Order No. 12 dt. 20/02/2019
The complainant had earlier filed a case against the o.p. in Barasat District Forum and subsequently as per the order of Ld. DCDRF, Barasat, North 24 Parganas the case was withdrawn. The case of the complainant in brief is that the complainant was approached by one of the officers of the o.p. no.1 and her husband with the assurance that if the complainant applies for ICICI Prudential Policy that would provide 15% to 18% better than fixed deposit or other investments. They further stated that if their persuasion is not satisfactory then there are options for surrender of the policies defer payment of three installments. In case of urgent need without telling or disclosing that there are surrender charges which vary 8/6/4/2%, if surrendered at the end of 3/4/5/6 policy years i.e. before maturity there will be 53% deductions made towards various charges from the 3 installments paid. The agent of the respondents did not disclose anything about the mortality rates. On 16/02/2007 o.p. no.1 asked the complainant along with her husband Manik kumar Paul for medical tests which was an additional medical requirement for life time policy applied by them individually. Accordingly, on the basis of the letter dated 16/02/2007 all the medical tests by empanelled doctors of the company were done in the letter dated 16/02/2007. It was further stated that if the medical association guideline were not fulfilled then the policy would be rejected after adjustment of Rs.850- for medical chares. The complainant opened policy being no. 04459694 with policy terms for 10 years and the date of commencement of 28/03/2007 with the premium amount of Rs.70,000/- per year without returning in terms of said guidelines of their own letter dated 16/02/2007, even though they found it is not acceptable as per their assessment. The matter would have been ended there itself. This is the first violation of the terms and conditions of the policy deliberately by the o.p. Subsequently by a letter dated 13/03/2007 the complainant was informed that former had revised the mortality charges of the complainant from Rs.11.83 to Rs.24.10 without providing any risk assessment details along with medical tests and doctors opinion. The complainant subsequently gave consent letter and the said letter was obtained by o.p. no.1 by suppression of fact that there was no adverse remarks of the medical evaluation of the company doctor. It was further alleged by the complainant that she was generally healthy and no serious ailments, as no adverse remarks of the doctors were communicated to her nor reflected in the medical reports or mentioned anywhere in the policy document.
The complainant paid three installments in terms of the policy condition to keep the policy in force and stopped further payment of installments. The complainant was very much worried for the poor fund value and was trying to find out reasons. The complainant’s husband received a letter dated 17/03/2007 with the revised mortality charges on 12/04/2014 unexpectedly in the old papers, after coming to know of the said fact the repeated reminders were sent to the o.ps. but no information was given to the complainant. Subsequently, the complainant while found that he was not in a position to pay the premium and after getting communication from the o.p. filed this case within the statutory period. On the basis of the said fact the complainant filed this case praying for direction upon the o.p. for refund of the premium amount along with compensation of Rs.1.00 Lakh and litigation cost.
The o.p. contested the case by filing w/v and denied all the material allegations of the complaint. It was stated that on perusal of the proposal form and the policy terms and conditions it is evidently clear that the premium was to be regularly paid by the complainant and the complainant was also aware of the same as she has paid three regular premiums amounting to Rs.2,10,000/-. However, the o.p. was not in receipt of any further premiums due since 28/03/2010. On the contrary the complainant has raised a cover continuation option requesting with the company on 08/11/2010 and the company had duly accepted the same in accordance with the Clause 4.4(c) of the policy terms in spite of paying all the three annual premiums and adopting the CCO the subject policy remained in force till the date of maturity. If any unfortunate incident were to have happened to the complainant during the terms of the policy the o.p. company would have duly honoured the claim under the same. This clearly shows that the o.p. company had covered the risk under the life of the complainant during the time of the policy and the complainant had reaped the benefit of the service of the o.p. company. The complainant failed to avail the free look option for cancellation of the policy. The complainant is an educated graduate and the complainant’s husband had also availed a life time plus policy from the o.p. company on the same date as that of the complainant. The complainant had invested huge amount of many but no prudent person would sign or invest or signed any document without understanding the intricacies or nature of the same. The complainant has also failed to file this case within the statutory period of 2 years and she is not a consumer as per CP act. It was further stated that the medical tests were conducted on 06/02/2007 and on perusal of the medical examination report it was noticed that there were certain discrepancies regarding ECG test of the complainant, due to it extra premium was decided to be charged to the complainant and her consent for the same was sought vide letter dated 17/03/2007 and the complainant provided her consent on the same letter after policy was issued. The policy documents clearly mentioned surrender charges, premium allocation charges, mortality charges and the charges under terms and conditions are very clearly defined under the policy as mentioned herein below.
1(f) Unit Linked Fund: means the pool of premiums paid by the policy holders and invested in a portfolio of assets to achieve the fund(s) objective. The price of each unit in a fund depends on how the investments in the fund perform. The fund is managed by the company.
1(j) Fund Value: is the product of the total number of units under the policy and the NAV. The fund value for the purpose of claims, surrenders or any other clause stated in this policy shall be calculated on the basis of the NAV table given in clause 6.
1(s) Premium Allocation charges means a percentage of the premium appropriated towards charges from the premium received. The balance known as allocation rate constitutes that part of the premium which is utilized to purchase (investment) units for the policy. This charge is levied at the time of receipt of premium.
1(t) fund Management Charge: means a charge levied as a percentage of the value of assets and shall be appropriated by adjusting the NAV. This charge is levied at the time of computation of NAV.
1(x) Mortality Charges: means cost of life insurance cover and is levied at a the beginning of each policy month from the fund by cancelling units for an equivalent amount.
The policy surrender value has been mentioned in the policy itself.
The complainant was informed all through email and it is not the case of complainant that the policy was mis-sold to her as a fixed deposit. It is pertinent to mention here that the complainant’s husband also availed the life time plus policy from the company on the same date. Hence it is safe to assume that both the complainant and complainant’s husband availed the same after understanding the features of the policy. The complainant in order to have the illegal gain from the o.p. falsely filed this case. On the basis of the said fact the o.p. prayed for dismissal of the case.
On the basis of the pleadings of parties the following points are to be decided:
- Whether the complainant had the policy with the o.p.?
- Whether complainant failed to pay the premium?
- Whether there was any deficiency in service on the part of the o.ps.?
- Whether the complainant will be entitled to get the relief as prayed for?
Decision with reasons:
All the points are taken up together for the sake of brevity and avoidance of repetition of facts.
Ld. Lawyer of the complainant argued that the complainant was approached by one of the officers of the o.p. no.1 and her husband with the assurance that if the complainant applies for ICICI Prudential Policy that would provide 15% to 18% better than fixed deposit or other investments. They further stated that if their persuasion is not satisfactory then there are options for surrender of the policies defer payment of three installments. In case of urgent need without telling or disclosing that there are surrender charges which vary 8/6/4/2%, if surrendered at the end of 3/4/5/6 policy years i.e. before maturity there will be 53% deductions made towards various charges from the 3 installments paid. The agent of the respondents did not disclose anything about the mortality rates. On 16/02/2007 o.p. no.1 asked the complainant along with her husband Manik kumar Paul for medical tests which was an additional medical requirement for life time policy applied by them individually. Accordingly, on the basis of the letter dated 16/02/2007 all the medical tests by empanelled doctors of the company were done in the letter dated 16/02/2007. It was further stated that if the medical association guideline were not fulfilled then the policy would be rejected after adjustment of Rs.850- for medical chares. The complainant opened policy being no. 04459694 with policy terms for 10 years and the date of commencement of 28/03/2007 with the premium amount of Rs.70,000/- per year without returning in terms of said guidelines of their own letter dated 16/02/2007, even though they found it is not acceptable as per their assessment. The matter would have been ended there itself. This is the first violation of the terms and conditions of the policy deliberately by the o.p. Subsequently by a letter dated 13/03/2007 the complainant was informed that former had revised the mortality charges of the complainant from Rs.11.83 to Rs.24.10 without providing any risk assessment details along with medical tests and doctors opinion. The complainant subsequently gave consent letter and the said letter was obtained by o.p. no.1 by suppression of fact that there was no adverse remarks of the medical evaluation of the company doctor. It was further alleged by the complainant that she was generally healthy and no serious ailments, as no adverse remarks of the doctors were communicated to her nor reflected in the medical reports or mentioned anywhere in the policy document.
The complainant paid three installments in terms of the policy condition to keep the policy in force and stopped further payment of installments. The complainant was very much worried for the poor fund value and was trying to find out reasons. The complainant’s husband received a letter dated 17/03/2007 with the revised mortality charges on 12/04/2014 unexpectedly in the old papers, after coming to know of the said fact the repeated reminders were sent to the o.ps. but no information was given to the complainant. Subsequently, the complainant while found that he was not in a position to pay the premium and after getting communication from the o.p. filed this case within the statutory period. On the basis of the said fact the complainant filed this case praying for direction upon the o.p. for refund of the premium amount along with compensation of Rs.1.00 Lakh and litigation cost.
Ld Lawyer of the o.p argued that on perusal of the proposal form and the policy terms and conditions it is evidently clear that the premium was to be regularly paid by the complainant and the complainant was also aware of the same as she has paid three regular premiums amounting to Rs.2,10,000/-. However, the o.p. was not in receipt of any further premiums due since 28/03/2010. On the contrary the complainant has raised a cover continuation option requesting with the company on 08/11/2010 and the company had duly accepted the same in accordance with the Clause 4.4(c) of the policy terms in spite of paying all the three annual premiums and adopting the CCO the subject policy remained in force till the date of maturity. If any unfortunate incident were to have happened to the complainant during the terms of the policy the o.p. company would have duly honoured the claim under the same. This clearly shows that the o.p. company had covered the risk under the life of the complainant during the time of the policy and the complainant had reaped the benefit of the service of the o.p. company. The complainant failed to avail the free look option for cancellation of the policy. The complainant is an educated graduate and the complainant’s husband had also availed a life time plus policy from the o.p. company on the same date as that of the complainant. The complainant had invested huge amount of many but no prudent person would sign or invest or signed any document without understanding the intricacies or nature of the same. The complainant has also failed to file this case within the statutory period of 2 years and she is not a consumer as per CP act. It was further stated that the medical tests were conducted on 06/02/2007 and on perusal of the medical examination report it was noticed that there were certain discrepancies regarding ECG test of the complainant, due to it extra premium was decided to be charged to the complainant and her consent for the same was sought vide letter dated 17/03/2007 and the complainant provided her consent on the same letter after policy was issued. The policy documents clearly mentioned surrender charges, premium allocation charges, mortality charges and the charges under terms and conditions are very clearly defined under the policy as mentioned herein below.
1(f) Unit Linked Fund: means the pool of premiums paid by the policy holders and invested in a portfolio of assets to achieve the fund(s) objective. The price of each unit in a fund depends on how the investments in the fund perform. The fund is managed by the company.
1(j) Fund Value: is the product of the total number of units under the policy and the NAV. The fund value for the purpose of claims, surrenders or any other clause stated in this policy shall be calculated on the basis of the NAV table given in clause 6.
1(s) Premium Allocation charges means a percentage of the premium appropriated towards charges from the premium received. The balance known as allocation rate constitutes that part of the premium which is utilized to purchase (investment) units for the policy. This charge is levied at the time of receipt of premium.
1(t) fund Management Charge: means a charge levied as a percentage of the value of assets and shall be appropriated by adjusting the NAV. This charge is levied at the time of computation of NAV.
1(x) Mortality Charges: means cost of life insurance cover and is levied at a the beginning of each policy month from the fund by cancelling units for an equivalent amount.
The policy surrender value has been mentioned in the policy itself.
The complainant was informed all through email and it is not the case of complainant that the policy was mis-sold to her as a fixed deposit. It is pertinent to mention here that the complainant’s husband also availed the life time plus policy from the company on the same date. Hence it is safe to assume that both the complainant and complainant’s husband availed the same after understanding the features of the policy. The complainant in order to have the illegal gain from the o.p. falsely filed this case. On the basis of the said fact the o.p. prayed for dismissal of the case.
Considering the submissions of respective parties it is an admitted fact that the complainant applied for the policy to the o.p. company. The complainant has alleged that through agent of the said company the she came to know the terms and conditions of the policy and she was not informed regarding the actual benefit to be availed by the policy holder. The complainant has made allegation against the agent of the said company but it is curious enough that the agent has not been made a party in this case and she has not mentioned the name of the agent who advised or allured the complainant to apply for the policy. It is found from the materials on record that the policy was opened in the year 2007 and the policy premium was paid as an actual premium of Rs.70,000/- per year. The complainant being an educated person and her husband had also applied for another policy and they were fully aware regarding the terms and conditions of the policy. The complainant after receiving of the policy could have applied for cancellation of the policy within the free look period but the complainant after continuation of the policy for three years and whenever she failed to pay the premium the policy became lapsed and the policy was with Unit Linked and the fund value is determined on the basis of the product of the total number units under the policy and the NAV is to be determined as per the Clause 6 of the policy document. The maturity charges is defined in the policy document which means cost of life insurance cover and is levied at the beginning of each policy month from the fund by cancelled units for an equivalent amount. The surrender value has also been mentioned in the policy document. From the materials on record it appears that the complainant failed to pay the premium, therefore, the policy became lapsed and the said policy lapsed in the year 2010 and after the lapse of several years particularly after the statutory period the complainant filed this case. In view of the said fact the case is also hit U/S24A of CP act. The complainant has stated that she was not informed regarding the grievance raised by her. It appears from the materials on record that the husband of the complainant as well as the complainant herself were informed through various emails and the o.p. company clearly explained the concept of charges and product opted by him/her. Now the complainant cannot ask for cancellation of the policy after receiving the maturity benefit. The subject policy matured on 28/03/2017 and as per the Clause 2.3 the company had duly paid maturity benefit of Rs.1,92,852.46 vide cheque bearing no. 337251 the said cheque was encashed by the complainant on 05/04/2017. The Clause 2.3 of the policy terms and condition clearly states that on payment of the maturity benefit the policy shall be terminated and the complainant will not be entitled to any further benefits. On survival of the life assured on the date of the maturity of the policy the maturity benefit equivalent to the fund value under the policy shall be payable. The policy holder shall have an option to receive the fund value as lump sum or as periodic payment however, a period of 5 years after maturity policy would be terminated upon the lump sum payment of the maturity benefit and all the rights, benefits and interests under the said policy shall extinguish since the complainant paid policy premium for 3 years. Therefore, she was not provided with all other benefits and accordingly, the amount was paid to the complainant. in view of the materials on record we hold that the complainant in order to have the financial gain against o.p. manufactured the case and made false allegation against the o.p. thereby we hold that the complainant filed this case has got no merit. Complainant filed this case without having any cogent reason whatsoever, therefore, she will not entitled to get any relief as prayed for. We also hold that there is no deficiency in service on the part of the o.p.
Hence, ordered,
That the CC No. 103/2018 is dismissed on contest without cost.
