CONSUMER DISPUTES REDRESSAL COMMISSION – X
GOVERNMENT OF N.C.T. OF DELHI
Udyog Sadan, C – 22 & 23, Institutional Area
(Behind Qutub Hotel)
New Delhi – 110016
Case No.329/2011
SATISH KUMAR TRIPATHI
C-4/JG-27A, KHIRKI EXTENSION.
MALVIYA NAGAR,
NEW DELHI-110017 .…..COMPLAINANT
Vs.
MAX NEW YORK LIFE INSURANCE CO. LTD.
MAX HOUSE, 3rd FLOOR,
1 DR. JHA MARG, OKHLA,
NEW DELHI-110020 ..…..RESPONDENT
Date of Institution-04/08/2011
Date of Order-01/06/2022.
O R D E R
Monika Srivastava
The complainant has filed the present complaint seeking Rs. 5,80,000/- towards amount paid to the OP i.e. Max New York life insurance and Rs. 1,00,0 00/- towards damages for harassment and mental agony and Rs.21,000/- as litigation expenses. The complainant is also seeking refund of entire amount at 18% per annum since September 2009.
It is the case of the complainant that he had taken a policy from the OP bearing number 2256822774 ‘Whole life’ and has been paying its premium regularly without any fault or break. It is further stated by the complainant that as per the terms of the policy the complainant was required to pay semi-annual premium and he continued to pay the same till March 2009. It is further stated by the
complainant that in April 2009, the collecting agent of the OP collected a cheque of premium from his residence and filled an amount of Rs. 5940/- when the complainant was not at his residence. It is the case of the complainant that he immediately called the customer care and told them that it ought to be a semi-annual premium which is around 3100/- as he had not exercised the OPPB option and he was told by the executive over the phone that the amount filled by the agent was due to a misunderstanding, treating the mode of payment of his policy as annual one which comes to Rs.5940/-. The complainant further stated that he was assured by the executive that he should not worry about the extra payment as the over and above amount of the premium would be refunded back to him or he will not be required to pay the next semi-annual premium which would be due in September 2009.
Complainant has further stated that he received a reminder in the month of September 2009 about payment of semi-annual premium and he again contacted the helpline and was told by the executive that it was already paid in the month of April 2009. The complainant was again in for a rude shock having to receive a call for payment of semi-annual premium and he made a complaint on 12.10.2009 to the OP being complaint number 1188808 wherein he was advised to make a formal representation to the OP’s email for adjusting his over and above payment which was wrongly unilaterally appropriated towards OPPB account which the complainant had not exercised at that time. The complainant informed these facts OP through email on 04.11.2009. In the month of April 2010, the complainant did not receive the receipt for his next premium on enquiry was told by the executive over helpline that his policy had been suspended due to non-payment of semi-annual premium for month of September 2009.
It is stated by the complainant that despite his efforts and his willingness to pay genuine dues, his complaint was not redressed and the attitude of the OP has been negligent, whimsical, uncooperative, unwarranted, unjustified and illegal. It has been stated by the complainant that mental agony and physical harassment has been caused to him and despite his legal notice the OP did not take any positive action on the request of the complainant and rather is shifting their burden onto the complainant. It is on these accounts that the complainant has filed the present case for deficiency in service against the OP.
On the other hand the OP has taken preliminary objections that the complaint is not maintainable as it does not disclose a consumer dispute. It is also stated that the complainant has not filed the present complaint before the insurance ombudsman which is the remedy as per the Redressal of Public Grievances Rules, 1998 framed by the Central Government.
The OP has stated that the complainant had fully understood the terms and conditions of the ‘Whole Life Participating Policy and had opted for certain riders along with the base policy and the duly signed proposal form number 225682277 dated 01.09.2002 was submitted by the complainant to the OP after careful deliberation. It is stated that the sum assured in the policy was Rs.1,77,022/- under the base plan a premium of Rs.5,940/- was to be paid semi-annually and on a regular basis to be paid towards the OPPB rider, the receipts of which are annexed as Annexed R-3 with the reply. The complainant further requested for addition of spouse rider to the base policy on 23.03.2004. It is further stated that on 17.09.2008 the complainant paid amount of Rs. 5,088. 88/- out of which Rs. 2,000/- was allocated towards OPPB and the remaining amount towards a semi-annual premium. The receipt of the said premium is annexed as Annexure R-6. It is stated that on 11.04.2009, the complainant had again paid an amount of Rs.5,940/- out of which Rs.2,851/- was allocated towards OPPB and the rest towards a semi-annual premium.
It is stated when the complainant called the toll free helpline number on 13.08.2009 he was informed about the premium due in the month of September 2009, and a payment reminder was also sent to the complainant on 06.09.2009. It is further stated that a letter confirming change in the policy to a reduced paid up policy was sent to the complainant on 04.10.2009 and the copy of the said letter is annexed as Annexure R- 9 with the reply. The complainant called the toll free helpline number on 20.10.2009 and informed the representative of the OP that he had already paid the premium due in September. The complainant was immediately informed that the premium due has not been received by the OP. On 03.11.2009, the complainant informed the OP that he wanted the money paid towards OPBB to be re-allocated from OPPB and the same should be re-allocated towards premium for September 2009.
On 30.03.2010, the complainant made the same request again and on 17.04.2010 and on 11.09.2010 when the complainant called up to inquire the status of his policy he was told that the same had lapsed as the premium had not
been deposited and if he wished to get the same reinstated, it would be done as per procedure after submitting his duly signed health declaration form. On 04.10.2010, the complainant sent a letter to the OP advising that he had paid a double premium in April 2009 which would cover for the premium amount for the month of September also and as per his request all details of the policy were e-mailed to the complainant on 11.11.2010. It is also stated that when the complainant on 22.11.2010 wrote about his grievance he was duly replied to by email dated 25.11.2010 wherein he was informed about the reinstatement procedure and the formalities needed to be completed and was also clarified that no amount has been transferred to any other policy as no excess amount has been received by the OP.
It is stated by the OP that the complainant has not taken any steps to revive the policy, the policy lapsed on account of ‘non-payment’ of the premium amount. The complainant was also provided a grace period of 30 days post the premium due within which the premium could have been accepted without interest. It is also stated by the OP that the ‘premium mode can be changed upon request by the policyholders written request and that change would become effective only on the policy anniversary date following the receipt of such request by the company’
In his rejoinder, the complainant has stated that OPPB is not a part and parcel of the insurance policy and like other riders it was totally optional on the part of the insured who may exercise or may not exercise with only a condition that it had to be exercised once in 2 years which fact is also apparent from the separate annual statement of the policy with other riders as well as separate statements in respect of OPPB benefits. The complainant has reiterated that the premium paid in April 2009 was excluding OPPB which is 3088.80 + 2851.2 which equals to 5940/-. It was further stated that the complainant was thoroughly and vigilantly following and pursuing his grievances but no proper response was given by the OP except in April 2010 wherein he was informed that his policy has been suspended.
Both the parties have filed their respective evidence affidavits as well as written arguments. having gone through the entire material on record this Commission is of the view that though the complainant made a payment of Rs. 5940/- in April 2009 however, at that time the complainant had not specified, either to the person collecting the premium or to the OP that he did not wishto pay the
premium towards OPPB rider nor was the request made in writing to the OP. The complainant, though has stated that he made call to the OP’s representative however the same is not proved. On the other hand, the OP has been able to prove on record that since the inception of this policy Complainant had been regularly paying premium both towards the policy as well as the rider of OPPB and that there was no change in instructions by the complainant not to use the premium towards the rider of OPPB in April 2009. The OP has also brought on record the term in the contract‘premium mode can be changed upon request by the policyholders written request and that change would become effective only on the policy anniversary date following the receipt of such request by the company’ that means in case of any change in premium, the same has to be by way of a written request and it would only be applicable from the time when the premium would be next due.
Having come to this finding this Commission is of the view that the complainant is not entitled to any refund of the premium paid as he has been successfully enjoying insurance coverage provided by the OP company from 2003 to 2009 for the premium that he has paid.Therefore, the complaint is dismissed being devoid of any merits. No order as to costs.
File be consigned to the record room after providing copy of the order to the parties. Order be uploaded on the website.
(Dr. RAJENDER DHAR) (RASHMI BANSAL) (MONIKA SRIVASTAVA)
MEMBER MEMBER PRESIDENT
