DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PALAKKAD
Dated this the 30th day of October 2020
Present: Sri.V.P.Anantha Narayanan, Member(President I/c)
: Smt.Vidya.A, Member Date of Filing:23/09/2016
CC /143/2016
Anusree.P.V,
D/o.P.V.Haridas, - Complainant
Puthan Variyam,
Pullode, Puthiyankam,
Erimayur, Palakkad,
Kerala - 678 545.
(By Adv.Viju Rapheal)
V/s
1. M/s.Tata AIA Life Insurance Company Ltd.,
(Represented by its Managing Director)
Corporate Office: Delphi-B Wing,
2nd Floor, Orchard Avenue,
Hiranandani Business Park, Powai,
Mumbai – 400 076.
2. The Manager, - Opposite parties
Tata AIA Life Insurance Company Limited,
2nd Floor, Malabar Fort, Kandath Complex,
Kandath Sudevan Road,
Sulthanpet, Palakkad – 678 011.
(By Adv.Ullas Sudhakaran for Opp. parties 1&2)
O R D E R
By Smt.Vidya.A, Member
Brief facts of the complaint
The complainant had joined the insurance scheme by the opposite parties by the name Tata AIA Life Insurance Maha Life Supreme(110N105vo1) on 20/12/2012 after paying an insurance premium of Rs.15,464/-. One of the agents of the opposite parties approached the complainant and stated that the insurance policy of the opposite parties had a term of 15 years and if the complainant pays three years premium, she can withdraw the premium amount as well as the benefits accrued on it, after completion of three years. The agent had also given a rosy picture of the benefits that would be accrued on completion of three years and showed her the table of benefits printed, published and circulated by the opposite parties to make her believe the claims put forth by him and forced the complainant to join the insurance scheme.
The complainant approached the branch office to know about the benefits and the officers of the opposite parties who were present in the office also explained about the benefits that would be accrued to her after the completion of three years and misled her to join the policy of the opposite parties. Neither the agent nor the officials of the opposite parties tried to make her understand the terms of the policy. The officials of the opposite parties who were present in the office made her sign in the dotted lines of the application form of the policy which was blank and was in English language which was not so familiar to the complainant. She was not even given an opportunity to read and comprehend the content of the application form which she had signed. They asked her some details about her job, income, nominee details and some questions relating to health and the first premium amount of Rs.15,464/- was collected from the complainant and assured her that the policy documents will be send to her house address from their corporate office at Mumbai. The officials of the opposite parties further assured the complainant that after the payment of insurance premium for three years, she can come and collect the insurance premium already paid along with the benefits accrued to the policy.
Believing the assurances and representations made by the officials of the opposite parties as well as their agent, the complainant had joined the insurance scheme and had paid the 1st installment. After the receipt of the policy document, she enquired with the agent whether she need to do anything with the policy document for which he assured her that all is well with the policy and she had only to pay the premium amount for next two years and at the end of three years, she will be entitled to the premium already paid along with the benefits. The complainant who is a young lady, self earner and belonging to low income group joined the insurance scheme of the opposite party for making some savings for her future needs. The complainant had no doubt about the credibility of the assurances given by the agent and the officials at the branch office of the opposite party. Hence based on these assurances, the complainant started paying the premium as directed by the officials of the opposite parties and altogether she had paid Rs.45,930/- for three years. The 3rd premium was paid on 22/12/2014 and after that the complainant approached the opposite parties for the assured benefits along with the premium amount paid by her towards the policy. But to the utter surprise and shock of the complainant, the officials of the opposite parties did not give the assured benefits and premium amount to the complainant. Finally the complainant sent a registered lawyer notice to the opposite parties demanding at least the paid premium amount and 12% interest of the said amount. But the opposite party did not pay the amount or gave a reply. The opposite party had sent a letter to the complainant demanding some more details from the complainant which she had already given when she approached the branch office for the receipt of benefit. The complainant had made sincere efforts to get the legally entitled amount under the insurance policy from the opposite party, but all went in vein. This caused great mental pain, agony and financial loss to the complainant. These acts of the opposite parties amount to clear deficiency of service and unfair trade practice. Hence this complainant is filed for getting an order directing the opposite parties jointly and severally to pay the paid premium amount of Rs.45,930/- with accrued benefits on premium as on 22/12/2014 when the complainant paid the 3rd premium amount along with 12% interest till realization and a compensation of Rs.75,000/- for mental agony and to pay the cost of the proceedings.
Complaint admitted and notice issued to both opposite parties. Both opposite parties appeared and filed their version.
The main contentions raised in the version of opposite party 1 & 2:
The opposite parties admits the fact that the complainant had joined the Insurance Policy named Tata AIA Life Insurance Maha Life Supreme as per policy number C225353273 issued by the opposite parties. But they denied the allegation that the complainant was lured into joining the scheme by the opposite parties and that the agent of the opposite parties stated the complainant that if she pays the premium for three years, she can withdraw the premium amount as well as the benefits accrued on completion of three years. According to them, the policy availed by the complainant from the opposite parties on 20/12/2012 is an Endowment Assurance Plan named “Tata AIA Life Insurance Maha Life Supreme” and its policy number is C225353273 and its date of maturity is 24/12/2047 and the mode of payment of premium is annual and the premium is to be paid for 15 years and the due date for payment of last premium is 24/12/2026.
The opposite parties admit that the complainant had paid Rs.45,930/- as premium for 3 years and the 3rd premium was paid on 22/12/2014. The opposite parties had vehemently denied all other averments in the complaint. According to them, their officials had clearly explained to the complainant about the terms and conditions, premium to be paid and the benefits of availing the policy and the complainant joined in the policy after properly understanding the same. Complainant is a graduate and it was the complainant who had filled up the application form for availing the policy and she had signed the same after reading and understanding the contents of the application form. The sales benefits illustration provided to the complainant prior to the availing of policy clearly depicts the benefit period as 35 years, premium paying period as 15 years, annual premium as Rs.15,000/- and the sum assured as Rs.1,50,000/-. Policy holder is also liable to pay service tax on premium at a rate fixed by the Government. Complainant is provided an option to surrender the policy after payment of premium for three years and under such circumstance, the complainant would be entitled to 30% of the total premium paid till date after excluding the premium paid for the 1st year. This condition is specifically mentioned in the projection of values attached to the sales benefit illustration provided to the complainant and she had declared that she had received a copy of this and understood the benefits and had signed the same. After availing the policy, original policy with conditions attached was also send to the complainant and the complainant was given an opportunity to return the policy within 15 days of receipt of the same if any of the conditions or clauses attached to the policy issued to her was not acceptable to the complainant under “Free Look Cancellation” and under such circumstances the opposite parties were bound to pay back whatever amount that was paid by the complainant for availing the policy.
The complainant after receiving the policy did not raise any objection with regard to any of the clauses and conditions attached to the policy and did not choose to return the same; but paid premium for three years. Under such circumstance, now she cannot raise a contention that she did not read and understood the conditions and clauses attached to the policy and she had signed in the dotted space in the blank application as per the instructions given by the officials of the opposite parties.
Complainant is a graduate and she cannot say that the application form was in English which was not familiar to her and so she was not bound by the terms and conditions of the policy.
In spite of the repeated reminders from the opposite parties the complainant did not remit the premium for the 4th year and so they were constrained to issue a notice on 25/01/2016 intimating that as the premium is not paid, all the benefits under the policy stands forfeited and an option was given to the complainant for reinstating the policy by clearing the dues. But the complainant did not avail that option and insisted for return of the premium amount to which she is not legally entitled. Repudiation of the complainant’s claim by the opposite parties is legal and the same would not amount to deficiency of service or unlawful trade practice as alleged by the complainant.
Complainant is not legally entitled for any of the reliefs claimed in the complaint and the opposite parties are not liable to pay any cost. Hence this complaint has to be dismissed with cost to the opposite parties.
From the side of the complainant, chief affidavit filed. Ext.A1 to A4 were marked and the Power of Attorney Holder(Father) of the complainant was examined as PW1. From the side of the opposite parties chief affidavit filed. Ext.B1 to B5 were marked and the Branch Assistant Manager of the opposite party was examined as DW1.
Main issues arising for consideration are:
- Whether there is any deficiency of service on the part of the opposite parties?
- If so, what is the relief as to cost/Compensation?
Issues 1&2
Heard both parties. We have perused the chief affidavits, documents and written arguments filed by both sides. It is admitted fact that the complainant joined in the insurance scheme named “Tata AIA Life Insurance Maha Life Supreme” as per policy numbered C225353273 issued by the opposite parties. It is also admitted by the opposite parties that the complainant paid premium for three years and a total amount of Rs.45,930/- was paid by the complainant and the third premium was paid on 22/12/2014.
The main contention of the complainant is that the complainant was lured into joining the insurance scheme of the opposite parties, by one of the agents of the opposite parties who misrepresented her that eventhough the premium paying term is 15 years, if the complainant pays three years premium, she is entitled to withdraw the premium as well as the benefits accrued on it after completion of three years. In this context it can be seen that Ext.A1 is the ‘policy document’ and the “proposal form” therein is signed by the complainant. Eventhough the complainant, in her complaint had stated that she was not given an opportunity to read and understand the policy terms and conditions and made to sign in the dotted lines provided for putting signatures by the officials of opposite party and the application form was filled by the agent without explaining the terms, that cannot be accepted. When a person signs a document which contains certain contractual terms, normally the parties are bound by such contract. When a party to the contract disputes the binding nature of the signed document, it is for him/her to prove the terms in the contract or the circumstances in which he/she came to sign the documents need to be established. So the complainant has to prove by cogent evidence the circumstances under which she came to sign the document and entered into the contract with the opposite party. Here in this case, no substantial evidence had been brought by the complainant to show that the misrepresentation on the part of the agent and officials of the opposite party made her join in the insurance scheme. Moreover the complainant as deposed by her father is a post graduate and in the normal circumstances should be able to read and understand the contents of the proposal form. The policy term, premium paying term, annual premium and the sum assured are clearly mentioned in the application form (proposal form). The complainant had signed the ‘declaration’ that she had received a copy of the “Sales Benefit Illustration”. In that also the particulars of insurance such as Benefit Period, Premium Paying Period, Annual premium and sum assured are clearly shown.
The policy also offers a ‘Free Look Period’ of 15 days after the receipt of the policy document. In that period, if the insurer is not satisfied with the terms and conditions of the policy, they can cancel the policy by giving a written notice in which case the insurer is entitled to premium paid into the policy after deducting some charges.
Here in this case, after receiving the policy document, the complainant did not opt for cancellation of the policy which means she has accepted the terms in the policy. So the complainant is bound by the terms of the policy and she is not entitled to claim anything more than what is covered by the insurance policy.
According to the complainant after paying the premium for three years, she approached the opposite party branch office for getting the premium amount and benefits and the officials of the opposite parties did not pay any money or attend her grievance properly. So the complainant was forced to send a ‘Lawyer Notice’ to the opposite parties.
It can be seen that Ext.A3 is the ‘Lawyer Notice’ sent by the complainant to the opposite parties on 17/06/2016 and Ext.A4 is the reply given by them. In Ext.A3, the complainant’s grievances are clearly explained and it clearly demands refund of the premium amount of Rs.45,930/-, paid by the complainant with 12% interest within seven days of the receipts of the notice.
In this context, it is pertinent to note that, the opposite parties in their reply notice has not mentioned anything about this. Further, they have asked for some more details from the complainant which according to her were already provided at the time of joining the policy. Ext.‘A3’ is clearly a ‘legal notice’ for which the opposite parties as the ‘Insurer’ is bound to reply. Instead of giving reply to the contents mentioned in Ext.A3, they have stated in Ext.A4 that it is not a ‘legal notice’ and asked for further details to examine the matter. In Ext.A4, the opposite parties could have explained in detail, the amount which the complainant is entitled to get on the discontinuation of the payment of premium and other matters related to it. The opposite party’s Manager who was examined as ‘DW1’ was asked about ‘Ext.A3’and ‘Ext.A4’ during his cross examination for which he answered that “complainant AS¨ XpI Xncn¨p thWsa¶v Bhiys¸«v kao]n¨ncp¶p. Cu XpI Bhiys¸«psImv complainant ‘legal notice’ BWv I¼\n¡b¨n«pÅXv. B t\m«okn\v phoneeqsSbmWv adp]Sn \ÂInbXv. Ext.A4 t\m«okv ‘further discussion-sâ `mKambn«v complaint close sN¿pt¼mÄ system generated Bbn t]mIp¶XmWv”. Then the witness added that Ext.A4 is ‘not system generated’. If the opposite parties had given a reply to the Ext.A3 ‘legal notice’ and Ext.A4 is sent only as a continuation of the discussion, they would have definitely mentioned this in Ext.A4. But nothing is there in Ext.A4 to show that they have properly explained to the complainant about the benefits and surrender value which she is entitled to get after the payment of premium for 3 years and the consequence if she discontinue the payment of premium after three years. So there is a clear deficiency in service on the part of the opposite parties in not properly informing their client about the amounts and benefits which she is entitled to even after her repeated enquiries and ‘legal notice’ asking for the amount. Accordingly they have to compensate the complainant for the deficiency in service on their part.
DW1 had deposed that the complainant is entitled to get surrender value as per the policy terms. As per his deposition “Terms of policy {]Imcw 3 hÀjw default CÃmsX {]oanbw AS¨pIgnªm policy holder¡v benefit\v AÀlXbpv. AhÀ¡v Hcp surrender value BWv In«p¶Xv. 3 hÀjw AS¨pIgnªm 30% of amount – first year payment BWv In«p¶Xv. Ext.B3, benefit illustration mention sNbvXn«pv. He further added that “policybpsS 13þ)as¯ t]Pn Non-forfeiture provision F¶p ]dª clause BWXv. AXn Guaranteed surrender value F¶ clauseemWv CXp ]dªncn¡p¶Xv. CXn option(a) guaranteed surrender value In«m\mWv CXnse lÀPn¡mcn¡v AÀlXbpÅXv.”
So the complainant is entitled to get the surrender value ie. 30% of the total premium paid excluding the premium paid for the 1st year.
Further, it is clear from the deposition of DW1 that the complainant had approached the 2nd opposite party’s office demanding the amount paid by her and she also sent a legal notice asking for the amount paid by her along with interest.
But the opposite parties had not paid the amount when she approached the 2nd opposite party’s office for the amount or even after sending the lawyer’s notice. This would have definitely caused mental agony to the complainant and forced her to file the present complaint. Hence the deficiency in service on the part of the opposite parties had caused mental agony and financial loss to the complainant for which they had to compensate her.
In the result, the complaint is partly allowed.
The opposite parties are jointly and severally liable to pay the surrender value of Rs.9,140/-(Rupees Nine thousand One hundred and Forty only) plus 9% interest per annum from July 2016(ie. 7 days after the receipt of legal notice) till realization and Rs.5,000/-(Rupees Five thousand only) for mental agony caused to the complainant and Rs.5,000/-(Rupees Five thousand only) as cost of litigation.
Order shall be complied within one month from the date of receipt of this order.
Pronounced in the open court on this the 30th day of October 2020.
Sd/-
V.P.Anantha Narayanan
Member(President I/c)
Sd/-
Vidya.A
Member
Appendix
Exhibits marked on the side of complainant
Ext.A1 – Original insurance policy issued by the opposite party dated 27/12/2012.
Ext.A2 – Original receipt for payment of 3rd yearly premium dated 22/12/2014.
Ext.A3(series)– Copy of lawyer notice issued to the opposite party dated 17/06/2016.
Ext.A4 – Original letter issued by the opposite party to the complainant dated 22/06/2016.
Exhibits marked on the side of Opposite parties
Ext.B1 – Application form dated 20/12/2012
Ext.B2 – Policy copy and conditions.
Ext.B3 series – Sales benefit illustration.
Ext.B4 – Copy of Premium payment notice dated 24/11/2015
Ext.B5 – Copy of lapse notice dated 25/01/2016.
Witness examined on the side of complainant
PW1 – Haridas
Witness examined on the side of opposite parties
DW1 – Arunkrishna.P.A
Cost : Rs.5,000/-
