State Consumer Disputes Redressal Commission
Aditya Birla Life Insurance Co Ltd vs Vaishali Sanjay Ghadge on 7 May, 2024
1 A/117/2022
Date of filing :28.01.2022
Date of order :07.05.2024
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION,MUMBAI, BENCH AT AURANGABAD.
FIRST APPEAL NO. : 117 OF 2022
IN COMPLAINT CASE NO.: 856 OF 2019
DISTRICT CONSUMER COMMISSION : AURANGABAD.
Aditya Birla Life Insurance Company Ltd,. Appellant
Through its Authorised Representative, (Adv.A.M.Kedar)
Having its office at-
One World Centre, Tower 1, 16th floor,
Jupiter Mill Compound, 841, Senapati Bapat
Marg, Elphinstone road, Mumbai 400013.
VERSUS
Tushar Sanjay Ghadge, Respondent
R/o Loni (Khurd), (Adv.R.V.Jadhav)
Tq- Vaijapur, Dist.Aurangabad.
CORAM: Milind.S.Sonawane, Hon'ble Presiding Member.
Dr.Nisha.A.Chavhan, Hon'ble Member.
Nagesh C.Kumber, Hon'ble Member.
JUDGMENT
(Delivered on 07/05/2024) Per Dr.Nisha Amol Chavhan, Hon'ble Member.
The Appellant has challenged in this appeal, Order and Judgment passed by the Ld. District Consumer Disputes Redressal Commission, Aurangabad dated 23.11.2021 in CC. No. 856/2019.
2 A/117/2022
2. The facts giving rise to this appeal are as under,
3. It is the case of respondent that, the father of the respondent died due to the cause sudden heart attack on 28/11/2018. After the death of respondent's father, he came to know about the life insurance policy No.05945153 taken by his father by paying the premium of Rs.1,74,992/- to the appellant Insurance Company on dated 21/2/2013. Respondent visited to the appellant office about the policy but he received the Policy termination letter on dated 31/12/2018.
4. Respondent submitted that, his father during his life time received a telephonic call from unknown person from the appellant company informing him that in order to claim the accrued bonus of Rs.10 Lakhs on his existing insurance policy, he has to take another/additional 3 insurance policies from appellant company. Respondent's father has refused to avail any additional policies, the appellant company by giving false assurance obtained cheques from him and using the documents of the existing policies, forged the signature on the proposal form and issued 3 different insurance policies.
5. It is submitted that, the Appellant Company informed the father of the respondent's father that if he wants to get the refund of entire premium, he has to pay at-least 2 premiums.
3 A/117/2022 Accordingly, he paid initial premium amount of RS.1,75,000/- for the policy No. 005945153 on 31/01/2013. That the father of the respondent's father noticed that the address on the policy was incorrect which was informed to the officers of the appellant company however he did not receive any satisfactory reason.
6. It is submitted that, respondent's father realized that he was cheated by the appellant company therefore he filed a police complaint in the police station but no cognizance was taken by the police, so respondent's father filed an application U/S 156(3) of CRPC, 1973 before the JMFC, Aurangabad. Accordingly, respondent's mother had preferred Revision petition U/S 397 of CRPC bearing Case No. 185/2019 before the Principal District and Session Judge, Aurangabad and said matter is pending for adjudication.
7. It is further submitted that, appellant company engaging into unfair trade practices, giving false assurance have extorted the insurance premium. Respondent further submitted that, this information was received by him from his advocate after the death of his father (insured) and hence he filed Consumer Complaint NO. 856/2019 alleging the deficiency service and claiming the refund of Rs. 1,74,992/- along with interest @18% 4 A/117/2022 per annum from 21/2/2013, till realization, as well as Rs. 1 Lakhs towards mental Agony and Rs.45,000/- towards cost of complaint.
8. Ld. District Consumer Dispute Redressal Commission Aurangabad allowed the complaint and directed the appellant to refund the premium of Rs.1, 74,992/- within 30 days to the respondent. Being aggrieved by the judgment and order of District Commission Aurangabad preferred this appeal.
9. Adv. A.M. Kedar appeared for appellant. Adv. R.V. Jadhav appeared for respondent. On 9/2/2024, direction was given to the both parties to argue the matter finally on next date without fail; else only present party would be heard alone. Accordingly on 12/3/2024, Adv. A.M. Kadar was absent. We heard the Ld. Adv. R.V. Jadhav for respondent as well as perused the record which has been by the both parties on record. This commission has made following observation.
OBSERVATION
10. Against this background, we perused the copy of the Complaint and written version given by the Appellant in original proceedings before the District Consumer Commission Aurangabad. We have also gone through the impugned judgment. It is found that, there is no error committed by the 5 A/117/2022 Ld. District Consumer Commission Aurangabad on the factual aspects. But District commission has not awarded the interest on the premium amount; therefore, order needs to be modified
11. It is admitted fact that, appellant company had issued a letter dated 3/3/2017 to the investigation officer of Jinsi police station and stated that, as per policy issued by them, they are ready to repay the premium amount as per their rules of the respondent.
12. On a discussion of the aforesaid principle, we would conclude that insurer is statutorily mandated as per Clause 3(ii) of the Insurance Regulatory and Development Authority (Protection of Policy Holder's Interests, Regulation 2002) Act dated 16.10.2002 (hereinafter referred to as IRDA Regulation, 2002) to the effect that the insurer and his agent are duty bound to provide all material information in respect of a policy to the insured to enable him to decide on the best cover that would be in his interest. Further, sub-clause (iv) of Clause 3 mandates that if proposal form is not filled by the insured, a certificate has to be incorporated at the end of the said form that all the contents of the form and documents have been fully explained to the insured and made him to understand. Similarly, Clause 4 enjoins a duty upon the insurer to furnish a 6 A/117/2022 copy of the proposal form within thirty days of the acceptance, free of charge. Any non-compliance, obviously would lead to the irresistible conclusion that the offending clause, be it an exclusion clause, cannot be pressed into service by the insurer against the insured as he may not be in knowhow of the same.
13. In view of the above, the impugned judgment and order dated 23/11/2021 passed Ld. District Commission Aurangabad in CC No 856/2019 is need to be modified as the District Commission has not awarded interest on the premium amount. In view of the above discussion and the reasoning, we are of the opinion that the appeal is devoid of merits and deservers to be dismissed. Hence we pass the following order.
ORDER
1. The appeal is dismissed.
2. The impugned judgment and order dated 23/11/2021, passed by the Ld. District Consumer commission Aurangabad, in C.C. No.856/2019 is to be modified.
3. The Appellant is directed to pay the premium of Rs.1,74,992/- to the Respondent with 18% per annum interest from the date of the receipt of the premium amount dated 21/2/2013 till realization.
4. The appellant is directed to pay a cost of Rs.10,000/- towards deficiency in service and Rs.10,000/- for physical and mental agony.
7 A/117/2022
5. Copies of the judgment are supplied to both the parties free of cost.
6. No order as to costs.
Palce :- Aurangabad.
Date :- 07/05/2024.
N.C.Kumbre Dr.N.A.Chavhan M.S.Sonawane
Member Member Presiding Member
UNK
8 A/117/2022
Date of filing :28.01.2022
Date of order :07.05.2024
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL COMMISSION,MUMBAI, BENCH AT AURANGABAD. FIRST APPEAL NO. : 118 OF 2022 IN COMPLAINT CASE NO.: 857 OF 2019 DISTRICT CONSUMER COMMISSION : AURANGABAD. Aditya Birla Life Insurance Company Ltd,. Appellant Through its Authorised Representative, (Adv.A.M.Kedar) Having its office at-
One World Centre, Tower 1, 16th floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone road, Mumbai 400013.
VERSUS
Vaishali Sanjay Ghadge, Respondent
R/o Loni (Khurd), (Adv.R.V.Jadhav)
Tq- Vaijapur, Dist.Aurangabad.
CORAM: Milind.S.Sonawane, Hon'ble Presiding Member.
Dr.Nisha.A.Chavhan, Hon'ble Member.
Nagesh C.Kumber, Hon'ble Member.
JUDGMENT (Delivered on 07/05/2024) Per Dr.Nisha Amol Chavhan, Hon'ble Member.
The Appellant has challenged in this appeal, Order and Judgment passed by the Ld. District Consumer Disputes Redressal Commission, Aurangabad dated 23.11.2021 in CC. No. 857/2019.
9 A/117/2022
2. The facts giving rise to this appeal are as under.
3. It is the case of respondent that, the husband of the respondent died due to the cause sudden heart attack on 28/11/2018. After the death of respondent's husband, she came to know about the life insurance policy No.005964008 by premium paid of Rs.1,74,992/- to the appellant insurance company on dated 28/02/2013 and second premium was paid of Rs.1,76,587/- total amount paid by the respondent's husband was of Rs.3,51,589/-. Respondent visited to the appellant office about the policy but she received the policy termination letter on dated 31/12/2018.
4. Respondent submitted that, her husband, during his life time received a telephonic call from unknown person from the appellant company informing him that in order to claim the accrued bonus of Rs. 10 Lakhs on his existing insurance policy, the he has to take another/additional 3 insurance policies from appellant company. Respondent's husband has refused to avail any additional policies, the appellant company by giving false assurance obtained cheques from him and using the documents of the existing policies, forged the signature on the proposal form and issued 3 different insurance policies.
10 A/117/2022
5. It is submitted that, the appellant company informed the respondent's husband that if he wants to get the refund of entire premium, he has to pay at-least 2 premiums. Accordingly, he paid initial premium amount of RS.1,24, 92/- for the policy No. 005872885 on 31/12/2012 and second premium was paid of Rs.1,76,587/- total amount paid by the respondent's husband was of Rs.3,51,589/. That the respondent's husband notices that the address on the policy was incorrect which was informed to the officers of the appellant company however he did not receive any satisfactory reason.
6. It is submitted that, respondent's husband realized that he was cheated by the appellant company therefore he filed a police complaint in the police station but no cognizance was taken by the police, so respondent's husband filed an application U/S 156(3) of CRPC, 1973 before the JMFC, Aurangabad. Accordingly, respondent's wife i.e. policy holder had preferred Revision petition U/S 397 of CRPC bearing Case No. 185/2019 before the Principal District and Session Judge, Aurangabad and said matter is pending for adjudication.
7. It is further submitted that, appellant company engaging into unfair trade practices, giving false assurance have extorted the 11 A/117/2022 insurance premium. Respondent further submitted that, this information was received by him from his advocate after the death of his husband (insured) and hence she filed Consumer Complaint NO. 857/2019 alleging the deficiency service and claiming the refund of Rs.1,74,992/- and second premium of Rs.1,76,587/- total amount paid of Rs. 3,51,589/-along with interest @18% per Annum from 28/02/2013 till realization.
8. Ld. District Consumer Dispute Redressal Commission Aurangabad allowed the complaint and directed the appellant to refund the premium of Rs. 3, 51,589/- within 30 days to the respondent. Being aggrieved by the judgment and order of District Commission Aurangabad preferred appeal.
9. Adv. A.M. Kedar appeared for appellant. Adv. R.V. Jadhav appeared for respondent. On 9/2/2024, direction was given to the both parties to argue the matter finally on next date without fail; else only present party would be heard alone. Accordingly on 12/3/2024, Adv. A.M. Kadar was absent. We heard the Ld. Adv. R.V. Jadhav for respondent as well as perused the record which has been by the both parties on record. This commission has made following observation.
OBSERVATION
10. Against this background, we perused the copy of the Complaint and written version given by the Appellant in original 12 A/117/2022 proceedings before the District Consumer Commission Aurangabad. We have also gone through the impugned judgment. It is found that, there is no error committed by the Ld. District Consumer Commission Aurangabad on the factual aspects. But District commission has not awarded the interest on the premium amount; therefore, order needs to be modified
11. It is admitted fact that, appellant company had issued a letter dated 3/3/2017 in favour of the investing officer of Jinsi police station and stated that, as per policy issued by them, they are ready to repay the premium amount as per their rules of the respondent.
12. On a discussion of the aforesaid principle, we would conclude that insurer is statutorily mandated as per Clause 3(ii) of the Insurance Regulatory and Development Authority (Protection of Policy Holder's Interests, Regulation 2002) Act dated 16.10.2002 (hereinafter referred to as IRDA Regulation, 2002) to the effect that the insurer and his agent are duty bound to provide all material information in respect of a policy to the insured to enable him to decide on the best cover that would be in his interest. Further, sub-clause (iv) of Clause 3 mandates that if proposal form is not filled by the insured, a certificate has to be incorporated at the end of the said form 13 A/117/2022 that all the contents of the form and documents have been fully explained to the insured and made him to understand. Similarly, Clause 4 enjoins a duty upon the insurer to furnish a copy of the proposal form within thirty days of the acceptance, free of charge. Any non-compliance, obviously would lead to the irresistible conclusion that the offending clause, be it an exclusion clause, cannot be pressed into service by the insurer against the insured as he may not be in knowhow of the same.
13. In view of the above, the impugned judgment and order dated 23/11/2021 passed Ld. District Commission Aurangabad in CC No 857/2019 is no need to be modified as the District Commission has not awarded interest on the premium amount. In view of the above discussion and the reasoning, we are of the opinion that the appeal is devoid of merits and deservers to be dismissed. Hence we pass the following order.
ORDER
1. The appeal is dismissed.
2. The impugned judgment and order dated 23/11/2021, passed by the Ld. District Consumer commission Aurangabad, in C.C. No.857/2019 is to be modified.
3. The appellant is directed to pay the premium of Rs.3,51,589/- to the respondent with 18% PA interest from the date of the receipt of the premium amount dated 21/2/2013 till realization.
14 A/117/2022
4. The appellant is directed to pay a cost of Rs.10,000/- towards deficiency in service and Rs.10,000/- for physical and mental agony.
5. Copies of the judgment are supplied to both the parties free of cost.
6. No order as to costs.
Palce :- Aurangabad.
Date :- 07/05/2024
N.C.Kumbre Dr.N.A.Chavhan M.S.Sonawane
Member Member Presiding Member
UNK
15 A/117/2022
Date of filing :28.01.2022
Date of order :07.05.2024
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL COMMISSION,MUMBAI, BENCH AT AURANGABAD. FIRST APPEAL NO. : 118 OF 2022 IN COMPLAINT CASE NO.: 857 OF 2019 DISTRICT CONSUMER COMMISSION : AURANGABAD. Aditya Birla Life Insurance Company Ltd,. Appellant Through its Authorised Representative, (Adv.A.M.Kedar) Having its office at-
One World Centre, Tower 1, 16th floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone road, Mumbai 400013.
VERSUS
Vaishali Sanjay Ghadge, Respondent
R/o Loni (Khurd), (Adv.R.V.Jadhav)
Tq- Vaijapur, Dist.Aurangabad.
CORAM: Milind.S.Sonawane, Hon'ble Presiding Member.
Dr.Nisha.A.Chavhan, Hon'ble Member.
Nagesh C.Kumber, Hon'ble Member.
JUDGMENT (Delivered on 07/05/2024) Per Dr.Nisha Amol Chavhan, Hon'ble Member.
The Appellant has challenged in this appeal, Order and Judgment passed by the Ld. District Consumer Disputes 16 A/117/2022 Redressal Commission, Aurangabad dated 23.11.2021 in CC. No. 857/2019.
2. The facts giving rise to this appeal are as under.
3. It is the case of respondent that, the husband of the respondent died due to the cause sudden heart attack on 28/11/2018. After the death of respondent's husband, she came to know about the life insurance policy No.005964008 by premium paid of Rs.1,74,992/- to the appellant insurance company on dated 28/02/2013 and second premium was paid of Rs.1,76,587/- total amount paid by the respondent's husband was of Rs.3,51,589/-. Respondent visited to the appellant office about the policy but she received the policy termination letter on dated 31/12/2018.
4. Respondent submitted that, her husband, during his life time received a telephonic call from unknown person from the appellant company informing him that in order to claim the accrued bonus of Rs. 10 Lakhs on his existing insurance policy, the he has to take another/additional 3 insurance policies from appellant company. Respondent's husband has refused to avail any additional policies, the appellant company by giving false assurance obtained cheques from him and using the 17 A/117/2022 documents of the existing policies, forged the signature on the proposal form and issued 3 different insurance policies.
5. It is submitted that, the appellant company informed the respondent's husband that if he wants to get the refund of entire premium, he has to pay at-least 2 premiums. Accordingly, he paid initial premium amount of RS.1,24, 92/- for the policy No. 005872885 on 31/12/2012 and second premium was paid of Rs.1,76,587/- total amount paid by the respondent's husband was of Rs.3,51,589/. That the respondent's husband notices that the address on the policy was incorrect which was informed to the officers of the appellant company however he did not receive any satisfactory reason.
6. It is submitted that, respondent's husband realized that he was cheated by the appellant company therefore he filed a police complaint in the police station but no cognizance was taken by the police, so respondent's husband filed an application U/S 156(3) of CRPC, 1973 before the JMFC, Aurangabad. Accordingly, respondent's wife i.e. policy holder had preferred Revision petition U/S 397 of CRPC bearing Case No. 185/2019 before the Principal District and Session Judge, Aurangabad and said matter is pending for adjudication.
18 A/117/2022
7. It is further submitted that, appellant company engaging into unfair trade practices, giving false assurance have extorted the insurance premium. Respondent further submitted that, this information was received by him from his advocate after the death of his husband (insured) and hence she filed Consumer Complaint NO. 857/2019 alleging the deficiency service and claiming the refund of Rs.1,74,992/- and second premium of Rs.1,76,587/- total amount paid of Rs. 3,51,589/-along with interest @18% per Annum from 28/02/2013 till realization.
8. Ld. District Consumer Dispute Redressal Commission Aurangabad allowed the complaint and directed the appellant to refund the premium of Rs. 3, 51,589/- within 30 days to the respondent. Being aggrieved by the judgment and order of District Commission Aurangabad preferred appeal.
9. Adv. A.M. Kedar appeared for appellant. Adv. R.V. Jadhav appeared for respondent. On 9/2/2024, direction was given to the both parties to argue the matter finally on next date without fail; else only present party would be heard alone. Accordingly on 12/3/2024, Adv. A.M. Kadar was absent. We heard the Ld. Adv. R.V. Jadhav for respondent as well as perused the record which has been by the both parties on record. This commission has made following observation.
19 A/117/2022 OBSERVATION
10. Against this background, we perused the copy of the Complaint and written version given by the Appellant in original proceedings before the District Consumer Commission Aurangabad. We have also gone through the impugned judgment. It is found that, there is no error committed by the Ld. District Consumer Commission Aurangabad on the factual aspects. But District commission has not awarded the interest on the premium amount; therefore, order needs to be modified
11. It is admitted fact that, appellant company had issued a letter dated 3/3/2017 in favour of the investing officer of Jinsi police station and stated that, as per policy issued by them, they are ready to repay the premium amount as per their rules of the respondent.
12. On a discussion of the aforesaid principle, we would conclude that insurer is statutorily mandated as per Clause 3(ii) of the Insurance Regulatory and Development Authority (Protection of Policy Holder's Interests, Regulation 2002) Act dated 16.10.2002 (hereinafter referred to as IRDA Regulation, 2002) to the effect that the insurer and his agent are duty bound to provide all material information in respect of a policy to the insured to enable him to decide on the best cover that would be in his interest. Further, sub-clause (iv) of Clause 3 20 A/117/2022 mandates that if proposal form is not filled by the insured, a certificate has to be incorporated at the end of the said form that all the contents of the form and documents have been fully explained to the insured and made him to understand. Similarly, Clause 4 enjoins a duty upon the insurer to furnish a copy of the proposal form within thirty days of the acceptance, free of charge. Any non-compliance, obviously would lead to the irresistible conclusion that the offending clause, be it an exclusion clause, cannot be pressed into service by the insurer against the insured as he may not be in knowhow of the same.
13. In view of the above, the impugned judgment and order dated 23/11/2021 passed Ld. District Commission Aurangabad in CC No 857/2019 is no need to be modified as the District Commission has not awarded interest on the premium amount. In view of the above discussion and the reasoning, we are of the opinion that the appeal is devoid of merits and deservers to be dismissed. Hence we pass the following order.
ORDER
1. The appeal is dismissed.
2. The impugned judgment and order dated 23/11/2021, passed by the Ld. District Consumer commission Aurangabad, in C.C. No.857/2019 is to be modified.
3. The appellant is directed to pay the premium of Rs.3,51,589/- to the respondent with 18% PA interest 21 A/117/2022 from the date of the receipt of the premium amount dated 21/2/2013 till realization.
4. The appellant is directed to pay a cost of Rs.10,000/- towards deficiency in service and Rs.10,000/- for physical and mental agony.
5. Copies of the judgment are supplied to both the parties free of cost.
6. No order as to costs.
Palce :- Aurangabad.
Date :- 07/05/2024
N.C.Kumbre Dr.N.A.Chavhan M.S.Sonawane
Member Member Presiding Member
UNK