SHRI SWAPAN KUMAR MAHANTY, PRESIDENT
This is an application u/s.12 of the C.P. Act, 1986.
The facts of the case as per the complainant are that the complainant took a policy from TATA AIA named TATA AIA Life Invest Assure Apex Policy (Policy Number U671806073) from OP 2 TATA AIA Life Insurance Company Ltd. through its representative who mislead the complainant about the terms and conditions of the policy. Complainant started the policy by giving Rs.99,900/- as premium and on 12.10.2011 and 27.07.2012 the said representative again collected Rs.99,916/- and Rs.1,01,100/- as renewal premium. Due to financial hardship complainant failed to deposit annual premium amount and requested the OPs 1 & 2 to return the invested amount but the OPs with an ulterior motive refused to pay the amount. Finding no other alternative, complainant issued legal notice dated 12.12.2016 requested the OPs to refund Rs.3,01,325/- along with interest thereon. The OPs mislead the legal notice and also denied receive of premium. Therefore, such act on the part of the OPs tantamount to unfair trade practice, deficiency in service and negligence. The OPs have violated the basic principles of insurance. Hence, the complaint.
The OPs have contested the case by filing Written Version admitting the fact that the complainant on March, 2010 approached the OPs and applied for a policy “ TATA AIA Life Invest Assure Apex “ for herself and duly applied for the same. As per terms and conditions of the policy, complainant is required to pay annual premium of Rs.1,00,542/- for a period of 10 years. The policy availed by the complainant is a regular premium Unit Linked Plan and the investment risk in investment portfolio is borne by the policy holder. That the original policy document was duly dispatched to the complainant through Speed Post and the policy document was delivered to the complainant. As per Regulatory and Development Authority (Protection of Policy Holders’ Interest) Regulation 2002 which gives the policy holder the option to return the policy stating the reasons thereof within 15 days from the date of receipt of the policy document in case the policy holder is not agreeable to the provisions of the same. The complainant did not exercise the right to cancel the said policy within the free look period which implied that she is agreeable to the terms and conditions of the policy.
The complainant paid initial premium but failed and neglected to pay subsequent premiums in respect of the said policy being No.U671806073. Thus, the policy got lapsed. That on 12.10.2011 the OPs Company received 2nd premium with a request to reinstate the policy but the signature of the complainant did not match with the policy document. As such, the policy could not be reinstated. The OPs sent long lapse refund value cheque of the policy to the complainant on 03.`11.2012 but it has been returned. The OPs received a letter dated 27.07.2012 along with cheque form the complainant with a request to reinstate the policy. After considering the requisite documents including medical papers furnished by the complainant, the OPs by its letter dated 30.04.2014 decided to reinstate the policy subject to increase the cost of insurance by 100 percent and such cost would be deducted from the Units. Complainant did not furnish her consent for reinstatement of policy. Thus, the policy could not reinstate and the OPs issued a cheque for Rs.2,19,670/- towards surrender pay out to the complainant but it has been returned.
The OPs vide their letter dated 14.10.2016 requested the complainant to provide NEFT particulars along with cancelled cheque in order to deposit the surrender value of the policy to her Bank Account directly. The complainant did not furnish the particulars, thereby the OPs revalidated the cheque dated 06.12.2017 for Rs.2,44,371.40. However, the same again returned. The OPs have acted as per the terms & conditions of the policy and there is no negligence or deficiency on the part of the OPs. Therefore, the OPs have prayed for dismissal of the complaint with cost.
Decision with Reasons
Both parties have tendered evidence through affidavit. They have also given reply against the questionnaire set forth by their adversaries. Both parties have also filed Brief Notes of Argument.
It remains undisputed that the complainant took a policy being No. U671806073 from OP No. 2 TATA AIA Insurance Company Ltd. through its representative by giving Rs.99,900/- as premium. It is also undisputed that the complainant failed to pay subsequent premiums within the due time for which the subject policy got lapsed. It is also true that on 12.10.2011 and 27.07.2012 the representative of the OP collected cheques of Rs.99,916/- and Rs.1,01,100/- from the complainant as renewal premium and those cheques were encashed in favour of the OP-2. There is also no dispute that considering the requisites documents furnished by the complainant the OPs vide its letter dated 30.04.2014 decided to reinstate the subject policy on condition to increase the cost of insurance by 100 percent and such cost would be deducted from the Units. Complainant did not furnish her consent for reinstatement of policy. Thus, the policy could not reinstate and the OPs issued a cheque of Rs.2,19,670/- towards surrender pay out to the complainant but it has been undelivered. In spite of request the complainant failed to provide NEFT particulars and cancelled cheque to the OPs in order to deposit the surrender value of the policy to the Bank Account of the complainant directly. Complainant failed to furnish the particulars, thereby the OPs revalidated the cheque dated 06.12.2017 for Rs.2,44,371.40. However, the same again returned.
The dispute cropped up when the complainant requested the OPs 1 & 2 to refund the entire invested amount, but the OPs refused to pay the amount.
Here the factual aspect of the matter is not at all disputed by the parties. Ld. Advocate for the OPs relying on a decision of the Hon’ble NCDRC in Dr. Aditya Prasad Roy – Vs – Mr. Suresh Mahalingam, CEO and Managing Director, TATA AIG & Ors reported in 2015 (I) CPR 204 (NC) and submitted that Complainant has failed and neglected to pay annual premium as per the terms of the policy the same was automatically surrendered and even did not furnish her consent for reinstatement of policy. Thus, the OPs issued cheque towards surrender pay out to the complainant.
It is true that as per condition of the policy, it is mandatory to the complainant to inform or to pray for cancellation of the policy within free look period but in the present case the complainant did not opt the said option of the policy and after lapse of more than three years the complainant requested the OPs for refund of entire invested amount of the policy which is beyond the terms and conditions of the policy. No case has been made out by the complainant that creating pressure upon her the representative of the OPs has forcefully issued the policy in favour of the complainant keeping her dark in respect of the terms and conditions of the policy. As such, the policy is accepted along with its tems and conditions by the complainant. Therefore, neither the OPs nor the complainant can go beyond the said terms and conditions of the policy. The complainant did not furnish her consent for reinstatement of policy. Thus, the policy automatically surrendered and the OPs accordingly, sent the surrender value cheque to the complainant twice without further delay. Even the OPs requested the complainant to provide NEFT particulars along with cancelled cheque in order to deposit surrender value to her Bank Account directly but the complainant failed to furnish such particulars. It is well settled that the Insurance Policy is totally based on utmost good faith of both parties. In the instant case breach of contract is occurred on behalf of the complainant as she failed to pay the premium amount and also did not give her consent for reinstate the policy. In case of non-payment of premium and / or her consent for reinstate the policy the Insurance Company has right to cancel the policy and in that respect such cancellation or surrender cannot be termed as deficiency in service. It is pertinent to mention that for showing good gesture the Insurance Company has duly sent the surrender value cheque to the complainant twice but the complainant did not accept the envelop containing the cheque.
Regard being had to the facts and circumstances of the case coupled with evidence and documents on record, we are of the view that there is no deficiency of service or unfair trade practice on the part of the OPs. As a result, the case merit fails.
Hence,
Ordered
That the complaint case be and the same is dismissed on contest against the OPs. There is no order as to cost.
The OPs are directed to release the settled amount of Rs.2, 44,371.40 along with simple interest at the rate of 5 percent P.A thereon since 07.12.2017 within 30 days from the date of this order.
