State Consumer Disputes Redressal Commission
Vinod P.Sharma vs Sbi Life Insu. Co. on 30 September, 2022
Daily Order M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BHOPAL PLOT NO.76, ARERA HILLS, BHOPAL FIRST APPEAL NO. 365 OF 2010 (Arising out of order dated 10.12.2009 passed in C.C.No.621/2009 by the District Commission, Gwalior) VINOD PRAKASH SHARMA, S/O LATE SHRI H. N. SHARMA, R/O 23, VIVEKANAND COLONY, VISHWAVIDYALAYA ROAD, GWALIOR. ... APPELLANT. Versus 1. SBI LIFE INSURANCE CO.LTD. THROUGH MANAGER, B-5-6, THIRD FLOOR, PLATINUM PLAZA, MATA MANDIR, SOUTH T.T.NAGAR, NEW MARKET, BHOPAL (M.P.) 2. SBI LIFE INSURANCE CO.LTD. THROUGH MANAGER, THIRD FLOOR, ALAKNANDA TOWER, CITY CENTRE, GWALIOR (M.P.) ... RESPONDENTS. BEFORE: HON'BLE SHRI A. K. TIWARI : PRESIDING MEMBER
HON'BLE DR. SRIKANT PANDEY : MEMBER HON'BLE SHRI D. K. SHRIVASTAVA : MEMBER COUNSEL FOR PARTIES : Shri Hemant Sharma, learned counsel for the appellant. Shri Vikas Rai, learned counsel for the respondents. O R D E R (Passed On 30.09.2022)
The following order of the Commission was delivered by A. K. Tiwari, Presiding Member:
This appeal is directed against the order dated 10.12.2009 passed by the District Consumer Disputes Redressal Commission, Gwalior (for short 'District Commission') in C.C.No.621/2009, whereby the complaint filed by him has been dismissed.
-2-2. The facts of the case in short are that the complainant /appellant had obtained SBI Life Unit Plus Policy no. 19004610003 from opposite parties/respondents for a period w.e.f. 29.05.2006 to 28.05.2016 after making payment of yearly premium of 1,00,000/-, out of which Rs.26,546/- were received for formalities and in different heads and the 50% of remaining amount of Rs.73,254/- was to be invested Equity Fund and 50% was to be invested in Growth Fund. It is alleged that policy along with Schedule I and receipt was sent. Thereafter on 28.12.2007, the opposite party sent a reminder for continuation of the policy. It is submitted that since the complainant does not want to continue the policy, he has not deposited the further premium. Thereafter on 27.06.2009 he sent a letter to opposite party no.2 for refund of amount invested in Equity Fund and Growth Fund except the premium for insurance. On such demand made by the complainant, the opposite party ought to have refunded the amount of equity fund @ NA8 Rs.29.92 per unit Rs.44181.75 and the amount of growth fund @ NAP Rs.16.56 per unit, Rs.42,417.94 but in the statement of account sent by the opposite party after deducting different charges, the amount of Rs.6,712/- was paid. The complainant/appellant therefore approached the District Commission alleging deficiency in service, on part of the opposite parties seeking relief of aforesaid amount with interest @ 18% p.a., compensation of Rs.25,000/- along with costs Rs.5,000/-.
-3-3. The opposite parties raising the preliminary objections resisted the complaint stating that the policy was issued in May-2006 and he filed a complaint after a period of 3 years which is barred by limitation as per Section 24A of the Consumer Protection Act, 1986 (for short the 'Act'). It is further submitted that as per terms and conditions of the policy schedule II under Clause 2(c) is stated that if, after the first year the premium is not paid within grace period, the policy will continue to remain in force subject to clause 13, which states that if after the first year of the policy, the premium is not paid within the grace period, the company will continue to liquidate an appropriate number of units to meet the mortality charges. Here, since the complainant did not pay the premium after first year, the company liquidate number of units to meet the mortality charges and remaining amount as surrender value of Rs.6,712/- was refunded to the complainant. However, as a special case and good will gesture, it has been decided to refund mortality charges of Rs.17,073/- and the same was refunded. The opposite parties insurance company has not committed any deficiency in service. It is therefore, prayed that the complaint be dismissed in limine.
3. The District Commission after hearing parties and considering the evidence available on record, dismissed the complaint holding that no deficiency in service is proved against the opposite parties. Hence this appeal by the complainant.
-4-4. Heard the arguments advanced by learned counsel for the parties. Perused the record.
5. Learned counsel for the complainant/appellant argued that at the time of supplying policy document, Schedule I and II were not provided to the complainant. He argued that when the complainant failed to deposit further premium, the opposite parties/respondents sent reminder for depositing the premium failing which the benefits will not be payable. When the policy was lapsed for non-depositing of premium, the opposite parties ought to have been paid the amount of Equity Fund and Growth Fund as per NAV. When the policy has become lapsed, how the opposite parties can deduct the premium and if they deducted the premium, it means the policy was in running condition. Even then the District Commission by holding that the opposite parties adjusted the amount of equity fund and growth fund in premiums, rightly dismissed the complaint. It is therefore prayed that the impugned order be set-aside and the appeal be allowed.
6. Learned counsel for the opposite parties/respondents supporting the impugned order submits that Schedules are the part of a policy and were very well supplied to the appellant. The company liquidate number of units to meet the mortality charges since the appellant did not pay the premium after one year and as per Schedule II clause 13, which says that if after the first year of the policy, the premium is not paid within the grace period, the -5- company will continue to liquidate an appropriate number of units to meet the mortality charges. Surrender value of Rs.6,712/- was refunded to the complainant and also, as a special case and good will gesture, mortality charges of Rs.17,073/- was also refunded to the appellant. The respondents insurance company has not committed any deficiency in service. The District Commission has passed a well-reasoned order. It is therefore prayed that the appeal be dismissed.
7. After hearing learned counsel for the parties and on perusal of the record, we find that the complainant has filed his affidavit along with documents C-1 to C-13. The opposite parties have filed affidavit of V. Srinivas, Head-Legal and Authorized representative along with documents R-1 to R-5. The dispute raised by the complainant that the opposite parties not returned him the amount invested in equity fund and growth fund as per NAV. On the other hand, the defence of the opposite parties is that since the complainant did not continue the policy after one year therefore as per terms and conditions i.e. Clause 13 of the Schedule II of the policy, the company liquidate number of units to meet the mortality charges and the remaining amount returned to the complainant.
8. The point rounds around the Clause 13 of Schedule II of the policy. The Clause 2(C) and Clause 13 of Schedule II Terms and conditions (Filed along with R-5) provides as under:
-6-Schedule-II Terms and Conditions Clause 2(c) If, after the first year following the Date of Commencement of Risk, the premium is not paid within the grace period, the Policy will continue to remain in force subject to the clause 13 of this document, If premium payments are subsequently.
Clause 13 Paid-up Value If, after the first year of the policy, the Premium is not paid within the grace period, the Company will continue to liquidate an appropriate number of units to meet the mortality charges, Rider Premiums (if applicable), extra premiums on basic cover and extra premium on riders and other expenses to keep the policy in force up to such time that Fund Value does not fall below Rs.10,000/- as on the date on which units are so liquidated.
If the Fund Value falls below Rs.10,000/-, the policy will lapse and the Fund Value will be paid to the Policyholder after deducting Rs.500 towards administrative expenses and other applicable expenses and all rights and benefits under the Policy will automatically cease.
No paid up value is available under this Policy for life cover and rider benefits.
9. Bare perusal of the aforesaid clauses it is clear that if after the first year of the policy, the Premium is not paid within the grace period by the policy holder, the Company will continue to liquidate an appropriate number of units to meet the mortality charges. In the instant matter admittedly the complainant/appellant did not pay the premium after first year of the policy and that is why the opposite parties/respondents insurance company liquidate an appropriate number of units to meet the mortality charges and the returned the remaining amount to the complainant/ -7- appellant and while doing so, it appears that the respondents have not committed any deficiency in service.
10. The complainant in his complaint has submitted that he had received only Schedule I with the policy, on the other hand in appeal, and learned counsel for the appellant argued that both Schedules I & II were not supplied by the respondents. In this regard we would like to refer letter dated 31.05.2006 (C-5) of the respondents to the appellant in which it has been specifically mentioned that "The policy document is enclosed. You have the option to return the policy to SBI Life Insurance Company Limited and cancel the cover within 15 days of receipt of the policy document, in the event you are not satisfied with the terms and conditions contained in the policy document." Had the complainant/appellant not satisfied with the terms and conditions of the policy, he could have refused to continue with the policy within 15 days, but he has not done so.
11. Similarly in the SBI Life-"UNIT PLUS Regular" policy document C-1=R-1, the complainant agreed to all the terms and conditions (which is marked as 'A' to 'A')--" It is agreed that the proposal and the personal statement together with any report or other document leading to the issue of this Policy shall form the basis of this contract of insurance and that all benefits are subject to the schedules, the terms and conditions and annexures of this document. It is agreed that in consideration of premium -8- received and subject to receipt of future premiums as herein stated, the Company will pay the appropriate benefits (without interest) as herein stated, to the Beneficiary (hereinafter defined), on proof to the complete satisfaction of the Company, in its sole discretion, of the benefits under the Policy have become payable."
12. In such circumstances, in view of the above, the contention of the complainant that the respondents did not supply him the terms and conditions or Schedule I & II and he has no knowledge of terms and conditions of the policy, cannot be accepted.
13. The opposite parties/respondents in their reply as also in affidavit has clearly given the calculation of Funds with their NAV and the amount. As per request made by the appellant vide letter dated 27.06.2009 (C-12) and dated 13.07.2009 (C-11) regarding refund of surrender value, the respondents vide their letter dated 13.08.2009 refund a sum of Rs.6,712/- vide cheque no.247199 dated 08.08.2009 as full and final settlement of all the dues under the policy. Thereafter as a special case and good will gesture, the respondents vide letter dated 02.11.2009 refund a sum of Rs.17,073/- vide cheque no. 594447 dated 31.10.2009 towards the amount deducted for mortality charges. What more the appellant wants. The respondents have given statement showing deduction of the amount under -9- different heads and at last they paid a total sum of Rs.23,785/- to the complainant/appellant.
14. It is also pertinent to mention here that even after receipt of aforesaid amount i.e. Rs.6,712/- and Rs.17,073/- the complainant/appellant neither in his complaint nor in his appeal has mentioned that he has received an amount of Rs.17,073/- also. He has only mentioned about Rs.6,712/-
15. In this view of the matter, we are in full agreement with the view taken by the District Commission that no deficiency in service is proved against the respondents.
16. In view of the above discussion, we do not find any illegality or infirmity in the impugned order passed by the District Commission, it is therefore upheld.
17. In the result, the appeal fails and is dismissed with no order as to costs.
(A. K. Tiwari) (Dr. Srikant Pandey) (D. K. Shrivastava) Presiding Member Member Member