Present :       Sri. C.T. Sabu, President

                                                            Smt. Sreeja. S., Member

                                                            Sri. Ram Mohan R, Member

15^th day of December 2022

CC 244/11 filed on 11/05/11

Complainants:         1.        Sosa Johny, W/o Johny, Kokkatt House, (Died)

                                                Avittathur.P.O, Thrissur.

                                    2.        Noel K Johny, S/o Johny, Kokkatt House,

                                                Avittathur.P.O, Thrissur.

Amended as per     3.        Navya Anto, W/o Anto, Ponthekkan House,

As per IA 262/22                Thrikkur, Thrissur.

Dated 18/04/22     4.        Nisha Kishore, W/o Koshore, Koottungal House,

                                                Kalparambu.P.O., Aripalam, Thrissur.

                                                (By Adv.Joy.T.I, Thrissur)

Opposite Parties:    1.        Managing Director, Bajaj Allianz Life Insurance

                                                Company Ltd, No.26, Akshaya Complex, Victoria

Road, Banglore.

2.        Branch Manager, Bajaj Allianze Life Insurance

Company Ltd, 2^nd Floor, Sreekumara Samajam

                                                Building, Kodungallur, Thrissur.

                                                (By Adv.Rajith Davis, Thrissur for OP1 & OP2)

                                    3.        Branch Manager, RMP (Prayan Exim), TC 38/82

                                                Opposite Netaji Ground, Aranattukkara,

                                                Thrissur-680 618.

                                    4.        T.K.Jose, S/o Kunjuvareed, Thommana House,

                                                Avittathur, Thrissur-680 683.

                                                (By Advs.Nalan T N & M Haridas, Thrissur)

                                                            O R D E R

By Smt. Sreeja S. Member:

             While collecting Rs.99,000/- vide DD No.843793, the opposite parties promised that they will provide to valid LI  Policy for Rs.1,98,000/- in the name of 1^st complainant at a premium of Rs.22,000/- and other policy in the name of 2^nd complainant for Rs.7,70,000/- at a premium of Rs.77,000/-. Accordingly necessary and sufficient data papers and ID proof were collected from the complainants along with the aforesaid payment. 3^rd and 4^th opposite parties were introduced the complainants to 1^st opposite party. In total violation of the promise and undertaking the opposite parties have failed to issue policy certificates to the complainants. complainants, as they could not understand the policy conditions and stipulations, could not pay further amounts as desired by opposite parties. Opposite parties have not explained or clarified the terms and conditions of scheme to the complainants and the complainants  were quite unaware of the terms and conditions of the insurance scheme. Opposite parties has committed manifested deficiency in service and dereliction of duty, which resulted in loss of Rs.99,000/-. Even without giving proper insurance certificates, the opposite parties unilaterally cancelled the policy and issued a notice stating that both policies were lapsed. The act of the opposite parties resulted in stress, strain and mental agony to the complainant due to non receipt of policy certificate. After the incident, as per the request of opposite party No.3 and 4, the complainant had approached opposite party No.2 for compensation. Opposite party No.2 has liability to compensate the complainant as it is the controlling authority of the opposite party No.1 Company in Kerala. The opposite party No.1 is the principal and No.2, 3, 4 are its agents. The complainant send lawyer notice asking to return an amount of Rs.99, 000/- along with compensation for stress, pain and mental agony ensued from deficiency of service from opposite parties. Opposite parties received the notice and failed to pay the amount. Hence this complaint.

2) Version by the 1^st and the 2^nd opposite parties :

All averments in the petition is strongly denied. The averment in para 2,3 and 4 that the 1^st and the 2^nd opposite parties have promised and undertook that the complainants will be issued with good and valid life insurance policy for Rs.7,70,000/- in favour of 2^nd complainant for a premium of Rs.77,000/- and another policy of Rs.1,98,000/- in favour of 1^st complainant for a premium of Rs.22,000/- and accordingly necessary and sufficient data papers and ID proof were collected from the complainant, and opposite party No.3 and 4 were introduced the complainant to opposite party No.1 is not correct have strongly denied. Total violation of the promise and undertaking the opposite parties have failed to issue policy certificates to the complainant. The complainant could not understand the policy conditions and stipulations, so they could not pay further amount is not correct, hence denied. Due to deficiency in service and dereliction of duty, the complainant sustained loss of Rs.99,000/- and also without giving proper insurance certificates the opposite parties unilaterally cancelled the policy and issued a notice stating that both policy were lapsed is not correct hence strongly denied. In fact it is the complainant who approached the opposite parties and evinced interest in availing policy in her name and also in her minor son (2^nd complainant) name and accordingly executed necessary proposal form and also furnished requisite documents. The complainant being a educated lady, was well aware about policy terms and conditions and more over she herself selected that the premium would be paid every year. The opposite parties had issued two policies one in the name of 1^st complainant under New Family gain scheme and as per the terms of policy she has to remit premium of Rs.22,000/- annually and the sum assured under the policy is Rs.1,98,000/- and  policy is 15 years and accordingly the opposite parties have also issued another policy in the name of 2^nd complainant under New Family Gain Scheme and mode of payment as opted by the 1^st complainant is annual and amount is Rs.77,000/- the sum assured under the policy is Rs.7,70,000/- and benefit term is 15 years. For the both policies the 1^st complainant had given standing instructions to invest 100% of the premium amount in equity index fund II and hence the complainants if at all eligible for any amount as per terms and conditions of the policy, they are entitled to the value of fund available to their policy account even if the fund value is less or more and not the amount they have invested, since the amount of premium invested by them in turn would have been invested by the opposite parties in the capital market and the entire such investment risk has to be Borne by the policy holder (complainants) and the fund value of the complainants would be based on the performance of the capital market.  30% of the premium paid during the  1^st year would be allocated in the fund value of the policy holder and balance amount would be towards various charge and 97% of the fund from second year onwards would be invested in policy holder (complainant) fund account. The complainants had enjoyed life cover till the policy got lapsed at the expense of the opposite parties. The complainants after paying 1^st premium failed to pay subsequent year renewal premium and hence the policyNo.77939452 and 78052408 got lapsed on 11/01/2009 & 15/01/2009 respectively. The policy holder has failed to pay before the expiry of grace period policy shall immediately lapse and policy holder can revive the policy within 2 years from the due date of 1^st unpaid regular premium failing which contract shall be terminated and fund value as per clause 25(h) if any would be paid at the end third policy year or at the expiry of revival period.  The act of the opposite parties are deficiency in service which resulted in stress, strain and mental agony to the complainant due to non receipt of policy certificate etc are not correct, hence denied. Complainant approached opposite party No.2 for compensation etc is not correct hence denied. The complainant send lawyer notice demanding to return the amount of Rs.99,000/- along with the compensation for stress, pain and mental agony which opposite parties fail to return is not correct, hence denied. The complainants had failed to revive the policy in spite of providing various reminders within 2 years, hence policy was terminated. Further as per Clause 25(h) if the fist three year regular premium are not paid and the policy is lapsed, the surrender charge on regular premium unit value would be 100% of the 1^st years’ annualized allocated premium. Therefore when the policy was terminated due o non fulfillment of terms and conditions by the complainant the entire allocated premium of fist year was forfeited as per the terms of policy. The policy got lapsed during the year 2008 and after giving sufficient time of 2 years to revive the policy, the complainants failed to revive the policy, which is nothing but sheer negligence of the complainants and hiding the true fact and by making false allegations that she had not paid premium because she had not received the policy terms. If at all she had not received the policy term, she should have approached the opposite party immediately and not after lapse of 4 years. There is no deficiency in service or unfair trade practice and as such the petition is not maintainable. The petition is barred by limitations. Hence prayed for a dismissal.

            3) Version by the 4^th opposite party :

Entire allegation in the complaint in detail. 4^th opposite party is not a franchise or  agent of 1^st opposite party. No promise or undertaking was made by the opposite party towards the complaint. The complainant is a well educated lady. There is no deficiency of service from the part of opposite party. This opposite party never approached the complainant for any act or favour. At time of remittance of premium 1^st complainant was abroad. The complainant is frivolous and vexations.

             4) Points for consideration are?

                        a) Whether there is any deficiency in service on the part of

                             opposite    parties or not?

                        b) Reliefs and costs?

            5) The counsel for complainant appeared before this Commission and filed proof affidavit in which he has affirmed and explained all the averments stated in the complaint in detail. The produced document was marked as Ext. P1 to P4. Ext.P1 is the lawyer notice dated 17/12/2011; Ext.P2 is the copy of demand draft dated 15/11/2007; Ext.P3 is the notice issued by 1^st opposite party to 1^st complainant and  Ext.P4 is the notice issued by 1^st opposite party to 2^nd complainant. From the side of opposite party also filed proof affidavit in tune with the version filed by them. The document produced by them is marked as Ext.R1to Ext.R3. Ext.R1 is attested copy of policy document; Ext.R2 is the proposal form in policy No. 77939452 and Ext.R3 is the proposal form in policy No. 78052408.

            6) Point No.1

                        The case of the complainant is that she entered in to an agreement with 1^st opposite party at the instance of 4^th opposite party and availed valid life insurance policy of Rs.7,70,000/- in the name of 2^nd complainant at a premium of Rs.77,000/- and another policy of Rs.1,98,000/- in the name of 1^st complainant at premium of Rs.22,000/-. The complainants executed necessary documents and the 1^st opposite party failed to issue policy certificate to the complainant. Ext.P3 and Ext.P4 are the last revival letters issued in the name of complainants. Since it is marked in evidence the complainant has to offer proper pleading or explanation regarding such documents. In fact, they plead that they did not obtain policy certificate. Ext.P1 lawyer notice is also silent with regard to Ex.P3 and Ext.P4 and those documents if received without basis it ought to have stated in the Ext.P1 notice calling to forfeit/cancel the notice and directing them to issue policy certificate. It is pertinent to note that at any point of time or through Ext.P1 no demand were made to issue policy certificate from the opposite parties as deficiency in service confine to allegation of no issuance of policy certificate. Considering Ext.P1, P3 and P4 it is obvious that the material facts regarding the transaction were suppressed by the complainant. On the other hand opposite parties deny the allegation regarding issuance of life insurance policy. They rely on Ext.R1, R2 and R3 documents. Ext.R1 is the copy of the policy document. It is stated as new family gain.

Policy description states that the policy is unit linked endorsement (regular premium type of product). It also covers death benefit and maturity benefits. Ex.R2 is the original of proposal form and it states as new family gain plan. When 1^st complainant examined before this commission, she admitted and deposed that Ext.R2 was executed by her. Further she deposed that point 5 in Ex.R2,  the premium was shown as annual and it was a unit linked one. She also admit Ex.R3 and deposed that it is also a unit linked and annual premium. The cross examination of RW1 the complainant suggested as specific case that Ext.R2 and R3 was not filled with regard to aforesaid point No.5 premium frequency and unit linked. If that be their case, she ought to have stated that those point No.5 in Ex.R2 and R3 left blank at the time of executing the document especially when those documents were shown to the PW1 at the time of examination. Ext.R3 and Ext.R4 show 100% investment equity growth fund. Therefore the contention of the complainant regarding the nature of the policy fails. To answer the same the complainant sought for a strange pleading that the 1^st complainant could not understand policy conditions. PW1 in cross examination stated she was a retired teacher and she could write and read and understand the meaning of English. So the evidence is tendered do not equates with the pleadings of the complainant and thus complainant failed to establish a cogent case before this commission.

            It is true that the policy were a unit linked capital market investment intending to gain profit and same amounts to commercial purpose. It is not proper to believe that a teacher qualified with graduation and higher, as shown in Ext.R2, could not understand the terms of the policy. Therefore considering  the evidence as a whole, we find that the complaint fails and same is dismissed accordingly.

            In the result complaint dismissed without cost.

            Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Commission this the 15^th  day of December 2022.

     Sd/-                                                      Sd/-                                                  Sd/-

Sreeja S                                             Ram Mohan R                                 C.T. Sabu

Member                                            Member                                            President

Appendix

Complainant’s Exhibits :

Ext.P1 is the lawyer notice dated 17/12/2011.

Ext.P2 is the copy of demand draft dated 15/11/2007.

Ext.P3 is the notice issued by 1^st opposite party to 1^st complainant.

Ext.P4 is the notice issued by 1^st opposite party to 2^nd complainant.

Complainant’s Witness:

PW1- Sosa Johny

Opposite Parties’ Exhibits :

Ext.R1 is attested copy of policy document.

Ext.R2 is the proposal form in policy No. 77939452.

Ext.R3 is the proposal form in policy No. 78052408.

Opposite parties’ Witness:

RW1- Abalmani

                                                                                                                              Id/-

Member