DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  22^nd  day of May, 2023

Present      :   Sri. Vinay Menon V., President

                  :  Smt. Vidya A., Member                        

                  :  Sri. Krishnankutty N.K., Member                                Date of Filing: 22/08/2022  

                         CC/151/2022

Sunilkumar K.T.

Sunisha Nivas,

Near Thuppallur Shiva Temple,

Kannadi, Palakkad – 678 701                               -                       Complainant

       (By Adv.Pramod P.K.)

                                                                                                Vs

1. PNB Metlife India Insurance Company Ltd.,

Techniplex Complex I,

Unit No.101, 1^st Floor,

Veer Savarkar Flyover,

Off SV Road, Goregaon West,

Mumbai – 400 062

2. The Branch Manger,

PNB Metlife India Insurance Company Ltd.,

Nirmal Chambers, 1^st Floor,

Opp. B.M Convent, Chandranager (PO),
Palakkad – 678 007                                         -                       Opposite parties

       (By Adv.C.Sreekumar)

O R D E R

By  Sri. Vinay Menon V., President

1. Essential facts for adjudicating the dispute are that during 2016, the complainant had availed a Met Life Major Illness Premium Cover floated by the 1^st O.P. Annual premium payable was Rs. 14,150/- for 10 years. Complainant had effected payment of the 1^st three premia. Due to Covid – 19 pandemic, the complainant defaulted subsequent premia. Thereafter at the instance of the staff of O.P., the complainant paid the premia of 2019, 2020 and 2021, along with revival fees in lump sum. But the O.P.s failed to revive the policy inspite of payment of the premia at the instance of the staff of O.P.1. Upon enquiry the complainant was informed that the policy was not revived for want of medical report. Even after handing over of the medical report, the policy was not revived.
2. O.P.s received notice, but they failed to file version or appear before this Commission and they were set ex-parte. Thereafter at a later stage, the O.P.s filed application to set aside the ex-parte order, but in view of the lack of statutory authority, said application was dismissed. 
3. In view of the absence of a version, the complaint need to prove only a prima facie case.
4. Evidence on the part of the complainant comprised of proof affidavit and marking of Exhibits A1 to A11.
5. Ext. A1 is the welcome letter and policy schedule and terms and conditions. Exts. A2 to A8 are a set of notices, postal receipts and acknowledgement cards to prove communication with O.P.s. Ext. A10 is a Bank transfer form showing transfer of Rs. 43,458/- from the complainant’s account to the O.P. The Bank has endorsed by its seal that the transfer is paid.
6. 3 years’ premia comes to Rs. 42,450/-. We reasonably presume that the balance is the revival charge.
7. Thus we are satisfied that the complainant has proved by adducing relevant documents that there is a prima facie case. The complaint therefore stands allowed as below:

1. The O.P. is hereby ordered to revive the policy bearing no. 21779954 and communicate the matter to the complainant.
2. The O.P. shall receive the premia for subsequent years after 2021 without any fine or penalty.
3. The O.P. shall extend all benefits permissible under the policy to the complainant if the complainant has met with any indemnifiable expenses in accordance with the terms and conditions of the policies revived (covering 2019, 2020, 2021)  upon receipt  of lumpsum payment, provided that the complainant has disclosed all material information regarding the health conditions of the beneficiaries covered under the policy upon revival.
4. In the event the O.P. is not ready and willing to comply with the directives in “A” and  “B” above, the O.P. shall return the lumpsum amount of Rs. 43,458/- to the complainant together with interest at the rate of 10% p.a. from 02/07/2021 till date of repayment.
5. If the complainant had incurred any expense as contemplated under directive “C”, the O.P. shall not repudiate or reject the claim under directive “D”.
6. The O.P. shall pay compensation of Rs. 50,000/- to the complainant.
7. The O.P. shall pay a cost of Rs. 20,000/- to the complainant.
8. The O.P. shall comply with the directions above within a period of 45 days from the date of receipt of this order failing which the complainant will be entitled to a solatium of Rs. 500/month or part thereof till date of  compliance/final payment of the amounts ordered to be paid.

Pronounced in open court on this the 22^nd day of May, 2023.

                                                                                           Sd/-

                                                                                                Vinay Menon V

                                                      President

                                                             Sd/-

   Vidya.A

                       Member        

       Sd/-                                             Krishnankutty N.K.

                                                                                                      Member

APPENDIX

Exhibits marked on the side of the complainant :

Ext. A1 – Copy of policy schedule  alongwith terms and conditions

Ext. A2 – Copy of lawyer’s notice dated 23/5/22   

Ext. A3 –   Original   postal receipts

Ext. A4 & A4(a)–   Copy of India Post consignment tract record alongwith certification under

                                Section 65 B

Ext. A5 –   Copy of lawyer’s notice dated 27/6/22

Ext. A6 –   Original returned notice

Ext. A7 –   Original postal receipt

Ext. A8 –   Original postal acknowledgment

Ext. A9 –   Certified copy of statement of account from Dhanalakshmi Bank

Ext.A9(a) – Original certification under Section 65 B

Ext. A10 –   Original of application for NEFT Transfer dated 2/7/2021

Ext. A11 –   Original check bearing No.379355 dated 2/7/2021

 Exhibits marked on the side of the opposite party:   Nil

Court Exhibit:  Nil

Third party documents:  Nil

Witness examined on the side of the complainant: Nil

 Witness examined on the side of the opposite party:  Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.

Forwarded/By Order,   

Assistant Registrar

Fair copy on        :  24/05/2023

Despatched on: