By. Smt. Renimol Mathew, Member:-
The complaint is filed Under Section 12 of the Consumer Protection Act of 1986 to get the death benefit of Rs.5,00,000/- of the deceased husband of this complainant with cost and compensation.
2. Brief of the complaint:- Sri. K. J. Joy, deceased husband of the complainant, had taken a life insurance policy from the opposite parties. The policy was taken on the insistence of the representative of the insurer. The complainant invested Rs.1,00,000/- on 21.12.2007 accordingly the policy bearing No.24034007106 was received with date of commencement on 31.12.2007, the sum assured is Rs.5,00,000/-. The investments was made on the belief that it was a single premium policy. On 04.07.2010 the husband of the complainant the policy holder died due to heart attack. After the death of the life assured the complainant approached the opposite party seeking the death benefits under the policy and she was informed that she is not eligible for the death benefits since they defaulted the periodical premiums, she will get only Rs.51,000/- from the opposite party. This amount is less than the money invested by her late husband. This complaint is filed to get the death benefit of Rs.5,00,000/- with compensation.
3. Notice sent to opposite parties. Opposite party No.1 entered and filed written version.
4. Opposite party No.1 filed version in short it is as follows:- Opposite party No.1 contented that they have not received any claim intimation from the complainant and this complaint is not entertainable before this Forum. Already there was an Order from the Insurance Ombudsman dated 07.09.2011 by which an award was passed for Rs.50,746.35. In order to implement the award, the complainant shall furnish to opposite party No.1 a letter of acceptance within one month from the date of receipt of award. But the complainant had not intimated the acceptance and thereafter the opposite party could not implement the award. Opposite party No.1 again contented that they have received only the initial premium, no further renewal premium has been received and hence the policy was in lapsed status with effect from 31.12.2008. The opposite party No.1 had sent lapse intimation letter on 30.06.2009. Hence the policy was in lapsed condition as on the date of death.
5. Actually this was a regular premium policy for a term of 5 years. In this case the policy was in lapsed condition with effect from 31.12.2008 and the date of death as per the complaint is 04.07.2010. Thus it is clear that the policy was in lapsed status as on the date of death. In the lapsed policy the holder of his legal heirs are entitled only for the fund value. The sum assured in not payable under the policy and the opposite party is ready to comply the Order of the Insurance Ombudsman. But complainant has not placed any application for fund value by intimating the death. The opposite party is ready and willing to pay this amount on receipt of the mandatory requirements as per the policy.
6. On considering the complaint and documents the Forum raised the following points for consideration:-
1. Whether there is any deficiency of service on the part of the opposite party?
2. Relief and Cost.
7. Point No.1:- The complainant filed affidavit and examined as PW1. Exts.A1 to A6 documents were marked. Ext.A1 is the Policy document. Ext.A2 is the Order of the Ombudsman with covering letter. Ext.A3 is the Copy of title deeds of the complainant. Ext.A4 is the copy of Ration Card. Ext.A5 is the Copy of Old Ration Card and Ext.A6 is the Identity Certificate. Opposite party No.1 is examined as OPW1, Exts.B1 to B8 documents were marked. Ext.B1 is the copy of letter issued by the complainant to opposite party No.1 dated 21.12.2010. Ext.B2 is the Reply letter to the complainant dated 28.12.2010. Ext.B3 is the Notice issued by opposite party No.1 to the complainant. Ext.B4 is the Copy of Proposal Form. Ext.B5 is the Copy of Demand Draft. Ext.B6 is the Copy of policy document. Ext.B7 is the Copy of the Order of Ombudsman. Ext.B8 is the copy of letter to the Ombudsman by opposite party No.1.
8. On perusal of the evidence and documents before us we finds that Sri. Joy had applied for Unit Plus II policy vide proposal dated 20.12.2007 for a term of 5 years with an initial deposit of Rs.99,000/-. He had opted frequency of premium as 'yearly'. He received a policy on 30.12.2007 for sum assured of Rs.4,95,000/- for a term of 5 years. The life assured has not paid any further premium, so the policy was in lapsed condition with effect from 31.12.2008. As the life assured died when the policy was in lapsed condition, the complainant cannot claim any death benefit. The complainant stated that she was not aware of the fact that the policy opted by her husband is regular premium. They taken the policy under the impression that it was single premium. The opposite party No.2 the agent convinced that this was a single premium policy. Only after the death of her husband on enquiry with the opposite party it was revealed that the life assured ought to have paid further premiums. The life assured as well as the complainant were not in a position to understand the policy conditions. It was also argued on behalf of the complainant that the agent of the opposite party insurer had cheated the life assured. But the opposite party No.1 contented that if the complainant was not satisfied with the policy and policy conditions, he could have opted for cancellation of the policy within the freelook period. That opportunity was not availed of by the life assured. So the contention of the complainant that the life assured was under the impression that he need to pay only single premium cannot be accepted. Moreover Mr. Joy received lapse intimation notice dated 30.06.2009 that is marked as Ext.B3. Opposite party No.1 further submitted that as per Schedule II, Clause 2(b) of Ext.B6(Policy document), within the first three years following the date of commencement of the policy, the premium is not paid within the grace period, all insurance cover (including rider cover), will automatically lapse. In the event of death after the grace period, before the lapse of the revival period, the fund value will be paid to the beneficiary. If the date of receipt of notice is taken as intimation, an amount of Rs.53,865/- is payable towards Fund value (as on 24.04.2012) under the policy. Opposite party No.1 again submitted that the mandatory requirements are not received Condition No.20 of the policy document also clearly lists the documents to be submitted for the assessment of the claim. The same has not been provided by the complainant till date.
9. The crux of the complainant is against the agent who has sourced this policy. The opposite party No.1 is not responsible for the acts of the commission or omission on the part of the agent. The policy was issued based on the duly filled and signed proposal form which is just and legal. If the complainant feels cheated by agent or agent committed any foul play he alone is liable to compensate the complainant. The Notice sent to the opposite party No.2 served on 30.04.2012 but he had not present before the Forum to defend the case against him. So opposite party No.2 is declared ex-parte on 30.05.2012. On perusal of Ext.A3, A4, A5 and A6 documents it is clear that the complainant and her deceased husband has belongs from very poor family. From the evidence and records we assume that they were taken this policy under the impression that it was single premium policy. On considering the financial background of this complainant there is no chance of joining the 5 year regular premium of Rs.1,00,000/-. Moreover opposite party No.2 never tried to appear before this Forum to adduce evidence. So the Forum feels that opposite party No.2 is hiding something, which resulted him non appearance. So we finds deficiency of service on the part of the opposite party No.2 by selling this regular premium policy as single premium policy. So opposite party No.2 is liable to compensate for the loss sustained by the complainant and we could not find any deficiency of service on the part of the opposite party No.1. As per the terms and conditions of the policy complainant is only entitled to get the fund value. The Point No.1 is found accordingly.
10. Point No.2:- The Point No.1 is found in favour of the complainant, hence the complainant is entitled to get cost and compensation. The Point No.2 is decided accordingly.
In the result the complaint is partly allowed and the opposite party No.1 is directed to pay the fund value of the Policy bearing No.24034007106 on receipt of mandatory requirements as per the policy. The opposite party No.2 is directed to pay Rs.25,000/- (Rupees Twenty Five Thousand Only) as compensation and Rs.5,000/- (Rupees Five Thousand Only) as cost of this proceedings to the complainant. Complainant also directed to furnish mandatory requirements before opposite party No.1. This Order must be complied by the opposite parties within 30 days from the date of receipt of this Order.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and Pronounced in the Open Forum on this the 28st day of May 2014.
Date of Filing:04.04.2012.
PRESIDENT :Sd/-
MEMBER :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
PRESIDENT, CDRF, WAYANAD.
APPENDIX.
Witness for the complainant:
PW1. Thankamma Joy. Complainant.
Witness for the Opposite Parties:
OPW1. Girish. Deputy Manager, SBI Life Insurance,
Kozhikode Branch.
Exhibits for the complainant:
A1. Policy Document.
A2. Order of Ombudsman with covering letter.
A3(Series). (a). Copy of the Title Deed.
(b). Copy of the Title Deed.
A4. Copy of Ration Card.
A5. Copy of Old Ration Card.
A6. Identity Certificate.
Exhibits for the opposite Parties.
B1. Copy of Letter.
B2. Reply letter. Dt:28.12.2010.
B3. Copy of Notice.
B4. Copy of Claim Form.
B5. Copy of Demand Draft.
B6. Copy of Policy document.
B7. Copy of Order of Ombudsman. Dt:07.09.2011.
B8. Copy of Letter. Dt:06.12.2011.
Sd/-
PRESIDENT, CDRF, WAYANAD.
