IN THE KODAGU DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, MADIKERI

ORDER DELIVERED BY HON’BLE PRESIDENT(I/C)                           SMT. C.RENUKAMBA

1. This complaint under section 12 of Consumer Protection Act 1986 to pass an order to direct the opposite party to pay the sum of Rs.90,000/- being the net claim amount pertaining to the  “Tata AIG Life Mahalife Gold Policy” bearing policy No.C223728745 at Madikeri with interest at the rate of Rs.12% P.A from the date of payment till realization, besides with Rs.20,000/- towards loss, inconvenience and damages sustained towards mental agony and Rs.10,000/- towards the cost of the proceedings.

2. The brief facts of the complaint is as under;

The complainant submits that, she obtained Life Insurance Pollicy of basic plan, from the opponent insurance company called “Tata AIG Life Mahalife Gold Policy” bearing Policy No.C223728745 at Babele, Virajpet Taluk, through the authorized agent India Infoline Brokers Ltd., Kushalnagar” on 09/08/2010 at a premium of half yearly installments of Rs.15,000/-.The complainant paid half yearly premium of Rs.15,000/- for a period of three years continuously and paid a total ;sum of Rs.90,000/-.

The complainant submits that due to some unavoidable circumstances and financial crisis, she could not continue the said policy and the same was discontinued.As per policy the policy holder has to pay the premium continuously for the period of three years and consequently she is eligible to withdrawn the premium paid with interest thereon.

Complainant further instructs that, she finds some difficulty to educate her son and as such she requested and demanded the company/opponent to repay the said amount, but they have refused to pay the same to her.She is badly in need of said amount.The opponent have deliberately failed to pay the said amount to her, which is highly illegal.She entitled to claim the investment money which she has paid for continuously for a period of three years.They are liable to pay said amount to her as per the policy.The opponent has committed deficiency of service on opposite partyagainst the complainant.

Complainant further submits that she issued a notice through RPAD dated 6/9/2016 for which the opposite party issued reply dated 26/9/2016 stated that the complainant is only entitled for the sum of Rs.9,469-37, but the said amount is not paid till today.Thereaftershe once again issued on more notice 17/7/2018, which was served upon the opponent.But they have issued vague reply denying the claim of the complainant.The opposite party issued one more letter dated 25/7/2018 to the complainant stating that, the grievance has been referred to the ‘Grievance Redressal Cell” for investigation of the matter and they would respond within a period of 10 days, but till today it has not been investigated and not settled.The opponent has not properly responded and not given proper service to the complainant.

It is submitted that on several occasions she requested and demanded the opponent to pay the said investment amount till today, but for one or the other reasons they have avoided to repay the said amount to her.She sustained huge mental agony and also sustained huge loss and damages, which cannot be compensated in terms of money.

The claim of the complainant was deliberately repudiated under the said order without verifying the terms and conditions of the aforesaid policy.The respondents have no manners of right whatsoever to repudiate the claim of the complainant and said rejection was highly illegal and against the principles of law.The reason quoted is not fair and proper.The opposite party is liable to reimburse the claim of the complainant.If the claim is not settled, she will be prejudiced and great injustice will be caused to her.The said rejection is nothing but the deficiency in service.The complainant is not satisfied with the rejection order made pertaining to the aforesaid policy.

The complainant prays that this Hon’ble Court may be pleasedto pass an order to direct the opposite party to pay the sum of Rs.90,000/- being the net claim amount pertaining to the“Tata AIG Life Mahalife Gold Policy” bearing policy No.C223728745 at Madikeri with interest at the rate of Rs.12% P.A from the date of payment till realization, besides with Rs.20,000/- towards loss, inconvenience and damages sustained towards mental agony and Rs.10,000/- towards the cost of the proceedings.

3. After service of notice to Opposite Party  appeared  through his counsel  and   filed  the version as under:-

That the opposite party submits that the complainant obtained life insurance policy “TATA AIG Life Mahalife Gold Policy” subsequently named “TATA AIA Life Mahalife Gold policy” bearing policy No.C223728745 from the opposite party with the sum assured Rs.3,27,000/-.The term of the policy was 60 years.The policy commenced on 9^th August 2010.Inspite of notices and reminders, the complainant failed to pay the renewal premiums since October-2013.The opposite party sent renewal notice to the complainant on 23/9/2013 intimating the non receipt outstanding premiums and also informed the complainant about the Automatic Premium Loan facility being applied explaining the process of availing the process of availing Annual Premium Loan.The complainant did not respond to the notice of the opposite party.Considering the default of the complainant, policy lapse notice dated 12/3/2014 was sent to the complainant specifically intimating that since the opposite party have not received the outstanding premium all the benefits under the policy obtained by the complainant stand forfeited.Even then the complainant failed to respond to the notice or made efforts to revive or renew the policy.

The complainant caused issue of a notice dated 06/09/2016 through her Advocate demanding repayment of the total premium paid for three years from 2011 to 2013 in a sum of Rs.90,000/-.The opposite party sent reply dated 26/9/2016 informing the default committed by the complainant and informing that the opposite party being a customer friendly organization further intimated to the complainant that in case the complainant intends to renew or revive the policy, she would have to submit Health Certificate and Rs.65,615/- towards the premiums due on a sum of Rs.59,372/- and interest on the premium due in a sum of Rs.5,127-02 with service tax of Rs.1,116/-on or before 15/10/2016 subject to review by underwriting team and any other requirement to be intimated.It was also clearly intimated if the complainant still is determined to close the policy then she would have to approach the nearest branch of the opposite party and complete the surrender formalities and collect the surrender value of Rs.9,469-37.The complainant neither responded to the suggestions of the opposite party nor renewed or revived the policy by making the payment as mentioned within the above mentioned date or even complied with the surrender formalities till now.

The policy of Insurance obtained by the complainant is subject to the terms and conditions of the insurance policy.The complainant failed to comply with the terms and conditions of the policy in respect of payment of the premium regularly or in respect of the renewal or revival of the policy or in respect of surrender of the policy.

The averments of para 2 of the complaint does not give the true picture of the transaction in respect of the insurance policy obtained by the complainant.

The opposite party is not aware of the averments of the paras 3 and 4 of the complaint.The complainant consciously obtained the insurance policy after knowing the terms and conditions of the policy.The complainant is bound by the terms and conditions of the insurance policy.The complainant is not entitled to the claim made by her in the complaint.

The averments of para 5 of the complaint that the opposite party in its reply to the Advocates notice had stated that the complainant is entitled to Rs.9,469-37 only but has not paid the said amount also is misstatement of facts.The complainant has suppressed the fact of non-surrender value of the policy.The complainant has not even produced any documents to show that she has surrendered the policy and requested for the payment of the surrender value of the policy.The second notice dated 17/7/2018 was suitably replied by the opposite party.The Grievance Redressal Celldid not entertain the grievance of the complainant as it was a clear case of default of the policy conditions.

It is false that the complainant requested and demanded the opposite party several times to repay the amount paid by her and the opposite party avoided to pay.On the other hand the opposite party specifically sent policy lapse notice and intimated the option and procedure for revival or renewal of the policy and the procedure to surrender of the policy as mentioned above.The complainant herself committed the default and failed to renew or review the policy or surrender the policy and the opposite party is not responsible or has not committed any deficiency of service in the case.The complainant is not entitled for repayment of the premium paid by her under the terms and conditions of the insurance policy.It is false that the complainant sustained mental agony or loss and irreparable damage.

There is no repudiation of the claim by the opposite party.In fact no claim for surrender value was made by the complainant.Actually the policy is not surrender till now.The complainant has not made claim in accordance with the terms and conditions of the insurance policy.The opposite party has acted in accordance with the terms and conditions of the insurance policy.The complainant is not entitled for the claim made by her in the above case.

The complaint is barred by time.Policy lapse notice dated 12/3/2014 was sent by the opposite party to the complainant.Opportunity to renew or review within 15/10/2016 was given.The complainant has not utilized the opportunity.The complaint was filed on 6/5/2019 more than 61 months after the issue of policy lapse notice and 30 months after the opportunity to renew or revive the policy before 15/10/2016.The complainant has not explained any grounds for condoning the delay.Hence the complaint is not maintainable under law.

The complainant is also premature as the policy is not yet surrendered.Without surrendering the policy, surrender value cannot be claimed.Thus there is no claim at all under law and also consequently there is no repudiation.

The complainant is not entitled to the relief claimed in the above case nor for interest or for any damages.

4. In this case complainant filed his examination-in-chief by way of affidavit evidence as PW-1 with documents marked as exhibits P-1 to P-8  and filed written Arguments.

5. In this case opposite parties also filed his examination-in-chief by way of affidavit evidence as RW-1 with documents marked as exhibits R-1 to R-17 and filed written Arguments and further written arguments.

6. The points that would arise for our consideration are as under;
   1. Whether the complainant proves the deficiency in service by the opposite party and thereby she is entitled for the reliefs sought ?
   2. What order ?

7. Our findings on the above points are as under;
   1. Point No.1 :- Partly Affirmative
   2. Point No.2:- As per the final order for the        

following ;

R E A S O N S

8. Point No.1:- Opposite party have agreed that the complainant has obtained life insurance policy under the name “TATA AIG Life Mahalife Gold” bearing No.C223728745 dated 9/8/2019 at a premium of half yearly  installments for three years for a total sum of Rs.90,000/-.

9. On verification of the documents it is observed that the complainant has paid premium for 3 years and has been a defaulter since 2013.  The opposite party has not denied the above facts, opposite party cannot repudiate the grounds of default.  The opposite party would have asked for surrender of the policy for the claim of Rs.90,000/-, but have not done so, therefore opposite party have caused deficiency in service.

10. The opposite party states that the complainant has filed this case after lapse of the policy for 61 months, hence, the case is not admissible.  But, the Commission has noticed that opposite party have undergone letter correspondence with the complainant on 26/09/2016 and on 25/07/2018.  Hence the case is admissible.    Therefore, opposite party’s liable to pay compensation as he has caused deficiency in service.  Therefore, point No.1 is answered in partly affirmative.

11.  Point No.2:- From the discussion made above and conclusion arrived at, we pass the following order;

O R D E R

1. The complaint of the complainant under section 12 of Consumer Protection Act 1986 is allowed in part.
2. The opposite party is directed to pay the sum of Rs.90,000/- (Rupees Ninety thousand only) being the net claim pertaining to the Tata AIG Mahalife Gold Policy” bearing policy No.C223728745 with interest at 9% per annum from the date of filing the complaint till realization to the complainant within 45 days of this order, failing which complainant is at liberty to have a redressal as per law. 
3. The opposite party is also directed to pay a sum of Rs.5,000/- towards cost and damages to the complainant.
4. The opposite party is also directed to pay a sum of Rs.10,000/- towards mental agony to the complainant.
5. Copy of this order as per statutory requirements be forwarded to the parties free of cost and file shall be consigned to record room.

 (Dictated to the Stenographer, transcribed, corrected and pronounced in the open Forum on this 25^th DAY OF FEBRUARY, 2022)

              (B. NIRMALAKUMAR)                    (RENUKAMBA.C)                                                     

                       MEMBER                              PRESIDENT(I/C)                      

Witnesses examined on behalf of the complainant

CW-1-  Smt.Usha P.M. (Complainant)

Documents marked on behalf of the complainant

Ex.P-1 : Copy of Insurance policy

Ex.P-2: Legal notice dated 6/9/2016

Ex.P-3 : Postal receipt and acknowledgement card

Ex.P-4:- Reply notice dated 26/09/2016

Ex.P-5:- Legal notice dated 17/7/2018

Ex.P-5:- Postal receipt and acknowledgement card.

Ex.P-6. Reply notice dated 27/7/2018

Ex.P-8: Premium payment list

Witnesses examined on behalf of the opposite party

RW-1 : Sri. P.B. Ganapathy, Manager, Tata Life Insurance Company

Documents marked on behalf of the Opposite parties

Ex.R-1: Application submitted for insurance by complainant

Ex.R-2. Amendment application for policy.

Ex.R-3. Basic definitions

Ex.R-4: Sales benefit illustration consisting of projection of values

Ex.R-5: Special reinstatement letter

Ex.R-6: Lapse notice

Ex.R-7:Premium payment notice

Ex.R-8: Lapse notice

Ex.R-9: Lapse notice

Ex.R-10: Non forfeiture benefit notice

Ex.R-11:Lapse notice

Ex.R-12: Non forfeiture benefit notice

Ex.R-13: Auto surrender Letter

Ex.R-14. Notice on behalf of complainant

Ex.R-15: Reply to notice on behalf of complainant

Ex.R-16: 2^nd notice on behalf of complaint

Ex.R-17: Reply to 2^nd notice on behalf of complainant

Dated:25/02/2022                                PRESIDENT(I/C)