Karnataka

Belgaum

CC/235/2015

Swayam J Desai - Complainant(s)

Versus

The Manager Bajaj Allianz Life Insurance Company Ltd - Opp.Party(s)

T C Desai

27 Mar 2017

ORDER

              

ADDITIONAL  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BELAGAVI

C.C.No.235/2015

Date of filing 07/05/2015

                                                         Date of disposal:05/04/2017

P R E S E N T :-

 

	(1)	Shri. A.G.Maldar, B.Com,LL.B. (Spl.) President.
	(2)	Smt.J.S. Kajagar, B.Sc. LLB. (Spl.)  Lady Member.

 

 

COMPLAINANT   -

Mr.Swayam Jaypal Desai, Since Minor Rep. by natural Father Shri.Jayapal Chandrakant Desai, Age: 40 Years, Occ: Agriculture, R/o: H.No.2133, Kore Galli,   Shahapur, Belagavi.                          (Rep. by Smt.T.C.Desai, Adv.)

 

- V/S -

 

OPPOSITE PARTIES  -

1.           2.

Bajaj Allianz, Life Insurance Co., Ltd., Rep. by Manager, GE Plaza, Yerwada, Pune – 411006. Maharashtra.   The Branch Manager, Bajaj Allianz, Life Insurance Co., Ltd., 1st Floor, Madiwale Arcade, Club Road, Belagavi (Karnataka).                       (Rep. by Shri.S.D.Killekar, Adv.                                           for Op.No.1 & 2)

 

By  Sri.A.G. Maldar, President.

 

1.      This is a Complaint filed by the complainant under Section 12 of the Consumer Protection Act, 1986 (herein after referred to as Act) against the Opposite Parties (in short the “Ops”) directed to make the payment of total premium amount alongwith interest @16% p.a. and future interest be awarded till complete realization of payment and award compensation and costs.

 

2.      The facts of the case in brief are that;

 

The case of the complainant that, the complainant has purchased the Life Insurance Policy in the name of Swayam Desai  bearing Policy No.0067416257 on dtd:19.09.2007 for sum assured of Rs.1,00,000/- and paid the premium amount of Rs.10,000/- towards first year as per receipt No.0095958057 dtd: 13.09.2007 through cheque bearing No.102446 and next consecutive year till 13.09.2009 and further the Ops have not accepted the premium amount of Rs.10,000/- and foreclosed the policy without intimating the complainant and issued the cheque without informing the complainant on dtd: 02.03.2010 and the said cheque could not reach to the complainant and further the complainant had made enquiry about his premium and policy, the Op.No.2 gave the policy accounting enquiry sheet, the policy is being foreclosed by the OP and the premium paid by the complainant in the year 2008 is considered as over payment and not accepted by the OP.

 

It is further case of the complainant that, the Ops have committed mistake and gave defective service to the complainant and further the complainant has got the demand slip dtd: 07.12.2008 about the lapse intimation from the company, it means the Ops have not taken precaution about the said policy and premium amount. Either the Ops should accept complainant premium and continue with policy, but Ops have failed to make payment of premium, in case of foreclosure. The Ops have breached the terms of contracts; thereby there is deficiency of service on the part of the Ops. Hence, the complainant has constrained to file this complaint.  

 

3.      After issue of notice to the Opponents. The Op.No.1 & 2, have appeared through his Counsel and resisted the claim of the complainant by filing his written version that, the complaint is false and the same is not maintainable either on facts or in law and further the complaint of the complainant is barred by limitation. Hence, the complaint is liable to be dismissed in limini with costs.  

 

It is further Ops contended that, the complainant has availed the policy in the year 2007 and if there is deficiency of service on the part of Ops, then the complainant has approached the Hon’ble Forum on or before 2009 i.e. within 2 years from the date of alleged deficiency and further it is contended that, the complainant premium payment terms was for 20 years and benefit term of 20 years, but the complainant failed to pay the regular premium amount and paid only one premium amount for the year 2007 and further the regular premium amount to keep the OP, then the policy in active mode and to avail benefits of the policy, but the complainant has failed to pay the subsequent premiums with the renewal dates as mentioned in the renewal reminder sheet of the policy bond, due to which the policy got lapsed and foreclosed for non payment of renewal premiums in time.

 

It is further case of the Ops that, the complainant had availed the said policy after agreeing to abide with the policy terms and conditions as declared by Op in the proposal form and further the premium amount is consideration for taking risk of life of the insured and presently the company is covering the risk of the complainant as the policy is still in Re-instated Stage and further the complainant had never exercised option under Free Look period towards cancellation of the policy at any point of time neither had approached to the Ops towards surrender of the policy. Thus, in the instant case, the complainant is not entitled to any compensation, as there is absolutely no material to substantiate his claim and there is no any deficiency of service on the part of the Ops, therefore, the OPs prayed to dismiss the complaint.

 

 4.     The Adv. for complainant has filed his affidavit and produced  documents i.e. Payment reference of Axis Bank, Demand notice, Xerox data copy of police acceptance, Xerox copy of letter issued to the OP Dtd:23.01.2015 and Original policy papers, for sake of our convenience we have marked as Ex.P-1 to Ex.P-5. On the contrary the OP.No.1 has filed his affidavit and has not produced any document. The Adv. for complainant has filed his written argument and argue the matter. The argument of Ops taken as heard.

 

 

Now, the following points that arise for our consideration in deciding the case are;

 

01.Whether the complainant has proved that, there is deficiency of service on the part of Op for not settling the  claim of the complainant?

 

02.What order?

 

5.      Our findings on the above points are as fallow;

 

01. Point No.1  in the Negative.

02. As per final Order.

 

                      R E A S O N S

 

After going through the complaint, written version and evidence of complainant & oral arguments  by the complainant, it is the case of the complainant that as admitted by the Ops that, Life Insurance Policy in the name of Swayam Desai  bearing Policy No.0067416257 on dtd:19.09.2007 for sum assured of Rs.1,00,000/- and paid the premium amount of Rs.10,000/- towards first year as per receipt No.0095958057 dtd: 13.09.2007 through cheque bearing No.10244. Further, it is case of the complainant that, for the next consecutive year till 30.09.2009 have paid full premium amount and the said amount has been not accepted by the OP, for that proposition the complainant has not lead the evidence towards that, the complainant had made effort to pay the premium amount, so the same has been not established by the complainant, the cogent and material document to hold that, the complainant has paid the premium amount and even the OP has issued lapse intimation letter towards 2^nd premium amount unpaid due dtd: 19.09.2008, vide letter dtd: 31.01.2009, which is marked as Ex.P-2, it is crystal clear that, as per Ex.P-2 which is produced by the complainant himself, wherein mentioned that, due date of 2^nd premium of 19.09.2008 for Rs.10,000/-. Despite, the lapse intimation given by the OP to the complainant, the complainant did not paid the premium amount and even he has not make effort to renew said policy. It is true that, the said policy is Unit Linked Policy and the essence of contract in between the OP is governed by the policy conditions. As per the terms of the policy and provisions of Insurance Law in regard to the Unit Linked Insurance Policy, Risk of Investment in the Market under the Policy Governed by the Policy Holder. Therefore, in view of the provisions of clause of the Policy Bond, the complainant is not entitled for refund of premium amount which has paid for 1 year. For that proposition of law, the Op quoted a decision of Hon’ble Supreme Court of India in Life Insurance Corporation of India V/s Maniram reported in III (2005) CPJ 31 (SC) wherein, lordship hold that, “ Insurance (Life : Lapse of Policy Non-Payment of premium, Insurance Company not liable – Terms and conditions of policy-payment of premium to be made within grace period of one month-policy would lapse in case of non-compliance-premium not paid within grace period-Insurance Company wholly justified in rejecting claim of complainant – No exception can be taken against such decision-For a bellow committed error of law in allowing claim of respondent – passed by three commissions set aside – consumer Protection Act, 1986 Section-12.”

 

 And as per Bajaj Allianz Life Insurance Co., Ltd., Policy Bond which is already marked as Ex.P-5, wherein the policy schedule condition No.5 – non-payment of regular premium and forfeiture as fallows;

 

1. If the Policyholder has failed to make a payment of Regular Premium due by the due date as specified in the Schedule, the Company shall give a grace period of 30 days (15 days, if the frequency of payment is monthly). If the Life Assured’s death occurs during the grace period, the full death benefits is payable.
2. If the unpaid Regular premium was due during the first three Policy Years, and the Policyholder has failed to make the payment before the expiry of the aforesaid grace period;

1.      The Policy shall immediately lapse along with all insurance covers
2.     The Policyholder may revive the policy within a revival period of two years from the due date of first unpaid Regular Premium subject always to Section 5) d) below, failing which the contract shall be terminated and 100% of the value of Accumation Units in respect of Regular Premiums as on date of lapse, and the Top Up Premium Fund Value, if any shall be paid at the end of the third Policy Year or at the expiry of the revival period, whichever is later.
3.      If policy is lapsed and the death of the Life Assured happens, the existing Fund Value would be paid and the policy will terminate immediately. 

C)       If the unpaid Regular Premium was due after the first 

          three  Policy Years,  and the  Policyholder has failed to

          make the  payment  before the  expiry of  the aforesaid

          grace period:

 

1.      Provided that the Policyholder has paid all regular Premium due for the first three Policy Years, the Policyholder will be given an opportunity to revive the Policy, subject always to Sec 5 d) below, within two years from the first unpaid premium. During this limited period of revival, the Policy shall continue with full Sum Assured and additional Rider benefits being in force subject to Section 28. All Charges will continue to be deducted by redeeming units at the prevailing Unit Price.
2.       If the Policyholder has failed to revive he Policy within the revival period of two years the Policy shall continue at the option of the Policyholder with full Sum Assured and additional Rider benefits being in force, until the Regular premium Find Value falls below 150% of the Annual Premium payable, upon which;

1.  The Policy shall terminate and
2.  All units shall be redeemed and a Surrender Value as per Section 6) c) is payable to the Policyholder.
3.  If the Policyholder does not opt to continue the Policy then the Policy would be terminated and the Surrender Value will be paid.
4.  Revival of the Policy is subject to the Policyholder paying all unpaid regular Premiums due and such other information and documentation as may be requested by the Company. The Company reserves the right to disallow the revival of the Policy on original Terms and Conditions.   

 

By looking to the written version and pleading of the complaint regarding surrender of the policy or refund of the premium amount paid, as contended by the Ops in written version, it is clear that, as per Regulation 6(2) of protection of Policyholder’s interest Regulation 2002 issued by the IRDA, the policy holder is at liberty to review the terms and conditions of the policy and has the option to cancel the policy by stating the reason for her objection within 15 days of the receipt of the policy bond (free look period), in such cases the Insurance company shall cancel the policy and return the amount by deducting the expenses incurred.   But the complainant never raised any objection within 15 days of the receipt of the policy documents.

 

Generally, the policies would have been based on payment of regular premium, in the instant case, the complainant has paid only 1^st premium which is admitted by the Ops and thereafter he has not shown any material for the payment of further premium and the complainant has not placed any material documents to show that, he has paid further premium i.e. 2^nd year premium regularly within grace period as per above scheduled mentioned. On perusing the above policy schedule, it is crystal clear that, the complainant has to pay premiums regularly before the expiry of grace period and also complainant had an opportunity to revive the policy within the revival period of 3 years from the date of last unpaid premiums and if he failed to revive the policy during this period, the contract shall be terminated on the payment of surrendered value. In the instant case, the policy was terminated due to non-payment of further premium as per the terms and conditions of the policy, and the termination of policy intimated by issuing terminating letter to dtd: 31.01.2009. Therefore, in our consider opinion that, the complainant should be aware of the terms and conditions under the policy and paid the further premiums regularly and kept the policy in force. But, the complainant has failed to do so.  In our consider opinion that, it is fault/negligent on the part of the complainant. So, he is not entitled any relief claimed by him under the policy and there is no any deficiency on the part of the Ops as alleged by the complainant.

 

The complainant contended that, on several times  requested to return the premium amount but there is no any single word about return/refund of premium amount as stated in the pleadings of the complaint,  So in our considered view the complainant has suppressed some material facts in respect of whether his prayer is for refund of money or revive the policy as mentioned in the pleading.   So it has been not detailed explained and analyzed by the complainant.    It is a strange thing that the complainant contended at this belated stage i.e., after lapse of seven years that he has approached this forum for claiming refund premium amount which has been paid in the year 2007 and even he has not paid the second premium and even the policy lapse notice has been sent by the Ops as per contention of the Ops   Why he has kept mum till 2015 when a complainant has paid  premium of Rs.10000/- though he had a knowledge regarding the premium amount paid and also due date of the yearly premium and why he has field this complaint after seven years is not explained in detail and now  he has taken the shelter without any base and without any legal notice asking for refund of premium paid amount and also there is no any document to show that he has requested earlier for refund of premium amount as alleged by the complainant, then how he could be alleged that there is a deficiency in service on the part of the Ops for not returning the premium amount. 

 

           Now complainant filed complaint before this Forum seeking relief towards refund of premium without issuing legal notice in respect of refund and suppressing the material facts towards premiums of 2008, 2009, it is evident from the documents produced by the complainant himself, which has been marked as Ex. shows that renewal premium not paid.  Further that the complainant has not taken any action against the Ops, when the Ops have issued policy lapsed notice dtd:31.01.2009, why the complainant kept mum till filling this complaint, so it clearly goes to shows that there is no any deficiency in service on the part of the Ops as alleged by the complainant and the complainant has failed to substantiate that there is deficiency in service on the part of the Ops as they have not returned the premium paid amount by producing the cogent evidence and material documents to show that he has requested on several times for refund the premium amount. Even the complainant is not eligible for surrender of policy also, as he has paid premium for only one year, it requires to pay minimum full three years premiums to get surrender value, which is calculated as 20% of the premium paid, excluding extra premiums if any, less 20% of total survival benefit.  

 

Under such circumstances, on perusal of the written version and documents produced by the complainant himself, in our considered opinion the complainant has not approached this Forum with clean hands and failed to prove the deficiency in service on the part of the Ops.   It is the duty of the complainant to disprove the contentions as contended in the  written version of the Ops. It is the mandatory duty of the complainant to prove that there is deficiency in service on the part of the Ops as alleged by herself.  Accordingly we answer this point in the negative and proceed to pass the following:

 

O R D E R

 

For the reasons discussed above, the complaint filed by the complainant U/s.12 of the Consumer Protection Act, 1986 is hereby dismissed.

 

No order as to costs.

 

 

            (This order is dictated to the Stenographer, transcript edited, corrected and then pronounced in the open forum on this 05^th  day of April, 2017).

 

Sri. A.G.Maldar,     President.

Smt. J.S. Kajagar,    Lady Member.