IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Thursday the 30th day of April, 2015.
Filed on 06.06.2013
Present
1.Smt. Elizabeth George (President)
2.Sri. Antony Xavier (Member)
3.Smt. Jasmine D (Member)
in
C.C.No.178/2013
between
Complainant:- Opposite Party:-
Smt.Gomathy Viswambaran 1. The Manager
Represented by the power of attorney Birla Sun Life Insurance Co. Ltd.
Sri.K.Prasad, Punthilethu House One India Bulls Centre
Karazhma Muri Tower 15th & 16th floor
Vallikunnam Village. Jupitor Mill Compound
(By Adv.R.Ullas) 841, Senapathi Bapat,
Elphinstone Road
Mumbai - 690 501.
2. The Manager
Catholic Syrian Bank Ltd.
Choonadu Branch
Elippakkulam - P.O. 690 501.
(By Adv.Raveendranathan Nair)
O R D E R
SMT. ELIZABETH GEORGE (PRESIDENT)
The facts of the case are as follows:
On 23.10.2007 the opposite parties approached the complainant and demanded her to take a gold plus policy of the 1st opposite party. Both of the opposite parties made her believe that this policy is a onetime payment policy and she will get a sum insured at the expiration of 3 years. Believing the assurance of the opposite parties, the complainant agreed to take a policy for Rs.15 lakh. The proposal form along with the premium amount of Rs.3 lakh was submitted on 23.10.2007 and the policy was issued on 24.12.2007. But the policy certificate along with other documents were entrusted to the complainant only on 20.03.2008, along with policy certificate and covering letter dtd.28.12.2007. In the covering letter, there is a reference regarding the right of the insured to ask for cancellation of the policy within the free look period. On January 2009, the complainant got a letter from the 1st opposite party demanding her to make the annual premium in order to avoid lapsation of the policy. The complainant was informed that she had to make a payment of Rs.10,000/- to avoid the lapsation. Hence the complainant remitted Rs.10,000/- on 31.01.2009, and again on December 2009, the complainant served another premium renewal notice and she had remitted Rs.10,000/- on 17..12.2009 as renewal of the policy. While so on 28.06.2011, the complainant put a request to the opposite parties to surrender her policy and return the premium with the sum assured. But the request was rejected and she got the reply that policy was lapsed and was not able to get the benefit under the policy. Aggrieved by the act of the opposite parties, the complaint is filed seeking the following reliefs against the opposite parties.
- To give the complainant the surrender value of the policy along with the sum assured and other benefits.
- To realize the interest of the surrender value and sum assured of the policy from the date of her policy surrender application.
- To realize the cost of the petition.
- To realize an amount of Rs.50,000/- as compensation for the mental agony caused to the complainant.
2. Version of the 1st opposite party:- The complaint is not maintainable. There is no cause of action in favour of the complainant. As per the terms and conditions of the contract, the complainant had to pay an annual premium of Rs.3 lakh per year for 3 years. Complainant failed to make the payment for renewal premium. Therefore, the opposite party issued lapsation notice dtd. 04.02.2009 informing the complainant that the policy had lapsed from January 2008 due to non receipt of the premium from 24.12.2008. Despite the information, the complainant failed to make the payment. Therefore, the opposite party again sent lapsation notice dtd.15.03.2009 informing the complainant to pay the remaining premium amounting to Rs.28,999/-. Though the complainant had paid an amount of Rs.10,000/- on 09.03.2009 and the next premium on 17.12.2009, the same is subject to market fluctuations and to get a good return, the complainant had to pay the correct premium. The complainant failed to remit the premium within the time frame. If the complainant was not satisfied with the terms and conditions, she should have return the policy documents within 15 days under free look period. The opposite party acted in good faith. There is no deficiency on the part of the opposite party.
3. Version of the 2nd opposite party:- The 2nd opposite party is an unnecessary party to this complaint. The 2nd opposite party is a third party to the contract between the contractor and the 1st opposite party. The 2nd opposite party never gave any assurance that the complainant would get the premium amount with benefits on completion of three policy years. If the customers are not satisfied with the terms and conditions of the assurance period, they can quit from the insurance scheme within the prescribed time. There is no deficiency in service on the part of the 2nd opposite party.
4. The power of attorney of complainant was examined as PW1 and the documents produced were marked as Exts.A1 to A6. No documentary evidence was adduced on the side of the opposite parties.
5. It is an admitted fact that the complainant had taken a gold plus policy for Rs.15 lakh from the 1st opposite party and the policy was issued on 24.12.2007. According to the complainant even though policy was issued on 24.12.2007 and the policy certificate along with other documents entrusted to the complainant only on 20.03.2008. The proposal form along with the premium amount of Rs.3 lakh was submitted on 23.10.2007. It is evidenced from Ext.A2. According to the complainant on January 2009 she got a letter from the 1st opposite party demanding her to make the annual premium in order to avoid the lapsation of the policy and she remitted Rs.10,000/- on 31.01.2009. The receipt of the same is produced and marked as Ext.A4. Again, in December 2009, the complainant was served with another premium renewal notice and accordingly she remitted Rs.10,000/- on 17.12.2009. Ext.A5 receipt evidenced the same. So according to the complainant she altogether remitted Rs.3,20,000/- with the 1st opposite party. On 26.08.2011 complainant requested the opposite parties to surrender the policy and return the premium amount with the sum assured. But, she got a reply that the policy was lapsed and she was not able to get the benefit of the policy. According to the opposite party, since the complainant failed to make the payment for renewing the premium, they issued a lapsation notice dtd. 04.02.2009 informing the complainant that policy had lapsed with effect from January 2008 due to the non receipt of the premium from 24.12.2008. Thereafter the complainant paid the premium on 09.03.2009 and 17.12.2009. Since the complainant failed to revise the policy within the time frame, the policy terminated.
6. Ext.A2 shows that the complainant paid the premium amount of Rs.3 lakh on 23.10.2007. But the opposite party issued the policy on 24.12.2007. Complainant remitted Rs.10,000/- each on 09.03.2009 and 17.12.2009 as per the intimation given by the opposite party. Exts.A2, A3, A4 documents show that the policy is renewed till March 2010. Opposite party failed to produce any communication given by them regarding the subsequent revival of the policy, the complainant approached the opposite party on 26.08.2011 to surrender the policy. According to the complainant she has not received with the policy certificate which she is entitled to. The opposite parties have failed to establish that they had forwarded the terms and conditions of the policy to the complainant. So it is clear that the complainant has lost her opportunity to surrender the policy within the policy within the free look period. Clause 6(2) of the Insurance Regulatory and Development Authority Regulations 2002 reads as follows: “While acting under regulation 6(1) in forwarding the policy to the insured, the insurer shall inform by 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 and conditions, he has the option to return the policy stating reasons for his objections, when he shall be entitled to refund of the premium paid, subject only to a deduction of a proportionate risk premium for the period on cover and the expenses incurred by the insurer on medical examination of the proposer and stamp duty charges“. Since the opposite parties denied the above opportunity to the complainant, the contract of insurance entered into between the complainant and the opposite parties becomes ab initio void. Under the circumstances we are of opinion that the complainant is entitled to get refund of the premium amount with interest. Hence the complaint is allowed.
In the result, the 1st opposite party is directed to refund Rs.3,20,000/- (Rupees three lakh twenty thousand only) to the complainant with 9% interest from the date of 26.08.2011 in which she served her policy. The order shall be complied within one month from the date of receipt of this order.
Dictated to the Confidential Assistant transcribed by him corrected by me and pronounced in open Forum on this the 30th day of April, 2015.
Sd/- Smt.Elizabeth George (President)
Sd/- Smt.Jasmine.D. (Member)
Sd/-Sri.Antony Xavier (Member)
Appendix:-
PW1 - Prasad.K.(Witness)
Evidence of the complainant:-
Ext.A1 - Special Power of Attorney.
Ext.A2 - Receipt of Rs.3 lakh dtd.24.10.07.
Ext.A3 - 1st Premium Receipt dtd.24.12.07
Ext.A4 - Receipt of Rs.10,000/- dtd.31.01.09.
Ext.A5 - Renewal Premium of Rs.10,000/- dtd. 17.12.09.
Ext.A6 - Letter dtd.28.12.07 issued by 1st opposite party.
Evidence of the opposite parties:- Nil
-//True copy//-
By Order,
To Senior Superintendent.
Complainant/Opposite parties/SF
Typed by: Pg/-
Compd. by: Pr/-
