Tamil Nadu

South Chennai

CC/334/2015

M/s.P.Kumar - Complainant(s)

Versus

The Manager, M/s.Max Life Insurance Co - Opp.Party(s)

Party in Persion

16 Jun 2017

ORDER

                                                                        Date of Filing :   31.07.2015

                                                                        Date of Order :   16.06.2017

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM, CHENNAI (SOUTH)

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

PRESENT: THIRU. M.MONY, B.Sc., L.L.B. M.L.,                     : PRESIDENT            

                  TMT. K.AMALA, M.A. L.L.B.,                                 : MEMBER I

             DR. T.PAUL RAJASEKARAN, M.A ,D.Min.PGDHRDI, AIII,BCS : MEMBER II

C.C.NO. 334/2015

FRIDAY THIS  16^TH   DAY OF JUNE 2017

P. KUMAR,

Advocate,

No.18/33, Bangaru Street,

Ayanavaram,

Chennai 600 023.

Tamil Nadu.                                                         .. Complainant

 

                                        ..Vs..

The Manager,

M/s. Max Life Insurance Co.,

Harrington Road,

Chetput,

Chennai 600 031.                                         .. Opposite party.

 

 

Counsel for Complainant           :    Party in person   

Counsel for opposite party        :    M/s. S. Dhakshnamoorthy   

ORDER

THIRU. M. MONY, PRESIDENT

          This complaint has been filed by the complainant against the opposite party under section 12 of the Consumer Protection Act 1986 seeking direction to pay a sum of Rs.1,01,545.82 towards two year premiums with interest and also to pay a sum of Rs.10,000/- for deficiency of service and Rs.40,000/- as compensation for mental agony and Rs.5,000/- as cost of the complaint.

 1. The averment of the complaint in brief are as follows:

         The complainant submit that  he has taken Life Gain Plus 20 participating Plan” insurance policy with the opposite party and policy No.is 8455830603.  Accordingly the complainant also paid a sum of Rs.50,772.91/- each two years premium.    The complainant further state that he could not able to pay the third year premium.   Hence he sent a letter to the  opposite party to surrender the said policy and encashment of the amount.    But the opposite party sent a letter to the complainant stating that the policy could not be surrendered unless he pay the third premium as per the terms and conditions of the policy.   Thereafter the complainant paid the 3^rd premium with late payment interest.    The opposite party has returned the cheque on 20.5.2014 stating that  “financial request decline”.   Despite of repeated demands made by the complainant to pay the amount towards first two premiums, the opposite party  rejected to pay the said first two premium amount due to medical fitness.      As such the act of the opposite party amounts to deficiency in service  which caused mental agony and hardship to the complainant.  Hence the complaint is filed.

2. The brief averments in Written Version of  the opposite party   are as follows:

         The opposite party denies all the averments made therein except those that are specifically admitted herein.     The opposite party admits that Life Gain Plus 20 participating Plan” insurance policy on the basis of duly filled and singed proposal form submitted by the complainant.  The opposite party also submit that the complainant has paid premium for the first two years and had failed to pay the third year premium and the policy stood lapsed on 11.7.2013.   The opposite party further state that  complainant has been duly informed through letter dated 25.10.2013 that as per the terms and conditions of the policy, the surrender of policy is permissible only after payment of three annual premiums and completion of three years.   The letter dated 16.5.2014 stating the reason for rejecting the reinstatement of the policy was sent along with the relevant medical records.    The opposite party also state that it has very well acted within the terms and conditions of the policy which is reproduced hereunder pertaining to revival of the lapsed policy.

       “ within three years after the policy has lapsed you may apply for revival of the policy, if you have not surrendered it, we may upon written request from you, and on production of evidence of insurability acceptable to us and at our discretion revive the policy on such terms and conditions as applicable at the time of revival. “

Hence there is no deficiency in service on the part of the opposite party and the compliant is liable to be dismissed.

3.      In order to prove the averments of the complaint, the complainant had filed proof affidavit as his evidence and documents Ex.A1 to Ex.A8 marked.  Proof affidavit of opposite party  filed and Ex.B1 to Ex.B5 marked on the side of the opposite party and oral argument let in.   

4.   The point for the consideration is: 

 

1. Whether the complainant is entitled to a sum of Rs.1,01,545.82 towards two year premiums paid by the complainant with interest as prayed for ?

 

2. Whether the complainant is entitled to a sum of RS.10,000/- towards deficiency of service and Rs.40,000/- towards mental agony and Rs.5,000/- towards cost of the complaint as prayed for ?

 

 

5. POINTS 1 & 2 : -

 

        Heard both sides.   Perused the records.  The complainant is an advocate availed Policy of insurance namely “Life Gain Plus 20 Participating Plan” as per Ex.B1 after duly signed the proposal form.  The policy No. is 845830603.  The complainant paid a sum of Rs.50,772.91 each for two years premiums.  Thereafter the complainant was not able to pay the premium for the 3^rd year and sent a letter Ex.A4 requesting to surrender the said amount.  The opposite party sent a letter Ex.A6 requesting the complainant to pay the amount towards 3^rd premium and reinstate the policy.   Accordingly the complainant paid a sum of Rs.52,356/- towards the 3^rd premium including interest, late fee etc. for delayed payment vide Ex.A7 acknowledgement.   Thereafter the opposite party without any reason sent their cheque along with “covering letter Ex.A8 refunding the 3^rd premium amount.   Thereafter repeatedly  the  complainant demanded to pay the amount towards first two premiums.   The complainant contended that the opposite party raising false contnetion regarding the medical fitness of the complainant and refund of the cheque are against true fact.  The complainant is hale and healthy the complainant has not suppressed any ailment much less chronic schedule disease.   Equally the refund amount is on flimsy and fancy grounds of the opposite party establishes the deficiency of service and unfair trade practice.   The complainant is claiming a sum of Rs.1,01,545.82 towards the premium amount and compensation for deficiency of service. 

 

6.     The learned counsel for the opposite party contended that admittedly the complainant has availed policy and paid two annual premium.    The complainant has not paid the 3^rd year premium.  Hence the opposite party requested to pay the 3^rd year premium.  The complainant also made a request for a surrender of policy and re-payment of the premium paid thereafter the complainant paid the 3^rd year premium with interest also.  The said 3^rd year premium was returned by the opposite party by way of their cheque on the ground that “financial request decline”.  The learned counsel for the opposite party further contended that the refund of the 3^rd year premium was based on the findings in Urinalysis includes 1000 mg / dl of sugar in urine as per Ex.B5.   The said refund is not for a schedule disease for repudiating the policy.    The learned counsel further contended that as per the terms and conditions the surrender value can be refunded only on payment of three consequent premiums.   The complainant paid only two premiums.   Hence the complainant is not entitled for surrender value.   But admittedly the 3^rd premium was received by the opposite party with interest for due revival of the policy and was encashed.  Thereafter a cheque was issued towards refunding the said amount with a covering letter stating  “financial request decline” there is no whisper regarding the medical fitness or medical infirmity.   Further the learned counsel for the opposite party cited a decision reported in

1. SUPREME COURT OF INDIA

Civil Appeal No.1375 of 2003

Suraj Mal Ram Niwas Oil Mills (P) Ltd

..Vs..

United India Insurance Co. Ltd and Anr.

 

2. Civil Appeal No.6277 of 2004

United India Insurance Co. Ltd.,

..Vs..

Harchand Rai Chandan Lal

 

The learned counsel further contended that the claim of Rs.40,000/- towards compensation for mental agony and Rs.10,000/- towards deficiency of service and cost of the complaint is exorbitant.    There is no basis for such a claim.    As per Ex.B1 Proposal form the condition for the cash value & Surrender Value are  as follow:

Cash Value :     

“This Policy will acquire cash value if it has been in force for at least three years and provided all the Premiums that have failed due have been received.  The guaranteed cash value in this policy will be 30% of the Premium(s) (excluding the first year’s Premium) receive. “

Surrender Value: 

After the Policy has acquired Cash Value, you may opt to surrender this Policy.  The Surrender Value payable will be subject to the condition that the Policy is in full force and that there are no statutory or other restrictions to the contrary.   The Surrender Value payable will be equal to Cash Value less any loan including interest accrued to date of surrender.

7.     Considering the facts and circumstances of the case, this Forum is of the considered view that since the complainant had paid the 3^rd annual premium at the request of the opposite party and was accepted by the opposite party and was duly encashed; refund of the said amount on the ground of medical certificate is against the terms and conditions of the policy and thereby the opposite party is liable to pay surrender value of the policy equivalent to guaranteed cash value as per the policy conditions after deducting 1^st year premium, in the remaining amount 30% of the premium amounting of Rs.15,000/-  and a sum of Rs.15,000/- towards compensation for mental agony with cost of Rs.5,000/- and point is answered accordingly.

In the result, the complaint is allowed in part.    The opposite party is directed to pay a sum of  Rs.15,000/- (Rupees Fifteen thousand only) as guaranteed cash value of the remaining premium  and  compensation  of Rs.15,000/- (Rupees Fifteen thousand only) towards mental agony and also cost of Rs.5,000/- (Rupees five thousand only) to the complainant.  

The above  amount shall be payable within six weeks from the date of receipt of the copy of the order, failing which, the said amounts shall carry interest at the rate of 9% p.a to till the date of payment.     

  Dictated by the President to the Assistant, taken down, transcribed and computerized by her, corrected by the President and pronounced by us in the open Forum on this the  16^th  day  of  June 2017.  

 

MEMBER-I                        MEMBER-II                             PRESIDENT.

Complainants” side documents:

Ex.A1- 11.7.2011  - Copy of policy , Max Life insurance.

Ex.A2- 5.8.2012    - Copy of receipt of insurance premium.

Ex.A3- 1.8.2013    - Copy of receipt insurance premium.

Ex.A4- 9.10.2013 - Copy of complainant letter to the opposite party.

Ex.A5- 25.10.2013         - Copy of letter of opposite party.

Ex.A6- 11.8.2013  - Copy of letter from opposite party.

Ex.A7- 8.5.2014    - Copy of Ack. letter from the opposite party.

Ex.A8- 20.5.2014  - Copy of letter from opposite party by cheque returned.

Opposite party’s side document: -   

Ex.B1-  11.7.2011 - Copy of Proposal form duly filled and signed by the

                               Complainant and the policy contract.

 

Ex.B2- 28.9.2013  - Copy of undated letter of the complainant and reply of the

                               opposite party.

 

Ex.B3- 9.10.2013   -  Copy of letter of the complainant dt. 9.10.13 and reply

           25.10.13    -   of the opposite party dt. 25.10.2013

 

Ex.B4- 8.5.2014     -  Copy of requisition for reinstatement of policy by the

           22.5.2014   -  complainant dt. 8.5.2014 and reply of the opposite party

 

Ex.B5- 16.5.2014  -  Copy of letter of the opposite party with medical records.

 

 

 

MEMBER-I                        MEMBER-II                             PRESIDENT.