Complaint presented on  :     31.05.2013

                                                                   Order pronounced on     :     23.01.2015

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM, CHENNAI(NORTH)

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

PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,         :      PRESIDENT

                    TMT.T.KALAIYARASI, B.A.B.L.,                   :       MEMBER II

FRIDAY THE 23^rd DAY OF JANUARY  2015

C.C.NO.116/2013

Mr.J A L Ganesan

Son of late Mr. A.Joseph,

Residing at No.A-37, Tower Block,

Taylor’s Road, Kilpauk,

Chennai 600 010

Permanent address

No.263, 2^nd  Street, Ganapathy Nagar,

Nagercoil 629 002.

                                                                                    ...  Complainant

..Vs..

Date of complaint                   :        31.05.2013

Counsel for Complainant             :        M/s. V.Jayachandran & Associates             

Counsel for Opposite parties        :        M/s. K.Rajasekaran & S. Uma Maheswari

O R D E R

THIRU.K.JAYABALAN, PRESIDENT     

Complaint filed  under section 12 of the Consumer Protection Act 1986 for a direction to the opposite parties  to  extend the mediclaim  insurance with accrued bonus, as the spouse is legally eligible under the clauses obtained in brochure 17,19,20(2), 28 and  to settle residual units proceeds with interest and to pay at Rs.15,00,000/- only as compensation on account of suffering and mental agony and to pay cost of the complaint.

1. The  case of the complainant is briefly as follows:

 The complainant is the husband of the  Dr.S.Valliammal as they had no issues  and they were committed  for social cause due to old age and they came across lot of advertisement about SCUP (Senior Citizen Unit Plan)  in English and vernacular daily and also through the representatives /agents of the opposite parties who were doing door to door  canvassing about the scheme and they explained the salient features of the scheme and induced  the complainant’s wife to join the SCUP.   In the said scheme, in the event of payment of Rs.33,000/- at one time, the unit holder and her spouse  would be entitled for  a medical coverage  of Rs.5,00,000/- only, plus 5% on the insured amount every claim free years and maximum of 10 unclaimed years, as bonus at Rs.2,50,000/- during their entire life time.  Further the official of the opposite parties informed that the policy holder and her spouse are entitled to get and share the medical benefits  during their entire life time and the age group allowed was between 55-60 years. The complainant wife in order to join the SCUP she made  a payment of Rs.33,000/- as one time lump sum investment on 23.05.1997 to share the benefits for herself and for her spouse.  At the time of joining the scheme the  complainant was 63 years and his wife was  58 years old. The opposite parties informed that joint membership is not allowed as per their brochure   and however the policy holder including her spouse is entitled to get medical benefits throughout their life time. In the application for SCUP there is a column to fill up the details of spouse based upon which log book was issued for both the unit holder and for the spouse. The complainant’s wife received letter dated 20.02.1998 from the opposite party seeking to return the log book for recording of unclaimed bonus accrued.  However, on the said date she had not been issued log book-cum-identity card from the opposite party which was due to be the issued one year from the date of payment on 23.05.1997.  The complainant’s wife brought to the knowledge of the opposite parties that actually she was not issued with the log book-cum-identity card and after several correspondence between the complainant’s wife and the opposite parties, lastly the opposite parties issued duplicate log book  on 09^th June, 1998 to the complainant’s wife.   As per the terms and condition governing the policy, the opposite parties had made endorsement of bonus earned time to time by the complainant and his wife in the log book commencing from 23.05.1999 and to till 2006. Further the  member  i.e.,  wife of the complainant and her spouse i.e., complainant, had not received any mediclaim  from the opposite parties till date.  Even for receiving the log book from the opposite parties the complainant’s spouse suffered with mental agony at the hands of the opposite parties.  During  April 2000, the complainant and his wife shifted their residence from Chennai to Nagercoil leaving Dr.Vijayalekshmi who is the daughter of  the younger sisters of the unit holder S.Valliammal and they had brought up her as they had no issue.  The unit holder S.Valliammal expired on 30.05.2005 and the same was informed by the complainant to the opposite parties by letter dated 29.01.2007 as the complainant also equally entitled to get the benefits as that of his wife and requested to update the records.  When the complainant wanted to withdraw the amount, the opposite parties had given an option that even after withdrawl the amount could be reinvested in any other scheme and  the same was refused by him.  The opposite parties  wrote to the complainant letter dated 10.03.2009 that they were unable to process the case of the complainant, as the option was signed by the third person   J.A.L.Ganesan.  Then the complainant strongly wrote a letter protesting for referring him as a third person after several correspondences the opposite parties wrote a letter dated 26.11.2010  declining to accede the request of the complainant.  The complainant as a spouse of the unit holder of his wife is entitle to receive the benefits after her death and further the documents of the  opposite parties themselves supports the case of the complainant and therefore the complainant filed this complaint praying to order to extend the mediclaim insurance with accrued  bonus to him and also to pay the residual units proceeds with interest and also to pay a compensation of Rs.15,00,000/- for the suffering of mental agony to him and also with cost of the complaint.

2. Written Version in Brief:

The case of the opposite party is that there is no deficiency of services involved in  the matter as provided  in Section 2(1)(o) of the Act 1986 and further the complaint is hopelessly barred by the limitation as the cause of action around on 23.05.1995 when the unit certificate issued in the name of S.Valliammal on single holding basis with nomination of V.Vijayalakshmi  and the complainant remained only as a prospective consumer and  hence the complaint filed by a prospective  consumer is not maintainable unde law.  Mrs. S.Valliammal had invested a sum of Rs.33,000/- on 23.05.1997 and she was allotted  unit certificate  No:SC973010000877 under SCUP.  The above amount had been utilized by the UTI purchased 3300 units @ 10/- per unit, invested  by S.Valliammal had been utilized by the UTI, for payment of 7 premiums to New India Assurance Company Ltd.(NIAC) in respect of the member after she attendend the age of 55 years and on  the date of termination of SCUP on 18.02.2008  total 1458.599 units were outstanding after paying aforesaid premium to NIAC. The rate of repurchase per unit as on 18.02.2008 was Rs.23.2257 per unit. The scup scheme was terminated on 18.02.2008  and however there is no loss to investors who has attained  the age of 58 years on or before the date of termination. The opposite parties also sent intimation letter to its members including Mrs.Valliammal and she can continue to  get the medical coverage  above  the age of 58 years and can withdraw the balance units.  The second opposite party received redemption from the complainant for releasing the balance maturity amount which was rejected with objection as he is not a spouse member or nominee as per their records.  By oversight the opposite parties have affixed seal  and stamp in the second page of log book without confirming holding detail in their records and the assumption that the details filled by the holder are according to the holding basis opted by the member at the time of investment.  The certificate was issued in the year 1997 in single holding basis with name nomination Mrs.V.Vijayalakshmi was registered as a nominee, the complainant may be directed to submit the redemption form duly signed by her to release the amount of Rs.33,876.98/- in her favour  the complainant has not approached the opposite parties till 2007. Therefore the opposite parties submits that there is no deficiency in service on the part of the opposite parties and they prays to dismiss the complaint.

3.       The Complainant had filed with his proof affidavit and documents Ex.A1 to Ex.A36 were  marked  on the side of the complainant. Ex.B1 to B5 were marked on the side of the opposite parties.

4. The points that arises for consideration are as follows:-

1)  Whether  the opposite parties 1, 2 & 3 committed  deficiency in service?

2)   To what relief the complainant is entitled to?

5. Point No : 1

It is an admitted fact that the complainant’s wife  Mrs.S.Valliammal invested a sum of Rs.30,000/- on 23.09.1997 and  she was issued with Ex.A5 unit certificate  dated  23.05.1997 under SCUP scheme with the nominee V.Vijayalaksmi and the unit holder Mrs.S.Valliammal died on 30.05.2005 and the same was informed by the complainant to the opposite party  under Ex.A12 dated  29.01.2007 and thereafter the complainant demanded to pay the proceeds of the unit certificate  of his wife to him in the capacity of spouse and the opposite parties informed the complainant that they could pay only to the nominee V.Vijayalakshmi of S.Valliammal  and hence this complaint before this forum. 

6.       The complainant contended that  his wife  joined the SCUP scheme at the age of 58 and as per the Ex.A5 unit certificate  and  Ex.A3 brochure both the unit holder  S.Valliammal and  her spouse is eligible  for  medical insurance  and even  on the death of the unit holder the surviving spouse is eligible  for medical insurance  and however  as per Ex.A6 log book they have not claimed  bonus for the period mentioned therein at any point of time and even after demand  by the complainant to settle the accrued bonus, residual unit proceeds  were denied by the opposite party denied the same and hence the complainant filed this complaint praying to direct the opposite parties to settle the accrued bonus, residual bonus with interest and also compensation. 

7.       The opposite party would contend that the government has terminated the scheme SCUP on 18.02.2008  and thereafter the units have invested with New India Assurance Company(NIAC) and further the mediclaim is payable only by the NIAC  and therefore non impleading of the NIAC is fatal to the complainant case as  the scheme closed on Feb 2008 and the complaint filed on only in the year 2013 and therefore the complaint is barred by limitation and further the unit holder S.Valliammal nominated V.Vijayalakshmi as her nominee and the complainant’s request to forward the particulars of nominee, failed to  furnish the same  and according to the opposite parties only the nominee is eligible to withdraw the proceeds of the units and further in the   log book-cum-identity certificate Ex.A6, in the particulars furnished relating to the complainant the seal of the office  wrongly affixed  and  by virtue of  Ex.A6 the complainant cannot claim  as spouse of  the unit holder to pay the  proceeds of  unit to him and therefore prays to dismiss the complaint.

8.       Admittedly the complainant’s wife S.Valliammal invested a sum of Rs.33,000/- with the opposite parties in the scheme  SCUP  on 23.05.1997 and  the complaint is filed  by the complainant in this forum on 31.05.2013.  The scheme SCUP was terminated on 8.01.2008 as per Ex.A16.  Complainant wrote Ex.A20 dated 20.04.2009 that he is eligible for the unit proceeds  as per Ex.A3 brochure. The opposite parties sent Ex.A25 dated  26.11.2010 to the complainant that  to send the redemption form duly signed by the nominee V.Vijayalakshmi. Further the opposite party sent another letter Ex.A26   dated 02.08.2011 wherein it is mentioned that  with reference to various letters and latest letter of the complainant dated 15.07.2011 they have taken up the case with their Registrar for further investigation/ revival and he will here from us shortly.  After such communication the opposite parties wrote to the complainant Ex.A29 dated  07.02.2012 and Ex.A30 dated 10.10.2012 wherein it is mentioned  in para5 as follows

As per the above statement the opposite parties already informed to the complainant through  communication dated 28.02.2007 and 19.03.2007 in the log book the  name Mr.JAL Ganesan was erroneously  entered. The above said communication dated 20.08.2007 and 19.03.2007 are marked as Ex.A14 & A.15 respectively.  In both the letters the opposite parties have not mentioned anything about that Mr.JAL Ganesan name erroneously entered.  Therefore it is held that only the first time the opposite parties  mentioned in Ex.A29 dated 07.02.2012 and Ex.A30 dated 10.10.2012 that the complainant name Mr.JAL Ganesan entered erroneously as S.Valliammal  as his spouse. Therefore it is further held that the opposite parties denied the complainant as spouse on 07.02.2012 and 10.10.2012 first time. Therefore such a denial gives cause of action to the complainant.  From the above said dates 07.02.2012 and 10.10.2012 the complainant filed the complaint within period of 2 years and therefore the contention of the opposite parties is that the complaint is barred by limitation is rejected.

9.       The next  contention of the opposite parties is that  the amount invested by the complainant wife  was invested with the NIAC and they  are only liable to pay the mediclaim and hence non inclusion of NIAC  is fatal to the complainants case and the complaint is liable to  be dismissed.  It is the opposite party who invested the  money of the complainant’s wife with the NIAC. They have  not invested in the NIAC at the request of the complainant. Therefore in such circumstances, it is held that  the non- impleading of NIAC is not fatal to the case of the complainant.

10. Ex.A5 is the unit certificate  issued to the complainant’s wife for investing a sum of Rs.33,000/-  as single holder with the opposite parties in the scheme SCUP. Ex.A3 is the brochure issued for the scheme SCUP. No doubt in  the unit certificate itself the nominee’s name was mentioned as V.Vijayalakshmi.  Whereas the complainant would contend that as per brochure, unit certificate and log book the complainant is eligible  to be settled with residual unit proceeds  in the capacity of spouse as per unit certificate issued  in her wife name.  However the opposite party would contended in Ex.A29,A30 and written version that  Mr.JAL Ganesan (complainant) name updated incorrectly in the log book of late Mrs.S.Valliammal’s  spouse and hence nominee V.Vijayalakshmi only eligible to get the residual proceeds of unit certificate.  Ex.A6 is log book-cum-identity card issued to S.Valliammal, in which she is mentioned as member.  On the reverse page of the identity card  the complainant Mr.J.A.L Ganesan was termed as name of spouse with his photo and he is also eligible for medical cover. Apart from that in the Ex.A5 unit certificate reverse page it is printed as benefit is available either for the member or for the member and spouse.  Further in Ex.A3 brochure clauses 17, 19,20(2) and 28 mentioned about the unit holder as well as the unit holder  spouse and both of them  have the benefit of medical treatment, if one person joined  as a member in the scheme SCUP.  Therefore as per Ex.A3, A5 & A6 apart from the unit holder the  spouse also will be covered under the  scheme for life  and as per Ex.A6 it is held that the complainant is the spouse of the deceased  S.Valliammal. Under Ex.A3 clause 13 says that

As per the above clause only both the member and spouse die the nominee shall be entitled for residual amounts.  Therefore the above clause further clarifies that  when his spouse is available and that the  spouse was recognized by the opposite party as per the brochure the nominee is not eligible for residual amounts. In the case in hand as per Ex.A6 the complainant was recognized as spouse of the deceased S.Valliammal by affixing the opposite party office seal. However the opposite party would contend that the seal was erroneously affixed in the Ex.A6 is not at all acceptable.  Therefore, the above clause  supports the contention of the complainant that after the death of  his wife S.Valliammal who is entitled for coverage till his life time as per the brochure and also entitle to get the residual unit  benefits  as per the unit certificate is accepted. However, inspite of the demand  made by the complainant to settle the residual to him and refusal of the opposite parties that they will settle only to the nominee is not acceptable and therefore it is held  that the opposite parties 1, 2,3  have committed deficiency in service to the complainant.

11. POINT NO: 2

Ex.A17  dated 8.02.2008 revised communication on  termination of SCUP scheme sent by the UTI to its members. In the said letter it is stated as follows:

As per the above statement even after paying the outstanding units in favour of the member they will continue to get the hospitalization cover provided by NIAC i.e., the member will get treatment under coverage even after receiving the payment of outstanding units. It is already decided point no.1 that as per clauses referred in Ex.A3 brochure, the complainant entitled for medical coverage in the capacity of spouse even after death of his wife S.Valliammal who is a member of the UTI.  Therefore as prayed by the complainant, he is entitled for medical insurance from the opposite parties.

12.     According to the case of the opposite parties set out in the Written Version that on the date of termination of SCUP a total 1458.599 units were outstanding after paying premium to NIAC and the rate of repurchase per unit as on 18.02.2008 was Rs.23.2257 per unit and the total amounts comes for the above said units Rs.33,876.98  as residual amount and for the said amount the nominee S.Vijayalakshmi is entitled. It is already held point no.1 that the complainant only entitled in the capacity of spouse and after the death of spouse only the said S.Vijayalakshmi is entitled for the above said amount as per EX.A3 brochure. Therefore the complainant is entitled for the above said residual amount of Rs.33,876.98/- from the opposite parties.  The complainant also claimed interest for the residual amount. It is categorically stated in Ex.A16 termination of SCUP scheme that after termination no interest could be claimed.  Therefore the complainant is not entitled for interest as prayed by him for the residual amount. 

13.     The complainant claimed a compensation of Rs.15,00,000/- on account of suffering and mental agony at the hands of the opposite parties.  Even after claim made by the complainant in the capacity of spouse, the opposite parties have not paid the residual amount to him in spite of several correspondence between them, the complainant  has suffered with mental agony is acceptable and  he has to be compensated with compensation is acceptable. However  as per Ex.A16 SCUP scheme  no compensation will be payable to anyone.   The termination of SCUP scheme is  dated 08.01.2008. In continuation of same another communication Ex.A17 dated 08.02.2008 revised communication and termination of SCUP scheme was sent to members enclosing the option form Ex.A18. The complainant would content that as per the option form communication to the members the complainant also duly filled and send to the opposite parties to reinvest the residual amount and however the opposite parties have not reinvested of the amount in spite of the receipt of the option form from  the complainant or paid the amount to the complainant and therefore in the circumstances the complainant is entitled for compensation.   The respondent would content that Ex.A16  termination of SCUP scheme specifically states that  no compensation   would be payable by them.  If that is so there is no necessity to send the option form for reinvesting the residual amount.  Since the opposite parties failed to reinvest the residual amount as contended by the complainant, he is entitled for compensation.  However the compensation claimed in the complaint is exorbitant and it would be appropriate to order a sum of Rs.50,000/- as compensation to  the mental agony of the  complainant.

14.     In the result, the complaint is partly allowed.  The opposite parties jointly and severally directed to extend the mediclaim insurance to the complainant till his life time, also directed to pay a sum of Rs.33,876.98/- rounded to Rs.33,877/- (Rupees thirty three thousand eight hundred and seventy seven only) as residual amount to him and also  pay a sum of Rs.50,000/- (Rupees fifty thousand only) as compensation to him besides a sum of Rs.3,000/- (Rupees three thousand only) as cost of complaint. The above amount shall be payable to the complainant within 6 weeks from the date of receipt of copy of the order, failing which the compensation amount shall carry with interest at the rate of 9%  per annum  till the date of payment.

  Dictated to the steno-typist transcribed and typed by her corrected and pronounced by us on this 23^rd day of January 2015.

             MEMBER-II                                                             PRESIDENT

COMPLAINANT SIDE DOCUMENTS:

OPPOSITE PARTY SIDE DOCUMENT:

             MEMBER-II                                                             PRESIDENT