Date of filing : 19-04-2011
Date of order 29-06-2012
IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD
CC.85/2011
Dated this, the 29th day of June 2012
PRESENT
SRI.K.T.SIDHIQ : PRESIDENT
SMT.P.RAMADEVI : MEMBER
SMT. K.G.BEENA : MEMBER
Shubhavathi, W/o. Venkataramana Bhat, } Complainant
Rep. by her son Muralikrishnan,
R/at Valakunja House, Po.Ukkinadka,
Badiadka village, Kasaragod Taluk.
Pin: 671552.
(C.Venkataramana Bhat, Kasaragod)
The Branch Manager, } Opposite party
Bajaj Allianz Life Insurance Co.Ltd,
Opp. Vyapari Bhavan, Kanhangad.Po.
Hosdurg Taluk.
(Adv. K.V.Jayaraj, Hosdurg)
O R D E R
SMT.K.G.BEENA, MEMBER
Subhavathi is a policy holder of Bajaj Allianz Life Insurance Co.Ltd and opposite party is Bajaj Allianz Life Insurance Company Ltd. Complainant is represented by her son Murali Krishna. As part of the business promotion, the agent of the opposite party approached Subhavathi, introduced “Bajaj Allianz Unit Gain Plus Gold” and collected `20,000/- in Policy No. 0683021920 for a sum assured of `1,00,000/- dated 14-02-2008. On 18-02-2011 complainant received a termination letter of the above said policy along with a cheque for `3,546/- as surrender value of the policy which is illegal according to the complainant hence this complaint is filed against the illegal act of opposite party.
2. According to opposite party all the allegations of the complainant are false and hence denied. Complainant had placed a policy proposal form before the opposite party for issue of a policy under the “Unit Gain Plus Gold Plan” on 16-01-2008 through an insurance consultant. The policy proposal was accepted and the complaint was issued with a policy. The policy was terminated as per the “Fore Closure” clause in the policy and surrender value was paid to her as per a cheque.
3. According to opposite party there is a grievance redressal committee under opposite party. Besides the Central Government has established Insurance Ombudsman to attend the grievances of policy holders. The complainant has not opted the inexpensive remedy before the said Forms. Moreover, the complaint is barred by limitation. As per the policy document complainant is given an option to review and to return the policy within 15 days of the receipt of policy document. As per the proposal the complainant is bound to pay premiums for a consecutive years. Complainant was to evade from payment of premiums. The complainant is liable to bear all consequences for non –payment of premiums under the policy.
4. Complainant’s son as the witness filed proof affidavit in support of complainant’s case as PW1.. Exts A1 to A3 marked. PW1 faced cross-examination on affidavit. Another witness examined as PW2. Ext.A4 marked. For opposite party operation Manager of Bajaj Allianz filed proof affidavit as DW1. Exts.B1 and B2 marked. DW1 faced cross-examination. Opposite party’s witness is examined as DW2. Both sides heard and documents scrutinized.
5. Now the points arises for consideration are:
1. Whether the complaint is maintainable?
2. Whether the complaint is barred by limitation?
3. Whether there is deficiency in service on the part of opposite party?
4. If so, what order as to relief and cost?
6. Here Smt. Subhavathi had obtained a life insurance policy named Bajaj Allianz Unit Gain Plus Gold on 14-02-2008 for a sum assumed of `1,00,000/- from the opposite party and paid a sum of `20,000/- as Ist instalment premium. While obtaining Ext.A1 policy, opposite party assured that a single yearly premium will also get a return of more than 20% per annum plus insurance coverage of `1,00,000/- on belonging the assurance of opposite party, complainant deposited `20,000/- with opposite party for which opposite party issued Ext.A2 receipt. On 18-02-2011 complainant received a termination letter of the above said policy along with a cheque for `3546/- as surrender value of the policy. This complaint is filed opposing the termination letter without the consent of the complainant along with Ext.A3 cheque issued to her.
7. PW1 further deposed that he don’t know the name of the agent. He was out of station at the time when complainant was joining in insurance. He was studying in Thaliparamba. He don’t know whether his mother read policy documents. Though he can read, he can’t understand the contents of the policy documents. He came to know that the agent told his mother that only single time premium is required.
8. As against the evidence of PW1 Opposite party examined as DW1. Exts B1 & B2 marked. Ext.B1 is the proposal form and Ext.B2 is the undertaking given by her husband in confirmation of payment in future premium marking of this document is objected by the counsel of the complainant. But the date of proposal form Ext.B1 is 16-1-2008, and date of undertaking Ext.B2 is 14-02-2008 since the dates of documents are different we are relying upon the deposition of PW1 that policy holder was given false promise that policy holders amount will be double on the 5th year. Though DW1 deposed that they have issued demand notice to the complainant in the 2nd and 3rd year. It is not produced before the Forum. Moreover it is not informed to the complainant that in the event of non-payment of premium policy will be cancelled.
9. The learned counsel for opposite party Sri.K.V. Jayaraj submitted that complainant violated policy conditions and thereby the policy is foreclosed as complainant failed to remit the 2nd instalment. Moreover there was no written authorization bySubhavathi, authorizing her son Murali Krishnan to file this complaint.
10. Point No.1: The first contention of the opposite party is that the complainant has not approached the grievance redressal committee or insurance ombudsman for the redressal of his grievance and without exhausting those remedies the complainant approached this Forum and therefore the complaint is not maintainable. We are unable to accept both these contentions. The Hon’ble National Consumer Disputes Redressal Commission in the case of Kamleswari Prasad Sing V. National Insurance Company Ltd. Reported in I (2005) CPJ 107 (NC) has held that even if a dispute is adjudicated before the Insurance Ombudsman even then the complainant can approach Consumer Forum seeking relief since the Ombudsman is not discharging judicial or quasi-judicial functions and their note is altogether different. If that be so, the proceedings before the Ombudsman is not mandatory one and it is not necessary that the complainant should exhaust his remedy before the Ombudsman. It is equally applicable to grievance redressal committee also.
11. Point No.2: Another contention of opposite party is that the complaint is barred by limitation. It is also not sustainable since the maturity of the policy is in 2018. That apart he has received the cheque for `3546/- towards the foreclosure of policy amount only on 18-02-2011. So the cause of action starts from 18-02-2011. Therefore the complaint is filed well within the time stipulated for filing the complaint and hence it is not barred by limitation.
12. In this case the specific case of the complainant is that she accepted the policy relying upon the words of the insurance agent that the policy holder will not loose any amount if she remits `20,000/- as single term premium for the proposed policy. PW1 during cross-examination has deposed that nobody explained them about the terms and conditions of policy at the time of proposing for insurance. They had not read the policy and they are entitled to get refund only as per the terms and conditions of the policy.
13. According to him they usually obtain the signature of the proposer in the proposal form and accept the money from him and duly sent to the head office of the company and in this policy the policy holder has to pay `20,000/- each for 10 years and the sum assured is 1 lakhs. In Ext.B1 proposal form page No.3 deals with the initial unit statements which does not say that the policy holder has to pay 20,000/- each for 5 years
14. Now the crucial question that poses before us is that why did the complainant file this complaint if she joined in the insurance scheme if she was fully aware about the terms and conditions of the policy and the payment of annual premium of `20,000/- continuously for 10 years for the sum assured `1,25,000/-. That remains unexplained by the opposite parties. So the case of the complainant that the insurance agent and Ist opposite party seduced her to join the policy by offering wild and tantalizing proposal that the policy holder will get `1,25,000/- on 10th year in the event of paying a single term premium of `20,000/- is appears to be true.
15. Another important point to be noted here that the agent who alleged to be seduced the complainant did not brought before us. When an allegation of seduction is made by the complainant it was the bounden duty of the opposite parties to examine the agent to prove the contrary, especially when the proposal contains a declaration by the agent(insurance consultant) that he has explained the nature of questions contained in the proposal form to the applicant and he has also explained the features and benefits of the plan and riders to the applicant and he also confirm that he has not induced or coerced and that the applicant/life to be insured have responded in their free volition. This declaration itself is a pointer to the fact that there may be inducement and coercion by agents to join in the insurance schemes and the said declaration is printed in order to avoid such complaints.
16 After the entry of private insurance companies in the insurance sector they are doing aggressive business. Earlier it was service oriented. But now a days it is purely business motivated as they are hell bent upon selling what they call ‘products’. As part of their aggressive business drive they offer bonanza gala galore to their agents and who in turn grab the prospective policy holders by their throat by making tall promises. In most cases insurance policies contain numerous terms and conditions that normally are not disclosed to the insured. No insurance agent would explain terms and conditions those appear to be adverse to the interest of the policy holder. The agent of the insurance company turns out to be a most vital factor. It is he who undertakes the insurance business on behalf of the insurer. He should make it a point to explain each and every condition or clause of the policy to the prospective policy holders which are printed in ‘small print’ of which ordinary persons would not be in a position to read between the lines.
17. From the evidence let in by the parties and also considering the facts and circumstances of the case we are of the opinion that at the time of canvassing the complainants what is transpired between the agent, Ist opposite party and the complainants as narrated by the complainant is true. Therefore the act of opposite parties amounts to deficiency in service. The contention that the complainant ought to have surrendered the policy within free look period of 15 days is also have no legs to stand since the proposal itself was obtained by inducement. A proposal which itself has no legal sanctity make the whole contract voidable at the option of the complainant irrespective of the limited days of free look period and therefore the complainants are not bound by the terms and conditions of policy.
In the result complaint is allowed and opposite party is directed to refund `20,000/- less than the amount already received by her i.e. `3546/-. Therefore the complainant is entitled for `16,454/- with interest @ 9% from the date of complaint till payment together with a cost of `3000/- within 30 days from the date of receipt of copy of this order. Failing which `16,454/- will carry interest @12% from the date of complaint till payment.
MEMBER MEMBER PRESIDENT
Exts.
A1. Policy Schedule.
A2. First premium receipt.
A3. Payment reference.
A4. Bajaj Allianz Life Insurance Co.Ltd Unit Gain Plus Gold.
B1.Proposal Form for Life Insurance.
B2. Letter sent by Venkatramna Bhat to Opposite party.
PW1. Muralikrishna.V.
DW1.Shinoj.P.T.K.
DW2.V.Venkataramana Bhat.
MEMBER MEMBER PRESIDENT
Pj/
