DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA

CC.No.350 of 26-08-2013

Decided on 17-12-2013

Sukhwant Singh aged about 60 years S/o Jawala Singh R/o St.No.1, Jujar Singh Nagar, Bathinda.

........Complainant

Versus

Met Life Insurance Company Pvt. Ltd., now PNB Metlife, through its Manager, near Hazi Rattan, Bathinda.

.......Opposite party

Complaint under Section 12 of the Consumer Protection Act, 1986.

QUORUM

Smt.Vikramjit Kaur Soni, President.

Sh.Amarjeet Paul, Member.

Smt.Sukhwinder Kaur, Member.

Present:-

For the Complainant: Sh.Sanjay Goyal, counsel for the complainant.

For Opposite party: Sh.N.K Batta, counsel for the opposite party.

ORDER

VIKRAMJIT KAUR SONI, PRESIDENT:-

1. The instant complaint has been filed under section 12 of the Consumer Protection Act, 1986 as amended upto date (Here-in-after referred to as an 'Act') by the complainant. The brief facts of the complaint are that the complainant has purchased one insurance policy bearing No.20187346 as informed on telephone and has paid the premium of Rs.99,900/- in the month of December, 2009 against the sum assured of Rs.9,99,000/- and was assured by the opposite party that he has to make the payment of the premium only once. Neither any cover note nor any separate terms and conditions or free look period were provided to the complainant. The complainant approached the opposite party for seeking the refund of Rs.99,900/- but it refused to refund him any amount and told him that he has to make the payment for the period of minimum 2 years otherwise he would not be entitled to get the refund. Hence the complainant has filed the present complaint to seek the directions to the opposite party to refund the amount of Rs.99,900/- alongwith interest, cost and compensation.

2. The opposite party after appearing before this Forum has filed its written statement and pleaded that the complainant is not consumer and referred the precedents laid down by the Hon'ble National Commission in the case cited as Ram Lal Aggarwalla Vs. Bajaj Allianz Life Insurance Co. Ltd. & Ors and Smt. Abanti Kumari Sahoo Vs. Bajaj Allianz Life Insurance Co. Ltd. etc. The opposite party further pleaded that after fully knowing about the terms and conditions the complainant has purchased the abovesaid policy. As per Clause 6 (2) of the Insurance Regulatory and Development Authority (Protection of Policyholder's interests) Regulations, 2002 the opposite party should inform the complainant by sending the forwarding letter that he is given the period of 15 days from the date of receipt of the policy document to review the terms and conditions of the abovesaid policy, in case he is not satisfied with the abovesaid policy, he can return the abovesaid policy within 15 days and will get the refund of the premium paid, subject only to the deduction of a proportionate risk premium for the period on cover and the expenses incurred by the insurer on medical examination of the proposer and stamp duty charges. The abovesaid policy was issued on 10.12.2009 and the policy documents were dispatched to the complainant on 14.12.2009 through Blue Dart Courier having POD No.40240377870 and the same was delivered to him on 18.12.2009. Despite receiving the policy documents the complainant has not raised any objections or complained during the free-look period, hence it was presumed that the contract of the insurance between the opposite party and the complainant was legally concluded. The complainant after completely understanding the terms and conditions of the product 'Met Smart Premier' had voluntarily filled up the proposal form bearing No.150569220 dated 30.11.2009 alongwith the Benefit Illustration form and Declaration for the Unit Linked products, signed it and offered the premium of Rs.99,900/- as initial premium under the said plan annually. Thereafter on receiving the duly filled up proposal form alongwith the initial premium of Rs.99,900/-, the opposite party evaluated and processed the proposal form on the basis of the information provided by the complainant and issued the policy bearing No.20187346 to him on 10.12.2009 for the premium paying term of 41 years against the sum assured of Rs.9,99,000/-. The complainant has failed to pay the premium towards 30.11.2010 as such his policy has lapsed as per the terms and conditions. The grace period of 30 days from the due date will be allowed for all modes of the payment of each subsequent regular premium. The complainant did not reinstate the abovesaid policy within the reinstatement window period, the abovesaid policy was foreclosed on dated 20.12.2012. The foreclosure amount of Rs.11,328.69/- has been refunded to the complainant vide cheque bearing No.146157 dated 3.1.2013. The cheque has been sent to the complainant on dated 11.1.2013 vide Blue Dart courier POD No.40415540863, but the cheque was returned as undelivered and the undelivered cheque has been accounted back to the policy. The said amount is lying in the suspense account. The company can reissue the cheque of the foreclosure amount to the complainant on his approval. The amount invested in the various income yielding funds, securities and market profit or loss. As the complainant failed to make the due premium payment and failed to reinstate his policy within the reinstatement window period, the abovesaid policy was foreclosed and the amount after the deductions was refunded to him through the cheque. The complainant has clearly mentioned in the proposal form that he is a retired clerk working with Co-operative bank, an educated person like him would not have given his money to any person blindly. All the terms and conditions were clearly explained to the complainant and thereafter he agreed to purchase the abovesaid insurance policy and filled up the proposal form. To support its version the opposite party has relied upon the various authorities.

3. The parties have led their evidence in support of their respective pleadings.

4. Arguments heard. The record alongwith written submissions submitted by the parties perused.

5. Admittedly, the complainant has purchased one insurance policy bearing No.20187346 from the opposite party with the premium of Rs.99,000/- against the sum assured of Rs.9,99,000/-

6. The dispute in the present complaint arose when the complainant approached the opposite party for seeking the refund of Rs.99,900/- but it refused to refund any amount and told him that he has to make the payment for the period of minimum 2 years otherwise he would not be entitled to get the refund. The complainant has specifically averred that no policy documents, separate terms and conditions or free look period option have ever been provided to him and at the time of selling of the abovesaid policy the opposite party assured him that only a single premium is to be paid to it against the abovesaid policy.

7. The submission of the opposite party is that this complaint is not maintainable and given the reference of the precedents laid down by the Hon'ble National Commission in the case cited as Ram Lal Aggarwalla Vs. Bajaj Allianz Life Insurance Co. Ltd. & Ors and Smt. Abanti Kumari Sahoo Vs. Bajaj Allianz Life Insurance Co. Ltd.. The opposite party further submitted that the complainant has offered the premium of Rs.99,900/- as initial premium under the said plan annually. The complainant after completely understanding the terms and conditions of the product 'Met Smart Premier' had voluntarily filled up the proposal form bearing No.150569220 dated 30.11.2009. Thereafter on receiving the duly filled up proposal form alongwith the initial premium of Rs.99,900/-, the opposite party evaluated and processed the proposal form on the basis of the information provided by the complainant and issued the policy bearing No.20187346 to him on dated 10.12.2009 for the premium paying term of 41 years against the sum assured of Rs.9,99,000/-. The policy documents were dispatched to the complainant on dated 14.12.2009 through Blue Dart Courier having POD No.40240377870 and the same was delivered to him on dated 18.12.2009. If the complainant was not satisfied with his policy, he has the option of free look period of 15 days to reconsider his policy, but he has not availed that option, meaning thereby he was fully satisfied with his policy. The complainant has failed to pay the premium towards 30.11.2010 as such his policy has lapsed as per the terms and conditions. The grace period of 30 days from the due date will be allowed for all modes of the payment of each subsequent regular premium. The complainant did not reinstate the abovesaid policy within the reinstatement window period, the abovesaid policy was foreclosed on dated 20.12.2012. The foreclosure amount of Rs.11,328.69/- has been refunded to the complainant vide cheque bearing No.146157 dated 3.1.2013. The cheque has been sent to the complainant on dated 11.1.2013 vide Blue Dart courier POD No.40415540863, but the cheque was returned as undelivered and the undelivered cheque has been accounted back to the policy. The said amount is lying in the suspense account.

8. The opposite party has placed on file Ex.OP1/2 containing pages 1 to 29, to show that the abovesaid policy has been sent to the complainant and the same has been received by him as in the column of 'received back' there is mentioned 'Self', but no affidavit in this regard of any official of courier service has been placed on file to prove that this policy has been received by the complainant. A further perusal of Ex.OP1/2 of page No.29 shows that the terms and conditions of the 'Met Smart Premier-Single Pay'. These terms and conditions of the 'Met Smart Premier-Single Pay' containing pages 1 to 12. Thus the version of the opposite party that the premium paying term is of 41 years falsifies by its own document, Ex.OP1/2. The terms and conditions of the 'Met Smart Premier-Single Pay' also show that under the Single Premium Paying policy vide Clause 15, Surrender Benefit is to be given as under:-

“15)Surrender Benefit:-No surrender value is payable during the first three years of the policy. After the first three policy years, the surrender value payable on surrender is equal to the Fund Value in the Unit Account.

For the purpose of Surrender Benefit, the Fund Value in the Unit Account will be determined using the Net Asset value on the corresponding Valuation Date falling on or immediately after the date of receipt of written request at our designated office. The rules in this regards as follows:-

If the request is received before 15:00 hrs on a business/working day, the corresponding valuation date is the same business/working day.

If the request is received after 15:00 hrs on a business/working day, the corresponding valuation date is the next business/working day.”

9. In the case in hand the averments of the complainant seems to be true as the opposite party itself placed on file the terms and conditions of the single premium, thus on the allurement of the opposite party he has purchased the policy in question. The complainant has purchased the abovesaid policy in the month of December, 2009. When the complainant approached the opposite party for the refund of the amount, it conveyed him that he has to make the payment for the period of minimum 2 years otherwise he would not be entitled to get the refund, whereas in the written statement of the opposite party, it has specifically mentioned that the premium paying term was of 41 years and the policy of the complainant lapsed as he has failed to pay the premium for the second year that was due on 30.11.2010. The grace period of 30 days from the due date will be allowed for all modes of the payment of each subsequent regular premium. The complainant did not reinstate the abovesaid policy within the reinstatement window period, the abovesaid policy was foreclosed on dated 20.12.2012. The foreclosure amount of Rs.11,328.69/- has been refunded to the complainant vide cheque bearing No.146157 dated 3.1.2013. The cheque has been sent to the complainant on dated 11.1.2013 vide Blue Dart courier POD No.40415540863, but the cheque was returned as undelivered and the undelivered cheque has been accounted back to the policy. The said amount is lying in the suspense account. The company can reissue the cheque of the foreclosure amount to the complainant on his approval. Hence the written statement of the opposite party is contradictory to the terms and conditions of the abovesaid policy placed on file by it, thus these terms and conditions of the policy falsifies its written statement, hence the complainant is entitled to get the refund of the amount as per above mentioned Clause 15 of the abovesaid policy. The opposite party has taken the support of the precedents laid down by the Hon'ble National Commission in case cited as Ram Lal Aggarwalla Vs. Bajaj Allianz Life Insurance Co. Ltd. & Ors and Smt. Abanti Kumari Sahoo Vs. Bajaj Allianz Life Insurance Co. Ltd. etc, whereas as per the precedent laid down by the Hon'ble National Consumer Disputes Redressal Commission, New Delhi in case titled Punjab Agricultural University Ludhiana Vs. UTI of India and Anr., Original Petition No.51 of 2005, decided on 17.4.2009, I (2012) CPJ 166 (NC), wherein it has been held:-

“i) Consumer Protection Act, 1986-Sections 2(1)(d)(ii), 2(1)(g), 21(a)(i)-Jurisdiction-Investment-Improving 'Livelihood Security' of employees-Complaint Maintainability of-Consumer-Commercial Purpose-Complainant /University invested funds of its employees with OP for their benefits-Some dispute regarding investments arose-Complaint filed-Deficiency in service alleged-Maintainability of complaint challenged on ground that complainant is not consumer as complainant invested money knowingly and investment could not be said to be for 'self-employment' or 'for earning his livelihood'-Reference made to decide that whether the complainant covered under definition of 'consumer' or not-It is clear that what was hired by complainant was 'services' and not goods-Aim of Act is to protect economic interest of consumer as understood in commercial sense as a purchaser of goods and in larger sense of user of services-Explanation following Section 2(1)(d)(ii) of Act would be clarificatory in nature and does not supplant meaning of word 'consumer', vis-a-vis, 'services' as it appears in main section where exclusion clause will come into play if it is for 'commercial' purpose-Having gone through meaning of word 'commercial' defined under various law dictionaries, it is no doubt that words 'commercial purpose' would cover undertaking, objective which is to make a 'profit'-Investment made by University for improving 'livelihood security' of their employees who would be left with better 'financial security', after retirement-Therefore, investment shall not under any circumstances fall under word 'commercial' excluding complainant from definition of 'consumer'-In view of above, no merit in objection raised by OP-Complaint is maintainable.”

Thus as per the precedent laid down by Hon'ble National Consumer Disputes Redressal Commission, New Delhi in case titled Punjab Agricultural University Ludhiana Vs. UTI of India and Anr. (Supra), this complaint is maintainable.

10. The complainant has paid the amount of the first premium in the month of December, 2009 and the policy has been issued to him on dated 10.12.2009. As per Clause 15 the period of 3 years has already been lapsed, hence the complainant is entitled for the surrender value as per Clause 15 of the policy terms and conditions. The opposite party has calculated the foreclosure amount of Rs.11,328.69/- wrongly, hence the amount of Rs.11,328.69/- is not payable to the complainant as foreclosure clause is not applicable in the case in hand. he is entitled for the surrender value as per Clause 15 of the policy terms and conditions. The opposite party will freshly calculate the amount payable to the complainant.

11. Therefore in view of what has been discussed above there is deficiency in service on the part of the opposite party. Hence this complaint is accepted with Rs.5000/- as cost and compensation against the opposite party. The opposite party is directed to pay the surrender value alongwith other benefits, if any, to the complainant and to furnish the detail of the amount payable to him.

12. The compliance of this order be done within 45 days from the date of receipt of the copy of this order.

13. In case of non-compliance, the interest @ 9% per annum will yield on the amount payable to the complainant.

14. A copy of this order be sent to the parties concerned free of cost and file be consigned to the record room.

Pronounced in open Forum:-

17-12-2013

(Vikramjit Kaur Soni)

President

(Amarjeet Paul)

Member

(Sukhwinder Kaur)

Member