Delhi

West Delhi

CC/12/154

Smt Sarika Kapoor - Complainant(s)

Versus

Aegon Religare Life Insurance Company limited - Opp.Party(s)

08 Feb 2017

ORDER

CONSUMER DISPUTES REDRESSAL FORUM (WEST)

GOVERNMENT OF NCT OF DELHI

150-151, Community Centre, C-Block, JanakPuri, New Delhi – 110058

 

                                                                                                       Date of institution: 05.03.2012  

Complaint Case. No.154/12                                                                                     Date of order:  08.02.2017                  

IN  MATTER OF

Smt Sarika Kapoor, R/o E-11/6, Vasant Vihar, New Delhi-110057                                                                                                                                                                              Complainant

VERSUS

Aegon Religare Life Insurance Company limited, 5B/3, 1^st floor, Tilak Nagar, Main Road, Delhi.                                                                                                                             Opposite party

 

 

ORDER

R.S. BAGRI,PRESIDENT

This complaint U/S-12 of the Consumer Protection Act is filed by Smt Sarika Kapoor named above herein after referred as the complainant for directions to the opposite party to refund Rs. 2,20,000/- of Premium of Policy nos. 091111092429 and 110112951073 paid by the complainant to Aegon Religare life insurance company limited herein after referred as the opposite party with interest @ 8% per annum and pay Rs. 2,00,000/- as damages for mental harassment and agony on account of unfair trade practice and deficiency in service on the part of the opposite party.

            The brief relevant facts necessary for disposal of the complaint are that in November 2009 the opposite party approached the complainant to invest in a 3 years plan with insurance cover with the opposite party. The complainant was to pay Rs. 50,000/- per annum for three years. But infact the plan was an insurance policy for 20 years for which first premium of Rs. 50,000/- was to be adjusted at the time of maturity of the insurance policy at the end of 20 years. At the time of taking of the plan agent of the opposite party did not show any illustration to her. Signature of the complainant are forged on the illustration at the back of the insurance policy.

            The complainant again in the month of January 2011 was contacted by Ravi Malhotra. Who introduced himself as Zonal Manager of the opposite party. He told the complainant

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that in “ Common Wealth Games “ the opposite party had made a profit of Rs. 1800 crores and to avoid payment of taxes on the profit the opposite party wanted to give bonus to its existing policy holders. The policy holder who invested Rs. 50,000/- with the opposite party   was to be given bonus of Rs.68,000/-, who invested Rs. 85,000 was to be given bonus of Rs. 1,13,532/-. The complainant trusted him. She had already suffered loss of Rs. 50,000 in the earlier policy, therefore, she did not hesitate to invest Rs. 35000/- more and earn bonus of Rs. 1,13,532 and recover her loss. Continuing with the earlier policy was not feasible for the complainant as the premium was a big amount for the complainant. Who is a single non-working parent and having a school going kid.

            On 24.01.2011, Mr. Pankaj Bhatia, who is Business Development officer of the opposite party came to the complainant. He offered her a money back plan. The complainant accepted the plan and policy letter of policy no. 110112951073 was issued on 31.01.2011. Even this time also the complainant was not shown any illustration by the agent of the opposite party. The complainant made her son nominee and her mother appointee of her minor son. Even signature of the appointee are forged.

            Ravi malhotra assured the complainant that check of bonus would reach the complainant in first week of February. But when 15 days passed she contacted him. He told the complainant that cheque was ready for dispatch. After 4-5 days some other employee of the opposite party contacted the complainant and told that he was calling from IRDA. They had received file of the complainant for paying bonus and cheque of bonus of Rs. 48,000/- after deducting TDS was ready and if she wanted bonus of Rs. 1,13,532 she was to invest Rs. 50,000 more. She suspected foul play and contacted Mr. Malhotra. Who assured that she was getting bonus of Rs. 1,13,532. The complainant again contacted Mr. Malhotra in March and inquired about bonus. Who told that it was financial year end. She would get check in April. But when the complainant in April tried to contact him he stopped taking her calls. She called to customer care of the opposite party and came to know that no bonus was declared by the opposite party.

            On 08.04.2011 she lodged a complaint at customer care of the opposite party. She made written complaint on 13.04.2011. She received reply from the opposite party that the policies are issued  as per rules and regulations after submitting proposal form and other documents by her.

            The complainant made written complaints to IRDA through post and e-mail dated 19.07.2011 and to the opposite party through e-mail dated 13.06.2011. But she did not receive any reply either from the opposite party or from IRDA. The opposite party has

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played fraud upon the complainant. There is unfair trade practice and deficiency in service on the part of the opposite party. Hence the present complaint for directions to the opposite party to refund Rs. 2,20,000/- of Premium of Policy nos. 091111092429 and 110112951073 paid by the complainant to the opposite party with interest @ 8% per annum and pay Rs. 2,00,000/- as damages for mental harassment and agony on account of unfair trade practice and deficiency in service on the part of opposite party.

            Notice of the complaint was sent to the opposite party. They appeared and filed reply to the complaint while contesting the complaint and raising preliminary objections that this forum has no territorial jurisdiction to entertain and adjudicate the complaint as no cause of action arose within  territorial jurisdiction of this forum, concealment of  relevant and true facts, distortion of facts and the complainant has alleged forgery of signature by the opposite party and to adjudicate the issue of forgery examination and cross-examination of witnesses is required. The dispute cannot be decided in summary proceedings. This issue can be decided by a Civil Court only. Hence this forum has no power to entertain and try the present complaint.

            On merits the opposite party asserted that on receipt of proposal forms from the complainant for issuances of insurance policies and believing the information given by her in the proposal form to be correct the insurance policies were issued. The policy no. 91111092429 was issued in favour of the complainant on 24.11.2009 with annual premium of Rs. 50,000/. The insurance policy was sent to the complainant on 24.11.2009 through courier and was received by her on 26.11.2009.The complainant for the first time made complaint on phone 07.04.2011 after 497 days from receipt the policy. Similarly the policy no. 110112951073 was issued on 31.01.2011 in the name of complainant with annual premium of Rs. 34,999/-. The policy was dispatch to her on 21.02.2011 and was received by her 23.02.2011. The complainant made first complaint on 07.04.2011 after lapse of a period of 43 days from receipt of the policy. Whereas free look period is 15 days from receipt of the policy as per the welcome kit. All other allegations of the complaint are denied and asserted that all documents are signed by all concerned. There is no forgery by the opposite party. The complainant has taken two insurance policies and after expiry of 15 days of the free look period the policy cannot be cancelled as per the terms and conditions of the insurance policy. The opposite party again prayed for dismissal of the complaint.

            The complainant filed rejoinder to the reply of the opposite party, while controverting their stand and reiterating her claim. She again prayed for directions as prayed for.

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When the complainant was asked to file affidavit in support of her complaint, she filed her affidavit dated 25.03.2013. Wherein she once again narrated the facts of the complaint. The complainant in support of her complaint has relied upon insurance policy nos. 091111092429 dated 24.11.2009 and 110112951073 dated 31.01.2011, letters of free look option, policy schedule, receipts of payment of premiums dated 24.11.2009 and complaint dated 13.04.2011, letters dated 10.04.2014, 14.04.2011, 15.04.2011, 27.04.2011, 28.04.2011 and 22.06.2011 and copy of complaint made by complainant to the customer care of opposite party.

            The opposite party filed affidavit of Shri Jitin Pramodrai Parekh dated 10.07.2013. Wherein he narrated facts of the reply and prayed for dismissal of the complaint.

We have heard the complainant and counsel for opposite party and have gone through material on record carefully and thoroughly.

After having heard both the sides, going through the complaint, reply, affidavits and documents relied upon by the parties it is evident that the complainant submitted proposal form on 20.11.2009 in the office of opposite party for 20 years life insurance policy on payment of Rs. 50,000/- annual premium. The complainant paid Rs. 50,000/- of premium vide receipt dated 24.11.2009. The opposite party sent free look option letter to the complainant on 24.11.2009. The free look option letter was received by the complainant on 26.11.2009. The complainant made first complaint on 13.04.2011 after lapse of a period of 497 days. Whereas the complainant could get the proposal form cancelled or change terms and conditions of the insurance policy within 15 days from receipt of the free look option letter.

The complainant submitted another option form with the opposite party on 27.01.2011. The opposite party issued insurance policy no. 110112951073 on 31.01.2011. The opposite party sent free look option letter to the complainant on 21.02.2011. Which was received by the complainant on 23.02.2011. The complainant made complaint 07.04.2011 after a lapse of period 43 days. Whereas she could withdraw the option form within 15 days from 23.11.2011 payment of first premium of Rs. 34,999/- and receipt of free look option.

Before proceeding further it is worth while to reproduce regulation 6(2) of the Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002 here in after referred as the Regulations. Which reads as under:-  

‘’Regulation 6 (2) While acting under regulation 6(1) in forwarding the policy to the insured, the insurer shall inform by the letter forwarding the policy that he has a period of

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15 days from the date of receipt of the policy document to review the terms and conditions of the policy and where the insured disagrees to any of those terms or conditions, he has the option to return the policy stating the reasons for his objection, when he shall be entitled to a refund of the premium paid, subject only to a deduction of a proportionate risk premium for the period on cover and the expenses incurred by the insurer on medical examination of the proposer and stamp duty charges. ‘’

            Hon’ble State Commission of U.T. Chandigarh in appeal no. 276/2012 titled Subhash Chander vs. Aegon Religare Life Insurance Company Ltd. decided on 06.11.2012 held that the policies as per regulation 6(2) of the Regulation option for cancellation of the policy or change in terms and conditions of the policy can be exercised within 15 days. When the option of free look period is exercised after a lapse of a period of 15 days from receipt of the letter for option for free look period no relief can be granted.  

            Similar are the facts of the present complaint the policy no. 091111092429 was taken by the complainant on 24.11.2009. The free look period option letter dated 24.11.2009 was received by the complainant on 26.11.2009. The complainant for the first time made complaint on 07.04.2011 after lapse of a period of 497 days. The policy no.110112951073 was issued in the name of complainant on 31.01.2011. The letter for free look period option was despatch to the complainant on 21.02.2011 and received by her on 23.02.2011. The complainant made complaint on 07.04.2011 after lapse of a period of 43 days. The complainant did not exercise her right under Regulation 6(2) of the Regulations within 15 days from issuance of the insurance policy and receipt of the option letter by the complainant.

            Admittedly, the complainant in respect of policy no. 091111092429 dated 24.11.2009 made complaint after a lapse of a period of 497 days and in respect of policy no. 110112951073 dated 31.01.2011 made complaint after 43 days. Therefore, the complaint is not entitled for any relief.   

The Complainant has alleged forgery of her signature by Opposite Party and the said aspect can be properly adjudicated only after taking detailed evidence of the parties, therefore, the complaint cannot be tried before by this forum. Where the complaints are adjudicated through summary procedure under the Consumer Protection Act. The parties in order to prove their case are required to produce witnesses and opportunity to examine, cross examine and re-examine various witnesses. The allegations of the complainant that her signatures were forged are required to be proved by way of evidence of handwriting and finger print expert. The opportunity of examining and cross examining the said expert witness shall be required to be given to adjudicate the present complaint, thus continuance of present summary proceedings as per the provisions of the Consumer Protection Act, will

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be highly prejudicial to the interest of the respondent. Thus in view of above present proceedings cannot be adjudicated in summary proceedings.

Our opinion is supported by case law reported as Janta Machine Tools Vs. Oriental Insurance Co. ltd. (1991) (I)  CPJ 234 (NC) and Panalal vs. Bank of India and Ors. (1992) (II) CPJ 487 (NC).

 It is evident from the above that the Complainant’s is not a simple case of deficiency in service rendered by the Bank. It involves determination of complex questions of facts and law which cannot be satisfactorily determined by this forum under the Consumer Protection Act. It would be better for the complainant to seek redress of her grievances in a Civil Court if so advised. With these observations the complaint is dismissed. The complainant is free to seek redress in a Civil Court if she so chooses.

 

Order pronounced on :

• Copy of order be sent to the concerned parties free of cost.
• Thereafter, file be  consigned to record.

 

 

 

(PUNEET LAMBA)                                    (URMILA GUPTA)                                        (R.S.  BAGRI)

   MEMBER                                                       MEMBER                                                  PRESIDENT