SMT. RAVI SUSHA : PRESIDENT
Complainant has filed this complaint U/S 12 of Consumer Protection Act 1986 against opposite parties seeking to get a direction to pay Rs.4,42,024/- to the complainant together with compensation.
The facts in brief in the year 2005 the 1st&2nd OP approached and insisted the complainant to join a new life insurance policy and also told him that the minimum period of deposit for the policy is for 3 years and after that insurer can continue or surrender the policy as per their will and wish and also told that if the insurer is to continue with the policy the insurer can get 100% increase every 3 years for the collected amount. The complainant joined a life insurance policy vide No.254637119. The 3 months premium is Rs.6100/-. Complainant paid 3 months premium amount upto 2009 without any failure . The complainant has paid altogether an amount of Rs.1,10,506 to the OPs. After surrender the policy as per this period complainant is entitled to get altogether an amount of Rs.4,42,024/-. But the OP paid only Rs.5,548/- to the complainant. On enquiry OPs told that the complainant is not entitled to get more amounts. The act of the OPs is illegal and erroneous. Hence this complaint.
After receiving notice, OPs 2&3 jointly filed version stating that the complainant had accepted the policy after agreeing to the terms and conditions of the policy. After having obtaining the policy, the complainant further had the option of returning the policy within a period of 10 days from the date of receipt of the policy. The complainant inspite of obtaining the policy documents did not exercise his option to return. From the above acts of the complainant it can only be inferred that by accepting the policy and paying the required premiums, the complainant had agreed to the terms and conditions of the policy, the premiums are payable to the company on the due dates as specified in the schedule . The complainant defaulted payment of premium due on 20/3/2009. According to the conditions of the policy , the policy was converted to Extended Terms Insurance on 20/3/2009 as the premium was discontinued, and the policy shall acquire cash value if the same is in force for at least three years and all due premiums have been received. The policy of the complainant was surrendered on 27/7/2018. The surrender value calculation logic as on surrender effective date 27/7/2018 is as follows. 1. Base cash value(as on NFO conversion date) = sum assured multiplied by CSV rate/1000=9,50,000 Base CSV rate/1000=Rs.19,142.42(2) PUA cash value (as on conversion date) = Accrued paid up assurance multiplied by PUA CSV rate/1000=33,838.21 PUA CSV rate/1000=6579.14. OPs further submitted that the ETI term is determined by applying ETI rates to coverage amount, coverage amount=base sum assured +PUA sum assured=Rs.9,50,000+33,838.21= Rs.9,83,838.21. ETI premium= Base surrender value=Rs.25721.56.ETI surrender value payable +ETI premium(1-9.35/11.88) =5,477.74. Contract of insurance is a contract based on the terms and conditions of the policy and the OP is liable only according to the terms , conditions, limitations and exclusions of the policy . OPs contended that the minimum period of deposit for the policy is for 3 years and after that the insurer can continue or surrender the policy as per their will and wish and also told that if the insurer is to continue with the policy the insurer can get 100% increase every 3 years for the collected amount, and the complainant joined a life insurance policy as per the advice and insistence of OPs 1&2, is false and hence denied. The further allegation that the complainant is entitled to get Rs.4,42,024/- from the Ps and that they are liable to pay the above said amount is false. The complainant was paid the amount of Rs.5,477.74/- payable according to the conditions of the policy. There is no deficiency in service on the part of OPs hence prayed for the dismissal of complaint.
At the evidence stage complainant has filed chief affidavit and documents. He was examined as PW1 and marked Exts.A1 to A5.(premium paid receipts). From the side of OPs 2&3, Exts.B1 to B6 were marked. Ext. B1 is the policy surrender form, Ext.B2 is proposal form, Ext.B3 policy document, Ext.B4 is policy surrender form, Ext.B5 intimation of surrender of policy, Ext.B6 surrender value of statement.
After that the learned counsel for complainant and learned counsel for OPs 2&3 filed their written argument notes.
OPs submitted that the complainant had submitted a proposal for issuance of policy for a sum insured Rs.95,000/- as the base policy and personal Accident benefit for a sum insured of Rs.425000/-. According to OPs, the duration of coverage for the whole life participating plan was to age 100/- and for waiver of premium rider to age 55 and personal accident benefit renewable every year. OP contended that policy and plan policy was issued as required by the complainant. Further submitted that complainant had accepted the policy after agreeing to the terms and conditions of the policy. The complainant was also provides for cancellation in the free look period whereby the complainant could cancel the policy by written request to the company within 10 days from receipt of the policy.
Complainant submitted that OPs told that they are providing maximum benefit for their customers and also the minimum period of deposit for the policy is for 3 years and after that insured can continue or surrender the policy as per their will and wish and also told that if the insured is to continue with the policy, he can get 100% increase every 3 years for the collected amount.
Here there is no dispute that the complainant had joined in the policy in June 2005 and permitted quarterly premium amount of Rs.6100/- till 2009 thus paid Rs. 1,10,506/- as premium to OPs. Further on July 2018 complainant applied to surrender the policy to 2nd OP and the OP had paid only Rs.5548/- to the complainant. OPs submitted that the complainant defaulted the payment of premium due on 20/3/2009. But Ext.A5 shows that the complainant had remitted premium on 9/2/2009. The complainant’s policy could not be converted to ETI.
Here OPs contention that complainant could cancel the policy by written request to the company within 10 days from the receipt of the policy. On the contrary, complainant submitted that he had no awareness about the policy terms and conditions and the benefit of policy was only informed by the OPs to him. According to complainant the policy terms and conditions were not given to him along with policy. OPs should have given the policy terms and condition with policy schedule to the complainant along with policy.
We are of the view that , onus of proof lies upon the OPs 2&3 to prove that policy along with terms and condition and schedule was supplied to the complainant. OPs had not produced any evidence in this regard. Further OPs should have provided the surrender value schedule also to the complainant along with policy or at least given to complainant when he had given policy surrender request. Without giving any such information to the insured, the calculation made by the Insurance company in deducting the premium remitted amount in many heads is nothing but deficiency in service and unfair trade practice on the part of OPs 2&3.
The complainant submitted that as per information given by OPs 2&3 he can get 100% increase every 3 years for the collected amount and thus on July 2018 when he surrender the policy, he is entitled to get an amount of Rs.4,42,024/- but OP had paid only Rs.5548/-. Here complainant failed to substantiate their version that he is eligible to get Rs.442024/- as surrender value on 2018.
Considering the facts and circumstances of this case, we are of the view that since complainant has not completed the policy mature period, he is eligible to get the total amount he had remitted towards premium amount with interest because OPs failed to provide the policy terms and condition and surrender value schedule to complainant.
In the result opposite parties 2&3 are directed to give Rs.110506/- with interest @7% per annum from the date of complaint till realization to the complainant. Rs.5548/- already given to complainant is to be deducted from the calculated amount. Opposite parties 2&3 are also directed to give Rs.10,000/- as compensation for the mental agony caused to the complainant due to the deficiency in service on the part of the opposite parties 2&3. Opposite parties 2&3 shall comply the order within one month from the date of receipt of the order. Failing which the amount of Rs.110506/- carries interest @12% per annum from the date of complaint till realization. Complainant is also at liberty to file execution application against opposite parties 2&3 for realization of the awarded amount as per the provision of Consumer Protection Act 2019.
Exts:
A1 to A5- premium paid receipts
B1- policy surrender form
B2- proposal form,
B3 -policy document,
B4 -policy surrender form,
B5- intimation of surrender of policy,
B6- surrender value of statement.
PW1-Sujithkumar.K.P- complainant
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
eva
/Forwarded by Order/
ASSISTANT REGISTRAR
