Delhi

East Delhi

CC/299/2019

PREM CHAND JAIN - Complainant(s)

Versus

MAX LIFE INS. - Opp.Party(s)

09 Jan 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. No.299/2019

 

	PREM CHAND JAIN        56-C, Gharonda Neem Ka Banger,        Patpar Ganj Village, New Delhi - 91.	….Complainant
Versus
	MAX LIFE INSURANCE CO. LTD. 6th Floor, Nipun Towers, Plot No.15, Karkardooma Community Centre, Delhi - 110092. ALSO at   11th Floor, DLF Square Jacaranda Marg, DLF Square, Gurgaon – 122002.	……OP

Date of Institution: 18.09.2019

Judgment Reserved on: 24.12.20

Judgment Passed on: 09.01.2023

                  

CORUM:

Sh. S.S. Malhotra (President)

Ms. Rashmi Bansal (Member)

Sh. Ravi Kumar (Member)

 

Order By: Sh. S.S. Malhotra (President)

 

JUDGEMENT

1. By this order the Commission shall dispose off the complaint filed by the complainant w.r.t. deficiency in service on the part of OP for not returning the full insured amount of the policy after its maturity.
2. Brief facts as stated by the complainant in the complaint are that complainant purchased a life maker premium unit linked investment from Shree Ganesh Corporate Service Ltd., New Modi Nagar (Delhi) an authorized agent advisor of the plan and polices of OP1 (having agent code No.223769), vide receipt dated 15.07.2009 having policy period of 10 years, having date of maturity 15.07.2019 and paid Rs.15000/- per six months i.e. Rs.30000/- annually for five years, and has paid total amount of Rs. 150000/- to OP which was the sum assured but after the maturity of this policy the OP issued a cheque of Rs.62245.10 only against Rs.300000/- as final settlement for the said investment plan which amounts to deficiency in service and therefore the complainant was compelled to file various representation to the OP but since he was not heard and the total “sum insured” amount has not been paid he has filed the present complaint inter alia praying that OP be directed to pay Rs.300000/- with interest to the complainant on account of loss suffered and Rs.50000/- towards compensation and legal expenses.
3. OP has filed its written reply, taking preliminary objection that the said policy as taken by the complainant was a unit linked policy which are speculative in nature and was taken for purely an investment purpose and therefore he is not a consumer and therefore the complaint is liable to be dismissed.
4. In support of this he has relied upon Ramlal Aggarwala Vs. Bajaj Alliance Life Insurance Co. Ltd. reported in 2013 SCC online NCDRC 399. It is further submitted that Insurance Policy has to be considered strictly as per the terms and conditions of the policy and therefore the complainant who has taken the policy at the age of 65 and who is also covered with death benefit has to adhered to the terms and conditions of the policy in strict terms. It is further submitted due to high age factor mortality charges were high and all such risks was explained to the complainant which is also evident from the illustration appended to the policy and as on the date of maturity the complainant was entitled to Rs.62245.10/- which have been paid to him and therefore there is no deficiency in service and the complaint is not maintainable and it is prayed that complaint of the complainant be dismissed.
5. Complainant has not filed Rejoinder and has filed his evidence where after OP was given opportunity to file its evidence but OP failed to file evidence and even failed to appear and as such OP was proceeded Ex- parte at that stage. No application for setting aside that order has been filed either before this Commission or before the Hon'ble State Commission.
6. The Commission has heard the arguments and perused the record.
7. The first issue as raised by OP, that complainant purchased a Unit Linked Investment Policy and therefore complainant is not a consumer within the definition of consumer as defined under CPA apparently is not well found as the fact is not in dispute as it was not a mere Unit Linked Investment Policy rather it was a Unit Linked Policy with the service to be provided to the complainant w.r.t. insurance cover. Once the services of the insurance were attached to the policy, the complainant therefore would be covered within the definition of consumer.
8. Now the next issue is as to whether there was any deficiency in service on the part of OP another not refund/returning the entire amount deposited by the complainant with OP. It is the case of the complaint that he deposited Rs.30000/- for 5 years to the totaling Rs.150000/- and he was to received to some short which as per policy was Rs.300000/- and the same is not been return by the OP and OP has return only Rs.62245.10 and therefore, it means to deficiencies in

service and as such OP is liable to pay complete amount of rupees i.e. Rs.300000/-i.e is the sum assure.

9. Ld. Counsel for OP has filed written statement and has tried to justify the refund of Rs.62245.10 by stating that this was the only fund value on the date of maturity and the same has been paid and no more amount is due. No doubt it is so stated by the OP in his written statement and in absence of the evidence of OP, the law is well settled that pleadings howsoever strong may be cannot take place of proof and since OP had not filed evidence, this argument cannot be appreciated.
10. Simultaneously, it is also clear that even if the reply of the OP is not read, the terms and conditions of the policy which are being relied  upon by the complainant has to be read for deciding the matter. The complainant has filed the policy document and as per policy document the complainant is not entitled to sum insured of Rs.300000/- as that would have been available to the complainant only, in case, when death benefits would have accrued i.e. as per the clause 2.1 where it is mentioned that in case of death of life insured company will pay Level Death Benefit which is higher i.e. either the fund value prevailing on the date which immediately follow the date of intimation of death or the sum assured. Therefore, the prayer that OP would pay Rs.300000/- to the complainant is not maintainable.
11. Now coming to the aspect as to how much amount the complainant was entitled. As per clause 2.2, if the life insured is living/surviving as on the maturity date, a benefit equal to the fund value prevailing on the maturity date will be paid if the settlement option as stated in clause 2 below has not be opted. The amount that the OP is liable to make the payment to the surviving insured is as per the fund value and the fund value is defined in Section 1(D), Fund Value means the total number of Units held in the unit account multiplied by the unit price.
12.  The onus of the fact as to what exactly was the fund value of the policy on the date of maturity, was upon the complaint, and complainant has not been able to prove that what exact was the fund value on the date maturity. No doubt this fact has been brought on record by OP also but OP has not filed any such record, and since, the onus was upon complainant and he has not been able to discharge the same, it cannot be said that there was any deficiency in service on the part of OP. Admittedly the policy which the complainant obtained from OP was linked plan policy which was subject to market risk and was speculative in nature. Therefore until and unless the complainant is able to show that he has been paid less than that of the fund value or he has been not treated at per w.r.t. terms and condition of the policy as on the date of maturity, no case can be made out with respect to deficiencies in service by the OP. Accordingly, in absence of any evidence on the record by the complainant and in view of terms and condition of the policy, the complainant has not been able to prove any deficiency in service by the OP. The complaint of the complainant is therefore dismissed.
13.  Copy of the order be supplied/sent to the parties free of cost as per rules.
14.  File be consigned to Record Room.
15. Announced on the 9th day of January, 2023.

Delhi.

     09.01.2023