Delhi

North East

CC/418/2011

Shri Pankaj Gupta - Complainant(s)

Versus

The ICICI Prudential Life Insurance Co. Ltd. - Opp.Party(s)

31 May 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 418/11

 

In the matter of:

 

	Shri Pankaj Gupta BT 54, Shalimar Bagh Delhi-110088	Complainant
	Versus
	The ICICI Prudential Life Ins. Co. Ltd. 7th Floor, Aggarwal Millenium Tower-1 Netaji  Subhash Place, Pitampura New Delhi-110034	Opposite Party

 

	DATE OF INSTITUTION:	15-12-2011
	DATE OF DECISION      :	31-05-2017

 

NISHAT AHMAD ALVI, MEMBER :

Order

1. As per complaint, complainant purchased a policy by the name Invest Shield Life Insurance policy from OP by issuing a cheque dated 02.09.2006 of Rs. 50,000/-. In pursuance of the same the Policy bearing No. 03358108 was issued by OP vide covering letter dated 12.09.2006. Complainant has alleged that at the time of offer of policy he was assured by the agent, who persuaded him to take the policy, of OP saying that his investment would be multiplied very soon. But didn’t disclose about various deductions like Premium Allocation charges, Fund Management charges, Policy administrative charges, maintainability charges, surrender charges etc. The agent only informed that payment of premium upto three years is necessary. After issuance of policy complainant received policy documents. Thereafter, complainant continued to pay the premium as Rs. 50,000/-on 02.09.16, Rs. 25,000/- on 25.11.206, Rs. 34,000/- on 05.01.2007, Rs. 50,000/- on 01.03.2007, Rs. 25,000/- on 12.05.2007, Rs. 75,000/- on 05.07.2007, Rs. 25,000/- on 11.09.2007, Rs. 50,000/- on 04.10.2007, Rs. 25,000/- on 10.11.2007, Rs. 50,000/- on 08.01.2008.  Thereafter, complainant paid Rs. 5,00,000/- (Rupees Five lacs only) on 04.09.2009 and Rs. 2,00,000/- (Rupees Two lacs only) on 24.05.2010.
2. On 07.09.2009, complainant requested for revival of policy, as it was lapsed, offering to complete the formalities required for the same. As per complaint, complainant has paid total premium amounting to Rs. 9,00,000/- (Rupees Nine lacs only) within lock in period of three years, between 11.09.06 and 10.09.09. In addition he has also paid premium for further 8 months i.e. since October 2009 to May 2010. But despite that policy was not revived. Rather complainant received refund from OP by way of two cheques dated 08.03.11 and 16.03.11 of Rs. 86,250/- and Rs. 7,00,000/- respectively, out of amounts paid by complainant against this policy, after total deductions of Rs. 3,13,480/- illegally. Complainant tried to contact the agent of OP, but he avoided to meet. Complainant issued a legal notice dated 05.08.2011 which despite service was not replied to by the OP.
3. The conduct of OP shows that it has not only indulged in unfair trade practice but is also deficient in rendering due service to complainant. It has cheated the complainant by extracting his hard earned money by making false assurances and concealing true state of affairs with regard to various charges.  Complainant has prayed for grant of claim of Rs. 5,38,480/- being the amount illegally deducted out of total premium paid with interest thereon, including compensation and litigation cost.
4. By filing its reply OP has denied all the allegations in the complaint taking preliminary objections of suppression and concealment of material facts, and not coming with clean hands. On merits OP states that the proposal form having all the informations, was duly filled by the complainant himself after fully understanding all the terms and conditions of said policy and giving declaration in lieu of acceptance of all these conditions. OP issued policy alongwith welcome kit which included copies of, free look policy letter, first premium receipt, proposal form of policy, terms and conditions. All these were duly received by complainant. There is also no letter from complainant that he has not received the same. By way of these communications complainant was specifically given 15 days free look period, in compliance of provision of Section 6(2) of Insurance Regulatory Development Authority (Protection of policy holder interest) Regulation 2002, mentioning if policy holder is not satisfied with any of the terms of the policy, he is at liberty to withdraw himself within that period. Complainant didn’t turn up within that period. It shows that he was satisfied with terms & conditions of policy. Besides, copy of proposal form, duly filled by complainant himself, was sent as aforesaid, to ensure once again that the complainant had checked and confirmed all the information provided by complainant in proposal form, was also not objected to by the complainant.
5. As per policy total sum assured was Rs. 30,00,000/- (Rupees Thirty lacs only) for which Rs. 25,000/- (Rupees Twenty five thousand only) monthly premium was to be paid. But since the very commencement of policy complainant didn’t pay the premium in time and till 11.12.2007 only Rs. 4,00,000/- (Rupees Four lacs only) in total was paid by him. Thereafter, no amount till September 2009 was paid. As there was no renewable premium, the policy came into lapsed category. It was only on 07.09.2009 that complainant paid Rs. 5,00,000/- (Rupees Five lacs only) as renewal premium with the request to reinstate the lapsed policy vide his letter dated 7.9.09. In response whereof OP sent letter dt 17.09.2009 to the complainant whereby he was asked to fulfill certain requirements, within 30 days, so as to review of foreclosed policy. This letter clearly mentioned that in case desired requirements are not fulfilled, OP shall not be in a position to reinstate the policy. Complainant neither contacted to OP nor fulfilled the desired additional requirements. Even request, to pay balance amount of Rs. 50,000/- (Rupees Fifty Thousand only), vide letter dated 06.10.2009 of OP, was paid no heed, by complainant
6. After foreclosure of the policy OP received an email dated 31.03.2010 from complainant requesting to reinstate the policy expressing desire to pay all outstandings. This email was duly replied by OP vide its letter dated 20.04.2010 stating that it is possible only if beside desired payments personal health declaration form is also provided to it. Thereafter, on 25.05.10 another amount of Rs. 2,00,000/- (Rupees Two Lacs only) was received, by OP, from complainant. In response whereof vide email dated 25.05.2010 by OP, complainant was requested to undergo certain medical tests which the complainant chose not to undergo. Hence, policy could not be reinstated and amount of Rs. 7,00,000/- received for reinstating the policy was refunded, by OP, to complainant. Cheque of this amount has also been encashed by complainant on 17.03.2011.
7. After receiving Rs. 7,00,000/- complainant sent legal notice dated 05.08.2011 which was duly replied by OP vide its letter dated 22.10.2011. Complainant failing to fulfill the required formalities to reinstate the policy, OP has also paid Rs. 86,520/- (Rupees Eighty Six Thousand Five Hundred Twenty only) being full and final payment, in accordance with clause 8 & 9 of policy, after making required deductions out of the all premiums paid. As the policy was foreclosed due to negligence of complainant only he can’t blame the OP and claim the entire amount with compensation etc. Hence, there being no deficiency on the part of OP the complaint may be dismissed.
8. By filing rejoinder to reply complainant denies all defences raised by OP and reiterates the contents of the complaint. Further stating that OP has malafidely deducted Rs. 3,13,480/- (Rupees Three Lacs Thirteen Thousand Four Hundred Eighty only) out of total amount deposited by complainant towards premiums. Thus indulging itself into unfair trade practice. In response to his letter dated 07.09.2009 OP never sent any reply dated 17.09.2009. The copy of the letter placed on record is fabricated one without any proof of dispatch or receipt thereof. Neither alleged letter dated 06.10.2009 was ever sent by OP. Even copy of the same is not placed on record by OP. Similarly letter dated 20.04.2010 was never sent by OP. There is no  postal receipt for the same. Even otherwise if presumed, without admitting, that letters were sent while complainant paid Rs. 5,00,000/- (Rupees Five lacs only) on 4.9.2009, Rs. 2,00,000/- (Rupees Two lacs only) on 24.05.2010 out of OP’s total demand of Rs. 7,00,000/- (Rupees Seven lacs only), duly received by OP for revival of policy, there was no occasion for complainant but to presume and legitimately expect that his policy will got revived. Alleged e-mail dated 25.05.2010 was also never sent by OP. There was no question for complainant for choosing not to undergo for medical test if at all they were required, for the simple reason that one can’t be expected to prejudice himself.
9. Both the parties filed their respective affidavits of evidence and relevant documents.
10. Heard both the parties and perused the record.
11. The documents placed on record by complainant are copies of, Policy document containing terms & conditions of policy, Receipts of premium paid, Statement of account of amount deducted from bank account of complainant against payment of premium, Notice dated 05.08.2011 and proofs of payment of Rs. 5,00,00/- (Rupees Five lacs only) and Rs. 2,00,000/- (Rupees Two lacs only) by the complainant for revival of lapsed policy.
12. OP in support of its defence has placed on record copies of proposal form filled by complainant himself, letter dated 17.09.2009 allegedly issued by OP, Email dated 31.03.2010 sent by complainant to OP, undated letter of the OP, letter dated 22.10.2011.
13. Admittedly there was a default in the payment of premium within the prescribed time on behalf of complainant. Request for revival and deposit of Rs. 7,00,000/- (Rupees seven lacs only) for revival of lapsed policy is also not disputed. Plea of having no knowledge of terms of policy by the complainant is not trust worthy as complainant himself has filed policy document. Only question to consider remains as to what are the formalities required to be completed by the complainant and whether he has completed the same or not.
14. Going through the record we find that condition of required payments for revival of policy is fulfilled, as admittedly Rs. seven lacs have been paid by the complainant and there is no further demand of any payment from the side of OP. Only dispute remains with respect to the condition of medical tests as allegedly demanded by the OP which complainant allegedly chose not to undergo. To verify the demand of these medical tests OP has referred its letters letter dated 17.09.2009, letter dated 06.10.2009 and letter dated 20.04.2010  and email dated 25.05.2010.  We find no copy of email and letter dated 06.10.2009. Letter allegedly of 20.04.2010 is also undated. There is no proof of dispatch and receipt of letters and reply of notice placed on records by OP. No doubt all these letters  mentioned requirement of medical examination but unless the requirements in these letters has any proof of due communication thereof we can’t blame the complainant for non fulfillment of same. Regarding the letters and email not placed on record OP is not entitled to raise any claim against those letters.
15. Even otherwise as also stated by complainant how one who could pay the entire required amount in time would chose not to undergo medical tests, that too fully understanding that non fulfillment of any of the condition could prejudice his rights with respect to revival of his policy. Now burden to prove that these letters were duly sent by OP and received by complainant, lies on the OP itself. For which we find no postal / courier receipt / acknowledgement alongwith these letters. OP has also not filed any affidavit of concerned person affirming that by this mode these letters were sent and duly received. Thus OP has categorically failed to prove that demand of medical tests were raised by OP, through these letters and we can’t hold the complainant liable for non fulfillment of these conditions. Even otherwise, if at all medical tests were so essential OP being in continuous touch with complainant might require him by issuing him a final reminder by a Registered AD Post prior to rejecting the request of revival of policy that too after duly receiving a substantial amount of Rs. 7,00,000/- (Rupees seven lacs only).
16. In the above said facts and circumstances we are of the view that though in case of default of complainant to pay premium as per policy, OP was very well entitled for the amounts so deducted. But is not so entitled now when complainant has completely fulfilled demands for payment of Rs. 7,00,000/- (Rupees seven lacs only), apparently with the intension to revive the policy after receiving this amount. Encashment whereof is also acknowledgement of the fact that OP required no more condition to fulfillment for revival of policy.
17. Therefore, holding OP guilty for deficiency in service and adopting unfair trade practice we direct it to pay to the complainant : -

1. An amount of Rs. 3,13,480/- (Rupees Three Lacs Thirteen Thousand Four Hundred Eighty only) illegally deducted with interest thereon @ 9% per annum from the date of refund of Rs. 86,520/- till final realization ; And
2. An amount of Rs. 50,000/- (Rupees Fifty Thousand only) as compensation for the harassment, mental paid & agony; And
3. A sum of Rs. 11,000/- as litigation cost.

18. This order shall be complied by the OP within 30 days from the receipt of this order failing which interest on the amount of Rs. 3,13,480/- (Rupees Three Lacs Thirteen Thousand Four Hundred Eighty only) shall be charged @12% per annum till the final compliance of this order.
19.  Let a copy of this order be sent to each party free of cost as per regulation 21 of the Consumer Protection Regulations, 2005.
20.  File be consigned to Record Room.

(Announced on  31.05.2017)    

 

(N.K. Sharma) President

(Nishat Ahmad Alvi) Member