Date of Filing       : 26.09.2016

                                                                                                                                 Date of Disposal:  01.08.2019

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

THIRUVALLUR

PRESENT: THIRU.   J. JUSTIN DAVID., M.A., M.L.,                    .…. PRESIDENT

                   TMT.      K.PRAMEELA. M.Com.,                                …..MEMBER-I

                   THIRU:  D.BABU VARADHARAJAN., B.Sc., B.L.,      ….MEMBER-II

CC.No.01/2017

THIS THURSDAY THE 1^st   DAY OF AUGUST 2019

 B.Ramasamy,

S/o.R.Balakrishnan,

H-22/3, 1^st Floor,

Aiswaryam Tower,

East Avenue,

Korattur,

Chennai -600 080.                                                                      …… Complainant.

                                                                   //Vs//

Aegon Life Insurance Company Limited,

Represented by its Manager,

Unit 4A, 4^th Floor,

A Block, Meena Kampala Arcade,

No.18 and 20, (Old No.113/114),

Sir Thyagaraya Road,

T.Nagar, Chennai -600 017.                                                     ……...Opposite parties

This complaint is coming upon before us finally on 18.07.2019 in the presence of M/s.P.R.S.Bharanivel Raaj and Mr.M.V.Seshachari, Counsel for the complainant and M/s.L.Thanigaivel , Counsel for the opposite party and having perused the both side documents and evidences, this Forum delivered the following:

ORDER

PRONOUNCED BY THIRU. J.JUSTIN DAVID, PRESIDENT.

This complaint has been filed by the complainant U/S-12 of the Consumer Protection Act-1986 against the opposite party for seeking direction to issue insurance policy as per the policy terms chosen by the complainant with premium payment terms of 5 years and policy terms of 10 years option or to pay sum of Rs.1,52,996/- being the premium paid by the complainant to the opposite party and to pay a sum of Rs.2,00,000/- towards compensation for the mental agony, hardship and strain caused  due to the deficiency in service and to pay a sum of Rs.15,000/- towards the cost of this litigation to the complainant.

2. Brief Averments in the complaint filed by complainant is as follows:-

   The complainant received telemarketing call from Jai Sri Ram Brokers stating that he was telemarketing agent of the opposite party and offered three policies with premium payment terms of 5, 10, 15 years and the policy term of 10, 15, 20 years respectively.  The complainant chose the policy with premium payment terms of 5 years and policy terms of 10 years option.  On 24.02.2015 the complainant had signed the proposal form Nos. as follows.

The complainant paid a sum of Rs.34,813/- through IVR Tele Banking service on 25.02.2015 and a sum of Rs.65,000/- paid by way of Cheque in favour of the opposite party on 25.02.2015 and a sum of Rs.87,998/- paid on 17.03.2015 through IVR Tele Banking services. The complainant received two letters on 18.03.2016 and another letter on 21.03.2015 from the opposite party demanding additional premium amount. As per the terms of the above letters the complainant has directed to sign in a copy of letter and submitted the same to the opposite party within a period of 14 days from the date of receipt the letter.  As per the above said letter, the opposite party has demanded additional premium from the complainant as follows.

The complainant received two polices on 20.03.2015 and another policy dated 23.03.2015 from the opposite party.  In the above said insurance policies, the opposite party without consent of the complainant and without waiting for 14 days time period mentioned in the aforesaid letters dated 18.03.2015 and 21.03.2015, had reduced the sum assured and also altered the policy and premium paying terms.  The details of the policies issued by the opposite party are as follows.

The opposite party without consent of the complainant has changed the policy terms as 15 years and premium payment terms as 10 years as against the policy term of 10 years and premium payment terms of 5 years as applied.  Further, the signature of the complainant had been forged at several places. The complainant neither agreed for reduced sum nor any such endorsement was made by the complainant.  The signature of the complainant in the said application had been forged by the opposite party. The complainant went to the office of the opposite party’s agent Jai Sai Ram Telemarketing agencies wherein the Manager namely Mr.Govindaraj has assured to get the defects rectified and gave an assurance in writing.  Thereafter on insistence of the complainant, the said agent took the complaint to the T. Nagar office of the opposite party wherein a complaint was made to the opposite party and all the original polices were surrendered to the opposite party.  But the complainant received a reply dated 01.07.2015 from the opposite party refusing to accept the request of the complainant to change the premium, premium payment term and policy term. The original insurance policies were also returned to the complainant.  The complainant has lodged a complaint as against the opposite party with the insurance ombudsman on 27.01.2016.  The insurance ombudsman had passed an order dated 15.02.2016 upholding the conduct of the opposite party.  The complainant received intimation by way of SMS on 21.03.2016 from his banker M/s.Axis Bank, Korattur Branch intimating that there is a request for ECS from the opposite party for the next year premium payment and asked the complainant to increase the funds in account of the complainant. The complainant had never submitted any application for ECS Mandate with his banker and never submitted any such application form with the opposite party.  Further the opposite party had sent a receipt dated 23.03.2016 for a sum of Rs.64,943/- as if the complainant had paid renewal premium for policy No.150214341026, which no such payment was paid by the complainant.  Axis Bank, Korattur Branch had also deducted a sum of Rs.300/- per policy totaling Rs.600/- for ECS return and the act of the opposite party amounts to deficiency in service.  Due to the act of the opposite party, the complainant had been put to severe hardship and mental agony.  Therefore the complainant had sent a letter dated 24.04.2016 to the opposite party once again requesting the opposite party to cancel all the policies and return the premium amount paid by the complainant.  Though the opposite party had received the said letter, they have neither replied nor complied with the demands made by the complainant.  However, the opposite party on 03.06.2016 has returned a sum of Rs.34,813/- being the premium paid on policy No.150214340376 stating that the said policy was cancelled within the free look period and that the action of the opposite party is highly illegal and unlawful.  The opposite party has failed for modify three polices issued to him.  Therefore, the opposite party ought to have returned the premium amount paid by the complainant in respect of all the three policies and not in respect of one policy alone.  Further the opposite party has refunded the aforesaid premium amount of Rs.34,813/- only on 07.06.2016 after the lapse of 15 months.  When the policies have been cancelled during the free look period itself, the opposite party ought to have refunded the amount immediately and the above act of the opposite party in refunding the premium amount after lapse of nearly 15 months amounts to deficiency in service.  Hence the complainant is constrained to file this present complaint.

3. The brief contention of written version of the opposite part is as follows:-

Aegon Life Insurance Company Limited is a Life Insurance Company and registered under the provision of section 3 of the Insurance Act-1938 and the relevant provision of the companies Acts-1956 and is engaged in business of providing life insurance cover to its customers.  On perusal of the complaint, it is evident that all the allegations are against the broker “Jai Sai Ram Broker, Chennai” but the complainant has not made the broker as a party in the complaint.  The company has issued the said policies in March 2015 as per mandate given by the complainant and has provided cover on his life.  The complainant has a period of 15 days free look to cancel or make any rectification in the policy, if he did not agree with the policy terms and conditions.  The complainant approached the company after 91 days for change of policy terms. But the complainant requested the company to cancel one policy and assured that he will continue two policies for 10 years.  The complainant filed a complaint with the ombudsman for cancellation of policies and the case did not sustain and was dismissed on 11.01.2016.  On 24.02.2016 the company as a special case, cancelled and refunded entire premium of Rs.34,813/- of policy No.150214340376.  After this the complainant neither paid any further renewal premiums nor approached the company and the complainant filed this present frivolous complaint with mala fide intentions and has misused the process of law.  In the present case, the respondent has acted strictly as per the mandate provided to it by the complainant in the proposal forms and issued the insurance policies in conformity with the insurance proposal received by it.  The company received the duly filled and signed proposal forms of the complainant and as per the mandate given in the form, believing what is stated in the proposal forms to be true and correct, issued the aid policy.  The company had made a call to the complainant at the policy pre-issuance stage to reconfirm the details and terms and conditions of the plan mentioned in the proposal forms.  The policies were issued only after confirmation from the complainant.  After receiving the policy document, the policy holder has a period of 15 days i.e., free look period during which if he is not satisfied with the applicable provisions of the subject policy, he could return the policy to the company.  In such circumstances the company would refund back the 1^st premium amount in accordance with regulation 6(2) of the IRDA (protection of policyholders’ interests) regulations 2002.  The complainant approached the company on 22.06.2015 i.e. after 91 days which is much beyond the 15-days mandated free look period for change of policy terms, the terms and conditions and the welcome letter clearly mentioned the provisions of free-look period.  The company rejected the request vide email dated 01.07.2015.  The complainant is not entitled to the relief prayed or any other relief for reasons mentioned in the proceeding Paras of this reply.  All the terms and conditions and benefits payable are mentioned in the proposal forms.  It is the duty of the complainant to read the policy documents carefully and then sign the same.  The complainant himself has slept over his right and not approached the company in the free-look period for cancellation or any changes of the policies.  That the complainant has not paid further renewal premiums and the complainant cannot put the onus on the respondents for his mistake and carelessness.  Hence this complaint should be dismissed in limine.

4. In order to prove the case, on the side of the complainant, the proof affidavit is filed as his evidence and Ex.A1 to 18 were marked.  While so, on the side of the opposite party, the proof affidavit submitted for his evidence and Ex.B1 to B10 are marked and also adduced oral argument on both sides.

5. At this juncture, the point for consideration before this forum is:-

(1) Whether there is any deficiency in service on the part of the opposite party?

(2) Whether the opposite party is liable to issue insurance policy to the complainant or to pay a sum of Rs.1,52,996/-to the complainant?

(3) Whether the complainant is entitled for compensation and cost from the opposite party?

(4) To what other reliefs, the complainant is entitled?

6. Point Nos.1 to 3:-

The complainant has submitted his proposal form to the opposite party through Broker of the opposite party namely JAI SAI RAM for taking polices and the proposal forms are marked on the side of the complainant as well as on the side of the opposite party. The complainant signed the proposal form No. 150214340376, for which he has paid a sum of Rs.34,813/-on 25.02.2015 towards premium and signed another proposal form No. 150214341026, for which he has paid a sum of Rs.65,000/- towards premium on 25.02.2015 and third proposal form No. 150314362905, for which he has paid a sum of Rs.87,998/- towards premium on 17.03.2015.  The opposite party also issued three policies to the complainant.  But the opposite party through letter demanded additional premium seeking there was elevated blood pressure to the complainant.  The opposite party demanded premium of Rs.40,222/- instead of premium amount of Rs.34,813/- for the proposal No.150214340376, demanded Rs.72,665/- instead of 64,998/- for the proposal No.150214341026 and also demanded Rs.98,377/- instead of 87,998/- for the proposal No.150314362905.  The complainant alleged that he has not given any consent for the change of policy terms and change of sum assured and premium and further alleged that the signature of the complainant has been forged by the opposite party.  The complainant has submitted the proposal form and other application to the opposite party through opposite party broker JAI SAI RAM, but the complainant has not added the broker as a party in the complaint.  The broker JAI SAI RAM is the necessary party in this complaint to prove the allegation regarding forgery signature of the complainant. Further the complainant has not filed any documents or evidences to prove the allegation of the forgery.

7. It is admitted by both the parties that the complainant had submitted three proposal forms for the premium amount of Rs.34,813/, Rs.65,000/, Rs.87,998/for issuance of  three insurance policies respectively and the opposite party has given three insurance policies.  But the opposite party issued insurance policies with premium amount of Rs.40,222/-, Rs.72,665/-, Rs.98,377/-respectively.  The complainant also received the policies in the month of May 2015 itself.  In the policies issued by the opposite party it is clearly stated if policy holder has not satisfied with any of the terms and conditions of the policy, policy holder may return the policy document to the company for cancellation along with a letter stating the reasons for disagreement within 15 days from the date this policy holder received the policy.  But here in this complaint the complainant has not returned the policy to the opposite party for cancellation within 15 days from the date of received the policy documents.  On the other hand, the complainant sent a letter to the opposite party on 17.06.2015 after 85 days.   Therefore the opposite party rejected the request of the complainant.  If really the complainant has not satisfied the policy terms and conditions then he ought to have returned the policy to the opposite party and seek refund the first premium within 15 days from the date of receipt of the policy.  But the complainant has not issued any letter to the opposite party to change the sum assured, period of policy and also premium payable.  The complainant has written a letter only on 17.06.2015 to the opposite party.  Ex.A8 is the copy of letter issued by the complainant to the CUSTOMER SUPPORT MANAGER of the opposite party dated 17.06.2015.  In this letter the complainant requested for change of policy and premium payment and the same was received by the opposite party on 22.06.2015, for which the opposite party sent a reply letter to the complainant on 22.06.2015.  Ex.A9 is the copy of reply letter.  In this letter the opposite party clearly stated about the cancellation of the policy as per the terms and conditions.  Therefore the opposite party has rejected the claim of the complainant.  Thereafter the complainant filed a petition before OFFICE OF THE INSURANCE OMBUDSMAN and OFFICE OF THE INSURANCE OMBUDSMAN also rejected the claim of the complainant.  Ex.A13 is the copy of award passed by the INSURANCE OMBUDSMAN.  The complainant very well aware of the terms and conditions of the policy and also the complainant is a graduate engineer, he might understood the terms and conditions of the policy.  The complainant if not satisfied the above polices, he ought to have cancelled the policies within the 15 days from the receipt of the policies.  But the complainant has not taken any steps to cancel or modify the policy as per the terms and conditions mentioned in the policies.

8. The complainant prays for an order against the opposite party to issue the insurance policy as per the terms and conditions chosen by the complainant or to pay a sum of Rs.1,52,996/- from the opposite party.  The complainant has taken three policies from the opposite party but in this complaint he prays for issuance of insurance policy.  With respect of the above said prayer the opposite party refunded the premium amount of Rs.34,813/-on 07.06.2016.  The complainant also admitted in the complaint about the return of premium amount of Rs.34,813/-. Since the complainant cancel the policy, the opposite party returned the premium amount of Rs.34,813/- with respect of one policy and therefore the  question of issuance of policy as per the terms chosen by the complainant does not arise.  Further the opposite party issued two insurance policies to the complainant, hence the question of payment of Rs.1,52,996/- does not arise.  Therefore the complainant is not entitled for issuance of policy as per the terms and conditions chosen by the complainant or payment of sum Rs.1,52,996/- by the opposite party. Therefore the opposite party is not liable to issue insurance policy as per the policy terms chosen by the complainant or not liable to pay a sum ofRs.1,52,996/- to the complainant.

9. It is admitted by the both parties that the complainant has cancelled one policy and the opposite party repaid the amount of Rs.34,813/- being the premium in policy No.150214340376.  But there is a delay of 15 months in refunding the premium amount.  It is the duty of the opposite party to repay the premium amount immediately on cancellation of the policy.  But here in this complaint there is delay in repayment of premium amount of Rs.34,813/- in respect of policy No. 150214340376 to the complainant and the above delay in payment of premium to the complainant amounts to deficiency in service and therefore the opposite party committed deficiency in service and the complainant is entitled for compensation of Rs.10,000/- and costs. Thus the point No.1 to 3 are answered accordingly.

10. Point No.4:-

In the result, this complaint is allowed in part.  Accordingly, the Opposite Party is directed to pay a sum of Rs.10,000/- (Rupees ten thousand only) towards compensation for causing mental agony to the complainant due to the deficiency in service on the part of the opposite party and also to pay a sum Rs.5,000/-(Rupees five thousand only) towards cost of this litigation to the complainant. With respect to other reliefs, this complaint is dismissed.

The above amount shall be payable by the opposite party within two months from the date of receipt of the copy of this order, failing which, the said amount shall carry interest at the rate of 9% per annum till the date of payment.

Dictated by the president to the steno-typist, transcribed and computerized by him, corrected by the president and pronounced by us in the open forum on this 01^st August 2019.

      Sd-                                     Sd-                                                          Sd-                                                                         

  MEMBER-II                     MEMBER-I                                         PRESIDENT

List of documents filed by the complainant:-

List of documents filed by the opposite party:-

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MEMBER-II                                     MEMBER-I                                         PRESIDENT