Consumer case against insurance company
KRISHNAN
(Querist) 02 May 2013
This query is : Resolved
I have filed a consumer case on behalf of my client. The case of my client is he had paid the 1st premium amount of Rs. 50,000 on 22.01.2009, then paid the second premium amount of Rs. 50,000/- through the credit card on 22.01.2010 but the second premium amount has not credited in his policy account, on the other hand the Insurance company asked him to pay the said amount and told him that the policy will be lapsed if he will not pay the said amount. My client repeated explaned about the payment but till May 2012 they forced and tortured him to pay. But subsequently after May 2012, their policy account shown that 50000 credited into his account. In between this my client became vexed and asked them to surender the policy and refund his amount. But they said that they could surrender the policy only after 3 years as per the policy conditions. But my client don't want to continue the policy because of their insufficient service and torture. Hence he didn't pay the premium for 2011 and 2012. Whether my client could succeed in this case for getting the refund amount with compensation of Rs. 2,00,000/-. Please kindly suggest me to proceed this case. Now i am the stage of filing the proof affidavit. What kind of defense can be taken by my client to succeed this case.
ajay sethi
(Expert) 02 May 2013
please read the terms and conditions of policy carefully .admittedly you have not paid premium of years 2011 and 2012 . the policy must be containing a clause that when premiums not paid for period of 3 years what would be the consequences . the issue as to whether you are eligible for refund or not depends upon the terms of the policy
Advocate Ravinder
(Expert) 02 May 2013
By the above, I understand that it is a private insurance company. Normally, they will do these types of frauds and tricks. Your money will be safe, do not worry.
If you are not interested in the insurance company, please stop paying the premiums immediately.
Immediately file a consumer case against the company. The court will order the company to produce all relavant records (including digital files) into the court for verification of how much amount was paid and on what dates. Also write a letter to the IRDA informing the same.
Kumar Doab
(Expert) 02 May 2013
Now the case has been filed and funds of the hapless customer are at stake.
The matter can be reduced to being as simple as that the company did not credit the amount of premium paid by customer for 2 years in policy a/c.
The customer feared he has been defrauded and why he should pay further.
It is a matter of Loss of Confidence.
The customer should have lodged a complaint with IRDA and MD of the company as well.
With reference to:
Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002.
The policy holder has assisted the company and thus has satisfied the clause number:
11. General (3)
The company might have defaulted on clause:
5. Grievance redressal procedure
10. Policyholders’ Servicing
If Mode of Payment of Policy; by credit card is advertised as one of the modes acceptable to the Insurance company in any of its brochures, in policy document, at its web site then customer can pay the amount by CC.
The CC was swiped by company in its office or at approved point of payment?
If the payment by CC was made at approved point of payment customer is not at fault.
You have mentioned that your client has repeatedly told the company that payment has been made.
Does he have any proof e.g. phone bill, email, acknowledgment of letter/CC charge slip or CC statement showing the amount paid by CC etc.
The company was duty bound to investigate and revert back to the customer.
After 2 years company has credited the amount in policy a/c.
This was the time to lodge another complaint and demand to inform where the funds were kept by the company for this period?
The question arises where this amount was siphoned off for 2 years by the company?
The company is certainly at fault.
However if company has been communicating to the customer it must have maintained a record including phone calls.
The question arises has the customer maintained a record. Customer should.
You may also go thru:
-------TREATMENT OF DISCONTINUED LINKED INSURANCE POLICIES) REGULATIONS, 2010
-------- GUIDELINES FOR GRIEVANCE REDRESSAL BY INSURANCE COMPANIES
4. Grievance Redressal System/Procedure:
(e) Where the grievance is not resolved within 3 working days, an insurer shall resolve the grievance within 2 weeks of its receipt and send a final letter of resolution.
(g). Where, within 2 weeks, the company sends the complainant a written response which offers redress or rejects the complaint and gives reasons for doing so,
(i). the insurer shall inform the complainant about how he/she may pursue the complaint, if dissatisfied.
(ii). the insurer shall inform that it will regard the complaint as closed if it does not receive a reply within 8 weeks from the date of receipt of response by the insured/policyholder.
Any failure on the part of insurers to follow the above-mentioned procedures and time-frames
would attract penalties by the Insurance Regulatory and Development Authority.
`
11. Policyholder Protection Committee:
Every insurer that ensure that the Policyholder Protection Committee, as stipulated in the guidelines for Corporate Governance issued by the Authority, is in place and is receiving and analyzing the required reports from the management and is carrying out all other requisite monitoring activities.
------- Handbook On Life Insurance;
Call Toll Free 155255 and seek details which might be useful to your case.
The similar cases decided by IRDA are available on website of IRDA.
The similar cases decided by Distt., State, national Commission can be accesses at:
Confonet
confonet.nic.in/
