Sri. P. Satheesh Chandran Nair (President):
The complainant filed this petition u/s.12 of the C.P. Act 1986.
2. The case of the complainant is briefly stated as follows: On 18.07.2011 the opposite parties issued an insurance under the plan named “Reliance Super Five Plus” to the complainant after receiving premium amount of Rs.1,49,959/- (One Lakh Forty Nine Thousand Nine Hundred and fifty Nine Only). According to him, the premium paying term is fixed for 6 years and the term of the policy period was for 11 years. The yearly installment premium was for Rs.1,49,959/-. The opposite party assured a basic sum of Rs.7,10,500/- on completion of the policy term. At the time of issuing the policy 2nd opposite party assured to the complainant that the said policy is a “Rider Benefit” scheme. On 17.08.2012 the complainant approached the 2nd opposite party for remitting premium due on 18.07.2012. But the 2nd opposite party refused to accept the premium stating that the remittance is belated. It is understood that the said policy was not “Rider Benefit” scheme and hence the complainant compelled to surrender the policy. But the 2nd opposite party not ready to return the surrender value of the policy. Complainant again contented that the acts of the opposite parties are amounts to misrepresentation of facts with regards to the policy conditions and the opposite parties are illegally offered false promises. Due to these reasons the opposite parties committed unfair trade practice and adopted unfair method and deceptive practice in obtaining the consent of the complainant for taking the said policy. Even though the complainant approaches the opposite parties to redress their grievances, but the opposite party did not turn up for redressing the complainant’s grievances. At last the complainant sent a legal notice on 01.02.2013 to opposite parties even then they have not turned up. Hence the complainant filed this petition before this Forum for return of premium amount of Rs. 1,49,959/- with interest, compensation, cost etc.
3. The complainant filed the above said petition before this Forum and the Forum entertained the complaint and issue notice to the opposite parties for their appearance. Even though the notices are duly served, the opposite parties did not appear before the Forum and they all are set exparte on 23.04.2013 and 11.06.2013. Aggrieved by this order, the opposite parties filed an appeal before the Hon’ble Kerala State Consumer Disputes Redressal Commission, Thiruvananthapuram and the said appeals is allowed and direct this Forum to give opportunity to file version and evidence for the opposite parties. On the basis of this order the 1st and 2nd opposite parties entered appearance before the Forum and filed their version. Even though, coercive steps are taken against 2nd opposite party they did not appeared before the Forum and hence 2nd opposite party is declared as exparte on 02.07.2015.
4. 1st and 3rd opposite parties are filed a joint version as follows. According to this contesting opposite parties the petition is not maintainable either in law or in fact. The complainant has taken this policy with full knowledge and only with the consent of the complainant. The opposite parties issued the insurance policy to him and in time the original policy documents are served to the complainant. The complainant has not raised any objection till this time with regard to the policy condition and the complainant fully accepted all the terms and condition of the policy. It is submitted that, the complainant remitted only one premium dated 18.07.2011 for Rs. 1,49,959/- and subsequently the complainant did not remit any of the premium which was due on 18.07.2012 onwards. The allegation of the complainant to the effect that, he was present on opposite party’s office for the remittance of 2nd premium is absolutely false. According to this opposite parties as per the terms and condition of the policy if a policy holder is defaulted the subsequent premium, it is a reason for lapse of the premium. If a policy is lapsed the insured is not eligible to get the remitted premium or any other benefits. According to him, on his part there is no unfair trade practice or deficiency in service as alleged by the complaint. For the above said reasons the contesting opposite parties have requested to dismiss the petition with cost.
5. In view of the petition, version and the documents before the Forum we would like to raise the following issues in this petition.
- Whether the petition is maintainable?
- Whether the opposite parties are committed any deficiency in service or unfair trade practice against the complainant?
- Regarding the relief and costs?
6. In order to prove the case of the complainant the complainant power of attorney holder one Simon Eapen filed a proof affidavit in lieu of chief examination and he is examined as PW1 and marked Exts. A1 to A5. Ext. A1 is the policy document issued by the opposite parties to the complainant, Ext.A2 is the copy of advocate notice send to the opposite parties, Ext.A3 series is the postal receipts, Ext.A4 series is the postal acknowledgement cards and Ext.A5 is the Power of Attorney. On the other side, for 3rd opposite party the Manager concerned of Reliance Insurance Company, Konni Branch filed a proof affidavit in lieu of chief examination he filed the said affidavit for and on behalf of 1st opposite party also. When we examine the proof affidavit of PW1 it reveals that, the content of the proof affidavit are more or less as per the tune of the complainant. According to his deposition he remitted the premium amount of Rs.1,49,959/- on 18.07.2011 to 1st opposite party on the basis of the assurance and advice given by the 2nd opposite party. He again deposed that, the complainant is made to believe the insurance policy is the “Rider Benefit” Scheme in case of accidental death, total/permanent disablement and also critical condition rider. It is also promised to offer loan facility on the basis of the policy and return of premium in case of surrender of policy and also a 30 days grace period for the payment of premium. He also deposed that, for the payment of 2nd installment premium scheduled on 18.07.2012 he approach the 2nd opposite parties bank at Konni, Pathanamthitta Dist on 17.08.2012. The 2nd opposite party did not receive the premium amount because the remittance is highly belated and against the provisions of reinstatement. The approach, attitude and reply of the 2nd opposite party were highly against the impression of the complainant. Due to this reason he decided to surrender the policy for the return of the remitted premium. According to PW1 the act of the opposite parties are clearly comes under unfair trade practice and they are adopted unfair method and deceptive practice in obtaining the consent of the complainant to avail the policy in question. The dealing of the opposite parties also amounted to deficiency in service against the complainant. Aggrieved by the approach of the opposite parties the complainant sent a legal notice on 01.02.2013 to all the opposite parties. But none of the opposite parties have not turned up to redress grievance of the complainant.
7. When we examine the evidence adduced by the 1st and 3rd opposite party through DW1 it reveals that, the complainant avail the policy with full awareness of its terms and condition and the policy documents are duly served to the complainant in time. He categorically deposed that, so far the complainant has not raised any objection with regard to the policy and policy condition, this can be considered as an acceptance of policy by the complainant. As per his testimony and pleading of the complainant to the effect that the complainant approached the 2nd opposite party on 18.08.2012 for the remittance of 2nd premium due on 18.07.2012 was a false story and categorically stated that, if an insured violated the terms and condition of the policy agreement the policy became lapsed as far as the insured is concerned. Though 1st and 3rd opposite party adduced oral evidence through DW1 he has not given any documents as evidence in his favour.
8. Point No.1:- In this case the opposite parties contention is that, the petition is not maintainable before this Forum. He submitted that, the complainant in this case is an insured and 1st and 3rd opposite parties are the officials concerned of the Insurance Company and 2nd opposite party is the authorized agent of 1st opposite party. It is also proved that, the complainant paid first premium as the consideration of the policy. On the basis of all these evidence we can safely come to a conclusion that the complainant is a consumer of the opposite parties. Hence above point found accordingly.
9. Point Nos. 2 & 3 : For the sake of convenience we would like to consider point No.2 and 3 together. When we consider the deficiency in services or unfair trade practice in this case we have to look into the nature of the policy and the assurance given by the opposite party at the time of availing the policy. When we examine the evidence in this case it is come out in evidence to the effect that, the complainant availed this policy as a “Rider Benefit” policy and under the name and style “Reliance Super Five Plus”. This also reveals that, even if an insurer is failed to remit the premium on a particular day a 30 days grace period can be availed by the insured. As per Ext.A1 policy documents page 11 in terms and condition it is stated, “Premiums : The Company allows a grace period of one month or 30 days from the due date for the payment of premiums. Should an otherwise valid claim arise under the Policy during the grace period, but before payment of the due premium, the Company will still admit the claim. In the event of a claim any unpaid premium for the Policy year will become due immediately”. Here it is evident to see that, the complainant approached the insurer on the 30th day of the premium due date. If a grace period of 30 days was there, what prevented them to accept the 2nd premium and allow the insured to stick on the policy? We do admit that, the opposite parties are not accepting the grace period alleged by the complainant. At the same time, it is to see that, the contesting opposite parties are failed to produce any documents to show that, there is no grace period for this kind of policy. In this event we have to rely the stand taken by the complainant with regard to the grace period. The opposite parties have a definite case to the effect that, if an insured is violate the terms and condition or failed to pay the subsequent premium the policy became lapsed and these policy holders are not eligible for any kind of relief or any right to return even the remitted premium. In order to substantiate this position, the contesting opposite parties are failed to produce any evidence or documents except their pleadings. It is clear that, the complainant approached the 2nd opposite party for all these dealings and the 2nd opposite party’s office was functioned at Konni. It is interesting to see that, the 1st and 3rd opposite parties in their version or at the time of adducing evidence disputed this fact. Hence the status of the 2nd opposite party which was alleged by the complainant was proved beyond doubt. When we examine the deposition of PW1 in cross it is clear that, PW1 he who accepted the policy document from the office of 2nd opposite party. The learned counsel who is appearing for the contesting opposite parties asked question with regard to the free look period of 15 days and also denied the attempt of the complainant for the subsequent remittance dated 18.07.2012. In all these question PW1 give proper answers as per his chief examination. In cross, the PW1 answered for a question “Policy condition അനുസരിച്ച് തുടർച്ചയായി 3 വർഷം തുക അടച്ചാൽ മാത്രമേ policy സംബന്ധമായ എന്തെങ്കിലും ആനുകൂല്യങ്ങള് ലഭിക്കുകയുള്ളൂ എന്ന് താങ്കള്ക്ക് അറിയാമോ? (A) അറിയില്ല. (Q) രണ്ടാമത് policy amount നൽകുന്നതിനായി പണം കൊടുത്തുവിട്ടതായി -അവകാശപ്പെടുന്ന വ്യക്തിയുടെ പേരും വിലാസവും ഹർജിക്കാരനോട് ചോദിച്ച് മനസ്സിലാക്കി Forum മുമ്പാകെ ഹാജരാക്കാമോ?(A) ഹർജിക്കാരനോട് ചോദിച്ചിട്ടു പറയാം'. If the contesting opposite parties have a definite case with regard to the continuous payment of 3 years for this policy, what prevented them to show that condition to PW1 at the time of cross-examination, in order to substantiate their case. Even though, the contesting opposite parties had taken a stand that, the policy in question was lapsed due to the nonpayment of 2nd premium these opposite parties are not seen to produce any letter of intimation with regard to the lapse of policy. When this DW1 in cross answered “18.07.2012 ൽ premium renewal ൽ ഉള്ള വിവരം complainant നെ അറിയിച്ചത് ഏത് രീതിയിൽ ആണ് (A) phone മുഖാന്തിരവും, SMS മുഖാന്തിരവും ordinary post ലും അറിയിച്ചിരുന്നു. രേഖകള് ഹാജരാക്കിയിട്ടില്ല. (Q) പരാതിക്കാരൻ 17.08.2012 ൽ opposite party യുടെ കോന്നി branch ൽ ബ്രാഞ്ചിൽ എത്തി premium renewal ൻറെ തുക അടയ്ക്കാൻ വന്നപ്പോള് താങ്കള് office ൽ ഉണ്ടായിരുന്നോ (A) ഇല്ല.” According to the above said testimony it is seen that, 1st and 2nd opposite party issued p remium renewal intimation to the complainant by phone, SMS and by ordinary post. In order to substantiate this position this opposite parties are failed to produce any documents to convince us. Therefore we can arrive a conclusion to the effect that, the allegation of the intimation of premium renewal was a false story narrated by the opposite parties.
10. The evidence adduced by PW1 in this case against 2nd opposite party is unchallenged before the Forum since he is declared exparte. At the same time we have to see that, the complainant is availed this policy as per the assurance and promises given by this 2nd opposite party. As we discuss earlier it is to see that, 1st, 2nd and 3rd opposite parties are jointly and severely liable to the complainant in this case. It is to see that, the complainant has taken an earnest step to remit the 2nd premium within the grace period of one month. But the opposite party concerned failed to accept it by one reason or other. The opposite parties failed to substantiate their case with regard to the refusal of the receipt of the premium before the Forum. Considering the nature and circumstances of this case the complaint is allowable. Hence point No.2 and point No.3 found accordingly.
11. In the result we pass the following orders:
- The 1st and 3rd opposite parties are directed to return the premium
amount of Rs.1,49,959/- (Rupees One Lakh Forty Nine Thousand
Nine hundred and fifty nine only) together with interest of 10% to the
complainant from the date of complaint onwards.
- 2nd opposite party is directed to pay an amount of Rs. 10,000/-
(Rupees Ten Thousand only) to the complainant with 10% interest from the date of receipt of this order.
- 1st and 3rd opposite parties are directed to pay a compensation of
Rs.20,000/- (Rupees Twenty Thousand only) to the complainant with an interest of 10% from the date of receipt of the order onwards.
- opposite parties 1 to 3 are also directed to pay a cost of Rs.3000/- (Rs.1000/- each) to the complainant with an interest of 10% from the date of receipt of this order onwards.
Declared in the Open Forum on this the 29th day of February, 2016.
(Sd/-)
P. Satheesh Chandran Nair,
(President)
Smt. K.P. Padmasree (member –I) : (Sd/-)
Smt. Sheela Jacob (Member – II) : (Sd/-)
Appendix:
Witness examined on the side of the complainant:
PW1 : Simon Eapen
Exhibits marked on the side of the complainant:
A1 : Policy document issued by the opposite parties to the complainant.
A2 : copy of advocate notice sent by the complainant’s advocate
to the opposite parties.
A3 series : Postal receipts.
A4 series : Postal acknowledgement cards.
A5 : Power of Attorney executed by the complainant.
Witness examined on the side of the opposite parties:
DW1 : Suresh Babu
Exhibits marked on the side of the opposite parties: Nil.
(By Order)
Copy to:- (1) Simon Eapen, Nediyakalayil Kizhakkethil House,
Oonnukal.P.O., Kozhencherry Taluk,
Pathanamthitta Dist.
(2) The Reliance Insurance Co. Ltd., (Reg.121), H Block
Dirubhai Ambani Knowledge City, Navi Mumbai,
Maharastra – 400 063.
(3) Mr. Anilkumar, Madhuvilasom, Maniyar.P.O.,
Punalur – 691325.
(4) Reliance Insurance Co. Ltd., 1st Floor, Kadamattu Peniel
Towers, Konni – 689 691.
(5) The Stock File.
