(Passed on dated 30th June 2015)
Per Shri Atul D. Alsi – Hon’ble President.
The complainant had obtained Reliance Market Return Plan (Regular) from O. P. at their Gondia branch vide contact No. 11708640 and client ID 03678879. The complainant had not received the policy documents.
2. The agent of O. P. namely Sudhir Patel informed the complainant that the complainant has to pay Rs.50,000/- to the company whereby he will get insured amount of Rs.1,00,000/- after five years from the date of commencement of policy. It is also informed by said agent that the said amount of Rs.50,000/- is refundable as Rs.1,00,000/- at the end of fifth years. So the complainant had paid Rs.50,000/- to the O. P. on or about 15.08.2008. The said agent had obtained the signature of the complainant on some blank forms.
3. The complainant went to the office of O. P. for refund of Rs.1,00,000/-. But unfortunately the concerned officer informed that the complainant had not paid the remained 4 premiums of Rs. 50,000/- each to the O. P. So the complainant had collected some papers from the office of the O. P. and found that the agent of O.P. had misrepresented the complainant. The officer of the O. P. only intended to return Rs.22,500/- to the complainant, which was not acceptable to the complainant. The complainant is entitled for Rs.1,00,000/- as assured by the O. P. Hence this complaint is filed.
4. The O.P. had given defective service by withholding the legal amount of the complainant.
5. The cause of action of this complaint arose on or about 14.08.2013 i.e. the at the end of fifth year when the complainant went for refund of his amount. The cause of action is continued one. Hence the instant case is under limitation.
6. The complainant prayed that to declare the O. P. are deficient to give service to complainant, issue direction to O. P. to pay Rs.1,00,000/- of policy amount, grant a compensation of Rs.10,000/- for mental and physical harassment caused to the complainant, grant a expenses of Rs.5,000/- caused to complainant for bringing the matter.
7. After receiving the notice issued by the Forum, the O.P. appeared through his counsel and filed his written statement before the forum.
8. In their reply, the O. P. submits that the present complaint does not disclose any “Consumer Dispute” as defined under the Consumer Protection Act and therefore, liable to be dismissed. The allegations of the complainant are not substantiated with any evidence. The ‘Market Return Plan (Regular) policy, which is in question, is a Unite Linked Policy. The Hon’ble National Commission on 23.4.2013 in Ram Lal Aggarwalla V Bajaj Allianz Life Insurance Co. Ltd.(RP No.658 of 2012) observed the following findings made by Commission : “The investment made by the petitioner/complainant was to gain profit. Hence, it was invested for commercial purposes and therefore, the petitioner/complainant is not a consumer under the opposite parties.
9. The complainant, Mr. Ashok, was issued policy bearing no. 11708640 under ‘Market Return Plan (Regular)’ plan on 20/03/2008. The sum assured under the policy was Rs.2,50,000/-. The policy term was for 5 years and it required annual payment of premium of Rs.50,000/- for 5 years. These details are known to the complainant as it was filled in Exh.A proposal form. However, only the first premium was paid by the complainant. The opposite party vide letter dated 9/6/2012 intimated the complainant that the policy was terminated with effect from 19/03/2012 due to non payment of renewal premiums within the revival grace period. However, no response with regard to this came from the complainant. The complainant had not approached this opposite party with any complaint with regard to mis-selling or with regard to non receipt of policy documents anytime before. It was only through the legal notice dated 2/8/2013 & not any other communication from the complainant received from the opposite party. The aforementioned legal notice was duly replied by letter dated 16th August, 2013 (Exhibit D-4 produced by the complainant) asking for details of the policy so as to enable to opposite party to look into the matter. The reply to the legal notice is produced herewith and is marked as Exhibit D. However, the complainant has not produced the necessary details to the opposite party.
10. Terms and conditions of the ‘Market Return Plan’ (Regular)’ are available in the policy documents. The replying opposite party is unaware of what transpired between the complainant and the alleged agent. The policy scheme as alleged in para 3 was never offered by the opposite party and the actual provisions of the plan can be seen from the policy document. The complainant is a literate and educated person. The proposal form ought to have been filed by the complainant himself. The “Plan Details’ in the proposal form clearly shows that the insurance plan required payment of annual premium payment of Rs.50,000/- for 5 years and the sum assured under the plan is Rs.2,50,000/-. Without prejudice to other submissions, the replying opposite parties would like to state in arguendo that even if any deception was acted upon complainant, it was only because of their negligence and carelessness.
11. It is to be noted that the opposite party had informed the complainant about the termination of the policy vide letter dated 09/06/2012, much before the complainant came forward seeking ‘refund’ of Rs.1,00,000/- . If at all the complainant was not in accord with the terms and conditions of the policy, the complainant could have cancelled the policy during the 15 day lock in period and sought refund of the premium paid by him.
However, no complainant regarding non-delivery of the policy documents was made by the complainant to the opposite party till date. The opposite party never assured the complainant payment of Rs. 1,00,000/- and the allegation is vehemently denied.
12. With regard to prayer, it is submitted that the complainant is not entitled to any relief from this Hon’ble Forum as prayed and this Hon’ble Forum may be pleased to dismiss the complaint with compensatory cost to the Opposite Party.
13. The complainant has filed Copy of letter dated 20/03/2008 sent by the opposite party to complainant at page no. 10, Copy of form obtained from office of O. P. at page no. 11, Copy of legal notice sent by complainant to O. P. at page no. 14, Copy of reply to notice at page no. 16 on record.
14. The learned counsel for complainant Mr. N. S. Popat has filed pursis stating that they don’t want to file written notes of argument and the complaint and document filed on record may kindly consider as oral argument.
15. The learned counsel for opposite parties Mr.Satish Ankar submits that the submissions of the complainant are mere fabricated stories. It is submitted that even if the complainant has got a grievance, it is with regard to his transaction with the alleged agent of the opposite party and not in regard to the deficiency in insurance policy availed by the complainant.
16. The complainant has not produced any evidence showing the deficiency of service of the replying opposite parties without which replying opposite parties is nowhere at fault or deficient in its service under the terms and conditions of the policy.
17. The complainant, Mr. Ashok was issued policy bearing no. 11708640 under “Market Return Plan (Regular)” plan on 20/03/2008. The sum assured under the policy was Rs.2,50,000/-. The policy term was for 5 years and it required annual payment of premium of Rs.50,000/- for 5 years. These details are known to the complainant as it was filled in proposal form. However, only the first premium was paid by the complainant. The Opposite party vide letter dated 09/06/2012 intimated the complainant that the policy was terminated with effect from 19/03/2012 due to non payment of renewal premiums within the revival grace period. The complainant had not approached this opposite party with any complaint with regard to mis-selling or with regard to non receipt of policy documents anytime before.
18. The terms and conditions of the life insurance plan taken by the complainant were clearly laid out in the policy bearing No. 11708640. Policy documents were dispatched to the complainant in time. If the complainants were not satisfied with the terms and conditions of the policy, the complainant had an option to cancel the policy within 15 days from the date of receipt of the policy. In such case, the replying opposite party shall refund the entire premium paid after deducting applicable administration charges. Therefore, complainant cannot now allege that he was not aware of the terms and conditions of the policy.
19. There are no oral rules and conditions of the policy.
20. In case the insured had any grievance, they could have well approached the replying opposite party within the statutory free look period. Hence in view of doctrine – “One who seeks equity must come with clean hands”, the complaint is liable to be dismissed.
21. Considering the rival contention of the party & submission made before us the following points arise for consideration & finding there on along with reasons.
Sr. No. | Points | Findings |
1. | Whether the dispute is consumer dispute? | YES |
2. | Whether the O. P. has committed any negligency of duty while repudiating the policy for non-payment of premium amount? | NO |
3. | What Order? | As per final order. |
REASONING & FINDINGS
22. The remedy under Consumer Protection Act, 1986 is remedy in addition to the legislations in force; therefore it is the choice of complainant to knock the door of any of legal system by filling suit in civil court or a complaint in consumer forum. The complainant is consumer because he avails the services from opposite party for the payment for his personal safety & not for commercial gain and hence dispute is “consumer dispute” and therefore the forum has jurisdiction to entertain the complaint. Hence the issue No. 1 is decided accordingly.
23. As to Issue No. 2:- The policy bearing No. 11708640 under “Market Return Plan (regular)” was issued by O. P. to complainant on 20.03.2008. The sum assured under the policy wasRs.2,50,000/-. The term of policy was for 5 years against the annual payment of Rs.50,000/- per year for the term of 5 years. The complainant had paid only 1st installment. The O. P. by issuing letter dt. 09.06.2012 terminated the policy for non-payment of subsequent premiums within renewal period therefore the policy was terminated w.e.f. 19.03.2012.
24. As per terms of agreement if the complainant was not in accord with the term and conditions of the policy the complainant could have cancelled the policy during 15 days from the date of commencement of policy & sought the refund of premium paid by him. But the complainant had lost this opportunity at earlier, now he is not entitled to use that option.
The complainant has signed the proposal form of policy in English therefore the contention of complainant that the complainant is illiterate person & signed the proposal form without knowingly & understanding can not be accepted. As per judgment in Kishor Rathod v/s M.D. ICICI Prudential in Revision Petition No. 3390/2013 “It was held that it must be borne in mind that the petitioner is an educated person. He was supposed to read each and every terms and conditions of policies.”
25. There can’t be oral terms and conditions of the policy. Each party has binding effect of frame work of policy. Therefore, the terms and conditions of policy are binding on parties of the policy. The complainant has not made agent as necessary party nor brought any evidence from agent therefore the contention of the complainant that he was told to make payment for 5 years is not corroborated. As per terms of policy the complainant has not paid 5 premiums within stipulated time. The complainant has paid only one premium installment of Rs.50,000/-. Therefore, the policy was rightly terminated by O.P. and informed accordingly to the complainant. The O.P. has paid Rs. 22,225/- by drawing cheque bearing no. 653287 dated 19/12/2014 towards refund of policy premium as per norms of refund of policy amount in case of lapsation of policy. The complainant has received the amount of Rs. 22,225/- under protest. Therefore, there is no negligency of service on the part of opposite party. For non-fulfillment of terms of policy conditions the complainant is himself is responsible therefore there is no negligency of service on the part of opposite party. Hence, the following order is passed.
- ORDER -
1. The complaint is dismissed.
2. No order as to costs.
