DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PATIALA. Complaint No.CC/10/738 of 30.8.2010 Decided on: 22.9.2011 Harbans Kaur aged about 70 years w/o Joginder Singh r/o 20510,Opp.Govt.Middle School, Factory Area, Patiala. -----------Complainant Versus 1. Metlife India Insurance Company Ltd., by its General Manager,2nd Floor,SCO-10,Chhoti Barandari, Patiala-147001 2. Metlife India Insurance Company Ltd.,by its Managing Director, Brigade Sehamahal, 5 Vani Vilas Road, Basavangudi, Bangalore-560004. ----------Opposite parties. Complaint under Section 12 of the Consumer Protection Act. QUORUM Sh.D.R.Arora, President Smt.Neelam Gupta, Member Present: For the complainant: None For opposite parties: Sh.K.K.Jain, Advocate ORDER D.R.ARORA, PRESIDENT It is the case of the complainant that she is retired teacher. In the year 2009 she visited the office of the ops for making an investment. She was advised by the officials to make one time investment which was beneficial for a retiree and it required single payment and the same would also cover the insurance of the investor. She was impressed with the said plan qua the benefits there of whereby the investment had to be made for a period of 8 years. The complainant accepted the offer and paid the premium of Rs.40,000/- as a signle payment. 2. After few days, the ops had sent policy No.1200900807419 to the complainant. However after enquiry the complainant had come to know that the ops had cheated her in as much as the date of maturity of the policy was 4th October 2040 having the premium term of 32 years of 40,000/- per annum. 3. The complainant made complaints against the aforesaid wrongful act of the officials of the ops. The officials subscribed an application for the cancellation of the policy in July 2009 and got the same signed from the complainant. The officials assured the complainant to issue the correct and proper policy for which the complainant had paid the amount of Rs.40000/-. Thereafter, the complainant approached the officials after a gap of few days but she failed to get the insurance policy. She approached the officials a number of times and ultimately it was said by them that the policy could not be cancelled and that fresh policy will be sent to her. After a gap of 2-3 months the officials of the ops refused to issue fresh policy and to refund the premium amount of Rs.40,000/-. 4. The complainant got a legal notice dated 6.8.2010 served upon the ops and approached this Forum through the present complaint brought under Section 12 of the Consumer Protection Act,1986( for short the Act) for a direction to the ops to refund the premium amount of Rs.40,000/- with interest 18% per annum; to pay her the compensation in a sum ofRs.50,000/- on account of harassment and the mental agony experienced by her in the hands of the ops and also to award her Rs.10,000/- as costs of the litigation. 5. On notice, ops appeared and filed their written version having raised certain objections interalia, that the complaint being false, malicious and malafide the same is liable to be dismissed under Section 26 of the Act; that the complaint lacks a cause of action and is based on surmises and conjectures and that the contract of insurance having attained finality and after the expiry of a free look period the policy terms and conditions permit the surrender of the policy only after the completion of three years. As regards the facts of the complaint, it is averred by the ops that the complainant after due deliberation and understanding all the terms and conditions of the "Met Smart Premier’ (a whole life unit linked policy) plan, had submitted the proposal form on 12.2.2009 thereby having offered to pay a premium of Rs.40,000/- per annum for a policy term of 32 years, the assured of sum being Rs.8lacs. Later on the complainant also signed counter offer letter dated 21.2.2009 having agreed to modify the cost of insurance. Based on the declarations made and information regarding the proposal form, policy No.1200900804419 was issued to the complainant on 24.2.2009. The standard terms and conditions alongwith policy schedule were also dispatched to the complainant on 27.2.2009 vide Blue Dart Courier bearing POD No.40206215475 and were delivered to the complainant on 2.3.2009. It was clearly spelt out in the welcome letter that in case the complainant was dissatisfied with the terms and conditions of the policy, she should return the policy within 15days of the receipt of the same and was entitled to the option for cancellation which was available to the complainant. 5. It was also clearly spelt out in clause 36 of the terms and conditions of the policy. 6. It was further averred that the policy was due for premium on 24.2.2010 regarding which the complainant was reminded vide renewal premium notice dispatched on 28.1.2010 followed by the reminder dispatched on 6.3.2010 but the same was ignored by the complainant. 7. It is further averred that after a laps of several months, the ops had received the legal notice dated 6.8.2010 from the complainant alleging the miss selling of the policy stating that she was under the impression that the policy was single premium plan and requested for the refund of the premium paid under the policy. The ops replied the said notice vide reply dated 7.9.2010, discarding the allegations. She was also informed that if she was not satisfied with the terms and conditions she could have got the same cancelled under the free look period of 15 days from the date of the receipt of the policy. 8. It is also the plea taken up by the ops that the complainant worked as lecturer in Govt. Girls High School for a period of over 40 years. It is unlikely that the complainant at the time of filling and later signing the proposal form was not aware about the terms and conditions of the policy. After denouncing the other allegations of the complaint, it was prayed to dismiss the complaint. 9. In support of her complaint, the complainant produced in evidence,Ex.C1, her sworn affidavit and the evidence of the complainant was closed by order of the Forum. 10. On the other hand, on behalf of the ops, their learned counsel produced in evidence Ex.R1, the sworn affidavit of Anil P.M. Deputy Director(Legal) and duly constituted attorney of op no.2 alongwith documents,Exs.R2 to R11 and closed their evidence. 11. The parties failed to file the written arguments. We have heard the learned counsel for the ops none having appeared on behalf of the complainant and gone through the evidence on record. 12. Ex.R2, is the copy of the application form, to have been filled in by the complainant on 12.2.2009 having opted for Unit Linked Met Smart Premier Policy having a premium term of 32 years, mode of premium being annual and the amount of the premium being Rs.40,000/- and the amount of the sum assured being Rs.8lacs. 13. It is very much recorded in the application form, Ex.R2 that the proposer was a Lecturer in Govt.Girls High School,Sanour, Patiala and therefore, it can not be believed that the complainant had not understood the contents of the application form,Ex.R2. It is also not the case of the complainant that the contents of the application Ex.R2 were not read over by her. 14. It has been admitted by the complainant that she had received the policy No.1200900807419 a few days after the filing of the application form and making the payment of the premium of Rs.40000/-.Ex.R3/1 is the forwarding letter dated 25.2.2009 of the policy addressed to the complainant and the same was accompanied by the policy,Ex.R6, containing the terms and conditions of the policy. The forwarding letter,Ex.R3/1 interalia provides, “ you have a period of 15 days from the date of receipt of the policy document to review the terms and conditions of this policy. If you have any objections to any of the terms and conditions, you have the option to return the policy as explained in the enclosed policy document.” Therefore, it would appear that the complainant accepted the terms and conditions of the policy and rather understood the import of the policy which clearly spelt out the term of the policy as 32 years having the sum assured of Rs.8lacs. In Ex.R5, the first premium receipt, the premium due was shown to be falling on 24th February of every year and the next due date was disclosed as 24.2.2010.In that way the complainant knew it very much from the very beginning about the nature of the policy qua the terms and conditions there of purchased by her. 15. There is no evidence to have been led by the complainant that she had ever filed any application, before the ops within Free Look Period for reviewing the terms and conditions of the policy. The complainant had sent the notice,Ex.R9 to the ops on 6.8.2010 i.e. much after the expiry date of the first premium due asking for the refund of the amount of the premium paid by her. 16. It was submitted by the learned counsel for the ops that the insurance policy does not provide for the refund of the premium and that under clause 15 of the insurance policy,Ex.R6, there is a provision for surrender benefit. It is provided that no surrender value is payable before 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 less the surrender charge as mentioned in clause 11(D) . For the purpose of surrender benefit the fund value in the unit account will be determined using the net asset value as on the corresponding valuation date falling on or immediately after the date on receipt of written request at the designated office. 17. It was submitted by the learned counsel for the ops that it is provided under clause 19 of the policy that, “during the three policy years,, if the Regular Premium is not paid within the grace period, the policy shall lapse. Once the policy lapses, the coverage under the policy ceases and deduction of mortality charges and rider premium charges, if any will be stopped. However, the policy would be still linked to the units until either reinstated as in clause 20 or surrendered as in clause 15. The policy administration charges would continue to be deducted. After the first three policy years, if regular premiums paid are not according to the attached schedule, the insurance cover would be extended subject to clause 21.” 19. Similarly the learned counsel for the ops submitted that under clause 20 pertaining to the reinstatement, it is provided that if the policy lapse during the first three policy years, the owner may reinstate the policy while the insured is alive if the owner: requests in writing for reinstatement within two years from the date the policy lapsed.(2) Provides satisfactory evidence of insurability(3) pays all due premiums to the date of reinstatement”. 20. `In the light of the aforesaid clauses of the insurance policy, it was submitted by the learned counsel for the ops that the policy has already lapsed and no benefit can be given to the complainant. 21. We have considered the submissions and find that in view of the aforesaid facts and circumstances discussed above, it would appear that the complainant has not approached the Forum with clean hands and she suppressed the material facts from the Forum that she purchased Met Smart Premium, a whole life Unit Linked Policy plan and she failed to adhere to the terms and conditions of the same, in as much as she failed to pay the first premium due and without having availed of the free look period provisions has approached this Forum for the refund of the premium amount, which is not provided under the terms and conditions of the insurance policy and consequently we do not find any substance in the complaint and the same is hereby dismissed. Pronounced. Dated:22.9.2011 Neelam Gupta D.R.Arora Member President
| | Smt. Neelam Gupta, Member | HONABLE MR. D.R.Arora, PRESIDENT | , | | 
