Tamil Nadu

North Chennai

13/2014

R.Chander, - Complainant(s)

Versus

The Manager, M/s.Bajaj Allaince insurance Co. Ltd, - Opp.Party(s)

M/s.T.Kumara Vijayan

30 Jan 2017

ORDER

                                                            Complaint presented on:  13.01.2014

                                                                Order pronounced on:  30.01.2017

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,        PRESIDENT

                    TMT.T.KALAIYARASI, B.A.B.L.,           MEMBER II

 

MONDAY  THE 30^th   DAY OF JANUARY 2017

 

C.C.NO.13/2014

 

Mr.R.Chander,

S/o Late Mr.C.Ravindran,

No.5, Veerasamy Street,

Royapuram,

Chennai – 600 013.

                                                                                    ….. Complainant

 

..Vs..

1.The Manager,

M/s. Bajaj Alliance Life Insurance Company Ltd.,

Old.No.276 & 277, New No.497 & 498,

4^th Floor, Isana Kalthima Building,

Poonamallee High Road,

Chennai – 600 106.

 

2. The Manager,

M/s. Bajaj Alliance Life Insurance Company Ltd.,

No.1078, II Floor,

United Chambers, Sathy Road,

Coimbatore, Pin – 641 006.

 

3.The Chief Operating Officer,

Bajaj Alliance Life Insurance Company Ltd.,

G.E.Plaza, Airport Road,

Yerwada, Pune,Pincode – 411 006

 

.....Opposite Parties

Date of complaint                                 : 21.01.2014

Counsel for Complainant                      : M/s T.Kumaravijayan, M.D.Leelavathi

Counsel for  Opposite Parties                  : M/s.S.Namasivayam,J.Ravindranath

                                                                    singh, R.Balambigai Gowri &

                                                                    T.Saminathan

 

O R D E R

 

BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,

          This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The  Complainant father Mr.C.Ravindran, was expired and was a practicing Advocate at Hon’ble High Court, Madras while so, he availed a Life Insurance Policy bearing Policy No.0141114318 from the Opposite Parties. The Complainant’s name was assigned as his nominee. On 20.07.2012 his father, the policy holder suddenly  suffering from giddiness and hence he was taken to hospital on the same day. However on 24.07.2012 he was dead and the cause of death was stated as “Cardio Respiratory Arrest” due to Carcinoma Lung with Bone Metastasis. The Complainant had sent the original policy  for the death payment. The Complainant father obtained 4 numbers of Life Insurance Policies from the Opposite Parties. Out of 4 policies, his father assigned his wife eas a nominee for 3 policies and remaining one was assigned his son, the Complainant herein as a nominee. The Complainant mother sent all the original policies to the Opposite Parties for the payment of death claim. Whereas the Opposite Parties have settled for only one policy and they have refused to settle for the other two policies. Hence the Complainant’s mother has also raised separate issue before this Hon’ble Forum.  The Complainant states that instead of complying the request of the Complainant the Opposite Parties threw back the request along with the original policy in an arbitrary manner. Hence the Complainant has no other option except to cause the issuance of Advocate notice, accordingly the lawyer notice was sent to all the Opposite Parties. The Life Insurance Policy are being taken by the public against the in foreseen death of the life, if it is a natural death other policy holder is eligible for the assured amount. Therefore the Complainant filed this Complaint to order the Opposite Party to the sum assured amount of Rs.2,00,000/- together with bonus and also to pay compensation for metal agony with cost of the Complaint.

2. WRITTEN VERSION OF THE  OPPOSITE PARTIES IN BRIEF

          The Complainant’s father Mr.C.Ravindran gave a proposal for Bajaj Allianz New Unit Gain of the Bajaj Allianz Life Insurance on 30.11.2009. The Sum Assured was 2,00,000/- the term of the policy was 15 years and the Annual Premium was Rs.20,000/-. Based on the information furnished by the Applicant policy bearing No.0141114318 was issued and the policy commenced on 01.12.2009 and to end on 01.12.2014. His son R.Chander was named the nominee.  The deceased Life Assured was an educated person and have signed all the documents in English. Further, he was well aware of the policy and its features and also the consequences of the non-payment of premiums. The Complainant had availed another policy with the company which clearly establishes his knowledge about insurance policies and obligations there under. Therefore, the company cannot be held responsible for the consequences on non-payment by the policy holder. The said Complaint Ravindran aged 60 years died on 24.07.2012. When claim was made by the Complainant, son of the deceased, on 08.08.2013 for the sum assured, it was found that the late Ravindran had subscribed for the policy first premium on 03.11.2009 and next premium was due on 03.11.2010, but he failed to pay renewal premium in spite of providing 30 days grace period and as a result the policy got lapsed for non-payment of premium on 03.12.2010. The policy holder was fully apprised that as per clause 32 (d) of the policy terms the premium allocation charge would be 55% and balance 45% i.e., Rs.9,000/- of the first year premium was credited to his fund account and all necessary charges like mortality charge, fund admin charge etc.,  as mentioned in policy terms would believed and the same would be deducted from the fund value. As per clause 5)b. of the policy terms in the event of failure to make payment of Regular Premium and non-payment even within the grace period in the first 3 policy years:  The policy shall immediately lapse for the insurance cover including the cover under all riders. However during the period of lapse, the policy shall continue to participate in the investment performance of the underlying   funds, subject to deduction of all charge as per section 3 and section 34 except mortality charge and Rider Premium Charge, if any. Further as per clause 5(b) ( ii) the policy holder was provided with 2 years to revive policy. The policy got lapsed on 03.12.2010 along with all insurance cover and rider benefits, if any, during the life time of policy holder and hence the Opposite Party is not liable to pay any sum assured under the policy. After receipt of the intimation from nominee/Complainant it was noted that Late Ravindran died on 24.07.2012 within revival period but before termination on 15.12.2012 and hence the policy may not attract termination charges and such charges are reversed and accordingly the Nominee/Complainant is eligible only for fund value amount of Rs.1514 for lapsed policy. Therefore for the forgoing reasons stated above the Opposite Parties have not committed any deficiency in service and prays to dismiss the Complaint with cost.

3. POINTS FOR CONSIDERATION:

          1. Whether there is deficiency in service on the part of the opposite parties?

          2. Whether the complainant is entitled to any relief? If so to what extent?

4. POINT NO :1 

          The Complainant father Mr.C.Ravindran advocate availed in a Life Insurance Policy bearing policy NO.0141114318 from the Opposite Parties  and in the said policy the insured son Mr.R.Chandar was assigned as his nominee.  The said policy with terms and conditions is marked as Ex.A1.The Complainant father was admitted in the hospital on 20.07.2012 for giddiness and however he was dead on 27.04.2012 due to “Cadio  Respiratory  Arrest and due to Carcinoma lung with bone metastasis”.  The deceased paid  first premium for his policy on 03.11.2009 and it is an yearly premium payable policy. The next due date for premium was on 03.11.2010. The deceased did not pay the second premium on the due date on 03.11.2010. However the insured has grace period   of 30 days  can pay the premium which was not paid on 03.11.2010 . The grace period also expired  on 03.12.2010. Till the expiry of the grace period  the deceased had not paid the second premium.

          5. The Complainant contended that  as per clause 5 (C) (i) of Ex.A1 conditions of the policy, the Opposite Party  should have given an opportunity to revive the policy within two years from the date of payment of the first premium and such opportunity was not given to the deceased as per the above said clause and therefore the police has not lapse and further in support of his conditions he relied on an order of the National Commission reported in III (2009) CPJ 25 (NC) (LIFE INSURANCE CORPORATION OF INDIA  & ANR VS. GOWRAMMA)  and since no notice was given as per the policy, the policy has not been lapsed and therefore the Complainant is entitled for assured amount as per the policy.

          6. The Opposite Party contended that since, the deceased has not paid the second premium amount on the due date and subsequently also not paid the premium within the 30 days of the grace period, the deceased policy lapsed and therefore the Complainant is not entitled for any amount in pursuance of the policy issued to the deceased.

          7. Admittedly the Complainant  deceased father  first premium  on 03.11.2009 and he is due to pay the  next premium on 03.11.2010.  As per Ex.A1 policy conditions clause 5 a grace period of 30 days is allowed to pay the premium from the due date. The grace period of 30 days is also  expires on 03.12.2010 and even after such period the deceased had not paid the next premium  and therefore in such circumstances due to nonpayment of premium the policy has lapsed.

          8. The counsel for Complainant  raised that an opportunity was not given as per clause 5  (C) (i)  to revive the policy. For better appreciation it is necessary to extract  clause 5. (b) (c) (i)

                   5. Nonpayment of Regular Premium and Forfeiture

                   a) *****omitted

b) In the event of failure to make payment of full Regular Premium falling due during the first three Policy Year and non-payment of complete amount due even within the grace period the policy shall automatically and immediately lapse for the insurance cover including the cover under all Riders and  

                   i) ***** omitted

                   ii) ***** omitted

C) In the event of failure to make payment of full Regula Premium falling due after first three policy years and non-payment of complete amount due even within the grace period and provided that the policy holder has paid all Regular Premium due during the first three policy years:

i) The Policyholder will be given an opportunity to revive the policy, subject always  Sub-Section d) within two years from the date of first unpaid Regular Premium. During this limited period of revival or up to the Maturity Date, if earlier, all the Charges will continue to be deducted per Section 33 and Section 34 below and the policy shall continue for full insurance cover subject to Section 25.

As per clause 5 (b) referred above in the event of failure to make payment of regular premium  even with the grace period in the first 3 policy years, the policy shall automatically and immediately lapse for the issuance of cover.  Further, as per clause 5(C)  in the event of policy holder failed to make payment of premium for the first 3 policy years, the policy holder is  not entitled an opportunity to revive the policy. In the case in hand also the deceased  paid only first premium alone and he had not paid premiums continuously for 3 years and therefore the deceased is not entitled  for any opportunity to revive the policy as per clause 5 (C) (i)  as contended by the Complainant.

          9. The National Commission held in III (2009) CPJ 25 (NC)  LIFE INSURANCE CORPORATION OF INDIA & ANR. Vs. GOWRAMMA) that the case is based on suppression of   material fact and therefore the Policy holder is entitled for opportunity of notice in that case. Whereas in the case the Opposite Party refuse to entertain the claim as the policy of the deceased lapsed due to nonpayment of premium  even after expiry of grace period. The Opposite Party also pleaded their case in their written version only as lapsed policy and not a case of suppression of materials facts. Therefore, in view of the forgoing discussion we hold that the deceased policy was lapsed due to nonpayment of second premium itself and hence the said policy was automatically lapsed as per clause 5 (b) of the condition of policy in Ex.A1  and hence it is held that the Opposite Parties 1 to 3 have not committed any deficiency in service.

10. POINT NO:2

Since the Opposite Parties have not committed any Deficiency in Service, the Complainant is not entitled for any relief and the Complaint is liable to be dismissed.

          In the result the Complaint is dismissed. No costs.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 30^th  day of January 2017.

 

MEMBER – II                                                               PRESIDENT

 

 

 

 

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1 dated  08.08.2013                  Letter from Complainant to Opposite Parties with

                                                      enclosures of original policy and other relevant

                                                    documents

 

Ex.A2 dated NIL                     Returned by the Opposite Party and dropped

                                                    Abundantly

 

Ex.A3 dated 27.09.2013                   Advocate notice to all Opposite Parties

 

Ex.A4 dated 09.10.2013                   Reply from 1^st Opposite Party

 

Ex.A5 dated NIL                     Claim Form

 

Ex.A6 dated 27.11.2010                   Premium Receipt for 2009-10 & 2010 - 11

 

LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES :

 

Ex.B1 dated NIL                     To whomsoever it may concern

 

Ex.B2 dated  NIL                    Proposal Form for Life Insurance

 

Ex.B3 dated 15.03.2013                   Service Bill

                                     

 

 

 

MEMBER – II                                                               PRESIDENT