DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

THIRUVALLUR

 

 BEFORE  TMT. Dr.S.M. LATHA MAHESWARI, M.A.,M.L, Ph.D (Law)                                  .…. PRESIDENT

                 THIRU.J.JAYASHANKAR, B.A.,B.L.,                                                                            .....MEMBER-I

                 THIRU P.MURUGAN, M.Com., ICWA(Inter)., B.L.,                                                 ….. MEMBER-II

 

CC. No.115/2022

THIS TUESDAY, THE 18th DAY OF OCTOBER 2022

 

Mr.P.Elumalai, S/o.Ponnusamy,

No.12, J-Block,

Dobikhana Housing Board,

Kosapet, Chennai -600 012.                                                               ....Complainant.

                                                                                     //Vs//

1.The Manager (CRM),

   Life Insurance Corporation of India Limited,

   Division Office –II

   C-47, Second Avenue,

   Anna Nagar Plaza, Anna Nagar, Chennai -600 040.

 

2.Mr.V.Selvaraj,

    Field Officer,

    Life Insurance Corporation of India,

    CBO-31, No.2, 3rd Cross Street,

    United India Nagar, Ayanavaram,

   Chennai -600 023.                                                                  …….Opposite parties.

 

Counsel for the complainant                              :       M/s.R.Ramesh, Advocate,

Counsel for the 1st opposite party                     :       Mr.V.Manisekaran, Advocate. 

Counsel for the 2nd opposite party                    :      Exparte.

 

This complaint is coming before us on various dates and finally on 07.10.2022 in the presence of M/s.R.Ramesh Advocate,  counsel for the complainant and Mr.V.Manisekaran Advocate, counsel for the 1st opposite and upon perusing the documents and evidences of both sides, this Commission delivered the following: 

 

 

ORDER

PRONOUNCED BY TMT. Dr.S.M. LATHA MAHESWARI,   PRESIDENT.

 

               The complaint was filed by the complainant U/S 12 of the Consumer Protection Act 1986 alleging in service on the part of the opposite parties  in not returning the Insurance premium amount paid by the complainant along with a prayer to direct the opposite parties to pay a sum of Rs.45,570/- towards the insurance premium amount paid by the complainant along with 24% interest and to pay a sum of Rs.1,10,000/- towards mental agony and litigation expenses to the complainant along with cost of the proceedings to the complainant.

Summary of facts culminating into complaint:-

 

The complainant submits that he took a C.P. Child Policy in his daughter E.Priyanka’s name on 15.12.2015.  As he was not educated well he was not aware of the terms and conditions of the policy.  The opposite parties pressured the complainant to take policy on his daughter’s name.  At the time of taking the above policy, the complainant informed to them that his daughter was a mentally retarded child.  Knowing fully aware about complainant’s daughter, the opposite parties had agreed and accepted for taking the policy in her name.  Further at the time of taking the policy on 15.12.2015 complainant daughter’s age was 15 years. The policy was from 15.12.2015 and ends on 16.11.2030 and the monthly premium amount payable by the complainant was Rs.1726/- per month.  The maturity amount payable by the LIC in the year 2030 was Rs.3,00,000/-.  After taking the policy, the complainant paid the monthly premium amount continuously for 24 months without fail to LIC.  Thereafter, due to some family, personal and medical problems to his daughter, the complainant was not in a position to continue to pay the monthly premium to the opposite parties. During the year 2018 the complainant met the opposite parties in person and explained his inability to pay the monthly premium amount to them.  At that time, they informed that they will send a letter to the complainant and after receipt of the same, the complainant could pay the monthly premium amount to them.  Accordingly the complainant received a letter from them and after that the complainant met them in person.  At that time the opposite parties gave one form to the complainant and asked him to get signature of the complainant’s daughter because she attained the age of 18 years.  The opposite parties very much aware that the complainant’s daughter was a mentally retarded person and she could not put her signature.  Since the complainant’s daughter could not sign in the form, the opposite parties asked the complainant not to pay further premium amount to the LIC. In the meantime on 19.03.2019 the complainant brought Rs.18,000/- for paying the pending premium amount to the opposite parties.  At that time the 2nd opposite party received the same but later on returned the said amount to the complainant for the above said reasons.  The complainant further submits that he was working as a TATA ACE Vehicle Driver and was a daily wager. In this regard, the complainant met the opposite parties in person for repayment of the premium amount paid by the complainant with regard to the policy.  But it was shocked and surprised that they refused and ignored to pay any amount to the complainant but they had sent the complainant from pillar to post without paying any mount to him.  Accordingly the complainant paid Rs.45,570/- towards premium amount for the above policy. So, all the efforts taken by the complainant for getting repayment of premium amount went in vain.  The complainant further submits that due to the deficiency in service on the part of the opposite parties, the complainant was put to mental agony and suffered lot. Hence the complainant issued a legal notice on 10.03.2019 to the opposite parties calling upon them to repay the premium amount along with compensation and damages, for mental agony, litigation expenses and loss of reputation suffered by the complainant totalling a sum of Rs.1,10,000/-.  After receipt of the legal notice, the 2nd opposite party sent an evasive reply. Thus aggrieved by the act of the opposite parties the complainant filed this complaint for the following reliefs;

To direct the opposite parties to pay a sum of Rs.45,570/- towards the insurance premium amount paid by the complainant along with 24% interest;

To pay a sum of Rs.1,10,000/- towards mental agony and litigation expenses to the complainant along with cost of the proceedings to the complainant.

Crux of the defence put forth by the opposite party:-

 

The 1st opposite party submits that the complainant had submitted a proposal on the life of his daughter on 15.12.2015 for sum insured Rs.3,00,000/- and agreed to pay a premium of Rs.5179/- for three months for 15 years at the time of submitting proposal.  The complainant has declared that his daughter was studying in 11th standard and enjoying Good Health. He also confirmed that his daughter was not suffering from any kind of illness and also that his daughter has not taken any treatment from any medical practitioner for more than a week since her birth and not absent from work place for more than a week.  Moreover 15 years old Priyanka had signed the proposal in English on 15.12.2015. The complainant had paid the premium upto December 2017 and not paid from March 2018.  He had paid 13 monthly premiums at Rs.1726X 3 Qly premium @ 5179 to the 1st opposite party. On 12.03.2018 he had paid two premiums via September 2017 and December 2017.  The 1st opposite party had not received any premium or deposit from the complainant after this payment.  During November 2018 the complainant had approached the 1st opposite party to continue the policy but as the policy was in lapsed condition, the 1st opposite party had requested him to submit the declaration of Good Health duly signed by the life assured to revive the policy.  At that time the complainant had revealed the life assured’s inability to sign the declaration and later on he had a submitted Medical Report in which the Medical Examiner had confirmed the defect of the life assured. Further the branch had sent the revival papers along with declaration of Good Health and full Medical Report to higher office on 23.11.2018 but the same has been declined by the competent Authority. The complainant neither revealed that his daughter was mentally retarded not produced any medical certificate at the time of inception of the policy.  So the underwriting Authority was not aware of the fact that the life assured was a mentally retarded. At the time of taking policy the complainant agreed to pay the premium @ 1726/- monthly and later he had requested to change the mode to Qly and agreed to pay at Rs.5179/- per Qly. The opposite party’s accepted the proposal on the basis that his daughter Priyanka was enjoying Good Health and was studying in 11th standard. Thus there was no deficiency in service from the 1st opposite party at any point.

The complainant has filed proof affidavit and documents Ex.A1 to Ex.9 were marked on their side.  On the side of 1st opposite party proof affidavit was filed and documents Ex.B1 & Ex.B10 were marked on their side.  Though sufficient opportunities was given by this commission the 2nd opposite party did not turn up before this commission to file any written version and hence he was called absent and was set exparte on 13.01.2020 for non appearance and for non filing of written version within the mandatory period as provided under the statute.

Points for consideration:-

Whether the alleged deficiency in service against the opposite parties in not refund the premium amount as requested by the complainant has been successfully proved by the complainant by admissible evidence?

If so to what relief the complainant is entitled?

Point No.1:-

On the side of the complainant the following documents were filed in support of the complaint allegations;

LIC Policy Certificate dated 15.12.2015 was marked as Ex.A1;

First premium receipt/renewal premium receipts was marked as Ex.A2;

Proposal deposit receipt dated 15.12.2015 was marked as Ex.A3;

Status report of the policy was marked as Ex.A4;

Disability Certificate of Cerebral child Priyanka was marked as Ex.A5;

Renewal intimation letter dated 26.09.2018 was marked as Ex.A6;

Medical Examiner Report dated 19.11.2018  was marked as Ex.A7;

Legal notice of the complainant dated 10.03.2019 along with acknowledgement card was marked as Ex.A8;

Reply from the 2nd opposite party dated 19.03.2019 was marked as Ex.A9;

 On the side of 1st opposite party the following documents were filed in support of their defence;

Proposal form was marked as Ex.B1;

Revival decision from Branch Office dated 17.12.2018 was marked as Ex.B2;

Revival form was marked as Ex.B3;

Medical report of Ms.priyanka was marked as Ex.B4;

Signature of the complainant and his daughter was marked as Ex.B5;

Aadhar Card, Smart Card, PAN Card and Driving License of the complainant were marked as Ex.B6 to Ex.B9;

Aadhar Card of Ms.Priyanka was marked as Ex.B10;

It was represented by both the parties that the written arguments filed by them may be treated as oral arguments for determination of the issue.

The crux of the written arguments filed by the complainant is that he being uneducated was not aware of the terms and conditions of the policy.  He took one Child Policy in his daughter’s name on 15.12.2015 and even at the time of taking policy he informed the opposite parties that his daughter is a mentally retarded child. Knowing fully aware of his daughter’s condition the opposite parties agreed and accepted for taking the policy in her daughter name.  The policy ends on 16.11.2030 and the monthly premium amount is Rs.1726/- per month and the complainant paid 24 months continuously.  In the month of 2018 he met the opposite parties and explained his inability to pay the monthly premium.  When the complainant approached the opposite parties requesting for repayment of the premium amount the opposite parties denied the re-payment of premium amounting to Rs.45,570/-. Thus aggrieved the complainant had come on with the present complaint for the relief as mentioned in the complaint.

On the other hand the 1st opposite party filed written version admitting the policy taken by the complainant.  However, it was denied by them that the complainant informed them that the daughter was a mentally retarded child. It was submitted by them that the complainant confirmed that his daughter is not suffering from any kind of illness and had not taken any treatment from any medical practitioner and moreover 15 years old Priyanka has signed the proposal in English on 15.12.2015. When the policy has got lapsed due to non payment of premium the opposite parties requested for declaration of good health for revival the policy.  But the complainant revealed that his daughter could not sign the declaration and submitted a Medical Report in which the Medical Examiner has confirmed the defect of the life assured. When the revival papers along with declaration of good health and full medical report was sent to higher officials the same was declined by the competent Authorities.  It was submitted that the complainant has paid Rs.46,605/-towards premium. As the policy was not paid for three full years, as per clause 4 nothing shall be payable and hence could not refund the premium paid by the complainant.  When the revival papers were sent to the Divisional office for consideration they did not accept.  Thus the 1st opposite party sought for the dismissal of the complaint alleging that there is no deficiency in service on their part.

On perusal of the documents and pleadings we could see that the complainant has taken a policy “LIC’s New Endowment Plan” in the name of his daughter E.Priyanka for a basic sum assured of Rs.3,00,000/- commencing from 15.12.2015.  It is seen that the renewal premium receipt was filed as Ex.A2.  The Disability Certificate of the insured was filed as Ex.A5 wherein it has been stated that the insured was suffering with mental retardation with 70% disability.  The Medical Examiner’s Confidential Report filed as Ex.A7 reveals that the life assured was having reduced mental intelligence. The revival decision given by the Branch Manager with respect to the life assured was filed as Ex.B2 which shows that the revival of the policy was “DECLINED” and revival was not possible.  When it is the defence of the opposite parties that the complainant failed to intimate about the mental condition of his daughter at the time of submitting the proposal, the complainant could not rebut the said contention and his only answer is that he was an uneducated man and not aware of the terms and conditions.  It is an established principle that the contract of insurance is based upon the principle of uberrima fida i.e. at most good faith.  In such circumstances the complainant not revealing the mental condition of the life assured at the time of submitting the proposal is clearly against the said principle.  It is also seen that the 1st opposite party has sent to competent Authority for revival of the policy along with the medical report of the life assured and thus had performed their part in taking steps to revival the policy.  However, the revival was declined by the competent Authorities for which the 1st opposite party could not be held liable. It is also seen that the complainant had not paid the premium continuously for three years from the date of taking policy entitling him for the surrender value.  As per the policy clause 4 which reads as follows;

“NON-FORFEITURE REGULATIONS:  If less than three years premiums have been paid in respect of this policy and any subsequent premium be not duly paid, all the benefits under this policy shall cease after the expiry of grace period from the date of first unpaid premium and nothing shall be payable”

When insurance was based upon a contract enforceable with terms and conditions agreed by both the parties, now the complainant cannot go back and say that he is not aware of the terms and conditions.  Hence we hold that the terms and conditions of the policy very well apply for the complainant’s case.  In such circumstances we have no other option but to hold that the complainant has not established any deficiency in service on the part of the opposite parties in not refunding the amount paid as premium on the ground that is not entitled for the same in accordance with the terms and conditions of the policy.  Thus we answer the point accordingly in favour of the opposite parties and as against the complainant.  

Point No.2:

With regard to the reliefs to be granted as we have held above that the complainant had failed to establish any deficiency in service on the part of the opposite parties, he is not entitled any relief as prayed in the complaint.  However, we direct the opposite parties to consider the request of the complainant to refund of the premium amount paid by the complainant as an onetime measure on humanitarian consideration within four weeks of request submitted by the complainant.  No order as to cost.

In the result, the complaint is dismissed.  No order as to cost. 

Dictated by the President to the steno-typist, transcribed and computerized by him, corrected by the President and pronounced by us in the open Commission on this the 18th day of October 2022.

    

 

  Sd/-                                                 Sd/-                                                            Sd/-

MEMBER-II                                  MEMBER-I                                               PRESIDENT

 

List of document filed by the complainant:-

 

Ex.A1 15.12.2015 LIC Policy Certificate. Xerox

Ex.A2 15.12.2015 First Premium Receipt/Renewal Premium Receipts. Xerox

Ex.A3 15.12.2015 Proposal Deposit Receipt. Xerox

Ex.A4 Aug.2016 Status Report of the policy. Xerox

Ex.A5 21.10.2016 Disability Certificate of Cerebral child Priyanka. Xerox

Ex.A6 26.09.2018 Renewal Intimation Letter. Xerox

Ex.A7 19.11.2018 Medical Examiner Report. Xerox

Ex.A8 10.03.2019 Legal notice of the complainant along with acknowledgement card. Xerox

Ex.A9 19.03.2019 Reply from the 2nd opposite party. Xerox

 

List of documents filed by the 1st opposite party:-

 

Ex.B1 ............... Proposal form. Xerox

Ex.B2 17.12.2018 Revival decision from Branch office. Xerox

Ex.B3 19.11.2018 Revival form Xerox

Ex.B4 19.11.2018 Full Medical Report. Xerox

Ex.B5 ................ Signature of Ms.E.Priyanka and her father P.Elumalai. Xerox

Ex.B6 ................. Aaadhar card of the complainant. Xerox

Ex.B7 ............... Smart card of complainant. Xerox

Ex.B8 ............. PAN Card of the complainant. Xerox

Ex.B9 .............. Driving licence of the complainant. Xerox

Ex.B10 .............. Aadhar card of Ms.Priyanka. Xerox

 

 

   

    Sd/-                                                 Sd/-                                                           Sd/-

MEMBER-II                                  MEMBER-I                                               PRESIDENT