IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOLLAM
DATED THIS THE 29TH DAY OF December 2015
Present: - Smt. G.Vasanthakumari, President
Adv. Ravisusha, Member
Adv.M.Praveen Kumar, Member
CC.No.02/2014
B.Sasidharan : Complainant
S/o Bhargavan
Pournami
Kulangarabhagom
Chavara
Kollam
[By Adv.Alex Thomas, Kollam]
V/S
1. M/s Bajaj Allianz Life Insurance : Opposite parties
Company Ltd. Reg. Office at G.E. Plaza
2nd Floor, Airport Road , Yerawara
Pune -411006
2. The Branch Manager
Bajaj Allianz Life Insurance Company Ltd.
Branch Office
Kollam
[By Adv.Venu.J.Pillai, Kollam]
ORDER
ADV. M. PRAVEEN KUMAR, MEMBER
Complainant’s case is that the complainant is the husband and nominee of Late.Smt.M.G.Beena Kumari, ‘Pournami’ Kulangarabhagom, Chavara, Kollam who had insured her life with the opposite parties for an assured sum of Rs.2,50,000/- as per Policy No.0077876418. The risk covered by the said policy commenced on 10/12/2007. The complainant was the nominee in the said policy who is entitled to receive the benefits under the policy upon the death of the life assured. The said Smt.M.G.Beena Kumari passed away on 22/11/2012.
(2)
When the said policy was issued in favour of wife of the complainant, the complainant and his deceased wife were given to understand that the policy holder need pay premium only once. Therefore, when the complainant submitted the claim form before the opposite parties demanding the sum assured and other benefits under the said policy, the opposite parties have refused to honour their commitment but instead sent to the complainant a cheque for Rs.31,413/- claiming that they have repudiated the complainants claim on the specious ground that the said policy lapsed due to nonpayment of subsequent premium installments. Since the said payment was not as promised by the opposite parties, the complainant refused to accept the said payment but returned it to the opposite parties.
Opposite parties have assured her and the complainant that on the death of the life assured before the maturity date, opposite parties will pay the nominee the sum assured, the top up premium sum assured, the regular premium fund value and the top up premium fund value as on the date of receipt of intimation of death to the opposite parties. Again the opposite parties have also assured the policy holder and complainant that if the policy has lapsed and the death of the life assured occurs during this period, the regular premium fund value as on date of receipt of intimation of death plus the top up premium fund value as on date of intimation of death would be paid to the nominee. The said assurances were made by the opposite parties through heir authorized agent Sri.D.Amrithlal, Suryavamsom, Uliyakkovil, Kollam. Policy holder’s initial premium of Rs.50,000/- which she paid on 10/12/2007 has now only a premium fund value of Rs.31,413/-. The complainant issued notices of demand to both the opposite parties on 10/05/2013 calling upon them to pay the complainant the sum assured of Rs.2,50,000/- along with other benefits within 15 days from the date of receipt of this notice along with the notice charge. Both the opposite parties duly received the said notice but have not cared to settle the said claim. Instead, they send a reply dated 05/06/2013 to the complainant containing false allegations. The opposite parties adopted an ‘unfair trade practice’ and there is ‘deficiency in service’ on the part of the opposite parties while repudiating the claim of the complainant. The complainant is entitled to get 18% interest also for the said amount from the date of death of the policy holder. Hence the complainant is praying to pass an order directing the opposite parties to disburse the said assured sum of Rs.2,50,000/- to the complainant as per the Policy No.0077876418 with 18% interest from the date of death of the insured till the date of realization of the said entire amount, award Rs.25,000/- as compensation for the mental agony and suffering
(3)
caused to the complainant due to the delayed and unreasonable repudiation of the claim of the complainant, and to allow Rs.5000/- towards cost to the complainant.
Opposite parties filed version contending that the Life Assured Smt.M.G.Beena Kumari had approached our insurance consultant and evinced interest to avail Bajaj Allianz Century Plus policy and accordingly executed proposal form. In the proposal from she had specifically selected for regular premium policy with premium payment term of three years and benefit term of 10 years. The premium payment mode opted by the policy holder was annual and premium amount was Rs.50,000/- and sum assured ie risk coverage under the policy was Rs.2,50,000/-. The policy holder after payment of 1st year premium, failed to pay subsequent year premium and as result policy was lapsed. As per clause 5,b,2, the policy can be revived within 4 years from the date of first unpaid premium and though the company is not liable to inform about the lapse and revival of policy as good will gesture and matter of fair practice the insurance company had contacted the policy holder many times over phone and also vide intimation letter informed the policy older to revive the policy. The policy holder failed to pay outstanding premium and revive policy and hence the policy was in lapsed conditions as on date of death of policy holder.
The policy holder may revive the policy within a revival period of four years from the due date of the first unpaid regular premium subject always to Section 5,d, and the company shall recover any due but unrecovered charges as per section 33 and section 34 except the mortality charge and any Rider Premium Charge, since due date of first unpaid regular premium, failing which the policy shall stand terminated and the surrender value as on date of termination as per Section 6,c, shall be paid at the expiry of the revival period of four years. First unpaid regular premium became due on 10/12/2008 and on 10/01/2009 policy got lapsed and all insurance covers provided including rider cover were withdrawn as per the policy terms and conditions. Further the policy holder had the option to revive the policy and accordingly last day to revive the policy expired on 10/12/2012. Since the policy holder ie the life assured died on 22/11/2012 before exhausting the revival period the entire fund value of Rs.31413/- without deductions of surrender charges were paid to the nominee of the policy holder account and
company is not liable to pay any further amount as prayed in the instant complaint by the complainant.
The points that come up for consideration are as follows:-
(1). Whether there is any deficiency in service on the part of opposite parties?
(4)
(2).Whether the complainant is entitle to get refund of Rs.2,50,000/- with 18% interest from the date of death of the insured from opposite parties ?
(3). Whether the opposite parties are liable to pay compensation and costs of the proceedings to the complainant?
The evidence in this case consists of the oral testimony of PW1 and PW2 and documentary evidence Exts P1 to P8.
The Points:- In order to prove the case of the complainant , complainant filed a proof affidavit in lieu of his chief examination along with 8 documents. On the basis of the proof affidavit, he was examined as PW1 and documents produced were marked as Exts P1 to P8.
It is an admitted fact that the complainant’s wife had taken a century plus policy in the year 2007 and premium of Rs.50,000/- was paid and counsel for the complainant argued that complainant’s wife had insured her life with the opposite parties for an assured sum of Rs.2,50,000/- as per policy number 0077876418 and the risk covered by the said policy commenced on 10/12/2007 and insured passed away on 22/11/2012, la ter complainant submitted claim form before the opposite parties demanding the sum assured and other benefits under the said policy, but opposite parties repudiated the claim given only a cheque of Rs.31,413/-hence it is clear case of deficiency in service on the part of opposite parties.
Opposite parties contended that the insured had availed Bajaj Allianz century plus policy and executed a proposal forum, in the proposal form she had specifically selected for regular premium policy with premium payment term of 3 years benefit term of 10 years, mode of payment was annual, premium amount was Rs.50,000/- and sum assured was Rs.2,50,000/- moreover the policy holder after payment of 1st year premium failed to pay subsequent year premium, and as a result the policy was lapsed ie first unpaid regular premium became due on 10/12/2008 and on 10/01/2009 policy got lapsed and all insurance covers withdrawn as per the policy terms and conditions, here the policy was not alive on 22/11/2012 ie the date of death of policy holder and also contended that they had not violated the terms and conditions of the policy document and there is no deficiency in service on the part of the opposite parties.
Complainant produced proposal form and marked as Ext.P1, which clearly seen that said policy is a Bajaj Allianz Century Plus policy having numbered 0077876418 regular premium of Rs.50,000/- , policy term is 10 years, sum assured is 2,50,000/-, premium paying term is 3 years,
(5)
frequency of premium payment is annual, due date of premium is 10 December of every year . More over complainant admitted that he had paid only one premium. Hon’ble National Commission in the Branch Manager Life Insurance Corporation of India and another V/s Sri Ranganathan (2014(2)CPR 230(NC) ) has observed that as policy lapsed before death of insured, no claim was payable under policy and in Sheela Devi V/s LIC of India (2014(2) CPR 557(NC) also observed that repudiation of death claim on ground of lapse of policy is proper.
On examination of the documents produced we are constrained to believe that out of 3 premiums, 2nd premium became due on 10/12/2008 and then after the policy got lapsed. Policy holder died on 22/11/2012. Hence complainant is not liable to get to the sum of Rs.2,50,000/- and other benefits. Since insurance being a contract between the parties , they are bound by the terms and conditions of the policy. It is settled position that nobody can go beyond the terms and conditions of the policy. Here the complainant failed to prove any violation of any of the conditions of the policy on the part of the opposite parties. We find that opposite parties have paid whatever amount complainant is entitled to. Hence we are not in a position to attribute any deficiency in service on the part of opposite parties.
In the result, the complaint is dismissed with no cost.
Dated this the 29th day of December 2015.
G.VASANTHAKUMARI:Sd/-
ADV.RAVISUSHA: Sd/-
ADV.M.PRAVEENKUMAR: Sd/-
Forwarded/by Order
Senior Superintendent
I N D E X
PW.1:-Sasidharan
PW.2:-Amrithalal
Ext.P.1:- Policy bond
Ext.P.2:- Premium receipt dated 10/12/2007
Ext.P.3:- Death certificate
Ext.P.4:- Repudiation letter dated 07/03/2013
Ext.P.5:-Advocate notice
(6)
Ext.P.6:- Reply notice
Ext.P.7:- Postal acknowledgment
Ext.P.8:- Acknowledgment card of opposite party
