BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 95 of 2019
Date of Institution : 21.02.2019
Date of Decision : 05.02.2020.
Raghbir Kasnia aged about 63 years son of Sh. Begraj, Near Choupal, V.P.O. Nathusari Kalan, Tehsil Nathusari Chopta, Distt. Sirsa- 125110 (Haryana).
……Complainant.
Versus.
1. Bharti Axa Life Insurance Company Limited, Registered Office- Unit No. 601-602, 6th Floor, Raheja Titanium, Off Western Express Highway, Goregaon (E), Mumbai- 400 063, through its Managing Director/ Senior Vice President- Operations.
2. Suresh Kumar Mahajan, authorized agent Bharti Axa Life Insurance Company Limited Mobile No. 7065664588, resident of Bhadra Road, Nathusari Chopta, Tehsil Nathusari Chopta, Distt. Sirsa- 125110.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. SUKHDEEP KAUR…………… MEMBER
SH. SUNIL MOHAN TRIKHA……….MEMBER
Present: Sh. A.K. Gupta, Advocate for the complainant.
Sh. M.K. Singla, Advocate for opposite party No.1.
Opposite party no.2 exparte.
ORDER
In brief, the case of the complainant is that complainant is an agriculturist and he is not an educated person. He is also a handicapped person but has sound mind and not suffering from any disease. That in the month of December, 2017, op no.2 Suresh Mahajan who is an agent of op no.1 approached to the complainant and allured the complainant to get insured himself from op no.1 and disclosed several life benefits. The complainant accepted the proposal to get his life insured with op no.1 for sum assured of Rs.11,64,957/- for fixed term of 12 years and paid premium of Rs.97,999-07 on 28.12.2017. The payment was made through online system. It is further averred that complainant was duly got medically examined/ checked up by Dr. V.P. Goyal of Holy Nursing Home, Sirsa. The complainant was duly insured by op no.1 through op no.2 and a policy bearing No. 501-6537010 was issued to the complainant which is in his possession. That in the month of October, 2018, the complainant approached some agent of insurance company for preparing documents and to make payment of next premium amount of Rs.95,889-06 to op no.1 and he after going through the policy told the complainant that through this policy the complainant is not insured but one Krishan Kumar is insured. The complainant was very much shocked to hear that op no.1 has not insured the complainant and insured one Krishan Kumar to whom he has never proposed. It is further averred that complainant is married but he has no child male or female, natural or adopted. The complainant got himself insured with op no.1 and he has never got insured Krishan Kumar as alleged in the policy and by doing so, the ops have committed the offence of concealment, misrepresentation, fraud and forgery with the complainant for which the ops are also liable for criminal action. It is further averred that in this situation, the complainant is not in position to deposit the next modal premium amount of Rs.95,889-06 and cancelled the policy being the result of concealment, misrepresentation and fraud committed by ops and complainant is entitled to refund of the amount of premium of Rs.97,999-07 already deposited by him with op no.1 alongwith interest at the rate of 18% per annum and the ops are liable to return the same without any objection as the ops have violated terms and condition of policy by insuring a third person namely Krishan Kumar. That complainant approached several times in this regard to op no.2 but to no effect. It is further averred that complainant also got issued legal notice to op no.1 on 20.10.2018 but of no avail. Hence, this complaint.
2. On notice, opposite party no.1 appeared and filed reply raising certain preliminary objections. It is submitted that complaint is not maintainable at all and same is out of the purview of Free Look Period of 15 days as provided under the policy as the subject cited policy stands issued on 30th December 2017 and the policy bond stands delivered to the complainant on 17th January 2018 and complainant after in receipt of policy bond has never ever approached the op company with a best reasonable time to get the policy cancelled and complainant has silently retained the same for a long time and complainant after lapse of one policy year is alleging it a case of mis-selling despite the fact that there was no mis-selling on the part of op company and it is complainant who on his own free will has applied for purchase of policy in question on the life of one Krishan Kumar. If the complainant feels deceived, then the complainant was having due right to rescind the policy contract by way of moving cancellation request within a free look period of 15 days from the date of receipt of policy in question. So, from all corners, complaint is barred by policy contract. It is further submitted that insurance is a contract between the parties and is governed by Insurance Act, 1938 and both the parties are bound by the terms and conditions envisaged under the agreement in the form of policy. The policy was generated on the basis of proposal form and other documents submitted by complainant applied on the life of Krishan Kumar. Now, the complainant cannot be permitted to turn around. It is further submitted that if such sort of practice is allowed, it will lead to a wrongful practice by the people to take policy, enjoy the life cover and tax benefits and at a later stage come up with such a concocted story without having any basis of the same. That complainant has not approached the op company for a considerable long period and not at such a fag end, the complainant by concocting the flimsy story intends to take back the FYP against which the risk cover has already been enjoyed. It is further submitted that welcome call has been made by op company to complainant at his registered mobile and complete details of said welcome call is with the op company and in the said welcome call, the complainant agreed that he has been duly informed about the product he purchased on the life of Krishan Kumar. The complainant out of his own desire and after going through the entire terms and conditions of the policy contract had applied for life insurance policy in the name of Krishan Kumar from the op and had submitted duly filled proposal form and upon the request of complainant, the op had issued the policy as detailed above with the premium payment term of 12 years meaning thereby that under the policy, the complainant has to make payment of installment premium till consecutive period of 12 years from the date of issuance of policy but complainant after making payment of one year premium has not made payment of any further year premium and has started raising a issue of miss-selling after a long period. Now policy in question is in lapsed condition. It is further submitted that as per the terms of the policy contract, if the policy is not suitable, the policy holder may get his/ her policy reviewed by returning the policy and policy documents within 15 days from the date the policy holder received the policy. The insurance company will return the premium paid to the complainant after making certain deductions specified therein. In the present case, neither the complainant nor said Krishan Kumar after in receipt of the subject policy and policy documents approached the op to get subject policy reviewed/ cancelled within free look period. Remaining contents of the complaint are also denied to be wrong and prayer for dismissal of complaint made.
3. Notice issued to the opposite party no.2 received back with the report of refusal and none appeared on behalf of op no.2 and as such op no.2 was proceeded against exparte.
4. The complainant and op no.1 then led their respective evidence.
5. We have heard learned counsel for complainant as well as learned counsel for opposite party no.1 and have perused the case file carefully.
6. The complainant in order to prove his complaint has furnished his affidavit Ex.CW1/A in which he has deposed and reiterated all the averments made in the complaint. He has also furnished copy of policy document (pages 17) Ex.C1, copy of legal notice Ex.C2, copy of postal receipt Ex.C3 and copy of pass book Ex.C4. On the other hand, op no.1 has furnished affidavit of Sh. Snehal Sawant, Associate Manager Legal Ex.R1 and copies of documents Ex.R2 to Ex.R11.
7. It is proved on record that complainant had purchased a policy by making the payment of premium of Rs.97,999-07 to op no.1 for sum assured of Rs.11,64,957/- through op no.2 and the policy was issued for the period of 12 years.
8. The bone of contention between the parties is qua the name of the insured. As per contention of complainant, he got himself insured from op no.1 through policy in question through op no.2 and paid premium, but however, op no.1 issued policy with insured name as Krishan Kumar who is not connected in any way with the complainant.
9. On the other hand, there is specific plea of the op no.1 that insurance policy was issued as per proposal form Ex.R2 which was filled in by complainant himself through online and there is no fault on the part of op no.1. Moreover, complainant did not approach op no.1 within free look period and as complainant did not deposit further premium as such policy stands lapsed.
10. It is proved fact on record that complainant got this policy on payment of premium of Rs.97,999.07 from op no.1 through op no.2 and policy has been issued with name of insured person as Krishan Kumar. During the course of arguments, learned counsel for op no.1 has categorically conceded that this Krishan Kumar is not related from any corner with the complainant, but however, name of Krishan Kumar finds mention in the column of name of insured in the proposal form. Though there is a mistake in the proposal form as well as policy which has been issued on the basis of proposal form, but however, complainant is not supposed to suffer for lapses on the part of agent of op no.1 or of op no.1 since there is nothing on record to prove that online proposal form was filled in by complainant himself. So, it appears that in case the complaint is not allowed, complainant will definitely suffer loss of the amount of Rs.97,999.07 which he paid in order to get himself insured.
11. In view of above, we allow this complaint and direct the opposite parties to make refund of the amount of Rs.97,999.07 alongwith interest @7% per annum from the date of deposit of the money till actual realization. We also direct the ops to further pay a sum of Rs.5000/- as composite compensation and litigation expenses to the complainant. The ops are liable to comply with this order within a period of 30 days from the date of receipt of copy of this order, failing which complainant will be entitled to initiate proceedings under Sections 25/27 of the Act against the ops. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:05.02.2020. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
