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Max Life Insurance Co. Ltd. (formerly known as Max New York Life Insurance Co. Ltd.) v/s Joseph Abraham

    First Appeal No. 416 of 2013 (Arisen out of Order Dated 19/03/2012 in Case No. CC/12/146 of District Pathanamthitta)

    Decided On, 12 May 2014

    At, Kerala State Consumer Disputes Redressal Commission Thiruvananthapuram

    By, MEMBER

    For the Appellant: A. Abdul Kharim, R. Narayan, Advocates. For the Respondent: Thomas P Jacob, Advocate.

Judgment Text

A. Radha, Member

This appeal is preferred by opposite party against the order in C.C.No.146/12 on the file of CDRF, Pathanamthitta. The Forum below directed to pay the remaining2/3 of thematurity amount against the complainant’s policy with interest @ 12% p.a along with cost of Rs.5,000/-. Further direction is to pay Rs.15,000/- as compensation to the complainant by the 2nd opposite party.

2. The complainant’s case is that the complainant joined an insurance scheme of the 1st opposite party through 2nd opposite party who is the authorized agent of the 1st opposite party on payment of Rs.30,000/- on 14/03/2007. It is informed that the complainant had to pay Rs.30,000/- per year for 5 years and at the end of the 5th year the complainant will be entitled for a maturity value of Rs.1,69,119/- and also eligible for insurance coverage for Rs.2,00,000/- for the rest of the complainant’s life. On 21/03/2012 the complainant approached for reimbursement for the matured value. The 1st opposite party informed that the complainant would be entitled to get for 1/3 of the maturity value and 2/3 has to be invested and retained to other scheme. It is the allegation of the complainant that such a condition was not intimated or brought to the notice of the complainant. As the complainant was not satisfied with the opposite party he demanded the repayment of maturity value and the 1st opposite party issued only Rs.56,373/- as 1/3 of maturity amount. The act of the opposite party is arbitrary and unilateral and the condition of investment of 2/3 of the maturity value was not brought to the notice of the complainant at the time of joining the scheme. The new condition was not binding upon the complainant. Hence the complainant approached the Forum Below for direction to repay the remaining 2/3 amount with 12% interest and also for compensation of Rs.10,000/- and cost of the proceedings.

3. The 1st opposite party filed preliminary objection stating that the complainant has not mentioned the policy number or proposal number. The opposite party was unable to trace out the records of the complainant. It is also stated that the complaint is false and incorrect. The 2nd opposite party was exparte. Based on pleadings and the oral testimony of the complainant as PW1 the evidence was taken and the documents were marked as Exbt.A1 to A9 on the part of the complainant. With the evidence available on records the Forum Below allowed the complaint in favour of the complainant and the case of the complainant remained unchallenged.

4. The counsel for the appellant submitted that the respondent has not informed the Policy number or any details regarding the policy. It is submitted in preliminary objection filed before the Forum Below that the 1st opposite party was not able to trace out the policy number of the complainant. Hence the complaint lacks cause of action and it is abuse of law without giving details of the Policy number. The copy of the proposal form was submitted by the complainant before the Forum Below and it is evident that the complainant is well aware of the proposal No. which was not quoted in his communication. He also pointed out that along with the proposal form the complainant signed the declaration and confirmation which is binding on the proposer. The complainant was provided with the policy and acknowledged by the policy holder. The respondent cannot argue that he was not aware of the annuity charges and the terms and conditions of the policy. The counsel prayed for a remand giving opportunity to file a detailed version and also to contest the case.

5. It is argued by the counsel for the respondent that he joined the Maxlife Maker Unit linked pension plan risk element 2007 on 10/03/2007 and filed the proposal form with the appellant/opposite party. The respondent paid @ Rs.30,000/- each for 5 years and it was informed by the 2nd opposite party, the agent of the 1st opposite party that after completion of 5th year the complainant is entitled to get back the amount and coverage of insurance for the rest of life. It is true that the appellant filed preliminary version before the Forum Below and had not appeared thereafter. The respondent adduced evidence in support of his case and on the basis of the evidence and documents the Forum Below allowed the complaint directing to refund the 2/3 balance of the amount collected by the appellant. The respondent alleges that the appellant introduced a unilateral condition subsequent to the joining of the policy and it is not binding on the respondent. Hence the respondent is entitled for the remaining 2/3 of amount remitted by the complainant. The respondent also prayed for interest @ 12% and compensation for mental agony caused to the respondent.

6. Heard both sides in detail and we have gone through the documents on record. It is an undisputed fact that the complainant joined the policy of the opposite party and remitted Rs.30,000/- each for 5 years. The complainant’s argument is that he was under the impression that he will be refunded with the maturity value after completion of 5 years and he will be under the life coverage for the rest of the life. The 2nd opposite party, the agent, made him believe that the policy coverage will be entitled for the complainant even after 5 years. It is on that assurance the complainant availed the insurance policy. It is clear from documents that the 2nd opposite party remained exparte before the forum below. In appeal the 2nd opposite party was excluded from the party array and was not made the 2nd respondent in the appeal. The respondent had submitted letter regarding the refund of the 2/3 amount as per Exbt.A5 issued to the appellant regarding Policy No.434765822. The appellant had not disputed the letter nor the non receipt of the letter issued by the complainant. So also Exbt.A7 was the letter issued to the opposite party on 21/06/2012 wherein there had details regarding the policy in the notice issued on behalf of the complainant. So the ignorance of Policy No. by the appellant while filing the preliminary version cannot hold good to him. However, the photocopy of the proposal form produced by Exbt.A1 by the complainant and the Exbts.A2 and A4 contains the terms and conditions of the policy details which was produced by the complainant himself before the Forum Below. Hence he cannot argue that he was not aware of the terms and conditions of the policy. Exbt.A4 specifically give the details of the annuity options. Hence we are of the considered view that a

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contract is based on the terms and conditions and we cannot go beyond the terms and conditions of the policy. In this case we are of the considered view that the District Forum has not gone through the terms and conditions of the policy and we find that an opportunity is to be given to the appellants/opposite party to contest the case. In the result, appeal is allowed setting-aside the order passed by the Forum Below by giving opportunity to the opposite parties to contest the case on condition of payment of Rs.5,000/- to the complainant on appearance. The parties are to appear before the Forum Below on 17/06/2014. The office is directed to send a copy of this order to the Forum below along with LCR.