Sri Shyamal Gupta, Member

Challenging the Order dated 13-01-2015 passed by the Ld. District Forum, Burdwan in C.C. No. 15/2014, OPs thereof have preferred this Appeal.

In a nutshell, case of the Complainant is that, he took a unit linked policy from the OPs by paying a single premium of Rs. 5,00,000/-.  The said policy matured on 03-05-2013 with vesting proceeds amounting to Rs. 6,06,189.94.  The OPs vide their letter dated 03-07-2013 informed the Complainant about non-receipt of Annuity Application Form from him.  Being astonished, the Complainant expressed his dissatisfaction regarding management of his fund vide a letter dated 12-08-2013.  The Complainant, vide his aforesaid letter, also asked for return of maturity proceeds after deduction of charges, if any.  However, the OPs did not take any step to fulfill his wish.  Hence, the complaint.

It is stated by the OPs that policy documents containing detail terms and conditions were sent to the Complainant directly.  If the Complainant had any dissatisfaction about the same, he was at liberty to cancel the said policy within free-look period as mandated under Regulation 6(2) of the Protection of Policyholder’s Interest Regulations, 2002, but the Complainant did not opt for it.  In terms of Clause 3(i)(a) of the said Policy, the Complainant could take a part of the total utilized fund value in the form of cash and rest would be converted to an annuity at the rate  being offered by the OPs.  The policy of the Complainant matured on 03-05-2013.  Prior to the said date, the OPs sent an intimation letter dated 12-03-2013 intimating the maturity date.  It was further informed that in order to get lump sum cash, the Complainant was required to provide duly filled up documents and till then the vesting proceeds would lie with the Company without accruing any interest.  As the Complainant did not send the duly filled up annuity application form before the maturity date, the OPs sent reminders to the Complainant to this effect on 03-07-2013 and again on 05-08-2013, but to no avail.  Instead the Complainant asked for refund of the entire amount being the total unitized fund value.  The OP, by its letter dated 17-09-2013 clarified the Complainant had an option to surrender the policy prior to the date of maturity when he could get the amount of unitized fund value after deduction of surrender charges as per schedule.  Thereafter also, the OPs sent several reminder letters to the Complainant, but it too fallen on deaf ears. 

Decision with reasons

It is evident from the petition of complaint that the Respondent quite consciously opted for the Unit linked policy in question.  It being an open secret that such policies are beset with various risk factors, as a person of reasonable prudence, he ought to go through the policy documents very carefully in order to understand the nuances of said policy. 

There can be no two opinions as to the fact that one response to imminent disaster is to close one’s eyes and pray that the calamity blows over.  Some such impulse may have been behind the daft way in which the Respondent managed his unit linked policy. Otherwise, he would certainly make due enquiry about the prevailing unit fund value prior to the vesting date (end of policy term). 

In terms of Clause 5 of the said policy, a policyholder was given due liberty to surrender the policy after expiry of 3 years in which case one would get the unit fund value arrived at after deduction of surrender charge as specified in the schedule of charges. 

Be it mentioned here that, both the policyholder and the Insurer is bound to act strictly in accordance with the terms and conditions of the Insurance Policy.  No such aspersion is cast from the side of the Respondent that he was misguided by the agent(s) of the Appellants while making the policy.  Further, on receipt of policy documents, it was incumbent upon him to acquaint himself about each and every aspect of the policy terms and conditions.  If he did not do so, the buck, without any iota of doubt, stops at his doorstep. 

In the opinion of the Ld. District Forum, “…if the complainant is really aware the clause-3(i)(a) of the policy itself then definitely he would not avail the said policy which is clear when the complaint is not interested for annuity option form inspite of reminder from the authorized signatory of O.P.” (sic).  Nowhere in the petition of complaint, the Respondent made any such claim that he was not aware of Clause 3(i)(a) of the Policy in question.  Therefore, simply because the Respondent did not positively respond to the repeated reminders of the Appellants to discharge the requisite form, one wonders, how it could be a pointer of his ignorance of such clause under the policy in question.  Clearly, the Ld. District Forum decided the case based on surmises and conjecture which is not appreciable.  Even if it is assumed for the sake of argument that the Respondent was indeed unaware of such stipulations, ignorance is no excuse. 

It is the settled position of law that terms and conditions of the insurance is sacrosanct.  Therefore, until and unless it is proved beyond all reasonable doubt that the policyholder was misguided about such terms and conditions, he cannot back out of it at his whims and fancies. 

It being not a case of missale of insurance policy, the impugned order is not sustainable in the eye of law.

The Appeal, accordingly, succeeds.

Hence,

O R D E R E D

That A/357/2015 be and the same is allowed on contest.  The impugned order is hereby set aside leaving the parties to bear their own costs.