insured. Accordingly, when the complainant applied for premium offset and it was accepted by the OP1, bonus amount should have been adjusted against the premium. He was unnecessarily made to pay full premium. As there is no explanation from the OP1 on this aspect, we have to accept the complaint. This is deficiency in service on the part of the OP1. Nobody even appeared on behalf of the OP1 and contest the matter which shows lackluster attitude of OP1 towards its consumers.
9. For above reasons, we allow the complaint against the OP1 only and pass the following order.
ORDER
- The complaint is partly allowed against the OP1, Max Life Insurance Company.
- The OP1 is directed to pay bonus amount of Rs. 3868/- with 9% p.a. interest from 27/8/2016 to the complainant.
- The OP1 is further directed to offset the premium payable under policy No. 873989826 against bonus as per request of the complainant with effect from next date of premium, if not done already.
- The OP1 shall also pay compensation of Rs. 10,000/- for mental and physical agony and litigation cost Rs. 5000/- to the complainant.
- The order shall be complied within 30 days from receipt of copy of the order.
- There is no order against the OP2.
- Copy of the order shall be given to all the parties, free of cost.
