The complainant has filed the complaint against the OPs alleging therein that he purchased Max Life Guaranteed Income Plan(6 Pay) insurance policy from Max Life Insurance Co. Ltd (OP-1) vide policy no 265295188 through the Agent Axis Bank Ltd (OP-2). As per the policy bond the date of commencement of the policy was 03-Aug-2015. Date of Maturity of the policy: 03-Aug-21. Guaranteed Maturity Sum Assured amount Rs 7, 45,880/-.Benefits of the policy: Guaranteed Maturity Sum Assured or Survival Benefits as the case may be at the time of maturity of the policy. Policy Term: 6Years, Premium Payment Term: 6 Years. The complainant Paid yearly Premium of Rs 1, 18,500.13+Tax for six years starting from Aug-2015 to Aug- 2020 within due date of premium payment date. The complainant also said that in the policy bond there is option to receive the Guaranteed Maturity Sum Assured as a lump sum amount instead of receiving the survival benefit by submitting a written request before commencement of pay out period of survival benefit under the benefit clause No 2.1.4 in the policy bond (ANNEXURE -A). The complainant applied for payment of his Guaranteed Maturity Sum assured amount to OP-2 and OP-1, through e-mail, customer care helpdesk number and raised request in the customer login portal of OP-1 before 03-Aug-2021(ANNEXURE-I).It is the case of the complainant that  the OP-1 (Max Life Insurance Co.） did not agree to pay the guaranteed maturity sum assured amount of Rs. 7,45,880/- against his written request ,instead of that the OP-1 was ready to  pay the surrender value of the policy which was much lesser than guaranteed sum assured value. (Annexure-II). The complainant refused to surrender the policy before maturity date (03-Aug-2021) because he wanted exact guaranteed maturity sum assured value, not the surrender value which was lesser than guaranteed mature sum assured value by sending email to services.helpdesk@maxlifeinsurance.com on23-Jun-2021. (Annexure-III). The complainant wrote a letter on o6-Aug-2021 expressing his grievance to Manager Customer Services, Max Life Insurance Co. Ltd 3rd Floor, Operation Centre 90-A Udyog Vihar , Sector 18 Gurugram 122015,Haryana. (ANNEXURE-IX)

The complainant also said that without replying against his grievance letter, (ANNEXURE-IX), the OP1 transferred Rs 5,000.71 in the complainant bank account as a survival benefit on 6 Sept-2021and also delivered current policy status statement as of 5^th  Aug 2021 specially stating surrender value of the policy (Rs. 7, 45,730.82) and the date of maturity of the policy as 03-Aug-2031. [ANNEXURE X). Maturity Date written in the policy bond of the complainant is 03-Aug-2021.But as per current policy Status statement (ANNEXURE-X), the maturity date of the said policy has been set to 03-Aug-2031. It is the case of the complainant that the OP1 and OP2 neither intimated nor took any consent from the compliant (the policy holder).  OP-1 has changed the terms and condition of the said policy bond. At the time of selling the product the OP-2 had given a brochure to the complainant stating all benefits and policy term as 6 years of the product Max Life Guaranteed Maturity Income Plan (6 Pay) (ANNEXURE XII). But there is difference in policy term years between current policies status statement (ANNEXURE-X) and the brochure of AXIS BANK (ANNEXURE- XI).

The complainant case against AXIS Bank (O.P-2) is as an agent, OP-2 cannot turn down his responsibility regarding his services after selling products (policy).Complainant wrote about the IRDAI guideline on 16 March 2015 regarding appointment of Insurance Agents. Complainant clearly mentioned under the code of conduct of agent that agent must render necessary assistance to the policy holder or claimants or beneficiaries in complying with the requirements for settlements of claims by the insurer. OP-2 also never informed the complainant regarding the change of policy term year from 6 years to 16 years and also change of maturity date from 03-Aug-2021 to 03-Aug-2031. According to the complainant both the OP-1and OP-2 miss leaded him regarding the said matter that’s why complainant seeks redressal against both the OPs for his grievances.

Reliefs Claimed by the complainant:

1. Guaranteed sum assured money of Rs.7, 45,880/- with interest for delayed payment as per IRDAi norms.
2.  Compensation of Rs. 7, 00,000/- for harassment and mental pain and agony
3.  Cost of Litigation Rs. 25, 000/-
4.  Any other relief/relieves the commission may further award in the form of payment to consumer relief fund.

Total Claim Amount Rs: 14, 70, 880/-

The OP-1has contested the case and filed w/v on 22 December 2021 signed by Mr. Adarsh Dwivedi, deputy manager operations of max life insurance company limited having its office at plot no.90A, sector 18, udyog vihar, gurugram-122015 denying all material allegations and has stated inter-alia that the case filed by the complainant is not maintainable and the complainant has no cause of action to file this case. OP-1also files evidence by way of affidavit on dated 26/08/2022 signed by Preeti Singh, presently working as senior executive, customer service, operations of opposite party no. 1 i.e. Max Life Insurance Company, limited having its office at plot no.90c, sector 18, udyog vihar, gurugram-122 015. In both of the document the O.P-1 stated that as per the terms of the Policy, the subject Policy is an annuity policy for the sum assured of Rs. 7, 45,880/- (Rupees Seven Lakh Forty-Five Thousand Eight Hundred Eighty Only).The complainant had to pay Rs.1,18,500.13/-(Rupees One Lakh EighteenThousand Five Hundred Point Thirteen only), for a period of 6 (six) years from the date of issuance of the Policy. Complainant was duly communicated in regard to the statutory frec-look period of 15 days to review the terms of the policy contract and in case of any discrepancy and/or ambiguity, the complainant had the right to request for cancellation of the Policy. The complainant never raised any grievance with respect to the said Policy and as such, it was presumed that a legally binding contract was duly concluded between the parties. As per the terms and conditions the said policy will get mature after six years and before its maturity the complainant had to make a choice between two options, first to opt One Time Lump Sum Payment, Second, to opt for Survival Benefit (Income Benefit and Terminal Benefit). That in the instant case, the complainant had opted for Survival Benefit (Income Benefit and Terminal Benefit). The complainant even after declaring in the proposal form that he has read and understood all the terms and conditions of the policy got confused between Guaranteed Surrender Value and Guaranteed Maturity Sum Assured. It is also submitted by OP-1 that, since the complainant had opted for survival benefit, therefore, he was not entitled for one time lump sum payment (Guaranteed Maturity Sum Insured), therefore to get Lump Sum Amount he had only one option and that was to surrender his policy. OP-1 mentions that Guaranteed Surrender Value is slightly less than the Guaranteed Sum Assured. Since the complainant was not eligible for latter therefore, he could have opted former if he was really in need of money as stated by him. OP-1mentioned that instead of making surrender request, the complainant vide email 26.07.2021 requested opposite party-1 to remit the Guaranteed Sum Assured under the policy. Since the complainant is not entitled for the same therefore keeping faith in service sector the opposite party vide email dated 27.07.2021 informed the complainant to make surrender request either through the website or by visiting the nearest branch of opposite party and further informed that the cash surrender value as on date (27.07.2021) was Rs.7,44,835.76/.（Rupees Seven Lakh Forty Four Thousand Eight Hundred Thirty Five Point Seventy Six Only). Copy of email dated 26.07.2021 wherein the complainant mailed to the opposite party and copy of the email dated 27.07.2021 wherein the opposite party mailed to the complainant is annexed Exhibit-4. Since the Complainant did not make surrender request under the policy therefore adhering to the terms and conditions of the policy the opposite party intimated the complainant vide email dated06.09.2021 about the details of Monthly Income Benefits. OP-1 prayes for dismiss the complaint case with cost.  O.P.No-1 placed many Judgments of the upper courts in support of their version.

1. Vipin Kumar vs. ICICI prudential- Appeal no-95/2013, Honorable Cgandigarh SCDRC.
2. Prema and Ors.vs LICI IV(2006))CPJ239(NC)

3. Honorable Supreme Court of India, Vikram Greentech (I) Ltd. & Anr vs New India Assurance Co. Ltd on 1 April, 2009
4. Honorable Supreme Court of India, United India Insurance Co.Ltd vs M/S.Harchand Rai Chandan Lal on 24 September, 2004.
5. Honorable Supreme Court of India, Bharathi Knitting Company vs Dhl Worldwide Express Courier    on 9 May, 1996.

Decisions with reasons

Complainant is a consumer of the O.Ps. The complainant has both the territorial and pecuniary jurisdiction for filing the case before this commission. These points are never challenged by the OPs.

After 22/09/2022 we have allotted four (4) dates for filing Show cause by the OP-1. But the OP-1 was absent without taking any step. On dated 01/12/2022 we heard the argument of the complainant. After the arguments were heard and although the matter was fixed for pronouncement of judgment on 13/12/2022, on behalf of O.P-1 files hazirah. We have taken all the documents including W/V, Evidence on affidavit  filed by the O.P-1 in our consideration.

O.P-2, Axis Bank received the notice on 5^th October 2021 but the OP-2 desperately ignores the notice and none appears on behalf of the O.P-2 after giving a number of opportunities. On dated 17/03/2022 we run the case ex-parte against the O.P-2.

In the complaint petition (Para-3, Annexure-A) complainant refer benefit clause No-2.1.4 in the policy bond which reflect the same.

2.1.4. Under this Policy, You have an option to receive the Guaranteed Maturity Sum Assured as a lump sum amount instead of receiving the Survival Benefit, by submitting a written request to us before commencement of the Payout Period. Upon payment of the Guaranteed Maturity Sum Assured, this Policy will terminate.

In the present case, this commission has come to a finding that the OP-1 never challenge the upper mentioned version of the complainant. On the other hand  on dated 27.07.2021 OP-1 vide email, informed the complainant to make surrender request either through the website or by visiting the nearest branch of OP-1 and further informed that the cash surrender value as on date (27.07.2021) was Rs.7,44,835.76/.（Rupees Seven Lakh Forty Four Thousand Eight Hundred Thirty Five Point Seventy Six Only). The complainant claim from the O.P-1 was (guaranteed sum assured money) of Rs.7, 45,880/-. So, the dispute between the complainant and the OP-1 was for Rs. 1045/-Opposite party number 1 never gave any emphasis upon the point which is written in their insurance booklet/ policy bond (benefit clause No-2.1.4). Even when the compliment raised the issue to them they were strict to their point of view. Thus the deficiency and unfair trade practice from the part of the opposite party number 1 is established.

Opposite party number 2 AXIS Bank has a corporate identity .Being an insurance agent of the complement they did nothing as and when complainant duly communicate with AXIS Bank about the problem raised between the insurer and the insured person. Being an insurance agent AXIS Bank never feels to act according to the IRDA guideline for the insurance agents. OP number 1 is totally silent about their appointed insurance agent AXIS Bank. The melafide Nexus between both the opposite parties cannot be ruled out. Even after properly received the notice from this commission, AXIS Bank (O.P-2) never felt to appear before this Commission.

               In Haris Marine Products vs Export Credit Guarantee  on (CIVIL APPEAL NO. 4139/2020)25 April, 2022 the honble Supreme Court of India has observed as follows…. an ambiguous term in an insurance contract is to be construed harmoniously by reading the contract in its entirety. If after that, no clarity emerges, then the term must be interpreted in favour of the insured, i.e., against the drafter of the policy.

               In Gurmel Singh vs Branch Manager, National on (CIVIL APPEAL NO. 4071 OF 2022)20 May, 2022 the honble Supreme Court of India has observed as follows… In many cases, it is found that the insurance companies are refusing the claim on flimsy grounds and/or technical grounds. While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control

               In Life Insurance Corporation Of  vs Pramila Basak on 20 May, 2021 the hon’ble National Consumer Disputes Redressal Commission  New Delhi in Revision Petition No. 414 Of 2020     (Against the Order dated 17/12/2019 in Appeal No. 232/2018    of the State Commission West Bengal) observed as follows…The insurance contract being a contract of utmost good faith is a two-way door. The standards of conduct as expected under the utmost good faith obligation should be met by either party to such contract.

From the upper mentioned facts and circumstances it is clear that the complainant had suffered mental pain and agony and financial loss by the unfair trade practice, deficiency of service of both the opposite parties. Complainant is succeed to prove his case and the complement should be compensate by both the opposite parties

In view of the aforementioned discussions, we are of the view that the complainant is entitled to get reliefs as per Consumer Protection Act and there is deficiency in service and unfair trade practice on the part of the OPs. Thus, the consumer case is allowed in part on contest against the OP- 1 and ex parte against OP-2 with cost.  The consumer case is disposed of in the following terms:-

1. OP- 1 is directed to refund Rs. 7, 45,800/- to the complainant with interest @ 9 % p.a. from the date of maturity till realization. If any payment is already made by O.P-1 to the complainant will be deducted from the total awarded amount.
2. O.P-1 is further directed to make payment of Rs. 50,000/- (Rupees fifty thousand) only as compensation for harassment and mental agony caused to the complainant on account of deficiency in service and unfair trade practice.
3. OP-2 shall pay Rs. 30,000/- (Thirty Thousand) only as compensation for harassment and mental agony caused to the complainant on account of deficiency in service and unfair trade practice and costs of litigation. Out of this Rs. 30,000/- (Thirty Thousand) complainant will get Rs. 10.000/- (Ten Thousand) and 20.000/- will be deposited to the Consumer Legal Aid account of this commission.
4. Above payments shall be made within 30 days from the date of this order. Failing which the amount shall carry interest @ 9 % p.a. from the date of order till its realization. Complainant is given liberty to execute the order as per law of not paid by the OPs.

Let a copy of the order be sent / supplied at free of cost to the parties concerned.

The Final Order will be available in the following website www.confonet.nic.in