JUDGEMENT
Complainant by filing this complaint has submitted that on12.09.2005 the complainant applied for a Unit Gain-Plus Policy with Riders (Hospital Cash) benefit which was signed and received by Company’s Consultant one Jinia Roy on Company’s behalf. A crossed cheque No. 095266 of Rs. 15,150/- as premium + Rs. 150/- for Riders i.e. Hospital Cash benefit was issued and the company issued a computer generated receipt against the payment of Rs. 15,150/- vide Sl. No. 2275196 dated 12.09.2005.
Just after receipt of the said cash Bajaj Allianz company began to play a foul game and when contacted the aforesaid consultant told the complainant that on the ground of over-age the Riders (Hospital Cash) benefit could not be made admissible to the complainant and considering the op’s such sort of conduct complainant claimed the amount back as complainant was not interested without the Riders benefit. Subsequently the consultant of the op reported that the matter would be referred to higher authorities for consideration. However the amount of Rs. 150/- remained held by the company. After unusual delay received a policy document under product name Unit Gains-Plus without Riders i.e. without Hospital Cash benefit Policy No. 0010907910 and when the complainant raised the issue to the consultant and contacted with op and complainant sent a letter dated 15.02.2006 but op did not respond. Subsequently complainant lodged a formal complaint on 07.07.2006 on the ground that the cheque was for Rs. 15,150/- but that was tampered into Rs. 15,000/- by the op and considering all the above negligent and deficient manner of service and also considering other fact, complainant lodged a complaint to CA & FBP. But op did not turn up and as per advise of CA & FBP, complainant filed this complaint and complainant prayed for refund of the entire amount as deposited i.e. Rs. 15,000/- and complainant also prayed for compensation for harassment and for adopting unfair trade practice.
On the other hand op by filing this written version has submitted that the present complaint is not maintainable in view of the fact that complainant previously made a complaint being C.C. No. 360/2006 before this Forum for the same amount etc and that was dismissed up to Hon’ble National Commission for which the present complaint is not maintainable.
But it is admitted by the op that complainant applied for Unit Gain Plus Policy with Hospital Riders on 12.09.2005 and paid Rs. 15,000/- for first premium + Rs. 150/- as Rider cost and his cheque of Rs. 15,150/- was encashed by the insurance company but the Rider was not allowed and it is also admitted that the complainant claimed his money back as he was not interested on the policy without Riders. But complainant already received the policy document but alleged subsequently that while changing the policy without Riders, some entries at Column 4, 6 and 10 were tampered and manipulated and the insured claimed refund of the initial premium amount.
Moreover complainant filed Execution case E.A. 133/2011 but the Ld. Execution Forum had dismissed the execution petition vide order dated 13.06.2012. It is further submitted that complainant deposited only one premium policy being No. 0010907910 and thereafter no premium was paid under the policy and thereafter no premium was paid under the policy. Free look period of 15 days from the date of receipt of the policy had already over so the policy stood as lapsed due to non payment of annual premium after the 1st year as on 14.09.2006. The complainant had an option to revive the policy within 5 years of its lapse but the complainant refrained from depositing the requisite premium and the policy was foreclosed as per the terms and conditions of the policy on 17.12.2011. So in the above circumstances there was no laches or negligence on the part of the op and op complied every order of the Forum and State Commission and National Commission and accordingly the present complaint should be dismissed.
Decision with reasons
On meticulous study of the complaint and the written version of the op including the argument as advanced by the Ld. Lawyers of both the parties, it is clear that complainant applied for Unit Gain Plus Policy with Hospital Riders benefit on 12.09.2005 on payment of first premium of Rs. 15,000/- and Rs. 150/- as Riders cost. Admitted fact is that op encashed that cheque of Rs. 15,150/- by tampering it as Rs. 15,000/-. But ultimately op issued an Insurance Policy without Rider. Then and there complainant claimed the money back as he is not interested to such policy without Rider and considering that fact it is clear that op adopted unfair trade practice and though complainant prayed for Unit Gain Plus Policy with Riders and he paid total amount of Rs. 15,150/-. But op by manipulation issued a policy without Rider and forthwith complainant claimed his money back as he was not interested to continue the policy without the Rider cost what prompted the op to issue a policy without Rider and such type work on the part of the op since inception was completely against any insurance trade.
It is also admitted by the op that in previous Appeal FA No. 230/2008 passed on 12.02.2009 by State Commission’s order that the claim for refund of initial premium money of Rs. 15,000/- could be considered only in terms of the conditions of the policy and the complainant was therefore free to act as per their rules in the matter of refund of the aforesaid initial premium money. Subsequently Appeal was referred to National Commission being Revision Petition No.3235/2009 and National Commission also directed the op eventually to refund insurance amount paid for securing policy to the petitioner and that was passed on Revision Petition No. 3235/2009 and by that order also the National Commission has directed that amount would be refunded to the petitioner in the light of Rules that may be applicable and actually that order was passed on 07.04.2010. But as because the Revision Petition was dismissed the execution case which was dismissed but for that reason the complainant is not barred to get back the amount or his claim has not been sealed by the order of the State Commission and the National Commission passed against previous C.C. No. 360/2006. But as per order of the National Commission it was the duty of the op/insurance company to refund the said amount when admittedly the complainant did not continue the said policy and as per application of complainant the policy was not opened and fact remains as per IRDA guidelines it is the duty of the insurance company to refund that amount forthwith only deducting 5 percent as service charge etc but that has not been done by the op even after existence of the order of the National Commission passed in R.P. No. 3235/2009 dated 07.04.2010.
So, it is clear that the op has violated the direction of National Commission and when op did not consider the judgement of the National Commission, complainant was compelled to file this present case afresh and that is maintainable in the eye of law. Most interesting factor is that in the present case even after violating the order of the National Commission, the op has tried to argue before this Forum that this case is not maintainable. But we are convinced that the entire act of the op is violation of order of the Hon’ble National Commission and State Commission order and from the whole conduct of the op it is found that op has tried to grab the entire premium amount when the policy has been lapsed as per their version and National Commission already directed to refund the same and it is fact that as per IRDA guideline if any policy is found lapsed in that case the policy amount cannot be grabbed by the insurance company but that amount shall be refunded/returned to the insured after deducting 5 percent as service charge etc but that has not been done and it is a gross negligence and deficiency on the part of the op and in our view it is unfair trade practice on the part of the op and truth is that the private insurance companies are not refunding the premium amount in case of lapsed policy as they think that it is their capital.
Considering all the above fact and circumstances, we are convinced to hold that the entire defence of the op is baseless defence in this case and only to grab the money they have proceeded their entire defence and appeared before this Forum to grab the money and not to refund the same even after existence of the order of the National Commission and State Commission and even the IRDA also directed to refund the deposited premium amount in case of lapsed policy, but that has not been followed. So, we are convinced to hold that the ops shall have to refund the amount immediately after deducting 5 percent and also giving such compensation i.e. for harassing the complainant in such a manner for last year together and at the same time op shall have to give 8 percent interest p.a. over the said amount since 07.04.2010.
Accordingly the complaint succeeds.
Hence, it is
ORDERED
That the complaint be and the same is allowed on contest with cost of Rs. 5,000/- against the ops.
Ops are directed to refund the entire amount of Rs. 15,000/- after deducting 5 percent from the same as service charge and giving 8 percent interest over the said amount w.e.f. 07.04.2010.
For harassing the complainant and for violating the order of National Commission and State Commission and also for adopting unfair trade practice and causing mental pain and agony of the complainant, ops shall have to pay a compensation of Rs. 5,000/- to the complainant.
Ops shall have to comply the order and satisfy the decree and to pay the said amount after proper calculation to the complainant within one month from the date of this order failing which for each day’s delay, op shall have to pay punitive damages at the rate of Rs. 200/- per day as penal interest and if penal interest is collected it shall be deposited to this Forum.
For adopting unfair trade practice by the op and for violation of the order of National Commission and State Commission, op is imposed punitive damages to the extent of Rs. 5,000/- which shall be paid to this Forum within one month.
Ops shall have to comply the order very strictly within one month from the date of this order failing which penal action shall be started against them for which they shall be prosecuted u/s 27 of C.P. Act 1986.
