DISTRICT CONSUMER DISPUTES REDRESSAL FORUM PALAKKAD
Dated this the 13th day of August 2012
Present : Smt.Seena H, President
: Smt. Preetha.G. Nair, Member
: Smt. Bhanumathi.A.K, Member Date of filing: 13/02/2012
(C.C.No.37/2012)
K.Ramakrishnan,
S/o.Narayanan (Late),
Kandayil Veedu,
Chirappadam,
Post Thenkara,
Mannarkkad – 678 761 - Complainant
(By Adv.K.Dhananjayan)
V/s
1. P.Devakumar,
S/o.Ramankutty Vaidyar (Late),
Puthukudi Chola Veedu,
Post Karakurissi,
Palakkad
2.Branch Manager,
Bajaj Allianz Life Insurance Company Ltd.
First Floor, Surumi Plaza Building,
Fort Maidan,
Palakkad – 678 001
(By Adv.Rajesh M Menon) - Opposite parties
O R D E R
By Smt.PREETHA G NAIR, MEMBER
The complainant is a handicapped and was employed as LD clerk in Health Department. The 1st opposite party is an agent of the 2nd opposite party. The complainant is made believe by the 1st opposite party to remit Rs.30,000/- only for getting benefit of the policy. Further the complainant stated that 1st opposite party has fraudly made a fitness certificate to join Bajaj Allianz Life Insurance. Now the complainant is a pensioner and his wife is a patient. The complainant was resided in the house of 1st opposite party on the year 2008. On 4/7/2008 the complainant availed a loan of Rs.1 lakh to repair his house. At that time the 1st opposite party told the complainant to deposit Rs.30,000/- in the 2nd opposite party company to get Rs.90,000/- after 3 years. Then the complainant given Rs.30,000/- to 1st opposite party on 4/7/2008 to deposit the 2nd opposite party company. On 18/8/2008 the 2nd opposite party issued a receipt. After 1 year the branch office of 2nd opposite party at Palakkad sent a notice to demand further payment of Rs.30,000/-. Then the complainant approached the 1st opposite party and told the non payment of further amount. The 1st opposite party told that if the complainant has not paid the 2nd and 3rd installment of Rs.30,000/- each the policy will be lapsed. At the time of taking the policy the 1st opposite party demanded the payment of Rs.30,000/- at one time. Now the 1st opposite party stated that Rs.30,000/- each will be paid on 3 years, otherwise the remitted amount will not be refunded. Then the complainant availed a loan from Mannarkkad Rural Service Co-operative bank and paid Rs.30,000/- as the 2nd installment on 10/6/2011. Thereafter the complainant retired from the service and his wife had became a patient. So the complainant could not paid the further amount.
At the time of joining the policy the 1st opposite party demanded the medical certificate to the complainant. But the doctor in primary health department has not given medical certificate and told that he had 60% handicap. But the 1st opposite party had fraudulently made a medical certificate without the knowledge of complainant and joined the insurance.
At the time of issuing the 3rd notice from Palakkad Office the complainant directly came to the office and stated the true facts to the Manager. Thereafter the Manger had given a cheque of Rs.16,265.80 and received original policy certificate. Then the complainant approached the 1st opposite party to refund the balance amount deposited in the 2nd opposite party. But the 1st opposite party denied the balance payment. The act of opposite parties amounts to deficiency in service. Hence the complainant prays an order directing the opposite parties to pay the balance amount of Rs.43,734.20 and Rs.25,000/- as the interest of the amount and pay Rs.25,000/- as compensation for mental agony. 2nd opposite party filed version stating the following contentions. The 1st opposite party is an agent of the 2nd opposite party is admitted. It is true that the complainant had opted life insurance in the 2nd opposite party. After complying with all the required formalities the policy numbered as 0104261430 has been issued to the complainant. The policy named as “Bajaj Allianz new Unit gain”, the complainant had agreed with terms and conditions of the policy. The period of policy terms is for 15 years and the frequency of payment is on annual basis. The date of commencement of the risk is from 18/8/2008 to 18/8/2023 as per the terms and conditions of the policy. The sum assured is Rs.2,40,000/-. Considering the earning capacity and other aspects and the medical records produced, the policy is issued to the complainant on 20/8/2008. The detailed terms and conditions of the policy alongwith the first premium receipt is been given to the complainant. In which a fifteen days free look period is offered for which the complainant is not opted. Even after receiving the policy the complainant did not raised any complaint till 17/10/11. On 17/10/11 the complainant had sent a letter to 2nd opposite party stating that kindly make necessary arrangements to refund the policy as per the policy conditions. The 2nd opposite party had taken steps for refund of the amount. After receiving the amount, the complainant has not raised any objection to further claim of any amount as alleged in the complaint. At the time of receiving the amount, the complainant did not raised any contention that he is having any objection to receive the amount.
As per the terms and conditions of the policy contained in clause No.15 the policy holder is entitled to return the policy if he is dissatisfied for any reason give a written notice to the insurance company for the cancellation of the policy and not thereafter . All the terms and conditions contained in the policy are duly approved by the insurance regulatory development authority before it is issued to the policy holders and hence the terms are legal and binding upon both the parties to the insurance contract.
Considering the situation of the complainant, a special favour was given to him by repaying the amount of Rs.16,265/-. All statements regarding the complainant is a handicapped and his wife is a patient is made without having any medical records. As per clause 5(b) and clause 6(c) of the policy terms the policy will derive surrender value only after completion of 3 years provided all due regular premiums during the first three policy years have been paid. In this case though the policy holder has paid only 2 premiums he is not entitled for payment of any money as per the clause. But the opposite party company as a good will gesture refunded Rs.16,265/- after deduction of necessary charges.
The complainant had approached the insurance company for the purpose of availing insurance policy mainly to cover the risk of his life and the benefit under the policy will accrue in long run.
Further he has given standing instructions to the company through his proposal form that 100% of the premium which would be paid by him be invested in equity growth fund II and hence the investment is subject to fluctuations of capital market and the entire risk in such investment is born by the policy holder and the insurance company is just a facilitator for investments. As per clause 33(g) of the policy terms if any due regular premium is not paid during the first three policy years then the surrender charge would be equal to the amount of 45% of the regular premium payable in the first policy year. It is not correct to say that the complainant is not understood the policy condition. The complainant had an opportunity to withdraw from the contract of policy and thereafter 15 days grace period which is normally as the free look period. If the complainant had any dispute with regard to the policy he ought to have availed the free look period stipulated in the policy. The company has no relation with the complainant and any critical condition as alleged by the complainant and any personal problems faced by the complainant cannot be a ground for making any illegal and non maintainable claims. Any discontinuance is subject to surrender charges / penalty which is also duly approved by the insurance regulator. There is no deficiency of service on the part of 2nd opposite party. There is no prohibition for issuance of policy to a handicapped. At the time of joining the policy the complainant was employed as a Lower Division Clerk in health department and was earning an amount of Rs.2,00,000/- yearly. The complainant default of the 2nd installment and remitted the amount availing the benefit of revival of the policy. So the 2nd opposite party prayed that dismiss the complaint with cost.
Complainant and 2nd opposite party filed affidavit and documents. Ext.A1 to A7 marked on the side of the complainant. Ext.B1 to B10 marked on the side of 2nd opposite party. 1st opposite party was set exparte.
Matter heard.
Issues to be considered are
1. Whether there is any deficiency in service or unfair trade practice on the part of opposite parties ?
2. If so, what is the relief and cost ?
Issue No.1 & 2
Heard and perused relevant documents on record. The 2nd opposite party admitted that the 1st opposite party is an agent of them. 1st opposite party was set exparte. Admittedly the complainant had opted life insurance in the 2nd opposite party company. The complainant stated that the 1st opposite party informed him to deposit Rs.30,000/- in opposite party company will be received Rs.90,000/- after three years. But 1st opposite party has not filed version and affidavit. In Ext.B1 the proposal form clause 5 mentioned that premium frequency - single.
Clause 6(a) Proposal Deposit-Cash, Amount paid Rs.30,000/- In Ext.B10 the complainant had opted life insurance in the 2nd opposite party company on 18/8/2008. In Ext.A1 dated 18/8/2008 mentioned the frequency of payment : Annually and the premium installment : Rs.30,000/-. In Ext.A3 dated 9/12/2011 shows the 2nd opposite party company sent a cheque for an amount of Rs.16,265.80 to the complainant. Ext.A5,A6 and A7 are copy of letters sent to the 2nd opposite party by the complainant demanding the sum paid to the insurance. In Ext.A4 dated 30/9/11 the 2nd opposite party sent reply stating that if first three years regular premiums have not been paid and the policy is lapsed for insurance cover, the surrender value, if any would be payable at the expiry of the revival period or three policy years whichever is later. Thereafter the 2nd opposite party paid Rs.16,265.80 by way of cheque to the complainant on 9/12/11.
In the present case the complainant is a retired Govt.Employee and a handicapped. As per clause 7 of the Insurance Regulatory and Development Authority Regulations 2010, the table annexed2: maximum discontinuance charges for the policies having annualized premium above Rs.25,000/- to maximum of Rs.5,000/-. The complainant paid Rs.60,000/- as two installments. The 2nd opposite party has paid only Rs.16,265.80 to the complainant. So the balance amount is Rs.43,734/-. The opposite parties had not produced evidence to show that the full amount refund will be caused any loss. According to 2nd opposite party the policy being a unit linked insurance policy the funds are invested in market towards which certain charges are deducted as per policy terms. No documentary evidence produced by the 2nd opposite party to show that full amount invested in market. Further allegation of 2nd opposite party is that even after receiving the policy the complainant did not raised any complaint till 17/10/2011. Also offer a 15 days free look period from the date of receipt of the policy document.
As per Ext.A5 dated 26/9/11 the complainant demanded the policy amount after completing 3 years. As per clause 7 of Insurance Regulatory and Development Authority Regulations deducted Rs.5,000/- from the balance amount of Rs.43,734/- ie (Rs.43,734 – Rs.5,000 is Rs.38,734).
In the above discussions we are of the view that there is deficiency in service on the part of opposite parties. In the result complaint allowed. We direct the 2nd opposite party to pay Rs.38,734/- (Rupees Thirty eight thousand seven hundred and thirty four only) as the policy amount to the complainant. Also directed opposite parties jointly and severally liable to pay the complainant an amount of Rs.10,000/- (Rupees Ten thousand only) as compensation and Rs.1,000/- as cost of the proceedings.
Order shall be complied within one month from the date of receipt of order, failing which the complainant is entitled for 9% interest per annum for the whole amount from the date of order till realization.
Pronounced in the open court on this the 13th day of August 2012.
Sd/-
Seena H
President
Sd/-
Preetha G Nair
Member
Sd/-
Bhanumathi.A.K.
Member
APPENDIX
Exhibits marked on the side of the complainant
Ext.A1 – Photostat copy of premium receipt of Rs.30,000/- issued by 2nd
opposite party
Ext.A2 – Photostat copy of premium receipt of Rs.30,000/- issued by 2nd
opposite party
Ext.A3 – Photostat copy of Order copy of sanctioned amount of Rs.16,265.80 by
the 2nd opposite party to the complainant
Ext.A4 – Photostat copy of letter dated 30/09/2011 issued by 2nd opposite party
to the complainant
Ext.A5 - Photostat copy of letter dated 26/9/2011 sent by the complainant to
the 2nd opposite party.
Ext.A6 – Photostat copy of letter dated 15/12/2010 sent by the complainant to
the 2nd opposite party
Ext.A7 - Photostat copy of letter dated 02/11/2011 sent by the complainant to
the 2nd opposite party
Exhibits marked on the side of the opposite party
Ext.B1 – LIC Proposal Form of 2nd opposite party
Ext.B2 – Photocopy of Revised Offer Letter issued by 2nd opposite party
Ext.B3 – True copy of Election ID card of the complainant
Ext.B4 – True copy of Ration card of the complainant
Ext.B5 – True copy 3rd page of SSLC book of the complainant
Ext.B6 – Photocopy of Sample Benefit Illustration of 2nd opposite party
Ext.B7 – Photocopy of Know Your Customer Form of 2nd opposite party
Ext.B8 – Photocopy of Moral Hazard Report of 2nd opposite party
Ext.B9 – Photocopy Medical Under Writing Sheet of 2nd opposite party
Ext.B10 – Policy Document
Cost Allowed
Rs.1,000/- allowed as cost of proceedings.
