J U D G E M E N T
The case of the complainant in a nutshell is as follows:
The complainant purchased an insurance policy being no. U 141650267 on 29.9.2011 through the OP-4 in the branch office of OP-1. Before purchasing the policy the OP-4 persuaded the complainant to purchase one product a single policy premium amounting to Rs. 3, 75,000=00 under the name & style Tata AIG Life Insurance Invest Assure Apex Supreme. At the time of purchasing the policy the OP-4 gave assurance to the complainant that the said policy would be matured after one year and on maturity the complainant would get twice the amount of single premium and also assured that the complainant can withdraw the amount at any moment without any deduction. The complainant on good faith deposited Rs. 3, 75,000=00 for the said single premium policy on 10.10.2011 before the OP at Asansol Branch. After one year due to urgent need of money the complainant wanted to withdraw the maturity amount and went to the office of the OP-1 and then the complainant came to learn that the said policy for the period of ten years and the complainant would have to pay the premium annually @Rs. 3,75,000/- for nine times more. The complainant also came to know that if he wants to withdraw money, then he would have to pay at least five installment premiums against the said policy. The complainant became very much shocked as he is not in a position to pay further premium amount he has no source of income to fulfill the same. Then the complainant contacted with the OP-4 and wanted to know why the OP-4 has misguided before issuance of the policy. The complainant also requested the OP-4 to make arrangement for withdrawal of the said premium amount but very surprisingly the OP-4 completely denied this and said that the company policy rules and regulations have been changed in respect of the said product and so the complainant would have to pay at least five premiums to withdraw the money, which clearly indicates deficiency in service and unfair trade practice on the part of the Ops. Thereafter the complainant sent a letter to the OP-1 on 21.12.2012 stating the said fact and requested to look into the matter. But till today not a single response came from the part of the OP-1, which is also deficiency in service and unfair trade practice on their part. Then the complainant lodged a complaint before the Insurance Ombudsman at Kolkata on 10.3.2013 alleging deficiency in service and unfair trade practiced on the part of the Ops and as per their request the complainant also sent all the documents required to the Insurance Ombudsman, but no fruitful solution came from the part of the Insurance Ombudsman also. Thereafter complainant sent a lawyer’s notice dated 18.3.2013 to the Ops stating the entire fact of misguidance by the OP-4 with a request to make arrangement of the payment of the said premium amount along with interest as early as possible and to take necessary action against the OP-4. But the Ops did not take any proper steps till today. The complainant also lodged a complaint against the Ops before the Assistant Director, CA & FBP, Durgapur Regional Office. But the Assistant Director, CA & FBP, Durgapur Regional Office sent a reply to the complainant stating that the grievance of the complainant could not be redressed through the process of mediation due to non-response on the part of the Ops. Finding no other alternative, the complainant has filed this complaint praying for relief with a direction to the Ops to refund the premium amount to the tune of Rs. 3, 75,000=00 to the complainant, Rs. 2, 50,000=00 as compensation towards mental pain. Agony and harassment and Rs. 25,000=00 towards litigation cost.
The case has been contested by the Op-1, 2 & 3 by filing written version jointly denying the entire allegations made by the complainant in the petition of complaint. The Ops have further stated that the complainant approached through the agent of the OP and sought for an Insurance policy for himself. The agent of the OP explained about various polices out of which the complainant chose to avail a “TATA AIA Life Invest Assure Apex Supreme Plan”. As per terms of the said policy the complainant was required to pay a yearly premium of Rs. 3, 75,000=00 for 5 years with a policy term of 10 years. The policy document was sent to the complainant on 08.10.2011. Along with the original policy document, the complainant was also given an option to cancel the policy with Free Look Period, if he was not satisfied with the terms of the policy. The complainant did not opt for such option and did not returned the policy, from where it can be presumed that he was satisfied with the terms and condition thereof. The complainant paid only first premium for the policy but failed and/or neglected to pay the premiums for the next years. The OP sent reminder through premium payment notice but the complainant failed to pay the premium and as such the policy reached to “Lapse Status” and the OP duly communicated the complainant regarding lapse of the policy. The Ops have further stated that vide its reply dated 22.12.2012 duly informed the complainant about the inability to cancel the policy and refund the amount, as the request for cancellation is beyond the free looking period hence it is rejected as per the provision of IRDA guideline. The Ops have also stated that the policy is a long term contract and the terms and condition are binding upon the parties. As the insurer undertakes to indemnify the insured from future risk; it is the obligation of the insured to abide by the terms and condition. In the event of breach of terms, it vitiates the policy contract and absolves the insurer from its liability. Some of the relevant conditions are set out herein below:
Discontinuance of premium payment:
Where a regular premium due before the fifth policy anniversary remains unpaid at the end of the Grace Period. You will be entitled to exercise one of the following options:
- To revive the policy or
- Complete withdrawal without any risk cover
You are required to exercise either of the above options within the notice period. If you do not exercise the option within stipulated period, option (b) above shall deemed to have been exercise. If you exercise option (b) or do not exercise any option within the notice period as mentioned above, the fund value after deduction of the discontinuance charge as on date of discontinuance shall be credited to the discontinued policy fund maintained by us. The proceeds of the discontinued policy fund shall be refunded at the end of lock-in period of five years from the inception of the policy. In case of death during this period the proceeds of the discontinued policy fund shall be payable immediately.
The Ops have denied and disputed that the complainant is entitled to get refund of Rs. 3, 75,000=00 or compensation for the alleged harassment or litigation cost and prayed for dismissal of the complaint.
The case runs ex parte against the OP-4.
The Ops have filed documents like Xerox copy of the Policy document, Xerox copy of letter dated 22.12.2012 of Assistant Manager-Grievance Redressal Cell to the complainant, Xerox copy of letter dated 18.8.2014 of Senior Manager Legal, East Zone etc.
-: Decision with reasons :-
On going through the statements of both parties, documents as available on record and heard argument from both sides it is admitted position that the complainant purchased an insurance policy from the Ops by depositing an amount of Rs. 3, 75,000=00. But the allegation of the complainant is that at the time of purchasing the policy the agent (OP-4) of the OP-1 told him that it is single premium policy and gave assurance to the complainant that the said policy would be matured after one year and on maturity the complainant would get twice the amount of single premium and also assured that the complainant can withdraw the amount at any moment without any deduction. After one year when the complainant went to the office of the OP-1 for withdrawal of the maturity amount, then the complainant came to learn that the said policy is for the period of ten years and the complainant would have to pay the premium annually @Rs. 3,75,000/- for nine times more. The complainant also came to know that if he wants to withdraw money, then he would have to pay at least five installment premiums against the said policy. The allegation of the complainant is that the OP-4 has misguided him at the time of purchasing the said policy. So the complainant made complaint before the OP-1, OP-4 and the Insurance Ombudsman for redressal of his grievance and for refund of his premium amount paid by him at the time of purchasing the policy. But as they have not redressed his grievance so he files the complaint. On the other hand, the case of the Ops is that the complainant has purchased the policy after fully aware regarding the features, terms and conditions of the policy and signed the proposal form and on the basis of the said application form the Ops issued the said policy. As per terms of the said policy, the complainant was required to pay a yearly premium of Rs. 3, 75,000=00 for 5 years with a policy term of 10 years.
The main allegation of the complainant is that the agent of the OP-1 misguided him at the time of purchasing the insurance policy. But from the ‘Policy Information Page’ it is found that Policy Term is for 10 years, Maturity/Expiry Date is 2021/09/29 and Mode of Payment is Annual. Therefore, the complainant has every right to cancel the policy within the free look period in accordance with the IRDA Regulations (Protection of Policyholders’ Interests) if he was not satisfied with the terms and conditions/features of the policy, by giving written notice to the OP and he will receive the premiums invested into the funds as Unit Price as at the date of cancellation along with charges paid after deducting (a) for proportionate risk premium for the period of cover (b) medical examination costs, if any and (c) stamp duty, which has been incurred for issuing the Policy. Such notice must be signed by the policy holder and received by the Insurance Company within 15 days after the policy holder or the designated agent of the policy holder receives the Policy. Therefore, the complainant has failed to take the advantage of the free-look period which has been framed by the IRDA for protecting the interests of the investors/policyholders. In such a situation the complainant has miserably failed to substantiate any deficiency in service or unfair trade practice on the part of the Ops. Hence, it is
O r d e r e d
that the petition of complaint filed by the complainant is dismissed on contest. However considering the facts and circumstances of the case there is no order as to costs.
Let a plain copy of this order be supplied to parties free of charge.
Dictated and corrected by me.
(Durga Sankar Das)
Member
DCDRF, Burdwan
(Silpi Majumder) (Durga Sankar Das)
Member Member
DCDRF, Burdwan DCDRF, Burdwan
