Order No.  8  dt.  22/02/2017

       The fact of the case in brief is that in December,2013 and June 2014 o.p.no.3 approached the complainant to invest money to o.p. nos. 1 and 2  for purchasing  a life insurance policy. O.p.no.3 convinced the complainant that the policy would be against one time payment and after one year the complainant get the premium amount with 8.36% p.a. By the alluring proposal given by o.p.no.3 complainant invested Rs.50,000/- by draft being no.883618670 dated 29.01.2014 drawn on Indian Overseas Bank to purchase the policy and accordingly the policy was issued  by o.p.nos. 1 and 2  being no.0312177396.  Complainant  received the policy on 26.02.2014. After perusal of the document complainant became surprised to find  that the policy is of a regular policy and the premium would be paid annually for 12 years. On 02.03.2014 complainant requested o.p.no.3 over phone to cancel policy and requested to arrange for refund of the premium amount. Complainant also surprised to find that o.p. nos. 1,2 and 3 filled up the permanent address column in the proposal form on the basis of Ration Card and the bank savings account of the complainant. But the complainant was maintaining a current a/c with the bank. The complainant sent a letter on 17.04.2014 intimating the aforesaid lapses in the proposal form. The said letter was received by o.p.no.1 and 2  on 19.304.2014. O.p.no.1 intimated  the complainant vide their email dated 28.10.2014 that the complaint was sent to concerned department for updating. Thereafter complainant contacted with call center of o.p. on 12.02.2015 and 13.02.2015 requesting them to refund the amount. But to no effect.  Complainant also sent an email on 24.02.2015 requesting o.ps to return the premium amount but in vain. Hence the application praying for direction upon o.p.nos. 1,2 and 3 to refund the premium amount of Rs.50,000/- along with compensation of Rs.40,000/- and cost of Rs.10,000/-

          O.p. nos.1 and 2 appeared before this Forum and filed their w/v. In their w/v o.ps 1 and 2  denied all material allegation inter alia stated that the crux of the complaint is against the agent i.e. o.p.no.3. Therefore, the o.p.nos.1 and 2  are not responsible for any promises made by o.p.no.3. The policy in question is based on duly filled in and signed by the complainant. There is no dispute about the fact that the complainant had signed the proposal form. In the instant case the Insurance Policy has been issued on the principle of utmost good faith. The insurer cannot be made liable for the unauthorized action of any third party or the agent who is guided  by the Regulations of IRDA. The agent is conventionally used to mean Insurance Salesman and the term does not mean and should not be construed that there is a principal-agent relationship between the insurer and the insurance salesman. Hence o.p.nos. 1 and 2  cannot be held responsible. The complainant did not approach the o.p. nos.1 and 2  within 15 days free look period. Complainant has already enjoyed the insurance coverage for the perioed for which the premium was paid. Hence no question of refunding of premium, compensation, cost does not  arise at all. Hence the case is liable to be dismissed with cost. Though the notices were served upon o.p.no.3 and proforma o.p. no.4, they did not  contest the case by filing w/v. So  the matter was fixed ex parte as against o.ps 3 & 4.

Decision with reasons

          It is admitted fact that the complainant paid Rs.50,000/- for purchasing a Life Insurance Policy from o.p. nos. 1 and 2 through o.p. no.3. Accordingly  o.p. nos. 1 and 2 issued the policy being no.0312177396. In the complaint petition complainant stated that he received the policy on 26.02.2014 and after going through document complainant came to know that the premiums have to be paid for consecutive 12 years. Then on 02.03.2014 complainant requested the o.p.no.3 to cancel the policy and to refund the premium amount. Complainant alleged that in the proposal form the Ration Card no.  and the type of bank account had been mentioned wrongly but when the complainant received the policy on 26.02.2014 immediately thereafter he informed that matter to o.p. no.3. Complainant filed a photocopy of letter addressed to o.p.no.1 for returning  the policy bond. We find the photocopies of AD Card annexed with complaint petition wherefrom it reveals that the letters were received by o.p. nos. 1 and 2  on 19.04.2014. Thereafter  on 28.10.2014 o.p. nos.1 and 2 sent a letter through email that they have received the complaint and they had sent the complaint to the concerned department and they would updated  the complainant with the details shortly. Thereafter on 24.02.2015 o.ps sent a letter through email informing the complainant that their Customer Service Executive would get in touch with the complaint within 48 hours. Thereafter o.p. nos.1 and 2 did not contact with the complainant.

          In the w/v o.p. nos. 1 and 2 stated that the case of the complainant is against o.p.no.3 not against o.p. nos.1 and 2. But o.p.nos 1 and 2 had not denied that o.p. no.3 is not their agent. When the complainant made his grievance against o.p.no.3 for mis selling the policy in question. O.p nos. 1 and 2 did not take any initiative to look into the matter by communicating with o.p.no.3. The letters of the complainant received by o.p.nos 1 and 2  on 19.04.2014. Immediately thereafter o.p. nos. 1 and 2 did not give any reply to the complainant. After the lapse of four months on October,28, 2014 o.p.nos. 1 and 2 informed the complainant that his complaint had been sent to concerned department. But ultimately what was the status of the policy of the complainant it was not informed to the complainant. O.p. nos 1 and 2  had not denied that on 02.03.2014 i.e within one week after receiving the policy in question, complainant contacted  with o.p.no.3 for cancellation of the policy. The plea of the o.p. nos. 1 and 2  taken  in the w/v is that o.p.nos 1 and 2  cannot be made liable for any deficiency in service for act of the o.p.no.3. But o.p. no.3 is the agent of the o.p. nos. 1 and 2  who acted on behalf of the o.p. nos. 1 and 2. O.p. nos. 1 and 2 filed the IRDA notification dated 14.07.2000 with the w/v. In that notification the code of conduct of every insurance agent has been written clearly. In that notification it is clearly written that every insurance agent shall inform promptly the prospect about the acceptance or rejection of the proposal by the insurer [Regulation 8 (i) (h)]. In the instant case when the complainant informed o.p.no.3 for cancellation of the policy whether the agent informed the matter to o.p.nos. 1 and 2 is not clear. However the complainant sent the letter to o.p.nos. 1 and 2  which were received by them on 19.04.2014. But no action was taken against the agent. After sending the email on 28.10.2014 and 24.02.2015 o.p.nos. 1 and 2 did not inform the complainant about the status of the policy. They did not inform the complainant that the premium amount could not be refunded. O.ps 1 & 2 had not informed that complainant that for what reasons the premium amount could not be refunded. Only after the filing of the case o.p.nos. 1 and 2 took the plea in the w/v that premium amount cannot be refunded. If the o.p.nos. 1 and 2 informed the same earlier the complainant would not have filed the instant case.

          In view of above discussion we find deficiency in service and unfair trade practice on the part of o.ps 1 and 2  and as such complainant is entitled to get relief.

          As a result the complaint petition succeeds.

          Hence, ordered

          That the case no.34/2016 is allowed on contest against o.ps 1 & 2 with cost and dismissed exparte against o.ps 3 & 4.

The o.ps.1 & 2 are directed to refund  Rs.50,000/- (Fifty thousand) only to the complainant along with  compensation  of Rs.2,000/-(Two thousand) only and litigation cost of Rs.1,000/- (one thousand). O.ps are also directed to pay the aforesaid amount within 30 days from the date of communication of this order i.d., an interest @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.

Supply certified copy of this order to the parties free of cost.