Karnataka

Chitradurga

CC/56/2014

Shri.Dr.Manjunath Reddy S/o. Late G.Malareddy - Complainant(s)

Versus

The Branch Manager, Life Insurance Co.Ltd., - Opp.Party(s)

Shri.C.M.Veeranna

23 Apr 2015

ORDER

COMPLAINT FILED ON : 22/07/2014

     DISPOSED ON: 23/04/2015

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA

 

CC. NO. 56/2014 DATED:23rd  April 2015

 

PRESENT :-     SRI.H.RAMASWAMY                MEMBER

                                B.Com., LL.B.,(Spl.)

 

                SMT.G.E.SOWBHAGYALAKSHMI     MEMBER

                                B.A., LL.B.,

 

COMPLAINANT	Sri. Dr. Manjunath Reddy, S/o late G. Malareddy, Aged about 51 years, Medical Officer, Primary Health Center, Merasabihally Village, Challakere Taluk, Chitradurga District. Sri. (Rep by Sri. C.M. Veeranna, Advocate)
OPPOSITE PARTY/s	The Branch Manager, Life Insurance Company Limited, "Jeevan Jyothi" T,R. Nagar, Challakere,  Chitradurga.   (Rep by Sri. L. Madhusudhana,  Advocate)

 

SMT.G.E. SOWBHAGYALAKSHMI, MEMBER.

ORDER

 

The above said complainant has been filed by the complainant U/s 12 of C.P. Act 1986 for seeking the relief to direct the Opposite party (here in called Op) to revive the policy by collecting due premiums or direct the Op to return sum  of Rs. 2,23,815/- which was collected from the complainant. along with bonus with  interest at the rate of 24%  p.a. from the date collecting the Ist premium till the realization and also direct to pay sum of Rs. 10,000/- towards  mental agony and Rs. 5,000/- towards the cost of this proceedings and also to grant such other reliefs.

2. Brief facts of the complaint is that the complainant stated that complainant is working as medical Officer at Primary Health Center, Meerasabihalli Village, Challakere Taluk. One of agent of Ops company has approached the complainant and insisted to take a policy of Op company as it is well reputed and good company. The agent of  Op Company has suggested to the complainant to take a policy  by name "Jeevan Anand" policy. On believing the words of said agent, complainant took above policy on 28/03/2010 vide policy No:629345534 which has to be paid half yearly, the sum assured is Rs.10,00,000/-.

3. Complainant further stated that after taking policy complainant has paid five premiums in time for Rs. 44,763/- each. In the year 2012 complainant is suppose to pay the premium in the month of September. But due to his sudden cardiac related problem it was skipped out from the minds of complainant to pay the premium. As well as complainant was hospitalized during period of 05/12/2012 to 15/12/2012 in respect of his by-pass surgery. Later as per doctor's advice complainant was under complete rest for few months. Because of all these circumstances, made the complainant to forget to pay the premium in respect of above said. policy.

4. It is stated that, complainant approached the Op to take the premium for which Op has not replied to the words of complainant has often visit the Op office and informed about all things what are happened and also requested to collect the due premiums. But surprisingly Op has postponed the said matter one or other pretext. Again in the month of November 2013 complainant sent a requisition letter to the Op for which Op has replied merely stating that, "Policy cannot be considered for revival" without giving any valid reasons. All these things lead the complainant to suffer physically mentally and financially. Though the complainant ready to pay the premium which are due, Ops are not ready to collect the same for the reasons better known to them. Complainant has got issued a legal notice to the Op on 20/05/2014 through his counsel. For the said legal notice, Op has sent a vague reply, which is not at all tenable under the eye of law, thereby Op has committed deficiency in service and unfair trade practice towards complainant. Hence this complaint.

5.  It is stated that complainant has taken a policy from Op in the year 2010 by paying a premium, hence complainant is a consumer to the Op and said dispute is a consumer dispute. Cause of action for this complaint arose on 31/03/2010 on which the complainant has deposit the first premium amount i.e. Rs. 44,763/- also on 08/03/2014 the Op responded to the requesting letter given by complainant by stating that, their request is declined and also on 05/06/2014 when the Op has sent a vague reply as the policy is lapsed. Hence, the complaint filed today is within time and prayed for allow the complaint with cost.

6. On the service of Notice Op appeared through his counsel Sri. L.M. Advocate filed Vakalath for Op and filed version. It is admitting  that the Dr. Manjunatha Reddy, obtained an Insurance Policy from this Op bearing Policy No:629345534 with date of commencement as 28/03/2010 for a sum assured of Rs. 10,00,000/- under table and term 149-15 with installment premium of Rs.44,763/- payable half yearly premium under the policy  paid up-to March 2012 and first unpaid premium was September 2012. Rest of the averments in the complaint are all not known to this Op.

7. It is stated that this Op had received the premiums under the policy up-to March 2012 and first unpaid premium is September 2012. The other averments are not known to this Op and complainant is put to strict proof of the same.

8. It is stated that complainant i.e. Dr. Manjunatha Reddy had applied for revival of his policy on 29/10/2013 with mandatory requirements. The  revival of a Policy in law is a fresh contract and if both parties agrees, then the policy will be revived. As per the decision in given in R.P. No.649 of 2005 at NCDRC, New Delhi, LIC V/s Bhavani, it was mentioned that after the  expiry of the policy, if the party chooses to revive the contract of policy then revival, in law is clearly a fresh contract. After careful scrutiny of the Medical reports (the reports are sent to Central Office) this Op declined the revival of the policy as per the decision of the Central Office, Actuarial dept and informed the life assured accordingly. As mentioned in the complaint life assured not remitted the premium due on September 2012 and after the lapsed grace period of 30 days from 28/09/2010 to 28/10/2010 policy became lapsed status. If he had remitted the due premium on 28/09/2010 even have accepted the subsequent premium. Once the policy become lapsed status the policy is to be revived as per the conditions prevailing. The revival under the above policy was not accepted by the Central Office based on the Medical reports received by them in view of CABG, Diabetic Since 5 years, Hypertension. As such though he was required to pay the premium within the grace period, if the policy holder has not paid the premium within grace period the policy automatically went into a lapsed condition. The premium under the policy fallen due on 28/09/2010 and life assured undergone by pass surgery from 05/12/2012 to 15/12/2012. Complainant is being a Doctor, is  very well known about the terms and conditions of the policy that he had taken and paid 5 half yearly premiums should have remitted the premium when he knows very well about his health condition. After careful scrutiny of the submitted Medical and other reports of the life assured, by Medical experts at our central office, this Op declined the revival of the policy as per the decision of the Central Office and it is not possible to revive the policy.

9. Op further stated that the other averment mentioned in the prayer to refund the premium with interest is also not allowed as per rules. As per the policy conditions, for payment of Surrender value, premium under the policies are to paid for a minimum period of 3 years. Original policy bond issued by this Op under para 4 non forfeiture-Regulations.

10. The complainant not remitted the premium for a minimum period of 3 years, repayment of premium also not possible. There is no cause of action for the complaint and the alleged cause of action is false and concocted for the purpose of filing the complaint. The complainant is not a consumer as envisaged in the Act.

11. Since this Op declined the revival as per adverse medical reports and refund of premium also not possible where premiums are not paid for minimum period of three years there is no question of deficiency of service on the part of the Op and the complaint filed unnecessarily and prayed for dismissal of the complaint with exemplary costs.

12. Complainant himself examined as Pw-1 by filing the affidavit evidence  in which reiterated the contents of the complaint and filed 5 documents the same was got marked as Ex A-1 to A-5.  Ex A-1 Original policy,  Ex A-2 Discharge summary of the complainant issued by the Narayana Hrudayalaya Hospital, Bangalore, Ex A-3 Premium paid receipts, Ex A-4 legal notice, dated 20/05/2014, Ex A-5 replay notice, dated 05/06/2014.

13. On behalf of Op One Sri. K.R. Mohan S/o Raja Rao, Manager, (L&HPF Departments) LIC of India Divisional Office examined as DW-1 by filing affidavit evidence in which reiterated the contents of the version and filed 27 documents the same was got marked as Ex B-1 to B-27

14. Heard the arguments.

Now the point arise for our consideration for decision of above complaint is that:

Point No.1:- Whether the complainant proves that he has taken Jeevan Anand Policy from Op on 28/03/2010 vide policy No.629345534  premium amount of Rs. 44,763/- and premium paid half yearly for sum assured  of Rs. 10,00,000/- and complainant has paid 5 premiums for sum of Rs. 44.763/- each to Op company?

Point No.2:- Whether  the complainant proves that he has unable to pay the premium of above said policy in the month of September 2012, due to his sudden cardiac related problem and he was hospitalized and he was undergone by pass surgery in the month of December-2012 and he approached the Op and requested to collected the due premiums but Op has not collected the same. and again complainant sent a requisition letter to the Op in the month of November-2013 for which Op has replied and stating that policy cannot be considered for revival without any valid reasons thereby Op has committed deficiency in service and unfair trade practice and complainant entitle for reliefs as prayed in the complaint?

Point No.3:- What order.?

15. Our findings on the above points are as follows:

Point No.1:- Affirmative.

Point No.2:- Affirmative.

Point No.3:- As per the final orders.

Reasons on Point No.1 and  2.

16. We like to discuss the Point No.1 and 2 simultaneously for the sake of convenience. It is not in dispute  complainant had taken Jeevan Anand policy from the Op on 28/03/2010 vide policy no: 629345534 premium amount of Rs. 44,763/- and mode of payment half yearly for sum assured of Rs. 10,00,000/- it is not in dispute  that complainant has paid five premiums to the Op company. It is not in dispute that complainant has not paid the premium in the month September 2012 due to his ill-health  it is not in dispute that the complainant had under gone bypass surgery in the month of December-2012. It is not in dispute complainant approached the Op and requested to the collected due premiums. It is not in dispute that again complainant sent a the requisition  letter  to the Op in the month of November-2013 for which Op has replied and stating that policy cannot the considered for revival. It is only in dispute that Op has not collected due premiums form the complainant and not ready to revival of the policy, thereby Op has committed deficiency in service and unfair trade practice.

17. To prove the case of the complainant. Complainant himself examined as Pw-1 by filing affidavit evidence in which reiterated the contents of the complaint and filed  five documents the same was got marked as Ex A-1 to A-5. On perusal of the Ex A-1 Original policy bearing No: 629345534 dated 28/03/2010 sum assured is Rs. 10,00,000/- installment premium of Rs. 44,763/- mode of payment half yearly, it shows nominee B.T. Suvarnamma wife name and address of the life assured shows G.M. Manjunatha reddy medical officer primary Health Center, Meerasabihalli, Challakere Tq, Chitradurga District, on stipulated due date in March, September date of last payment 24/09/2024,  issuance of the policy is admitted by the Op. Ex A-2 Discharge summary issued by the Narayana Hrudayalaya Hospital, Bangalore it shows complainant has undergone bypass surgery, Ex A-3 shows complainant has paid premiums to Op with respected to the above said policy it is not in dispute. Ex A-4 Legal notice, issued by the complainant  through his Advocate on 20/05/2014. It shows complainant called   upon the Op for revive  the above said policy by collecting the due premiums, if you failed do so the return the 5 premium amount paid by the complainant within 15 days from the date of receipt of this notice, Ex A-5 Reply notice issued by the Op on 05/06/2014 to the complainant advocate. It shows  Op competent authority have taken decision to decline the revival. On the other hand on behalf of Op one Sri. K.R. Mohan S/o Raja Rao, Manager (L&HPF) LIC of India examined as Dw-1 by filing affidavit evidence while admitting complainant obtained insurance policy from the Op bearing policy No:629345534 with date of commencement as 28/03/2010 for a sum assured of Rs. 10,00,000/- under table and term 149-15 with installment premium of Rs. 44,763/ payable half yearly and further admits, Op had received the premium under the policy up to March 2012 and first unpaid premium was September 2012 and complainant had applied for revival of his policy on  29/10/2013 with mandatory requirements. Op have also admits that the complainant i.e. life assured had under gone by pass surgery, Ex B-1 to B-6 documents pertaining to complainant. On perusal of the Ex B-1 discharge summary shows the complainant undergone by pass surgery and it shows date of admission 05/12/2012 date of discharge 15/02/2012. It is clearly shows that the complainant had hospitalized as an inpatient  for a period of 10 days and he had undergone by pass surgery in the month of December-2012. It is  clearly shows that complainant has fell sudden heart problem earlier to his by pass surgery. Ex B-2 to B-6 special Medical  report of the complainant. It shows complainant  health condition is normal, Ex B-7 Medical examiners confidential report dated 30/09/2013 it  shows in column No.15  stated as follows. On examination whether he/she appears mentally and physically healthy? yes. It show at the time of examination i.e. on 30/09/2013 the complainant is physically and mentally healthy. Ex B-11 Ex B-12 and Ex B-13 personal statement regarding health shows in column 4 shows good, Ex B-14 physicians report. Ex    B-18 online underwriting Decisions of Actuarial Department south Central zone dated 22/01/2014.       Ex B-20 online revival decision dated 13/02/2014. Ex B-21 Ops office letter dated 08/03/2014 written to complainant. Ex B-22 office letter dated 13/03/2014 addressed to Divisional Office Shivomoga, Ex B-23 requisition letter  submitted by the complainant policy. Ex B-24 online underwriting decision dated 19/03/2014 Ex B-25 certified copy of letter dated 19/03/2014 address to complainant by Branch office, Challakere Ex B-26 central office mail dated 27/08/2014 intimating the reasons for declining  the revival of complainant policy, Ex B-27 reply notice dated 05/06/2014, Ex B-21 date 08/03/2014 shows that the Op informed the complainant his policy cannot be considered for revival and declined. On perusal of the version, affidavit and documents like Ex B-21, Ex-B-25 and Ex B-26 shows that the Op has not considered the complainant policy for revival and Op has not ready to collect the due premiums and also the reasons for non-acceptance of revival based on medical reports, the medical report of complainant shows that the complainant suffered and taking treatment for heart decease. So the Op has not accepting the revival of the policy. Complainant admits that he has not paid the premium of September 2012 in time due to illness and hospitalization it is not an intentional but bonafide reason. The complainant has not paid the premium of September 2012 in time.

18. Complainant advocate argued that the complainant took policy by name "JEEVAN ANAND" on 28/03/2010 the sum of assured is Rs. 10,00,000/- and paid premium of Rs. 44,763/- mode of payment half yearly and complainant paid 5 premiums in time for  sum of Rs.44,763/- each, complainant is suppose to pay the premium in the month of September 2012 but due to his sudden cardiac related problem it was skipped out form the mind of complainant to pay the premium.  Complainant was hospitalized and under gone by pass surgery in the month of December-2012 due to his ill-health complainant unable to pay the premium of September-2012 in time. Later complainant approached the Op and requested to collect the premium which is due. Counsel for the complainant further argued that again complainant sent requisition letter to the Op in the month of November-2013 for which Op has replied merely stating that "policy cannot considered for revival" without  giving any valid reasons though the complainant ready to pay  the premium which are due but Op is not ready to collect the same thereby Op has committed deficiency in service and unfair trade practice towards complainant. It is the bounden duty of the Op to revival the policy by collecting the premiums and further argued that after collecting the premium amount from the complainant. Op cannot set back from their duty obligation lies on the Op to revival the policy. Otherwise Op has to return the premium amount paid by the complainant along with interest and other benefits and  prayed for allow the complaint with cost.

19. On the other hand Op counsel argued that the complainant has not remit the premium due on September-2012. For payment of premium condition No.2 of the policy a grace period of one month or 30 days. If the premium is not paid before the expiry of the days grace the policy lapses. If the policy holder has not paid the premium with in grace period the policy automatically went into a lapsed condition. The Revival of the policy in law is a fresh contract and if both parties aggress  then the policy will be revival. After  careful scrutiny of the  medical reports this Op declined the revival of the policy as per the decision of the central office  and informed the life assured. Sri L.M. Advocate for Op further argued that the complainant is being a doctor is very well knows about the terms and conditions of the policy that he had taken and paid 5 half yearly premiums should have remitted the premium when he knows very well about his health condition. As per the policy conditions for payment of surrender value, premium under the policies are to paid for a minimum period of 3 years. The complainant has not remitted the premium for a minimum period of 3 years. Repayment of premium also not possible Op declined the revival as per adverse medical report there is no question of deficiency of service on the part of this Op and prayed for dismissal of the complaint with exemplary cost.

 20. On perusal of the complaint affidavit evidence and documents. It is clearly shows that complainant obtained LIC Policy from Op for sum assured Rs. 10 lakhs and paid 5 premiums half yearly and also shows  complainant undergone by pass surgery and further shows, later complainant approached the Op and requested to collect the premium which is due. On perusal of the entire case papers and documents. It's shows the complainant has oftenly visit the Op office and informed his health condition and requested to collect the due premiums and revival of his policy but Op has replied merely stating that "policy cannot be considered for revival" with out giving any valid reasons. As per the contention of Op the surrender value, premium under the policy to be paid for a minimum periods 3 years. In this case complainant has not surrender the policy he requested to revival of the policy in case of the surrender of the policy at least full 3 years premium have been paid in respect of the policy  remitted the premium for a minimum periods 3 years as per the condition of the policy.  But in this case complainant  has requested to  revival of the policy. So the question of policy condition para 4 non-forfeiture regulation does not arise.   It is  clearly shows that the complainant has ready to pay the due premiums but Op has not ready to receive the premiums and also Op has not ready to revival of the policy. Life insurance is a contract it is clearly shows complainant is ready and willing to pay due premiums but Op has not ready to collect or accepting the due premium of September-2012 without valid reasons the act of the Op amounts unfair trade practice and deficiency in service towards complainant.  Op has issued the LIC policy to the complainant and to collecting the premium by name "Jeevan Anand" but the attitude of the Op has not given any Anand in the life of complainant i.e life assured because complainant paid 5 half yearly premiums of Rs. 44,763/- each. If the Op has not interest to revival of the policy he must return the premiums collected  from the complainant. If the Op has not considered the policy revival Op should pay the 5 premiums collected by them. Because the complainant is already under gone by pass surgery and he spent more amount towards his health. If the Op cannot be considered the revival of the policy. Life assured and his family members suffer financially therefore it is the duty of the Op to return the premiums which is collected from the complainant along with interest and other benefits. Op has not at all to escaped from his liability. So the Op is liable to return the premiums which is collected from the complainant i.e. sum of Rs. 2,23,815/- with 12% interest from the date of declined i.e. 8/03/2014 till the date of payment and also Op has liable to pay the compensation of Rs. 10,000/- towards mental agony and Rs. 5,000/- towards cost of this proceedings to the complainant with in two months. Accordingly we answer the point No.1 is held as affirmative and point No.2 is held as affirmative.

        Point No.3:- As discussed on the above points and for the reasons stated there in we pass the following:-

 

                                        ORDER

 

        It is ordered that the complaint filed by the complainant U/s 12 of CP. Act 1986 is hereby partly allowed.

 

        It is ordered that Op is directed to pay sum of Rs. 2,23,815/- along with interest at the rate of  12% interest p.a. and other benefits  from the date of declined i.e. 08/03/2014 till the payment to the complainant with in two months from this order.

 

        It is further ordered that the Op is directed to pay sum of of Rs. 10,000/- towards mental agony and         Rs.5,000/- towards cost of this proceedings to the complainant.

        Accordingly complaint is partly allowed.

 (This order is made with the consent of  Member after the correction of the draft on: 23/04/2015 and it is pronounced in the open Court after our signatures.)

 

MEMBER                                                                 MEMBER                       

 

Annexures:

Complainant by filing  affidavit evidence taken as Pw-1 Witness examined onbelalf of complainants:

                                                -Nil-

Op.No.3 by filing affidavit evidence taken as Dw-1

Witnesses examined on behalf of Ops:

-Nil-

Documents marked on behalf of complainants:

01	Ex-A-1:-	Original Policy bond
02	Ex-A-2:-	Discharge Summary
03	Ex-A-3:-	Proposal Deposit Receipt four
04	Ex-A-4:-	Office copy of the Legal notice.
05	Ex-A-5:-	Reply Notice.

Documents marked on behalf of Opponent:

01	Ex B-1:-	Certified copy of Discharge summary dated 15/12/2012, 6 pages pertaining to Dr. Manjunatha Reddy vide I.P.No.AD1001121200240.
02	Ex B-2:-	Certified copy of Routine Urine Analysis, Report dated 30/09/2013
03	Ex B-3:-	Certified copy of Lipodogram, Report dated 30/09/2013
04	Ex B-4:-	Certified copy of Blood Sugar Tolerance Report Test dated 30/09/2013
05	Ex B-5:-	Certified copy of Haemogram Report dated 30/09/2013
06	Ex B-6:-	Certified copy of Electrocardiogram dated 09/10/2013
07	Ex B-7:-	Medical Examiners Confidential report dated 30/09/2013
08	Ex B-8:-	Certified copy of Proposal Rating Sheet dated 08/11/2013
09	Ex B-9:-	Certified copy of Revival Quotation dated 10/10/2013
10	Ex B-10:-	Certified copy of Online underwriting decision dated 16/11/2013
11	Ex B-11:-	Certified copy of Personal Statement regarding Health dated 30/09/2013
12	Ex B-12:-	Certified copy of Personal statement regarding Health dated 12/12/2013
13	Ex B-13:-	Certified copy of personal statement regarding Health dated 09/1/2014
14	Ex B-14:-	Certified copy of Physician Report dated 12/12/2013 given by Dr. Mukunda Rao.
15	Ex B-15:-	Certified copy of Echocardiogram report dated 12/12/2013
16	Ex B-16:-	Certified copy of computerized Treadmill test dated 09/01/2014
17	Ex B-17:-	Certified copy of CTMT Summary report and Linked Median report 11 pages
18	Ex B-18:-	Certified copy of online underwriting decision dated 22/01/2014
19	Ex B-19:-	Certified copy of Special Blood Sugar Tolerance report dated 01/02/2014-2 pages.
20	Ex B-20:-	Certified copy of online Revival Decision dated 13/02/2014
21	Ex B-21:-	Certified copy of letter dated 08/03/2014 written to Dr. Manjunatha Reddy.
22	Ex B-22:-	Certified copy of Office letter dated 13/03/2014 addressed to Divisional office Shivamoga.
23	Ex B-23:-	Certified copy of Letter dated 13/03/2014 submitted by Dr. Manjunatha Reddy for reconsideration of Revival.
24	Ex B-24:-	Certified copy of  online underwriting decision dated 15/03/2014 intimating the Regret reconsideration, Decline Decision stands.
25	Ex B-25:-	Certified copy of letter dated 19/03/2014 addressed to Dr. Manjunatha Reddy by Branch office Challakere.
26	Ex B-26:-	Certified copy of mail dated 27/08/2014 intimating the reasons for declaiming the revival of Dr. Manjunatha Reddy.
27	Ex B-27:-	Certified copy of given to legal notice given Advocate sri. C.M. Veeranna on 05/06/2014 by CRM Dept., DO. Shivamogga.

 

 

MEMBER                                                       MEMBER                           

Kms.*