DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-VII (SW)

[GOVT. OF NATIONAL CAPITAL TERRITORY OF DELHI]

FIRST FLOOR, PANDIT DEEP CHAND SHARMA SHAKAR BHAWAN

CASE NO. CC/309/2019

                                                                                             Date of Institution  :  12.07.2017

                                                          Order reserved on  :  21.03.2023

                                                         Date of Order :  08.05.2023

In the matter of:

Diwakar Gupta,

S/o Lt Sh. Raj Kumar Gupta,

R/o E-11-E, MIG Flats, G-9,

Area Rajouri Garden,

New Delhi-110064.                                                  ….              Complainant

VERSUS

1. Tata AIA Life Insurance Company Ltd

2^nd floor, Param Towers, Plot No 11/5B,

Pusa Road

New Delhi-110005.

Also at :

2. Tata AIA Life Insurance Company Ltd,

Plot No 2 & 3, Unit No. 202 & 216,

Second Floor, Aggarwal Towers,

Sector 5, MLU,

New Delhi -110075.….Opposite Parties

ORDER

(By SH. SURESH KUMAR GUPTA, PRESIDENT)

1. The complainant has filed a complaint under section 12 of Consumer Protection Act 1986 (hereinafter referred to as Act) with the allegations that he has taken an Insurance Policy under the name “Mahalife” bearing No. C-101371230 dated 22.11.2004 of opposite parties.  He was supposed to pay annual premium of Rs. 11,138/- for a period of 12 years starting from Nov 2004 till 22.11.2015. The OP was to pay non-guaranteed bonus on the completion of six  years.  The company was to pay non-guaranteed bonus on year to year basis plus guaranteed Bonus amounting to Rs. 7500/- per annum on completion of 12 years. He did not pay the premium after completing six years and thereafter paid the arrears of balance six installments on 04.07.2016.  The OP was supposed to pay an amount of Rs 7500/- per annum as guaranteed bonus on the receipt of all the installments on 22.11.2016.  The OP has paid Rs 3255/- towards non-guaranteed bonus but did not pay the guaranteed bonus. He has requested the OP to do the needful by various emails and phone calls but in vain.  The OP has also not paid Rs 990/- due on 22.11.2011 qua which request was also made but in vain. Hence, this complaint.

2. The OP has filed a reply wherein preliminary objections are raised to the effect the complaint is vague, false and vexatious as same is filed in order to harass the OP.  No consumer dispute has been raised by the complainant. There is no deficiency in service. The complainant was required to pay premium on yearly basis for a period of 12 years i.e. 2015 and thereafter he was entitled 5% of the face amount (Rs 1.5 lacs) i.e. Rs 7500/- per annum and dividend every year till the complainant is alive.  The complainant has paid the premium till 2011 and therefore, as per provisions of the policy, Automatic Premium Loan (APL) was applied to the policy which was intimated to the complainant. The Automatic Premium Loan was applied as cash value was sufficient to keep the policy active. On 04.07.2016, the complainant has paid a sum of Rs 80796/-.  The said amount was not sufficient for APL repayment.  The premium paid on 04.07.2016 was got adjusted for the payment of premium for the years 2010-2013. The balance APL was not paid.  The coupon pay out of Rs 7500/- for the year 2016 has been adjusted in the repayment APL loan.  The complainant has still to remit Rs 4826.94 but OP has waived-off the said amount and started paying the dividend and coupon payout from 2017 onwards. There is neither any deficiency in service nor unfair trade practice on the part of OP. The complainant has received the policy documents so it was his duty to read and verify the details before approaching the OP.  The complainant has never approached the OP for rectification meaning thereby that complainant has consented to all the details in the proposal form as well as to the term of the policy.  The complaint does not disclose any cause of action. The details of the dividend and coupon payout made to the complainant are like this :

3. The OP has reminded the complainant to pay the premium and complainant was also informed that APL has been applied under the policy and requested to submit a written request in case the complainant wants to opt for reduced paid value or cash value accrued under the Policy.  The letter dated 07.02.2017 of the complainant was duly replied vide letter dt 11.02.2017 by the OP that coupon payout has been adjusted towards APL repayment and same could not be paid.  There is no deficiency in the service on the part of the OP.

4. The complainant has filed the rejoinder to the reply wherein the stand taken in the complaint is reaffirmed and denied the stand taken in the reply by the OP.

5. Both the parties have led evidence.

6. The complainant has filed his own affidavit in evidence wherein he has corroborated the version of the complaint as set out in the beginning while briefing the facts and relied upon the documents Ex CW-1/A-1 to 5 (though exhibits are not put on the documents).

7. The OP has filed the affidavit of Sh. AnmolKishor, Manager (Legal) in the evidence and reaffirmed the stand taken in the reply and also reliance on the documents i.e. Exhibits R1 to R5.

8. We have heard Ld counsel for the parties and pursued the entire material on record.

9. The certain facts are clear from the record. The complainant has filled the proposal form and benefit illustration form dated 22.11.2004 Ex R1 for taking the policy from OP.  The policy bearing No C-101371230 dt 22.11.2004 i.e. “Mahalife” plan Ex R2 was issued by OP in favour of the complaint. The complainant was to pay premium of Rs. 11,138/- per year for 12 years starting from Nov, 2004 till 22.11.2015.The terms & conditions of the policy Ex R2 shows that complainant can withdraw or return the policy within 15 days i.e. under the free look cancellation period but complainant did not opt for it meaning thereby that complainant has accepted the terms & conditions of the policy Ex R2.

10. The complainant was entitled for a dividend which has been paid regularly to him.
11. The complainant was entitled for payout coupon of 5% of the sum assured (i.e. Rs 1.5 lacs) i.e. Rs 7500/- per year starting from 2016 till he is alive on the payment of premium regularly for 12 years.

12.  The complainant has only paid 06 yearly installments and thereafter he has paid the balance six installments amounting to Rs 80,796/- on 04.07.2016. The payout coupon for the year 2016 was not paid to the complainant by the OP.

13. The terms & conditions of the policy say that if the premium is not paid within the grace period and no non-forfeiture option has been elected, we will advance the premium due as automatic Loan as long as the cash value is equal to or greater than the premium in default plus any indebtness. We will continue to extend an Automatic Premium Loan at subsequent due dates provided the cash value is sufficient.

14. The complainant has initially paid only 06 yearly installments.  OP has issued lapse notices Ex Annexure R3 dated 26.12.2008, 23.12.2010, 23.12.2011 and 23.12.2015. The complainant has paid the balance six installments on 04.07.2016 meaning thereby that the balance six installments have been paid on the receipt of last lapse notice dt 23.12.2015.

15. The OP has issued a letter dated 22.11.2016 to the complainant that coupon payout of Rs 7500/- due on 22.11.2016 Ex Annexure R4 has been adjusted towards indebtness of the policy and a sum of Rs 4750.72 has to be paid by the complainant to the OP. The policy has been renewed.  It was brought to the notice of the complainant that Automatic Premium Loan clause has been applied to the policy which is clear from Annexure R5. The legal notice dt 07.02.2017 of the complainant was duly replied by the OP vide Ex Annexure R6.

16. The insurance policy is to be interpreted as per the terms & condition of the policy documents which is binding between the parties. Nothing can be added or deducted in order to give different meaning to the terms & conditions of the policy.  It is settled Law and terms & conditions are of paramount importance.

17. The complainant has not paid the premium installments in time which led the OP to invoke automatic non-forfeiture provision incorporated in the policy.   The automatic premium loan was applied to the case in hand by invoking automatic non- forfeiture provision as cash value under the Policy was sufficient to keep it active. The complainant has paid the balance 06 installments on 04.07.2016 and the amount was not sufficient for APL repayment as amount stands adjusted for the premium for the years 2010-2013. The coupon payout for the year 2016 was not issued as the amount of the coupon stand adjusted in the repayment of APL loan.  The complainant was also to pay Rs 4826.94 in terms of automatic non-for feature provision, which has been waived-off by OP. The complainant has not received coupon payout of Rs. 7500 for the year 2016 as OP has invoked automatic non- forfeiture provision for his non-payment of the six yearly installments in time. All this has been done in accordance with the terms & conditions of the policy Ex R2 and no deficiency of service can be found on the part of OP.

18. The onus was on the complainant to prove that there was deficiency of service on the part of OP. Mere filing of an affidavit is not enough to prove deficiency of service unless supported by some other material in the form of documentary evidence. The complainant has filed to bring on record any material to show that there was deficiency of service on the part of OP.

19. In view of our aforesaid discussion, the complainant of the complainant is dismissed with no order as to the cost.

• Copy of the order be given to the parties free of cost.

• File be consigned to record room.

• Announced in open court.