Date of Filing:29.05.2014

   Date of Order:28/02/2017

ORDER

BY SRI.H. JANARDHAN MEMBER:

1.     This is the complaint filed under Section 12 of the Consumer Protection Act, 1986 against the Opposite Party (herein referred in short as O.P) alleging the deficiency in service and prays for direction to the O.P to cancel the insurance policy bearing No. C035188816 issued in favour of complainant and to repay Rs.1,35,174/- being a amount paid towards the  premium of the insurance policy along with interest at rate of 18 % per annum and to pay damages of Rs.10,000/- as compensation for mental agony and Rs.10,000/- towards cost of the litigation.

2.     The facts in brief are that, O.P.No1 and 2 are engaged in business of providing different types of healthy insurance policies to its customers.   The complainant had availed a TATA AIG LIFE MAHA LIFE GOLD policy, which is a death benefit policy for an insured amount of Rs.5,00,000/- from the O.P vide policy No. C035188816. The complainant states that he is a subscriber to the policy since 17.05.2011 and he has paid the first premium on 17.11.2011 itself and the said policies last premium due date is 17.11.2015.  The policy subscription is to be paid semi annual i.e. twice in a year. Further states that, in toto complainant paid Rs.1,35,174/- towards the insurance premium on different dates shown in the complainant.  ON 12.12.2013 complainant dropped a cheque in favour of TATA AIG company limited in their drop box situated at Srirampura Bengaluru and the same has been debited from the account on 17.12.2013 which is reflected in the bank statement of account(bank pass book). The complainant alleges that inspite of having paid the insurance premium well within the grace period of 30 days, the O.P lapsed the insurance policy of the complainant under the pretext of non-payment of premium.  The O.Ps started sending message to the complainant informing about the lapse of insurance policy for non-repayment of premium, though it is paid well within the due date by the complainant.  Thereafter complainant to resolve the issue personally visited the office of the O.P several time but he was unable to get proper and satisfactory response from the concerned officer of the O.Ps.  After much follow-up i.e after 45 days the O.ps admitted the inconvenience caused and deficiency in service made by the O.p have sent renewal life insurance premium receipt dated: 31.1.2014 and reinstatement letter dated 31.1.2014 to the complainant through e-mail. Accordingly insurance policy was reinstated from January 31, 2014.  The complainant states that he being a central Government employee visited the office of the O.Ps several times for the mistake committed by the O.P s which caused lot of inconvenience in attending his regular job and have to suffer monitory loss and hence alleged that deficiency service on the part of the O.P. Further complainant demanded to cancel the insurance policy issued on 17.5.2011 and to pay the insurance premium paid amount to an extent of Rs.1,35,174/- but the O.Ps refused to cancel the insurance policy and to repay the amount paid.     Hence this complaint.

3.     Upon issuance of notice to the O.Ps. appeared through their counsel and filed the version in the version O.P. contained that the complainant is not maintainable either in law or on facts.  Further contended that the complaint lacks bona-fide cause of action and the present complaint is premature as the complainant himself failed to make a written request with respect to the surrender his policy.   As per the terms and conditions of the policy and as per the IRDA regulation in order to considered the claim of the complainant it is necessary to receive the intimation from the policy holder/nominee however, upon the receiving request the OP will process the surrender request as per the terms and condition of the policy and will pay the surrender value to the complainant if any.  On the basis of information provided in the proposal form and on the payment of premium amount was issued in the name of the complainant the same was dispatched at the correspondence address of the complainant. Under the said policy the premium payable was Rs.22,529/- which was to be paid semiannual as per terms of 15 years and the sum assured was 5 lack.   As per the terms and condition of the policy the complainant may surrender his policy after payment of premiums for at least three consecutive years and as such the policy shall acquire the guaranteed surrender value since the complainant has paid the premium first three consecutive years the complainant is eligible to surrender his policy and the opposite party shall pay the surrender value as per the terms and condition of the policy.  As the complainant has not made any representation for surrendering the policy there is no deficiency in service on the part OP and on other grounds prays for dismissal of the complaint.

4.      In order to substantiate the case of the parties and both parties filed their affidavit evidence and also heard the arguments.

5.    On the basis of the pleadings of the parties, the following points will arise for our considerations are:-

                (A)   Whether the complainant has proved

                     deficiency in service on the part of the O.Ps?

(B)  Whether the complainant is entitled to

     the relief prayed for in the complaint?

(C)   What order?

6.     Our answers to the above points are:-

POINT (A) & (B):      In the affirmative.

POINT (C):       As per the final order

for the following:

REASONS

POINT No.(A) & (B):-

7.    on perusing the pleadings of both the parties it is undisputed fact that complainant had availed a TATA AIG LIFE MAHA LIFE GOLD policy which is a death benefit policy for an insured amount  of Rs.5,00,000/- from the O.P vide policy No.C035188816. The said policy was obtained on 17.05.2011 upon the payment of the first premium of Rs.22,529/- from the said policies last premium due date is 17.11.2025. The mode of payment of premium of the said insurance policy is semi annual and that is two times payable in a year within the due date and with a grace period of 30 days from the due date if not paid within due date.  The complainant has paid Rs.22,529/- on or before all the due dates without fail. It is also not in dispute that the complainant in total paid Rs. 1,35,174/- towards the insurance premium.   Further it is not in dispute that in the first week of November 2013 a remainder letter for payment of renewal premium on the due date 17.11.2013 with grace period of 30 days was received by the complainant as per the said intimation letter the 6^th premium of Rs.22,529/- was strictly payable on or before 17.12.2013.  Accordingly the complainant had dropped a cheque in favour of OP No.1 in the drop box in Srirampura Bengaluru on 12.12.2013 and the same was debited to the account of complainant on 17.12.2013 which was reflected in the pass book of the complainant. 

8.     Now the crux of the matter is to consider after the due payment by the complainant to the Ops towards the premiums of the insurance policy and the same was not renewed.  On perusing the documents the amount remitted by the complainant towards the renewal of the policy was encashed by the OP on 17.12.2013 itself.  But due to the mistake on the part of the OP the policy was lapsed though the complainant had made the payment in time but due to the act of the OP the policy was lapsed but when the complainant intimated about the payment details.  The allegation of the complaint is that,  but the OPs has not given satisfactory reply as to why the policy was lapsed and failed to solve the issue and the OPs did not cared to issue the premium certificate and premium certificated dated 23.01.2014 did not carry the premium amount paid by the complainant. After issuing the legal notice as per Annexure–H ink page No.54 of the complainant. The OP in response to the legal notice of the complainant to the cancel the policy and to refund the amount paid by the complainant to the said legal notice the OPs had given a response to the complainant on 19.03.2014 in which the OPs admitted that the complainant had remitted the payment of Rs.22,529/- vide cheque No.497 on 12.12.2013 and the same was cleared on 17.12.2013.  However, inadvertently there was a delay in applying the premium in the policy and same was applied on 06.01.2014 due to which there was a receipt of the lapse notice dated 18.12.2013 and there was a renewal call and as per the Annexure –I at ink page No 56 of the complainant the OP admits the fault and interest towards the lapse of the policy was waived off and the complainant’s policy was regularized on 31.01.2014 and Perusing the Annexure–I glaringly it appears that there is deficiency in service on part of the OP. Further OP also not disputed the lapse of  policy on account of mistake and contended that mistake is due to inadvertent technical fault and it was not the intention to harass the complainant.  However, the complainant had no insurance coverage from 18.12.2013 to 31.01.2014 that is for 45 days inspite of the payment of the premium well within time if something might have happened to the complainant then the complainant would be in trouble for no fault of him. On the basis of evidence on record, the mistake occurred from the side of the O.Ps whatever it may be the reasons. The O.P is the mighty institute has to take care of all its duties without any negligent but O.P is not diligent in its duty, for which complainant obviously suffered mental agony. Hence, O.P has to compensate the complainant.  So far as the cancellation of policy is concerned it is to be considered by the O.ps as per the insurance terms and conditions and the complainant is entitled for surrender value only.  Under the circumstances, we hereby given liberty to the complainant to move the papers to get the surrender value of the policy as per the terms and conditions of the policy or complainant can continue the policy.  However, inspite of payment made towards the particular period premium by the complainant but the O.Ps did not renewed it for whatever it may be the reason it is obviously deficiency on the part of the O.Ps and hence complainant obviously suffered mental agony for which O.Ps has to compensate suitably.  In the attendant circumstances of the case, we deem it just and proper to direct the O.Ps to pay compensation of Rs.10,000/- to the complainant along with cost of Rs.2,000/- it will meet the ends of justice. Accordingly, we answered these points in the Affirmative.

POINT No. (C):- 

9.     On the basis of the answering the Point No. (A) and (B) and in the result, we proceed to pass the following:-

ORDER

1. The complaint is allowed in part with cost.
2. The O.Ps No.1 and 2 jointly and severally liable to pay Rs.10,000/- to the complainant  within 30 days from the date of receipt of this order failing which OPs are directed to pay an interest at the rate of 9% per annum on the above said amount.
3. The O.Ps shall pay Rs.2,000/- to the cost of the proceedings.
4. The O.Ps are hereby directed to comply the order of this Forum within 30 days from the date of receipt of this order, and  to submit the compliance report to this Forum within 45 days from the date of receipt of this order.
5. Send a copy of this order to both parties free of cost.

(Dictated to the Stenographer, transcribed and computerized by him, corrected and then pronounced by us in the Open Forum on this the 28^th Day of February 2017)

MEMBER                 MEMBER                PRESIDENT

*Rak