Hon'ble Mr. Haradhan Mukhopadhyay, President.
The refusal by the OP to repay the insurance claim money is the bone of contention which led this Complainant to file the present case. The basic fact of the case of the Complainant is that the Complainant Mr. Andrias Tudu invested money with the OP Birla Sun life Insurance Company vide policy No. 004274502, Id No. 4103444623 from OP company at Cooch Behar Branch through Agent Smt. Nupur Kr. Deb in 2010 which commenced on 28.07.10 at annual premium of Rs.25,947/-. At the time of the said endowment policy the OP assured for rendering proper service and accordingly Complainant deposited consecutive three years policy premium to the extent of total deposit of Rs.77,841/-. Subsequently in 2014 due to paucity of fund the Complainant intended to surrender the said policy and accordingly met with the OP Company for getting prematurity amount. At that time the OP procrastinated the matter for long time and ultimately the OP Company did not provide the money. Due to such unethical activity the Complainant suffered financial loss against which the Complainant sent a legal notice through his Advocate on 16.05.16 which the OP received but did not accept the claim of the Complainant. Thus the OP has violated terms of the policy and the same resulted in unfair trade practices and deficiency in service for which the Complainant sustained mental pain and agony. The Complainant therefore prayed for directing the OP to pay Rs.30,000/- for deficiency in service, Rs.50,000/- towards compensation for mental pain and agony and Rs.10,000/- towards cost of proceeding.
The OP contested the case by filing written version denying each and every allegation. The defence case as stated in the written version inter alia discloses the positive case of the Complainant that the policy in question is a Unit Linked policy which entirely depends on the market conditions. The amount invested by the Complainant was fully utilised in the capital market. In the event policy being cancelled either due to non-payment of premium or due to surrender of the policy the company shall repay the value of the units after deducting the cancelation charges. In the instant case, the Complainant failed to pay further premium and paid only three consecutive annual premiums towards the policy, so the policy was lapsed on 28.01.15. The Complainant stopped paying the premium of Rs.13,944/- for which the said policy was lapsed and the OP sent lapsation notice on 09.03.15 wherein the Complainant was asked to pay all the due premiums and non-payment of such premium it would be deemed that the Complainant had exercised the option to complete withdraw from the policy and his policy would be terminated alongwith insurance cover will cease after completion of two years of lapsation period as provided in the policy. The Complainant had an option to reinstate the policy by 25.06.16. But despite receiving the lapse notice on 09.03.15 the Complainant remained silent till 25.06.16 and as such the policy was terminated. The policy did not accrue any fund value as on lapse date so no surrender value is paid or payable. The Complainant claimed was reverted on 09.06.16 wherein it was made clear about the lapse. On the consent of the Complainant the said policy was registered and as such the Complainant is estopped from challenging the terms of the policy. There is no negligence on the part of the OP. There is no cause of action of the present case. The OP therefore prayed for rejecting the said case. The OP claimed that the case is liable to be dismissed with cost. The specific case and the denial of some basic point as well as rising of several allegations of the parties pursued this Commission to ascertain the following points.
Points for determination
- Whether the Complainant is a consumer and the case is legally maintainable or not?
- Whether the Complainant is entitled to get any relief?
- To what other relief if any the Complainant is entitled?
Decision with reasons
Point No.1.
It is the admitted fact that the Complainant is the legal heir of the policy holder. There is no denial of the fact that the policy holder Mr. Andrias Tudu is the registered policy holder of the Birla Sun Life Insurance Dream Endowment plan vide policy No. 004274502, Id No. 4103444623 with the OP company with commencement from 28.07.10 at a policy premium of Rs.25,947/-. It is also admitted fact that three consecutive premiums were paid on behalf of policy holder. Subsequently, the said policy could not be proceeded and the premium could not be paid due to paucity of fund and finally the said policy was intended to be surrendered in the year 2014. But it was procrastinated by the OP and the prematurity money was not paid.
Whether the said demand of prematurity money was proper or not would be ascertained through analysis of the evidence but the relation between Complainant and the OP is absolutely as a consumer being a purchaser and benefit provider as a seller. Therefore the relation between the Complainant and the OP is well within the perview of the C.P. Act.
While deciding the question as to whether the case is legally maintainable or not, regard being had to the fact that the Complainant paid three premiums consecutively with the hope that he would continue the policy but due to sudden paucity of fund he was compelled to stop the policy. Therefore, the case cannot be said to the barred by any law. Accordingly, the case is legally maintainable.
The observation made herein above led to the inference that the case is legally maintainable.
Accordingly, Point No.1 is answered in positive and decided in favour of the Complainant.
Point Nos. 2 & 3.
These points relate to ascertainment of the question as to whether the Complainant is entitled to get the relief prayed for or to any other relief.
The Complainant in order to substantiate the case adduced evidence by means of filing evidence on affidavit and documents.
It is the admitted fact that the Complainant purchased insurance policy from the OP having policy No.004274502 under the description given herein above. It is also admitted fact that the Complainant deposited three consecutive premiums. Annexure-A discloses that the said policy was opened on 28.07.10. The date of maturity of the said policy is 28.07.2040. First amount of premium was paid as per Annexure-B to the extent of Rs.12,974/. Annexure- B/1 discloses that the annual premium for Rs.12,974/- was paid in the name of the Complainant another premium of Rs.12,974/- was paid on 11th August, 2011 vide Annexure-B/2 and third premium was paid on 03.02.12 for Rs.12,975/-. Annexure- B/4 also discloses that the OP received Rs.25,948/- from the Complainant towards the insurance policy.
The Complainant categorically stated that he could not continue the said policy due to paucity of fund after payment of three consecutive premiums.
So we have to look into the terms and condition of the policy as to the fate to the said policy which was stopped before its maturity. The clause of termination of policy discloses that the policy was terminated inter alia at the earliest of the date on which the two years period ends after the policy has lapsed and not being revived as per premium discontinuance provision. There is also the provision about the premium discontinuance it discloses inter alia that “If you are unable to pay the policy premium by the due date, you will be given a grace period of 30 days during which time all insurance under this policy will continue.”
The OP took the defence plea that it is the admitted fact that the Complainant stopped paying the premium and resultantly the policy has lapsed. Even after receipt of lapsation notice the Complainant did not act positively. A copy of the lapsation notice is filed before this Commission wherefrom it is found that the Complainant was informed that the policy was not enforced due to no receipt of renewal premium to enable reinstatement of the policy. He was asked to deposit a sum of Rs.53,053.32.
There is no averment by the Complainant that the said notice was complied with or the policy was revived.
Therefore, the Complainant cannot be said to have complied with the terms and condition of the policy.
There is a chequered history of the case. The Complainant died during the pendency of the case and as such the legal heirs being sons of the Complainant were substituted. The substitution petition was allowed vide order No.30 dated 04.03.2020 and accordingly the legal heirs of the Complainant were substituted.
Ld. Advocate for the Complainant drew the attention of this Commission on a clause of the said policy wherein the rule as to policy surrender is disclosed to the extent as under:- “You may surrender this policy to us at any time for its surrender value. This contract, including all insurance will terminate on the date you surrender your policy and you will not be able to revive your policy thereafter.”
Ld. Advocate argued that therefore the Complainant has a right to surrender the policy. But in the instant case the policy was not surrendered but it was lapsed due to non-payment of premium. Even if the said clause is attracted or invoked then the Complainant ought to have revived. On the contrary the legal notice given by the Complainant to inform him the surrender procedure for obtaining the premature amount. So the Complainant was finally intended to surrender the policy.
Thus the Complainant seems to have taken this course for realisation of the premature amount. The said notice was given through registered post which was sent to the OP. It was informed through the reply letter from the OP Company Annexure-E that the Complainant was given an opportunity to reinstate the policy within two years of lapsation but the Complainant preferred not to revise the policy.
Thus having assessed the evidence on record and the terms and conditions of the policy reasonable inference is drawn that there is no scope to entertain the claim of the Complainant. However, the Complainant should get the actual amount paid as premium alongwith interest as refund of the money invested as per the existing agreement and terms and conditions of the policy.
In the back drop of the discussion made therein vis-à-vis the observation made therein above the Commission comes to the finding that the Complainant is not entitled to get the relief as prayed for.
Issue Nos. 2 & 3 are accordingly decided in negative and go against the Complainant. In the result the complaint case fails.
Hence, it is
Ordered
That the case No. CC/83/2017 be and the same is dismissed on contest without cost.
Let a plain copy of this order be supplied to the parties concerned by hand/by post forthwith, free of cost for information and necessary action, if any.
The copy of the Final Order is also available in the official Website www.confonet.nic.in.
Dictated and corrected by me.
