KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION

                            VAZHUTHACAUD THIRUVANANTHAPURAM                                                                                                                   

                                     APPEAL NO.385/10

                             JUDGMENT DATED 31.1.2011

PRESENT

JUSTICE SHRI.K.R.UDAYABHANU                --  PRESIDENT

Mary V Cherian,

W/0 Eapen Thomas,

Kressil, Theodical P.O,                                                --  APPELLANT

Thiruvalla – 689 613 residing at

B13, GNRA, Jayaprakash Lane,                      

Kudappanakkunnu,

Thiruvananthapuram.   

   (By Adv.G.K.Sudheer)

                   Vs.

1.      The LIC of India          

          reptd. by its Divisional manager,

          Divisional Office, “Jeevan Prakash”

          P.B.No.609, Nagambadom,

          Kottayam – 686 001.

2.      The Branch Manager,                               --  RESPONDENTS

LIC  of India, Aban Towers,

Kumbazha Road, Pathanamthitta.

3.      Vijayan Pillai,

          LIC Agent, Krishna Vilasam,

          Ayoor South P.O.

             (By Adv.G.S.Kalkura)                                               

JUDGMENT

JUSTICE SHRI.K.R.UDAYABHANU,PRESIDENT

                    The appellant is the complainant in CC.83/83/06 in the file of CDRF, Pathanamthitta.  The complaint stands dismissed.

                    2. It is the case of the complainant that on the complaint of the third opposite party/LIC agent, she submitted a life insurance proposal to the first opposite party/LIC to the second opposite party/Branch Manager of LIC in the first week of October 2004.  The first premium of Rs.21,252/- was paid as per cheque dated 11.10.04.  It was subsequently known that the third opposite party/agent did not possess a valid license at the time when he solicited the business.  The cheque amount was debited on 11.10.04 by the LIC. The proposal was dated 12.10.04.  On receipt of the policy document, it was found that the commencement of the policy is dated 6.11.04 which is 25 days subsequent to the date of payment of premium and the submission of the proposal.  Subsequently, on enquiries it was found that the post dating of the commencement of the coverage was on account of the delay in re-instating the license of the third opposite party.  Despite repeated representations, the matter was not settled.  The copy of the proposal was not sent along with the policy document as is mandated by the regulations.  Although, the matter was intimated to the agent he did not take any steps.  The policy was sent back to the opposite party requesting to rectify the belated coverage.  The request was not allowed and she received the policy back after a lapse of considerable time.  The mandatory free look period as stipulated was not intimated to the complainant.  Vide letter dated 6.4.05 the complainant has intimated the opposite party as to the above matters.  The complainant has requested to cancel the policy.  The complaint has also represented before the Grievance Redressal Officer vide letter dated 14.5.05.  There was no action on the same.  Subsequently, the complainant received a letter dated 6.6.05 mentioning that the complainant had through a telephonic talk conveyed her  decision to accept the policy as such and intimating that the error  was deeply regretted.  According to the complainant, she has not made any telephonic conversation with the opposite party.   She has re-iterated the same vide letter dated 13.5.05.  It is alleged that the terms and conditions of the proposal has been unilaterally altered by the opposite party.  Complainant has alleged deficiency and has sought for return of the premium amount paid with interest at 12% and compensation of Rs.15,000/-.

                    3. The opposite parties 1 and 2 have filed joint version   admitting the receipt of the premium amount.   The proposal dated 12.10.04 was received only on 23.11.04 and the proposal was accepted on 1.12.05 subject to the receipt of fresh satisfactory health declaration.    The declaration was received on 20.12.04 and the formalities was completed on 23.12.04 and the policy was issued on 7.1.05.  The date of commencement was allotted as on 6.11.04 in order to give the lower age benefit to the complainant.  It is alleged that the complainant has not intimated her intention to get the policy cancelled within 15 days of receipt of the same.   As per LIC Circular dated 15.1.03, the Branch Office need not sent the copy of the proposal along with the policy documents.   It is stated that a letter nil dated was received requesting the   change of the date of commencement of the policy as 11.10.04 and on the basis of this the second opposite party made telephonic discussions with the complainant.  It was on the basis of the same that the policy coverage date was allotted after convincing the complainant about the lower age benefit.  As per the IRDA (Protection of Policyholders’ Interests Regulations, 2002) it is specifically provided that if the policy holder dis-agree to any of the terms and conditions, the policy shall be returned within a period of 15 days stating the reasons for such return.  In the instant case, the letter was received only on 6.4.05.  It is pursuant to that the telephonic discussion was made and the policy certificate was returned with a covering letter dated 6.6.05.  It is contended that the Form No.382 was issued along with the policy by them specifically mentioning that the policy holder if disagrees with any of the conditions can return the policy within 15 days. 

                    4. The evidence adduced consisted of the testimony of PW1, DW1 and Exts.A1 to A12.

                    5. The Forum has dismissed the complaint up-holding the contentions of the opposite party that the complainant has not intimated her intention to get the policy cancelled within 15 days of receipt of policy documents.  The counsel for the appellant has stressed the fact as per Regulation 6 (2) of the Protection of Policy holders’ Interests Regulations, 2002  that “ while forwarding the policy to the insured, the  insurer shall inform by the letter forwarding the policy that he has a period of 15 days from the date of receipt of the policy document  to review the terms and conditions of the policy and where the insured disagrees to any of those terms or conditions, he has the option to return the policy stating the reasons for his objection, and  then he shall be entitled  to a refund of the premium paid, subject only to a deduction of a proportionate risk premium  for the period of cover and the expenses incurred by the insurer for medical examination of the proposer and stamp duty charges.”  In the instant case, although it is contended that Form No.382 incorporating Regulation 6 (2) has been forwarded no objective evidence in this regard has been produced.  In fact, the opposite parties have not produced any documents in support of the above contentions.

                    6. The complainant has disputed the entry in Col.No.3 of Ext.A9 proposal which is the copy of proposal sent by opposite party to the complainant subsequently on request.  Therein, the complainant has allegedly written as 26.6.04 as the date of the policy to be back dated.  On verification, we find that there is overwriting on the word “no”, and 26.10.04 is added.  In view of the case of the complainant that the policy coverage ought to have been on 11.10.04 there is no scope for mentioning the date 26.10.04.  Hence, the allegation of the complainant that the above date has been subsequently added appears true.  Ext.A9 proposal bears the date 12.10.04.   According to the opposite party, the same has been received on 23.11.04.  There is such a date seal.  There is no reason for such a delay.  The complication with respect to the agents license appears true in view of the   document produced later at the appellate stage by the complainant.  The same   was obtained under the Right to Information Act.  The amount has been encashed on 11.10.04 is not disputed.  There is no reason as to why the opposite parties insisted to continue  with the policy when the complainant has expressed her desire at the earliest as to her intention as to cancel the policy as she was annoyed with the  action of the opposite party in post dating of coverage by 25 days.  In view of the fact that the opposite parties have not intimated at the time of forwarding the policy that she has option to return the policy  if she has not in agreement with the conditions of the policy.  The complainant is entitled to get the premium returned as the mandatory provision under Regulation 6 (2) of the above mentioned regulations has not been complied with.  The opposite party is not entitled to retain the policy premium.  Hence the order of the Forum is set aside.  The opposite parties are directed to refund the premium amount of Rs.21,252/- to the complainant with interest at 9% per annum from 11.10.04 the date of encashment of cheque.  The complainant will also entitled to cost of Rs.5000/-.  The amounts are to be paid to the complainant within   3 months from the date of receipt of this order, failing which the complainant will be entitled for interest at the rate of 12% from 31.1.11, the date of this order.

              Office will forward the LCR to the Forum along with the copy of this order.

JUSTICE  K.R.UDAYABHANU --  PRESIDENT