Upholding the orders passed by fora below, the national consumer disputes redressal commission (NCDRC) directed Bajaj Allianz Life Insurance Company Ltd to pay a balance Rs10.24 lakh to a policyholder as per the schedule of the unit-linked insurance plan (ULIP) equity growth fund policy. The complainant was sold the ULIP policy, saying that at the end of the policy period, she was entitled to a guaranteed return of 14%pa (per annum) on the premium paid or the net asset value (NAV), whichever is higher.
In
an order last week, the NCDRC bench of Dr Inder Jit Singh (presiding member), says, "The state commission has given a well-reasoned order duly addressing the contentions of the insurance company and we are in agreement with its observations and findings...we are of the considered view that there is no illegality or material irregularity or jurisdictional error in the orders of the state commission. Hence the same is upheld. The revision petition (RP) lacks merit and the same is dismissed."
The bench also pointed out how, after filing the complaint with the police concerning an allegedly forged or fabricated policy schedule, Bajaj Allianz Life Insurance never pursued or followed up on the matter with the police, resulting in a no status report.
Mumbai-based Asha Ramesh Shah bought a ULIP policy from Bajaj Allianz Life Insurance for five years till 2011 for an annual premium of Rs5 lakh. For three consecutive years, she paid the premium of Rs5 lakh per year. On policy maturity, she filed a claim seeking Rs25.47 lakh from Bajaj Allianz Life Insurance as per the schedule of the ULIP policy.
However, Bajaj Allianz Life Insurance only paid back Rs15.23 lakh, the premium paid by Ms Shah, who contended she is entitled to receive an additional Rs10.24 lakh from the insurer as per the policy schedule. After giving notice to Bajaj Allianz Life Insurance, she filed a complaint before the additional Mumbai suburban district consumer disputes redressal forum.
Both the district forum and the Maharashtra state consumer disputes redressal commission allowed the appeal filed by Ms Shah and directed Bajaj Allianz Life Insurance to repay the balance maturity amount to her.
Aggrieved by these orders, Bajaj Allianz Life Insurance approached NCDRC with its revision petition. It contended that the policy bought by Ms Shah was a ULIP and hence, there was no guaranteed return for the policy. It also submitted that the (policy) schedule produced by Ms Shah along with the policy is a forged and fabricated document and does not bear the signature of the insurer's then chief executive officer (CEO) Sam Ghosh.
Bajaj Allianz Life Insurance submitted that, on the date of maturity, it had already given the amount to Ms Shah which she was entitled to get, based on that policy. She is not entitled to get an additional amount as she claimed from Bajaj Allianz Life Insurance, the insurer contended.
NCDRC also noted that Bajaj Allianz Life Insurance stated that it has filed a report at the Malad police station about the allegedly forged schedule. However, the legal heirs of Ms Shah submitted that at the time of taking the policy, Bajaj Allianz Life Insurance had provided policy documents along with the schedule, and the schedule is part and parcel of the insurance policy given to Ms Shah.
The counsel for the Shahs also submitted that if Bajaj Allianz Life Insurance contends that the schedule is forged and fabricated, the burden is on the insurer to prove it.
Dr Singh from NCDRC also observed that the state commission mentioned that there is no evidence on record that Bajaj Allianz Life Insurance had given any letter to Ms Shah about the lapse of her policy, showing the policy continued for five years.
During a hearing on 4 October 2023, the bench directed Bajaj Allianz Life Insurance to submit a copy of the entire file of Ms Shah, complete standard policy document, detailed calculations and updated status of its police complaint.
Bajaj Allianz Life Insurance submitted some documents. However, during the final hearing on 4 June 2024, NCDRC noticed that the insurer did not submit a copy of the entire file of Ms Shah.
The counsel for Bajaj Allianz Life Insurance stated that these records are not available with the insurer.
NCDRC also observed that instead of standard policy documents, the insurance company submitted a copy of a policy issued to some other person.
Regarding the status update from the police station, Bajaj Allianz Life Insurance submitted that it was informed that the records have since been destroyed, and no further information is available.
Dr Singh from NCDRC says, "It is important to note that it is the insurance company who has filed the complaint before the police with respect to the forged schedule with the policy. It was only after the order dated 4 October 2023 directing the insurance company to file an updated status on the police investigation on the (policy) schedule being fabricated or forged one, as contended by it before the fora below that on 30 October 2023, Bajaj Allianz Life Insurance wrote to the Officer Incharge of Malad police station seeking an update on the progress of the investigation. In response, the concerned police officer has replied on 30 October 2023 that the record requested by the insurance company are out of date and has been destroyed. Accordingly, there is no information available in the Malad police station in respect of application of Bajaj Allianz Life Insurance. With respect to the request of the insurance company whether a case has been registered or how, the police officer conveyed that the information is also not available."
While disposing the revision petition, NCDRC directed Bajaj Allianz Life Insurance to pay the balance Rs10.24 lakh to the legal heirs of Ms Shah, the original ULIP policyholder.
(Revision Petition No427 of 2019 Date: 2 July 2024)
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