On 15/07, Mr. Salesh. P.C, CSO, Metlife conducted medical tests in their panel M/s. Shankars Clinic, Alleppey in presence of Mr. Satheesh Krishnan. Further they took my signature in blank PF No. 106940115 for a single time policy of Rs, 1 lakh, convinced me that since the PF requires some technical expertise to fill it up, they will complete the formality on my behalf.
On 17/07 at Coimbatore, I drawn a DD No. 908814 dated 17/07 for `1 lakh in favour of Metlife Kottayam and send it through courier along with the copy of my salary slip for the periode of Jun- July to Mr. Biju Joseph, Geogit Alleppey with a written request to hand it over to Mr. Jijo since the former was introduced me to Metlife.
During the month of September the policy document received at my native place address Alleppey, Kerala and the same was remained at my home since I was at my work place Coimbatore. Further that, somebody called from Metlife on my given mobile number and asked me whether I got the policy document or not and for that I confirmed the same that the document received at my home which was not opened. But the caller does not inform me anything about the contents of the policy document. Further in the month of October when I was at my home on leave, I checked the courier received from Metlife which contains the following documents (Xerox copies enclosed):
1. policy document vide policy No. 1200700379049 date of issue 14/09,
2. terms & conditions in 14 pages dated Karnataka stamp duty dated 19/09
3. Xerox copy of PF No. 106940115 dated 17/07 with Metlife Inward seal dated 26/07.
4. FPR No. FPR/0138583 dated 19/09 with Karnataka stamp duty.
5. Statement of account as on 14/09 dated 19/09
In pursuance to the policy document, some female caller from Metlife contacted me and asked about the receipt of all documents. Further she enquired me that, whether I was interested in life assurance or investment. I replied her that I have opted the same as a onetime investment. She paid regards as usual and end up the conversation.
On October I again received one cover from Metlife which contains the following documents:
1. covering letter named Medical report for application #KLK106940115 dated 16/10
2. Xerox copy of receipt from Sankars Clinical Lab & ECG, Alappuzha dated 15/07 for urine test
3. Three Xerox copies of receipt from Sankars Clinical Lab & ECG, Alappuzha dated 15/07 for blood report.
4. Xerox copy of ECG graph
5. Tread mill test summary report of Sankars Clinical Lab & T.M.T, Alappuzha date which is illegible to read
On perusal of the whole correspondence received from Metlife, I noticed several contradictions which are as follows:
1. Blood test & urine test conducted on 15/07, but the PF & DD dated is on 17/07.
2. DD drawn at SBI, Coimbatore on 17/07 and the filled up PF is also 17/07 place Alleppey.
3. PF and DD accepted by Metlife, Kottayam on 26/07 but policy commencement date was 14/09 after a lapse of about 2 months.
4. The PF filled by some other person and does not bear any name or signature of the person who filled the PF.
5. Though the provision for remittance of money in the mode of crossed cheque, compelled me to deposit by the mode of DD.
When informed the matter to Mr. Salesh. P.C, CSO/Metlife over phone, he replied that these all are normal mistakes and did not affect me in any way, so not to worry about that. He added that, the other matter like the terms of the policy will be as such as I desired. Hence I was confident about the reply of the responsible official of Metlife, I seldom sit on my investment.
The whole things becomes a dispute when during the month of September I received several calls from call centre personnel’s and insisted me to remit the regular premium of about one lakh for the year 2008. I explained the entire above episode and the assurance given by Mr. Salesh. P.C, CSO/Metlife while applying the policy as a onetime investment. I felt that all my explanations fall in dumb ears, when I hear the version that the policy conditions are for a regular one and could not able to change it in to one time policy. The drama continued in the month of September also and they warned me that if the amount of `2 lakhs comes as dues not paid, my policy will lapse and the entire amount will forfeit. I requested the call centre personnel’s to connect me to some of the responsible persons of Metlife, but not done.
During the year again I received a call from the call centre and some offer has been given to me for renewal of the policy duly paying all the dues. When I hesitated, they informed me that operate the option of surrender and the surrender benefit will be as per the terms & conditions of the policy document. Further on my request they informed me that on surrender I may get approximately `30, 000/- after deducting all the charges as mentioned in the T&C.
In this connection, I send an email to [email protected] on July 8th duly narrating all the facts and requested to return my whole amount since the policy was technically misselled to me. My mail was replied by one Mr. Vikram V, Senior Executive, Grievance Redressal Team from Metlife on July 20th. In which he replied that the free look periode was over and cannot cancel the policy, but I can surrender the policy as per the terms and conditions sent along with the policy. Unfortunately he never said anything about the queries raised by me.
The contradictions came in to my notice only on 16/10 (date of receipt for Xerox copies of medical tests) after expiring about one month from 19/09, when I received the policy documents. Either they may knowingly delayed to send the Xerox copies of medical tests to simply pass the free look periode of 15 days with a malafide intention or to conceal the facts from me. Though the copies of all documents with the company, knowing the above said improper practice, Sri. Vikram. V, Senior Executive, Grievance Redressal Team, Metlife replied on his e-mail interaction ID: 012517645 dated 20/07 that the matter should be intimated to the company within the free look periode and now the company is not in a position to accept my allegations about the mistakes noted by me. But I can opt for surrender benefit which will come around ` 16, 328.04 approximately for ` 1 Lakh.
When I gone through all the policy T&C send to me, I found that the clause 15 exclusively says about the conditions for Surrender benefit which reads as in page No.7 as- No surrender value is payable during the first three years of the policy. After the first three policy years, the Surrender Value payable on Surrender is equal to the Fund Value in the Unit Account less the surrender charge as mentioned in clause 11 (D).
The clause 11 shown in page No.5, heading as Charges with sub clauses serially numbered as:
1. Premium allocation charge (page 5)
2. Fund management charge (page5)
3. Policy administration charge (page5)
4. Surrender charge (page6)
5. Switching charge (page6)
6. Mortality charge (page6)
7. Rider premium charge (page6)
8. Partial withdrawal charge (page6)
9. Miscellaneous charge (page7)
It is understood that, the charges if any related to surrender benefits to this policy is extensively be mentioned in Clause 11 (D) as per the “Clause 15 Surrender Benefit” of policy T&C. But here in this policy document T&C, the Clause 11 (D) is not incorporated and the reason best to known to the company only. When I queried the insurer under what provisions of T&C of the policy my premium amount is attracting surrender charges, they replied that the surrender charges are applicable as per clause 11-4 of the T&C. But the insurer who drafted the policy terms and conditions forgotten to give definitions or explanations for the clause 11 (D) which incorporated in clause 15 for surrender benefit. As any layman can see that the Clause 15 is exclusively governing about the conditions for surrender and in which it is clearly stated that “…… the surrender charge as mentioned in clause 11 (D)” not as clause 11-4.
When raised up this matter to the knowledge of the appropriate authorities of the concern they also have different opinions and contradictory explanations which are as follows:
-Sri. Vikram. V, Senior Executive, Grievance Redressal Team informed me that the policy owner has the option to surrender the policy after three years and for further clarification refer the surrender clause in the T&C.(from which is clear that the surrender benefit is governing by the surrender clause in the T&C). Further he accepted that is an “incorrect detail” in relation to the disputed clause 11 (D).
In another reply, the same officer mentioned that surrender and other charges details are available in the policy document page 5 and 6 for further clarifications.
-Sri. Sathyappa. K, Senior Executive, Grievance Redressal Team stated in his e-mail that the surrender clause is available in page No.5 and 6 of the policy document in detail. (the surrender charges mentioned exclusively in page No.6 and the clause for surrender benefit is mentioned in page No.7)
-Sri. Kapil Sharma, Senior Manager, Grievance Redressal Team had different opinions and explanations for the clarification about the 11 (D) in the T&C which are as follows:
o The referred clause pertaining to surrender in the policy document is to be read conversely i.e. 11-4 & 11-D (not 11-D it is 11 (D). I think no value for the words and expressions in a contract agreement)
o The reference there is made to clause 11 and sub clause 4 which has details pertaining to surrender (surrender benefit or surrender charge?)
o There is no mistake in the policy terms & conditions and more specifically to the surrender clause (then why the clause 11 (D), moreover there is no such clause termed surrender in the T&C?)
o The surrender charges are applicable as per clause 11-4 mentioned in the T&C (clause 11-4 is mentioned with some surrender charges but what about the surrender charges as per clause 11 (D) mentioned in clause 15?)
o Clause 11 and subsection 4 are to be read conversely as 11 (D) and the nomenclature used (if such what about the other clauses like 11 (A), 11 (E), 11 (H) and 11 (I) mentioned in the policy T&C?)
o There is no change in the policy document or the terms and conditions of the policy, what we are trying to explain is that we need to interpret the numbering conversely (if there is no change in the policy document or the terms and conditions, why to interpret conversely when 11-4 and 11 (D) since the earlier one is numeric and the later is alphanumeric? It can be accepted if mentioned 11.4 or 11 (4) for eg.)
o The surrender clause is explicitly mentioned in clause 11 and subsection 4, hence there is no ambiguity in terms of the applicable charges. Now under clause 15, the reference given is to clause 11 (D), which is to be read as 11 (4) (here again mentioned clause 11 (4) instead of 11-4. Moreover, if there is no change or mistake happened in the policy document T&C why one should read 11 (D) as 11 (4)?)
o There is no mistake and the clause is to be interpreted in conjunction and conversely (what is the reason or intention of putting 11 (D) in clause 15?)
o We have already re-iterated that there is no mistake in the policy document but I do agree that to make it simpler to comprehend we could have mentioned 11 (4) (still they are confusion about the clause 11-4 or 11 (4). If there is no mistake then why to simplify and to comprehend?)
o We would like to reiterate the surrender charges are applicable as per clause 11-4 mentioned in the terms and conditions of the policy (what about the surrender charges mentioned in clause 11 (D) as spelt in clause 15)
From the above it is pertinent to say that, the uppermost authority of the company itself could not able to give transparent and crystal clear explanations/clarifications within the legal frame which governed the insurance industry. But they are very particular about to deduct the charges illegally from this policy, though what are all the surrender charges not mentioned in the policy document terms & conditions in reference to clause 11 (D).
From the changing versions of Mr. Kapil Sharma, it is clear that the company had committed a blunder mistake of non incorporation of clauses 11 (A), 11 (D), 11 (E), 11 (H) & 11 (I) and its contents in the terms and conditions. Now they are giving vague, irrelevant and unconstitutional explanations to claim their mistake as legal.
Above all, on 08/09, the company sent one Ms. Anitha. M, Branch Service Manager, Metlife, Trichy and one Mr. Shiva, some executive of Metlife, Trichy along with one other person, visited my office at around 01.15hrs in the afternoon and verified all the policy documents duly took Xerox copy of page No.5 & 6 of the policy documents. They also thoroughly gone through all documents and orally accepted that as per the T&C, my policy does not attract any type of charges. Added that may be it is a mistake committed by the company and they will send a report to the company as such. But on 09/09, Mr. Vikram. V, Senior Executive of the company reverted by email, stating that, they are not in a position to refund the fund value or waive the charges, since the surrender and other charges are available in the policy document in page No.5& 6. Later Sri. Manjunath. H.C, GRO, Metlife by his interaction on my mobile from 080-26502244 on 12/09 at 14:51PM for a call duration of 00:02:57 hrs, also confirmed the version of former in the same line that the clause 11 (D) should be read as clause 11.4 and it is a mere printing mistake. From the version of both the executives, it is clear that the company does not give any value or veracity of the words, expressions, clauses, sub clauses, legal validity of the policy document as they change it accordingly for the benefit of their concern not to the policy holder.
Apart from the unincorporated T&C in clause 11 (D), there are several other clauses are mentioned in the T&C of the policy document which were not incorporated or explained. They are:
1. In page No.8, Clause 16. Partial withdrawal, 3rd para reads as – the partial withdrawal amount will be paid by encashing units from the surrender value of the withdrawable part as detailed in the surrender provisions after deducting the partial withdrawal charges as mentioned in clause 11 (H).
2. In page No.9, Clause 17. Sub heading Premium (Re) direction, 2nd para reads as – you would have the option to change the premium allocation proportions once every policy year free of charge. Subsequent changes would be considered as an alteration and would attract a miscellaneous charge as detailed in clause 11 (I).
3. In page No.9, Clause 17. Sub heading Unit Allocations, 1st para reads as – Net premiums (paid before the premium due date) after premium allocation charge as in clause 11 (A) will be used to buy units in the Unit Linked Funds using the Net Asset Value as on the premium due date.
4. In page No.9, Clause 17. Sub heading Unit Allocations, 2nd para reads as - Net premiums (paid after the premium due date) after premium allocation charge as in clause 11 (A)(Net Premiums) will be used to buy units in the Unit Linked Funds using the Net Asset Value as below:
5. In page No.11, Clause 23. Switches between Unit Linked Funds, 1st para reads as- Switching between Unit Linked Funds can be done at any time after the first six months by submitting a written request to the company. On request the Fund Value in the Unit Account can be switched to the new Unit Linked Fund after deducting the switching charge as mentioned in clause 11 (E).
As such, it is evident that, either, there may be some conditions and terms as per the alphanumeric clauses 11 (A) to 11 (I) in clause 11 and that are exclusively governing some conditions on the related issues as mentioned above. Since the policy issued to me does not attracts any charges for Partial withdrawal vide Clause 11 (H), Premium (Re) direction vide clause 11 (I), Unit allocation vide Clause 11 (A), Switches between unit linked funds vide Clause 11 (E) and at last Surrender charge as mentioned in Clause 11 (D), because the conditions governing to the above spheres are not incorporated in the policy document issued to me.
Or in other hand, the company intentionally left about the above clauses categorically to suppress or conceal the real facts regarding the clauses from the policy holder to engage them in the insurance to flourish their business.
If it is all printing mistakes, the company can amend or correct the mistakes as per Clause 10 - Other conditions governing unit linked funds-Changes to terms and conditions in page No.4 and that also has been not done.
After exhausting all the redressal mechanisms provided by the insurance company, my statutory right of surrendering the policy as per the terms and conditions is still unsolved and unheard by the company. Without any fear or guilty conscious the company clearly stated that they can’t surrender the policy without surrender charge and clarifying their status quo without any legal aspects added with an advice to me that if I am not satisfied with their stand raise up the issue with Insurance Ombudsman.
On the other hand, while settling a claim for a policy, if an irrelevant mistake or fault in the documents will be lead to the dismissal of the claim, but the above severe mistake committed by the company is not taking in to consideration. In both ways the customer will become scapegoat.
When the complaint does not find any satisfactory deliverance from the insurance company, I escalated the matter to IRDA vide token No. 10-11-017277 dated 26th Sep.. In this regard the IRDA vide their letter dated 13th Oct., advised me to raise the issue with Ombudsman, since the nature of grievance falls within the scope of RPG Rules 1998. Even though the matter escalated to IRDA, the insurance company replied they are in the same status quo to not return my money as per Clause 15 of the terms and conditions of policy.
It is nothing but clear cut violation of policy T&C and core ethics of Insurance business. Hence it is requested that, taking in to consideration of all the above said evidences, treat the policy contract as void for the mistakes committed by the insurer to protect the interest of policy holder. Keeping in view of the above developments, it is sincerely upraised the following as legal rights to claim my invested amount of one lakh with benefits:
a) The policy terms and conditions clause 15 solely explaining about the terms for surrendering a policy after completion of three years.
b) Though the surrender charges mentioned in clause 11-4, the surrender charges attracted to this policy as per clause 15 in the event of providing surrender benefit to any policy holder is clearly mentioned that the surrender charges as per 11 (D).
c) The unambiguous clause for charges in clause 11 running from page 5 to 7 of the policy terms and conditions explains about surrender charges as per clause 11-4 but not mentioned anything about what are all the surrender charges as per clause 11 (D). Hence using clause 11-4 for deducting surrender charges from this policy is violation of policy terms and conditions and also violating the contract agreement.
d) The other charges like unit allocation charge is also clearly mentioned in clause 19 and in which it is explicitly mentioned that the premium allocation charge as per clause 11 (A) will be deducted from the net premium paid before the premium due date. The company used the clause 11-1 of the policy terms and conditions to deduct the aforesaid charges from this policy are violation of policy terms and conditions and also violating the contract agreement.
e) The contents of this policy document and terms & conditions to be treated as a legal document by virtue of registering under stamp duty Act. However, any changes in the law, legislation or taxation, change in circumstances etc. can be done only with the prior approval of IRDA which is clearly mentioned in clause10. Without adopting all these legal frameworks, the company or its representatives or the authorized persons cannot interpret any words, phrases, numbers, letters, combinations of numbers/symbols/letters etc.
During the period of correspondence with the company in conflict with the clause on surrender charge mentioned in clause 15, the company adopted some other method to pacify me with a third party. The reply e-mail of Mr. Vikram. V dated 17th Aug is very much evident that the company is behind the episode. If they are in a safe corner why they adopted such mal practices to settle the issue?
Quoting all the above facts and with documentary evidence the issue has escalated to Insurance Ombudsman on 09/03 and they also rejected my complaint vide reference I.O (HYD):L-20-0012-986-12/03 dated 14/03 delivered on 14/04 with a reason that “The matter relating to the complaint is beyond the purview of the Office of the Insurance Ombudsman and hence it is not entertainable” but not mentioned what are all the reasons to reject my complaint.
If such is the situation how can a customer get justice for the mistake not committed by him.
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