Order-18.

Date-21/04/2015.

This is an application u/s.12 of the C.P. Act, 1986.

          Complainant by filing this complaint has submitted that OP runs insurance business by appointing corporate agent for the purpose of convincing public at large that the facility they offered is the best policy better than the other Insurance Company and in fact in the month of February, 2014 complainant received one phone call from a person claimed himself as authorized agent of OP and tried to convince the complainant that there is an attractive offer for the businessman like the complainant and also stated that the policy in question is recently launched by the OP Insurance Company.  At the first instance the complainant gave no importance to the policy in question but the said agent again and again contacted the complainant and tried to convince that the policy in question is suitable as it is one term policy and subsequently, agent stated that if the complainant purchased the one term policy and the agent also added that if the complainant avoided the policy in question by paying Rs.2 lakhs in that event he shall have to get loan of Rs.10,00,000/- and being allured complainant paid Rs.2 lakhs by way of two cheques being nos.310301 and 310302 dated 19-02-2014 drawn on UCO Bank, Barasat Branch for purchasing that one term policy but after paying the said amount complainant did not get any certificate and in the month of April, 2014 when complainant again went to Orissa for business purpose at the relevant time one of the staff/labour of the complainant received the policy in question and after returning on 30-04-2014 complainant got it and after going through the policy he came to know that the policy is in the head of regular premium schedule and its policy’s terms and condition is not for one term policy and complainant for the was perplexed when it was detected that on the policy in question the complainant’s signature was forged and given mobile number was imaginary.  Further it was found that complainant’s signature in four pages.  Thereafter, complainant found that he has been deceived when he contacted the agent and he assured that the defect would be removed but surprisingly OP’s did not take any steps and moreover, it was found that payment of premium per year Rs.1 lakh which is not possible to pay for the complainant, thereafter, complainant submitted a letter to the OP for taking necessary steps but OP did not pay any heed and also did not refund the same and practically the agent has misguided the complainant and managed to procure this policy which is no doubt an unfair trade practice on the part of the agent of the OPs for the purpose of premium as entire amount of Rs.2 lakhs.  So, the complainant has prayed for relief.

          On the other hand, OP Insurance Company by filing written version submitted that there was no negligence, deficiency in service on the part of the OPs and the complainant as a businessman had good knowledge and after understanding the terms and condition of the insurance product “Smart Cash Protect” plan had voluntarily applied for an insurance policy vide proposal form bearing No.AF002029321 dated 15-02-2014 and the complainant is the life assured and Sh. Shanti Ranjan Das is the nominee and he had given all relevant details and information in the prescribed form for a sum assured of Rs.20,61,690/- for which a Premium amounting to Rs.2,00,000/- was proposed to be paid annually for the period of 15 years and the coverage term is also 41 years and complainant after understanding all the terms and condition and realizing the entire facts signed and deposited the said amount and also confirmed in the declaration made in the application form.  Moreover, complainant submitted Pan Card, Voter I.D., I.T. Returns, Aadhar Card etc. duly understanding the terms and conditions and OP sent a letter on 18-02-2014 for the medical examination to the complainant and medical examination of the complainant were conducted on 19-02-2014.  Thereafter, proposal form was accepted policy document was sent on 24-02-2014 by speed post which was delivered to the address of the complainant on 04-03-2013.  But as per condition of IRDA complainant ought to have filed cancellation of the said policy within free look period but that had not been done and on 19-03-2014 OP received a request for rectification on the name of the complainant and on the basis of rectification in the name of the complainant informing by letter dated 30-04-2014 so, all the allegations as made in the complaint is false and fabricated and in fact, there was no question of mis-sale and agent did not anyway deceived the complainant and, in fact, prayer for cancellation was received on 27-03-2014 and same was duly replied on 12-03-2014 and in the above circumstances, there was no negligence, deficiency on the part of the OPs and there is no ground to deceive the complainant for which the complaint should be dismissed.

Decision with Reasons

On proper evaluation of the complaint, written version including the total document it is found that practically signature of the complainant was taken by the agent in the proposal form and entire part was filled up subsequently by agent.  Fact remains, agent of the complainant on the date of application was 58 years but the policy covers a life span of 41 years which is completely absurd.  Another factor is that in the application form if for 15 years Rs.2 lakhs as premium is paid in that case total payment of premium is Rs.30 lakhs whereas sum insured is Rs.20,61,690/- and no prudent man shall have to take such sort of policy which is completely less than the deposited premium.  Another fact is that in the application form it was not noted what type of the said policy was what is the terms and condition and at the same time OP has failed to produce any document to show that before accepting the policy complainant was examined by the OP insurance company to justify that complainant realized the total aspect of the policy and the so called future benefit etc. and whether agent properly get the complainant a chance to realize the policy or not but as per IRDA Rules before accepting any policy a consent letter shall be accepted by the OP Insurance Company after examining the complainant’s satisfaction about accepting the same and at the same time in the said consent letter the total liabilities of the complainant to pay shall be disclosed and at the same time the actual capacity of the complainant for the purpose must be there and insurance company shall be satisfied that the purchaser has his capacity to pay it but in this case it is proved that nothing has been done by the OP but fact remains that OP has no way stated that they examined the complainant and became satisfied about the capacity to pay Rs.2 lakh as premium per year and also to prove that they submitted such proforma to the complainant to know the satisfaction of the complainant and most interesting factor is the OP insurance company has not stated anything about allegation against the agent because all over in India DHFL is a known cheat insurance company and their agents are similarly cheat person and they are appointed by OP insurance company only for the purpose of collecting premium anyhow and most of the private insurance companies are follower of the said path, somehow only to secure one term premium amount and thereafter to declare that insurance policy is a lapsed policy and in the present case it is the duty of the OP to prove that their agent had not deceived him but they are silent in this regard which simply proves that said insurance company are in the market having their no contract with the purchaser of the policy to know about their financial capacity, to know whether purchaser realized the fate of the policy, future benefit of the policy etc.  But after considering the entire fact we find that OPs are very silent in this regard even they have not stated that complainant had financial capacity for payment of Rs.2 lakhs premium for 15 years.  Another factor is that in the said application form the nature of the policy is not noted and terms of policy is not noted but everything was filled up by the agent who are appointed by the OPs for which for the purpose of deceiving the customers at all level and anyhow to collect first one premium which shall be the capital of the company they are always telling that the lapse amount cannot be returned.  Truth is that such sort of insurance company should be controlled at once from all level otherwise people to of India at rural level and urban level shall be cheated by the insurance company.  Jahn Tirello, the present year Nobel Laureate has pointed out that Bank and Insurance Company shall be controlled otherwise total insurance business shall have to cheat and deceive the poor villagers of urban rural and city level because they know that it is impossible for any person to pay Rs.2 lakh as premium for 15 years.  Practically a premium of Rs.2 lakhs can be paid by a person who has his good income about Rs.50 lakhs per year but in the present case the complainant is a very poor shop owner who sells small item and he is not income tax payee also so, apparently complainant is a member of a poor middle class family, he has no capacity to pay premium for 15 years on payment of Rs.30 lakhs.  We have gathered that this tactical business is run through the private insurance companies and in the present case no doubt the complainant has been deceived by the agent of the OP and no doubt OPs have not denied that allegation against the agent and have not taken any such step against them and that is the main motto of the private insurance company only to collect first premium and by that way to swallow it through their cheated agents and in the present case it is proved that complainant was completely deceived by the agent of the OPs.  OPs have their no way to deny the fact that in the application form there is any consent letter and no such details about the proposal form which was supplied by the OP to the complainant for securing as consent.  So, it is clear that it is no doubt a tactical game on the part of the agent and agent deceived the complainant on behalf of the OP for which we are convinced that entire sale of the policy was mis-sale and deceiving the complainant it was sold which is proved for which we are confirming that this complainant is entitled to get back the entire amount of Rs.2 lakh after deducting 5 percentas service charge from the OPs and also some compensation and litigation cost complainant is entitled to as he has been deceived by the OP’s agent that means by the OP in this regard.

In the result, the case succeeds.

Hence,

Ordered

That the case be and the same is allowed on contest against the OP with a cost of Rs.5,000/-.

          OPs are hereby jointly and severally directed to refund and pay Rs.2,00,000/- after deducting 5 percentas service charge and also a compensation of Rs.10,000/- to the complainant for mental pain and agony caused by the OPs and for deceiving the complainant in such a manner through their agent of the OPs.

          OPs are hereby jointly and severally directed to satisfy the decree within one month from the date of this order failing which for non-compliance of the Forum’s order a penal interest  at the rate8 percentshall be assessed till full satisfaction of the decree, and if it is collected it shall be deposited to the Forum’s account.  Even if it is found that the OPs are reluctant to comply the order in that case penal proceeding u/s.27 of the C.P. Act, shall be started for which further penalty and fine may be imposed.