Before the District Consumer Dispute Redressal Commission [Central District] - VIII, 5th Floor Maharana Pratap ISBT Building, Kashmere Gate, Delhi
Complaint Case No.244/05.09.2019
Sh. Vinay Kumar s/o Prabhu Dayal
r/o 921, Sector-6, P and T, R. K. Puram, South West,
Delhi-110092 …Complainant
Versus
M/s Bharti AXA Life Insurance Co Ltd
Delhi Jhandewalan, First floor, Caxton Press Building,
2-E Rani Jhansi Road Jhandewalan Extension,
New Delhi -10055 [new address adopted] ...Opposite Party
Date of filing: 05.09.2019
Coram: Date of Order: 04.10.2024
Shri Inder Jeet Singh, President
Ms Rashmi Bansal, Member -Female
FINAL ORDER
Inder Jeet Singh , President
It is scheduled today for order (item no.35)
1.1. (Nature of pleadings) – The complainant’s complaint is narrative, without details of subject insurance policies , its numbers, date, sum insured or tenure except mentioning of year 2016 or 2017 in sub-paragraph 3.5 of the complaint. However, documentary records are filed with the complaint. On the other side, the OP has given details of facts with the date, month, year, description of three insurance policies issued with date, premium amount, tenure,\names of person covered, etc. Accordingly cases of both the sides will be mentioned.
1.2 (Introduction to case of parties) - The complainant/Insured filed the complaint against Insurer/OP by alleging unfair trade practice, mis-selling of the insurance policies and deficiency of services. When the complainant asked for refund of amounts, it was declined. Now, the complainant through this complaint seeks refund of paid premium, compensation of Rs.1,00,000/- in lieu of mental pain and costs besides other appropriate reliefs.
1.3. But, the OP denies allegations of unfair trade practice, mis-selling of the policies and of deficiency of services on its part, consequently the complaint is liable to be dismissed. The complainant failed to pay the timely premium in respect of two policies, the premium paid at the initial stage in respect of two policies was for the period cover under the risk, the premium stand exhausted. The policy was lapsed. The claim was rightly declined.
2.1. (Case of complainant) –The complainant is working in private job to earn his livelihood. The OP is life insurance company, it deals in such policies across the country. The complainant was first sold insurance policy by the OP, thereafter he was coaxed in surrendering the same and then again sold insurance policies. The acts of OP are arbitrary and it led to losses to the complainant.
2.2. The complainant was approached by Sanjay Kumar and persuaded the complainant to buy insurance policy as it would yield great returns. The complainant paid the premium continuously for five years and after completion of the policy term, he was awaiting for the yield to mature.
However, in between the complainant was again approached OP’s representative Sh. Vipin, who coaxed the complainant in surrendering the policy prior to maturity date. Since the complainant lacks in education and want of acquaintance with the terms of the policy contract as well as he fell prey to the representative of OP, he agreed to surrender the policy. The complainant has pressed to invest in the new policy in the name of his children of surrender value of the policy, the complainant followed as suggested and advised to him.
2.3. It was 2016, when first premium was paid and it was assured that no further premium would be payable. But in 2017, the complainant received a call for due premium notice, which shocked the complainant and he enquired from the OP. The representative of OP and other persons denied of one time premium but asked the complainant to deposit the premium again. The complainant protested it but no result.
He has been running from pillar to post but the OP remained insensitive and insisted for payment of premium, which complainant never agreed to pay premium for another ten years vis-à-vis the complainant was contended with the earlier policy. However, the OP first induced to the complainant to buy policy, then mis-selling of two policy. It is unfair trade practice and deficiency of services. That is why this complaint for direction to the OP to refund the premium amount and to direct the OP not to ask further premium and to pay compensation of Rs.1 lakh and litigation cost.
2.4 The complaint is accompanied with photocopy of identity card, letter regarding insurance policy no. 500-6622269 (to identify it at glance, hereinafter it is referred as the “first policy”), first premium receipt, policy detail and receipts of premium paid and policy documents; letter, first premium receipt and material regarding insurance policy no. 501-4680622 wef 29.07.2016 (hereinafter it is referred as the “second policy”); first premium receipt and material regarding insurance policy no. 501-4680614 w.e.f 29.07.2016 (hereinafter it is referred as the “third policy”), proposal forms, correspondence with the OP inclusive of emails and Whatsapp messages.
3.1 (Case of OP) - The OP denies the allegations of complaint that it is without substance and cause of action. The complainant was served with the copy of insurance policies from time to time, there was period of 15 days as free look period but complainant failed to exercise that option to give up the policy, therefore, the policy is binding on the complainant; the complainant cannot return the policy after free look period of 15 days. [the OP relies upon Mohan Lal Benal Vs. ICICI Prudential Life Insurance Co. Ltd. RP. No. 2870/2012 dod 16.10.2012, Harish Kumar Chadha Vs. Bajaj Allianz Life Insurance Company RP. No. 3271/2013 dod 07.10.2013, Shrikant Murlidhar Apte Vs. LIC of India RP. No. 634/2012 dod 02.05.2013]. Moreover, there is no scope for refund of the premium paid in the present case since the premium given by the insured stand exhausted to cover the risk for the period for which premium was paid vis-à-vis it is not the case of complainant that risk was not covered to refund the premium (the OP relies upon LIC of India Vs. Siba Prasad Dash IV 2008 CPJ 156 N/C para 5).
Moreover, the complainant has received the policy documents and he had not opted for free look period to withdrawn from the policy, therefore, it is a concluded contracts of insurance policy between the parties, it is to be construed strictly. The OP refers cases in the paragraph 10 of written statement to support this plea (viz. Surajmal Ramnivas Oil Mills Pvt. Ltd. Vs. United India Insurance Co. Ltd. 2010 (10) SCC 567 and three other cases).
3.2. The “second policy” and the “third policy” were not one time premium plan and the policies were issued as per proposal forms received from the complainant, which also mentions the option applied by the complainant with premium amount. Paragraph 11 of the written statement reproduces the images of proposal forms for such option in respect of the second and the third policy.
Agents are licensed with the IRDA, they function independently of the insurance company, therefore, the services rendered by an agent to the complainant is in fact agent of the complainant and not of OP. The complaint suffers from non-joinder of the said agents. The master is liable for the acts of an agent, (while referring Santanu Prasad AIR 1966 SC 1697). The insurance policy was issued on the basis of information given in the proposal form, the complainant would have been to the proposal form and it is binding on him.
3.3 The complainant was issued first policy on 24.11.2010 for a tenure of ten years subject to premium term of five year, subsequently it was surrendered on 24.11.2016. The second and the third policy were issued on 29.07.2016 for policy period of ten years each, with premium payment tenure of ten year each, both were effective from 29.07.2016, the next premium was due on 28.07.2017 but for want of payment of the premiums, the second and the third policies were lapsed. The complainant was delivered two policy documents on 22.08.2016.
The complainant surrendered the first policy on 19.07.2016 on request of the complainant with necessary documents, an amount of Rs. 3,19,959.69p was paid into the account of complainant as surrendered benefit through NEFT, which was credited in his bank account on 28.07.2016. However, the complainant failed to pay the renewal premium in respect of the second and the third policy, the same were lapsed in terms of the policy as per clause-4 under Part-D of terms and conditions of policy, there was period of two year to avail the option, however, for want of payment of premium, the said period expired on 28.07.2019. The written statement also reproduces the terms and conditions of the policy in the body of written statement.
The complainant approached the OP on 31.08.2018 by visiting the office, while making complaint of mis-selling of the second and the third policy and for refund of the premium. However, pursuant to the terms and conditions of the policies, the request of complainant was resolved by email dated 03.08.2018. The complainant again approached OP on 28.02.2019 and 05.04.2019 for reinstatement of the policy followed by receipt of another letter dated 11.11.2019 but the OP rightly rejected the same, which was communicated to the complainant on 01.04.2020, while reaffirming the previous decision dated 03.08.2018.
The complaint is false and frivolous, there is no deficiency of services or short of the services or unfair trade practices, which the complainant was required to show, but he failed, the complaint deserve dismissal ( the OP refers Ravneet Singh Bagga Vs. KLM Royal Touch Airline 2000 1 SCC 66) .
3.4 The written statement is accompanied with proposal form of first policy, of second policy and of third policy, terms and conditions of policy bond, policy document of other policies and letter dated 03.08.2018.
4. (Replication of complainant) –The complainant file compact rejoinder, while denying the allegations in the written statement but reaffirming the contents of complaint as correct. Neither the complaint suffers from non-joinder of the parties vis-à-vis there is no cause of action against the OPs, the complainant was not made aware about the free look period. The complainant is entitled for the relief claim.
5.1 (Evidence)- The complainant led his own exclusive evidence by detailed affidavit Similarly , the OP also led evidence by filing affidavit of Shri Ayan Chakraborty, Senior Manager- Legal.
5.2 (Final hearing)- Both the parties have filed their written arguments. At the stage of final submissions, Sh. Shri Hemant Kumar Niranjan, Advocate for complainant and Sh. Kunal Nema, Advocate for OP presented their submissions.
6.1 (Findings)- The contentions of the parties are considered keeping in view documentary and other evidence of parties, case law referred and relied upon. The parties’ case and documents proved have already been referred, therefore, it does not need to reproduce them again, however, their rival contentions will be appreciated while analyzing and weighing the evidence.
6.2. After taking into account, all such materials, the following conclusions are drawn.
(i) There is no dispute regarding the first policy, its tenure, payment of premium and its maturity date, however, the complainant has reservation that he was induced and coaxed by the representative of OP to surrender the first policy for investment in other policies.
(ii) The complainant has not highlighted the role of agents qua three policies and similarly OP has also not brought on record the role and function the said agents. Otherwise, the insurance contract is between the insurer and the insured to meet the contingency and indemnify in case of any peril. Therefore, there are no circumstances that agents were necessary parties to the complaint or the complaint suffers from non-joinder of necessary parties. This conclusion also disposes of the objection of OP.
(iii) There is no dispute about receipt of the second insurance policy and the third insurance policy alike first insurance policy by the complainant from OP. In fact, after surrender of first policy, the complainant had received surrendered value in his account.
(iv) The complainant had not only received policy document of the first policy but also of the second and the third policy, he was aware of free look period of 15 days for an option whether or not to go ahead with the policy. The complainant had not exercised that option not to go head after receipt of the second and the third policy, being substantive subject matter of this complaint nor he had any complaint against surrender of the first policy, another limb of the complaint.
(v) The circumstances of want of exercising the free look period option within stipulated period of 15 days despite receipt of policy document, waives of the complainant’s right to ask for cancellation of insurance policy after that period. In addition, when the due premium was not paid vis-à-vis the period of two years elapsed, not only the policy ended but also the premium paid stand exhausted for covering the risk against the premium paid initially.
(vi) Since the parties are bound by the terms and conditions of the second policy and the third policy and by virtue of these covenants, the policy had elapsed and the premium amount stand exhausted/used for covering the risks of that period.
(vii) Since the OP had invoked appropriate provisions of the second insurance policy and the third insurance policy, it cannot be construed deficiency of services or of unfair trade practice. Similarly, the complainant had received surrendered value in respect of first policy and further period had also elapsed after surrender of the first policy, the other two policies were also obtained by the complainant, then no grievances remains in respect of surrender of first policy. Therefore, there is also no deficiency of services or unfair trade practice qua first policy.
6.3. In view of the conclusion drawn in paragraph 6.2 above, the complaint fails. The complaint is dismissed. There is no order as to costs.
7. Announced on this 4th day of October, 2024 [अश्विन 12, साका 1946]. Copy of this Order be sent/provided forthwith to the parties free of cost as per rules, besides to upload on the website of this Commission.
[Rashmi Bansal]
Member (Female)
[Inder Jeet Singh]
President
[ijs122]
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