O R D E R<br /> <br /> <br /> <br /> SRI.D. KRISHNAPPA, PRESIDENT:<br /> <br /> <br /> The grievance of the complainant against the Op in brief is, that he had taken a policy from the Op from 07/11/2005 for a face value of Rs.4.00 lakhs with quarterly premium payable at Rs.1,667/- each and that policy was due to mature on 11/07/2015. That he was paying the premiums quarterly regularly and up to February 2008 paid a total premium of Rs.15,183/- . Due to financial recession he could not update the quarterly installments since February 2008 therefore approached Op for paying the lapsed installment but Op refused to receive. As he was not satisfied with the conditions of the policy he approached Op for cancellation of the policy and to refund the entire premium paid with consequential benefits but Op despite reminders and legal notice has failed to pay the paid up policy amount and therefore has prayed for a direction to the Op to pay him Rs.15,183/- along with interest and to award damages of Rs.25,000/- with costs.<br /> <br /> 2. Op has appeared through his advocate and filed version contending that the complaint is not maintainable and the complainant is not a consumer under the act. It is further alleged that complaint is barred by limitation. It is further stated that as per clause 6(2) of Insurance Regulatory and Development Authority (Protection of policy holder’s interests) Regulations 2002, the insured had an option to accept the policy or refuse within 15 days after the receipt of policy but he did not express his unwillingness to have the policy, on the contrary has accepted the policy. This Op further narrating the procedure for renewal of the policy has admitted to had issued a policy in favour of the complainant for assured sum of Rs.4.00 lakhs and quarterly premium payable as stated by the complainant. The complainant is asking for cancellation of the policy in the year 2010 is in violation of free look provision provided for exercising an option for accepting or refusal of the policy and Op by denying the allegations of deficiency in service has prayed for dismissal of the complaint.<br /> <br /> 3. In the course of enquiry into the complaint, complainant and Dy. Director of Op have filed their affidavit evidence reiterating what they have stated in their respective complaint and version. The complainant along with the complaint has produced a copy of premium paid and copy of legal notice he got issued to the Op. Op has produced a copy of application form given by the complainant, copy of premium paid, with a copy of conditions of the policy. We have heard the counsel for both parties and perused the records. Counsel for the Op has also filed his written arguments.<br /> <br /> 4. On perusal of the above materials, following points for determination arise.<br /> <br /> 1. Whether the complainant proves that the Op has caused deficiency in his service in not refunding the paid up premium amount.<br /> 2. To what relief the complainant is entitled to?<br /> <br /> 5. Our findings are as under:<br /> <br /> Point No.1 : In the affirmative <br /> Point No.2 : See the final order<br /> <br /> REASONS<br /> 6. Answer on point No.1: As narrated above in brief, the Op has admitted to had issued an insurance policy in favour of the complainant for a sum of Rs.4.00 lakhs with effect from 07/11/2005 maturable on 07/11/2015. The Op has also not denied the contention of the complainant that he has paid quarterly premium regularly up to February 2008 and has paid the total sum of Rs.15,183/-. It is not in dispute that the complainant thereafter from February 2010 did not pay the premium amounts and policy came to be lapsed. The complainant though has contended that he had approached Op to renew policy by offering to pay premiums but in the next stretch he has admitted that because of financial recession he could not pay the future premiums. Therefore, there is no dispute that the policy lapsed some where during February 2008.<br /> <br /> The complainant claimed for refund of paid up money with interest and other benefits. The Op has not specifically set up any defense in not paying the paid up premium amounts. In the version and affidavit evidence he has only referred to the renewal procedure and payment of defaulted premiums. It is found that the Op has not set up any defense under the terms and conditions of the policy in refunding the paid up premium amounts. Thus the complainant should be understood to have come up with this complaint claiming paid up value and other consequential benefits. As the Op has not come up with any defense or legal bar we shall have to examine the conditions of the policy to know whether the complainant is entitle for the paid up value.<br /> <br /> The Op has produced copy of the terms and conditions of the policy which is besides providing provision for reinstatement of lapsed policy contain surrender provision. Condition No.11 under the heading “Non forfeiture option upon non-payment of premiums”. Under this, it is manifest that the doors are not shut against insured to get the benefit under the lapsed policy. This condition provides if the premiums are paid for at least 3 full years and if subsequent premium is not duly paid, the insured shall have the option for reduced paid up insurance amount which has to be worked out under that condition. The Op it is found on the request of the complainant has not acted upon in accordance with condition No.11 of the conditions of the policy to work out the amount payable to him which amounts to deficiency in the service of the Op. When the counsel for the Op was heard, in this Op not acting under this condition, the counsel was not in a position to submit to this forum regarding the Op not acting under condition No.11. Therefore, holding that complaint deserves to be allowed, we direct the Op to work out the amount payable to the complainant under condition No.11 of the policy and to pay that amount without any further delay. With this observation, we answer point No.1 in the affirmative and pass the following order.<br /> <br /> O R D E R<br /> <br /> Complaint is allowed. Op is directed to work out the amount payable to the complainant under the lapsed policy in accordance with condition No.11 of the condition of the policy within 30 days from the date of this order.<br /> <br /> Op shall also pay cost of Rs.2,000/- to the complainant.<br /> <br /> Dictated to the Stenographer. Got it transcribed and corrected. Pronounced in the Open forum on this the 9th August 2010.<br /> <br /> <br /> <br /> <br /> MEMBER MEMBER PRESIDENT<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />