Date of filing:      15.11.2019

                                                                                                                                 Date of disposal : 29.11.2022

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

THIRUVALLUR

 

 BEFORE  TMT. Dr.S.M. LATHA MAHESWARI, M.A.,M.L, Ph.D (Law)                 .…. PRESIDENT

                 THIRU.P.MURUGAN,M.Com.ICWA(Inter),B.L.,                                        ....MEMBER-II

 

RBT/CC. No.52/2022

THIS TUESDAY, THE 29th DAY OF NOVEMBER 2022

(CC.No.26/2019 sent from DCDRC, Chennai North)

 

Mr.Kottai Kulandai,

No.33-D, Balaji Nagar 1st Street,

Royapettah, Chennai 600 014.                                                  .........Complainant. 

                                                                          //Vs//

1.M/s.UTI Financial Centre,

   Rep. by its Branch Manager,

   Capital Tower, Ground Floor,

   No.180, Kodambakkam High Road,

   Nungambakkam, Chennai -600 034.

 

2.M/s.UTI Mutual Funds,

    M/s.Karvy Computer Share Private Limited,

    Rep. by its Regional Manager,

    Serilim Gampally, Hyderabad -500 032.                                   ...Opposite parties

 

Counsel for the complainant                              :   M/s.A.P.Ramesh, Advocate.

Counsel for the opposite parties                      :   M/s.S.Indumathi Ravi, Advocate.

                         

This complaint has been filed before DCDRC, Chennai (North) as CC.No.26/2019 and transferred to this commission by the order of the Hon’ble State Consumer Disputes Redressal Commission, Chennai and taken on file as CC.No.52/2022 and this complaint coming before us on various dates and finally on 08.11.2022 and  upon perusing the documents and evidences of both sides, this Commission delivered the following: 

 

ORDER

PRONOUNCED BY TMT. Dr.S.M. LATHA MAHESWARI,   PRESIDENT.

 

This complaint was filed by the complainant u/s 12 of the Consumer Protection Act, 1986 alleging deficiency in service against the opposite parties  in repudiating the insurance claim along with a prayer to direct the opposite parties to pay a sum of Rs.2,00,000/- towards compensation for the mental agony and hardship caused to the complaiannt and to pay a sum of Rs.2,50,000/- being the eligible insurance policy target amount along with cost of the proceeding to the complainant. 

Summary of facts culminating into complaint:-

 

It was the case of the complainant that in the year 2007 opposite parties had approached the complainant and requested to join in UTI Mutual Fund and the opposite parties officials had explained about the Mutual Fund and thereafter they also furnished informations about the maturity amount under various mutual fund scheme. Upon such promise and assurance the complainant decided to enroll as a member in the UTI Mutual Fund in his wife name Angela Kulandai vide Folio No.51417497179.  She joined in UTI-ULIP Scheme as on 2nd November 2007.  As per the clause and condition mentioned in the plan, the complainant has to pay yearly premium a sum of Rs.25,000/- per year for a period of 10 years and the said UTI-ULIP policy would be matured after the expiry period of 10 years. Complainant Kottai Kulandai has been shown as nominee in the UTI-ULIP scheme enrolled in the complainant’s wife name. The complainant paid the entire premium amount and during the period the same got matured.  She paid last premium amount on 09.11.2016.  The Policy Holder, complainant‘s wife Angela Kulandai expired on 15.05.2017 leaving behind the complainant as sole and surviving legal heir to succeed. The complainant made a representation to the opposite parties to receive the matured UTI-ULIP Insurance Policy in the complainant‘s wife name.  After receipt of the same letter UTI has transmitted the actual value of amount of unit to the nominee account i.e. complainant‘s bank account on 28.07.2017.  In the said representation the complainant also mentioned about to arrange for getting the eligible amount of life insurance coverage under the ULIP scheme but opposite parties kept silent. Policy holder i.e. the complainant‘s wife Angela Kulandai expired on 15.05.2017 before six month period of maturity of the scheme and hence fully eligible for insurance coverage. Complainant forwarded a representation to the UTI Head Office at Hyderabad for getting the eligible amount of life insurance coverage under ULIP Scheme, the same was received by them, but of no use since no reply. Thus the complainant issued a legal notice but they neither came forward to settle the matter nor responded for the same. Thus aggrieved by the act of the opposite parties the present complaint was filed to direct the opposite parties to pay a sum of Rs.2,00,000/- towards compensation for the mental agony and hardship caused to the complaiannt and to pay a sum of Rs.2,50,000/- being the eligible insurance policy target amount along with cost of the proceeding to the complainant. 

Crux of the defence put forth by the opposite parties:- 

The opposite parties filed version disputing the complaint allegations contending interalia that the present complaint was without any actionable cause, as the complainants have failed to disclose any facts to support the allegations of any deficiency in service. Taking into consideration the complainant’s ability to invest and the risk factors involved, provided all the information to the complainant to take a decision in opting to investment in a particular Mutual Fund Scheme.  Since the complainant wanted to take a mutual fund in the name of his wife, several options and the mutual fund policies were clearly explained to the complainant and based upon the feedback, the complainant chose to opt for UTI Unit Life Insurance Policy Scheme only after understanding the complete benefits and other terms and conditions pertaining to the said policy.  Before investing in the said scheme, a copy of the scheme information document was completely read over by the complainant and his wife and after having understood the complete documents, agreed to opt for the said scheme.  There has been no compulsion or coercion on the part of the opposite parties to influence the complainant to invest in one particular scheme. Under the said UTI ULIP Scheme the plan was either for ten year or 15 years, which are the options available for the unit holder to decide.  The complainant opted for maturity of the policy having an expiry period of 10 years.  In addition to the choice of the two plans there was also two other options namely an option of Declining Terms Insurance Cover and Fixed Term Insurance.  The complainant opted for Declining Term Insurance Cover.  The difference between the two was that in Declining Term Insurance Cover, Life Insurance Cover was provided to the extent of the unpaid chosen target amount in the event of any eventualities which does not extend towards non-payment of due amount which ought to have been paid. In the present plan opted by the complainant, the Unit Holder had chosen ten years plan by placing target amount of Rs.2,50,000/- which amount was fully paid by the Unit Holder as early as on 09.11.2016 much ahead of the maturity date and the opposite parties have duly remitted a sum of Rs.4,06,985.73/- subsequent to the date of maturity i.e. on 28.06.2017.  Complainant opted to pay an initial sum of Rs.25,000/- at the time of lodging the Application fixing the target amount as Rs.2,50,000/-.  The yearly premium amount to be paid was directly paid by the complainant’s wife through her bank account for the said scheme. Complainant’s wife had paid the entire premium amount and the same got got matured.  She had paid the last due of tenth premium on 09.11.2016 and thereafter expired on 15.05.2017.  It was also admitted by the complainant that after the death of the policy holder the complainant had approached the opposite parties to receive the maturity UTI ULIP Insurance Policy to be handed over to the complainant who was the nominee for the said scheme.  The complainant was called upon to furnish certain documents which the complainant had furnished and that the opposite parties upon verification of the said documents transmitted the maturity amount of Rs.4,06,985.73/-.  Hence for the total purchase value of Rs.2,50,000/-, the opposite parties have transmitted a sum of Rs.4,06,985.73/- on the date of redemption i.e. on 28.07.2017.  However, the complainant after receiving the maturity amount has been insisting upon his eligibility to an amount under the life insurance coverage under the UTI ULIP Insurance Scheme. As per the UTI ULIP SIP and MICRO SIP Instruction Manual it was clearly stated that for a scheme opted under the Declining Terms Insurance cover, the Life Insurance Cover was to the extent of unpaid amount of the chosen target amount.  The Policy had clearly made a distinction between the unpaid amount and due amount in the sense assuming if a Unit Holder expired six months before the date of the maturity of the scheme, the complainant was entitled to receive the Life Insurance Cover to the extent of unpaid target amount.  However, in the case of complainant’s wife, the complainant himself admits that the unit holder even before her unfortunate demise on 15.05.2017 had paid the last premium amount on 09.11.2016.  Hence there was no unpaid amount to reach the target amount for claiming the Life Insurance Cover under the Scheme of Declining Term Insurance Cover. In such circumstances the opposite parties have diligently upon submitting the forms transmitted a sum of Rs.4,06,985.73/- to the nominee, the complainant herein.  The opposite parties clearly explained to the complainant that in view of the fact that the investor has expired after payment of the entire term of investment, his wife would not be eligible for any insurance coverage.  Complainant has not made out any cause of action for entertaining the present complaint as against the opposite parties and thus they sought for the complaint to be dismissed.

On the side of complainant proof affidavit was filed and submitted documents marked as Ex.A1 to A9. The opposite parties filed proof affidavit and submitted documents marked as Ex.B1 on their side.

Points for consideration:

Whether the repudiation of insurance claim raised by the complainant for the death of his wife by the opposite parties amounted to deficiency in service?

If so to what reliefs the complainant is entitled?

Point No.1;-

The following documents were filed on the side of complainant in support of his contentions;

UTI Insurance Plan Application was marked as Ex.A1;

UTI-ULIP Slip and Micro SIP Instruction was marked as Ex.A2;

Account Statements was marked as Ex.A3;

Death Certificate of K.Angela Kulandai dated 27.05.2017 was marked as Ex.A4;

 Representation letter given by the complainant to the opposite party dated 17.07.2017 was marked as Ex.A5;

Reminder letter sent by the complainant dated 17.08.2017 was marked as Ex.A6;

Representation letter given by the complainant to the opposite party dated 05.02.2018 was marked as Ex.A7;

Legal notice issued by the complainant dated 28.06.2018 was marked as Ex.A8;

Acknowledgement card for proof of delivery was marked as Ex.A9;

On the side of opposite parties the following documents were filed in proof of their defence;

a) UTI ULIP & MICRO SIP Instruction Manual was marked as Ex.B1;

  Point No.1:-

Written arguments filed by the complainant and it was represented that the same may be treated as oral arguments.  On the side of opposite parties written arguments was filed and oral arguments was also made.

The crux of the written arguments filed by the complainant is that he had taken a policy in his wife’s name in UTI ULIP Scheme and the maturity of the policy was fixed at 10 years i.e. on 02.11.2017.  Entire premium amount, even the last premium was filed.  The complainant’s wife expired on 15.05.2017. The complainant approached the opposite parties for maturity sum and the insurance amount however they paid only the maturity sum assured and not the insurance claim.  It is submitted by him that the complainant’s wife had died within the policy period and hence was entitled to the insurance claim under the Life Insurance Coverage UTI, ULIP Insurance scheme. This has been mentioned in UTI ULIP SIP and MICRO SIP Instruction Manual.  Inspite of making representation dated 17.07.2017 the insurance claim was not paid.  Thus the complaint sought for the insurance claim for the death of his wife.

On the other hand, in nutshell the opposite parties argued that after the death of the complainant’s wife on 15.12.2012 the maturity amount of Rs.4,06,985.73/- was paid to the complainant. The policy period was between 02.11.2007 to 02.11.2017. However, as the complainant had choosed declining term insurance cover and that even before the death of the complainant’s wife the entire premium amount has been paid there was no unpaid amount to reach the target amount for claiming the Life Insurance Cover under the scheme of Declining Term Insurance Cover.  This aspect was misunderstood by the complainant. Thus stating that there is no deficiency on their side the opposite parties counsel sought for dismissal of the complaint.

On perusal of the entire pleadings and materials this commission is of the view that the defence raised by the opposite parties seems to be acceptable as even vide Ex.A2 the policy document filed by the complainant under clause 6 it has been given clearly as follows;

Under Declining Term Insurance Cover: Life Insurance cover is to the extent of the unpaid but not due amount of the chosen target amount as applicable for the yearly instalment payment.  No life insurance cover is payable in case of death less than 6 months from the commencement of membership.  For 6 months and above but less than 1 year the life insurance cover is 50% of the target amount unpaid but not due. For example for target amount of Rs.1,20,000/- under the 10 year plan, the yearly instalment due is Rs.12,000/- and the unit holder had died after paying only Rs.7,000/- (7monthly instalments) the Life insurance Cover payable is 50% of Rs.1,20,000/- less Rs.12,000/- i.e. Rs.54,000/- and not Rs.56,500/- (50%of Rs.1,20,000/- less Rs.7,000/-).  For 1 year and above 100% of the target amount unpaid but not due is payable.  For example under the10 year plan for a target amount of Rs.1,20,000/- in case a unitholder dies after payment 15 instalments (Rs.15,000/- the life insurance cover payable is Rs.1,20,000/- less Rs.24,000/- i.e.Rs.96,000/-).

It is not disputed that the complainant had opted for declining Term Insurance Cover which aspect is evident as per Ex.A3 wherein it has been clearly stated that UTI – UNIT LINKED INSURANCE PLAN – 10 YEAR PLAN – DECLINING TERM INSURNACE COVER and the Balance  Units: 17,415.699/-.  Thus when the entire premium has been paid by the complainant’s wife, he is not entitled for the insurance claim for the death of his wife as already the premium amount was paid and also he had received the maturity sum assured as per the terms and conditions of the policy.  Hence this commission holds that no deficiency in service was committed by the opposite parties in declining the insurance claim made by the complainant.  This point is answered accordingly. 

Point No.2:-

As we have held above that the complainant had failed to prove any deficiency in service on the part of the opposite parties, he is not entitled to any reliefs as claimed in the complaint from the opposite party.  Thus we answer the point accordingly.

In the result, the complaint is dismissed.  No order as to cost. 

Dictated by the President to the steno-typist, transcribed and computerized by him, corrected by the President and pronounced by us in the open Commission on this the 29th day of November 2022.

 

  Sd/-                                                                                                                  Sd/- 

MEMBER-II                                                                                                    PRESIDENT

 

List of document filed by the complainant:-

 

Ex.A1 01.11.2007 UTI Insurance Plan Application. Xerox

Ex.A2 01.11.2018 UTI-ULIP Slip and Micro SIP Instruction Manual. Xerox

Ex.A3 ............... Account Statements series. Xerox

Ex.A4 27.05.2017 Death Certificate of K.Aagela Kulandai. Xerox

Ex.A5 17.07.2017 Representation letter. Xerox

Ex.A6 17.08.2017 Reminder letter. Xerox

Ex.A7 05.02.2018 Representation letter. Xerox

Ex.A8 28.06.2018 Legal notice. Xerox

Ex.A9 .............. Acknowledgement card. Xerox

 

List of documents filed by the opposite party:-

 

Ex.B1 .................. UTI-ULIP Slip and Micro SIP Instruction Manual. Xerox

 

 

 

   Sd/-                                                                                                                Sd/-

MEMBER-II                                                                                                  PRESIDENT