Order-16.

Date-08/02/20165.

In this complaint Complainant Satya Mondalby filing this complaint has submitted that ops are the insurance company and complainant is a bonafide consumer of the op within the meaning of C.P. Act, 1986 and op by appointing corporate agent used to convince public at large that they offered the best policy better than the other insurance sector.

Sometime in the month of February 2014 complainant received one phone call from which a person who claimed himself as authorized agent of the op nos. 1 & 2 and tried to convince the complainant there was an attractive offer for the businessman like this complainant and also stated that the policy in question was recently launched by the op Insurance Company, but complainant did not give any importance about the said call.But the said agent again tried to convince that policy in question as it is a ‘one term policy’ and

here is not the end of the said agent, he also stated that if complainant avoided the policy in question by paying of Rs. 40,000/- in that even he will not be eligible and realising that it is the best policy i.e. ‘one term policy’.So, being convinced by the ops’ agent, complainant thought that it was fitted for him and complainant will have no headache for giving premium from time to time and as a result of which complainant as per assurance of the ops’ agent, ultimately took the policy being Policy No.00286197 and the plan name of the said policy was Smart Cash Protect and date of commencement of the said policy was 20.01.2014 with a hope that he shall have to get loan in question and they also stated that if they took more than one policy it will help the complainant to get the loan in hassle freeway and at that material point of time the remote villagers complainant and their family members were passing their days with acute financial crisis as their family business was in a stake condition and to revive the business in question a huge amount of money was urgently needed.

But after receiving the said amount from the complainant, it was surprising to note that the ops were very reluctant to deliver the policy certificate and when asking the said corporate agent, the said agent conveyed that due to official procedure it was getting late and complainant will get the same very soon.But after lapse of considerable period this complainant suddenly received the questioned policy and unfortunate complainant is not so educated so with the help of one family member gone through and came to know the content of the policy in question and after hearing, complainant was astonished and practically perturbed observing the fact that the policy in question is not at all one time policy and in the head of Polity Term it was detected that the policy terms of the said policy in question was for 35 years and regular premium have to pay of Rs. 39,480/- per year.

On perusal of the said policy, this innocent complainant was literally perplexed that there was no discrepancy on the said policy from which it was evident that everything was intentional and on seeing the same complainant totally broke down mentally and physically and realized that ops totally misguided and cheated this complainant by mis-selling the product.

Thereafter complainant contacted with the corporate agent of the op and on that occasion the said corporate agent assured the complainant that they solved the dispute and requested to contact ops’ office.Thereafter innocent complainant ran from pillar to post and requested op nos.1&2 repeatedly to look after the matter, but ops were very much reluctant and by this way when considerable period were lapsed, complainant found no other alternative but wrote complaint letter regarding unfair practice of op no.2 and submitted the same to the Branch Manager stating all the misdeeds done by the ops’ men and requested to refund hard earned money back dated 12.06.2014.

In reply ops practically stated nothing but to give assurance that they valued the complainant association and hope to resolve his complaint to the best of its satisfaction but in fact in reality ops did nothing.When all the efforts of the complainant went in vain inspite of several contracts to the official of ops, ops neglected to perform it and lastly on the last part of May, 2014 i.e. 20.05.2014 complainant received one letter from the op which was practically mysterious to complainantas contents of the letter was hazy and by way of letter ops refused the request of the complainant for cancellation of the policy and refund of the amount and practically due to mis-sell and misconduct and deceitful manner of trade, complainant has suffered much pain, agony, anxiety, unnecessary harassment and for not refunding of the same amount, complainant suffered huge loss for the misconduct, mis-sell in negligent and deficient manner of service, complainant prayed for deposit the amount by cancelling the said policy and also for compensation for harassment, anxiety etc.

On the other hand op nos. 1 &2 by filing written statement submitted that there is no negligence and deficiency in service whatsoever on the part of the ops in dealing with the concerned policy when complainant neither raised any objection within the Free Look Period though he received the policy document nor complainant never reported any query at the time of getting Welcome call made by the op before or after issuance of the policy and now in order to harass the ops has filed a false and frivolous complaint.

It is specifically mentioned that complainant completely understood the terms and condition of the insurance product Smart Cash Protect plan voluntarily applied for an Insurance Policy vide Proposal Form bearing no. AF001782382 dated 11.01.2014and complainant signed for a sum assured of Rs. 3,43,645/- for which premium amounting to Rs. 39,480/- was proposed to be paid annually for the period of 15 years and the Coverage Term is also 35 years and complainant after understanding all the terms and conditions which was duly explained to him, signed the Proposal Form and thereafter he received the policy document but prayed for cancellation within the free look period and complainant took the policy after completely understanding the terms and condition of the same content of the proposal form which was also explained to the complainant in his vernacular language as can be seen on the proposal form and complainant took the policy being satisfied with the terms and condition of the policy and also as per the Procedure op on 17.02.2014 made a Pre Insurance Verification Call where the complainant was explained all the product features and on the said call, complainant himself confirmed that he was satisfied with the product.

Thereafter op issued a policy bearing no. 00286197 having commencement date 29.01.2014 and sent the policy documents which complainant received on 26.02.2014.But thereafter op also made Welcome Call to complainant, however best reason known to the complainant that he did not attend the call and as per IRDA Rules, complainant had his scope to cancel the said product within 15 days of receipt of policy bond (Free Look Period).But complainant did not opt for which complainant is not entitled to any relief and complainant is estopped challenging the terms and conditions of the policy and not only that complainant filed three applications and purchased policy by sending it.

So, it is clear that complainant purchased it knowing fully well with the terms and conditions of the policy and thereafter he was satisfied knowing fully well of the benefit of the policy.In the above circumstances, this complaint should be dismissed.

Decision with reasons

On an in depth study of the complaint and written version and also hearing the arguments as advanced by the Ld. Lawyers of both the parties, it is found that complainant resides at Gaighata of North 24 Parganas District at Village- Subidpur whereas the Branch Office of the op is at Kolkata.

Fact remains that complainant prior to purchase of the policy never went to Branch Office of Kolkata of op and there was no talk in between the complainant and Branch Office sent at Kolkata.On the contrary from the complaint, it is found that the company’s agent went to that village and invariably allured the complainant by stating that it is single premium policy on payment of one premium.Complainant was not reported to pay further premium and policy shall continue and against that policy, complainant shall have to get loan and invariably considering the financial condition and business condition of the complainant, complainant relied upon the assurance as made by the agent and no doubt the agent of different private insurance companies’ are loitering in the villages for alluring the villagers for purchasing the product of said insurance company like the op and all over West Bengal being allured lakhs of people in such a manner were allured to open policies in the name of different customers and by adopting such procedure the ops present agents allured the complainant and complainant as a villager failed to realise the fate of the policy and the terms and conditions of the policy and in such a manner this policy was sold by the agents and in fact claim of the op that op talked with the complainant about submission of application for purchasing the policy etc. which is completely false and fabricated.On the ground there is no phone or mobile of complainant and there is no mobile or phone number.Then how the op Branch Manager and their men talked with the complainant and it is found a false story of the op and this is the common defence in all cases as so many cases are filed in this Forum and all the cases have been allowed and ultimately they have refunded the amount.

In this particular case it is proved that at any point of time before the accepting the application for purchasing the policy, op or their men never talked with them and never collected any consent from the complainant to satisfy the op that complainant realized the contained terms and conditions of the policy and he is liable to pay premium etc.Butin the defence the op has tried to say that they made call and talked with the complainant is completely false and fabricated.

Truth is that ops’ office is situated at Kolkata and they are continuing such sort of deceitful manner of trade staying in cool chamber but dishonest agents are spreaded all over India in the rural villages and they are collecting one premium and telling that one premium is sufficient and in such a manner the Insurance Company has been increasing their capital and that is their business and op knows very well that so called insured has purchased those product for their need but unable to pay such a huge amount at a time per year.

At the same time private insurance companies are very much reluctant to satisfy about the actual financial condition of the insured and insured shall be able to pay the yearly premium or not whether the insured has accepted to pay it.But it is only business tactics to collect one premium because they are well known that the insured cannot be paid further premium and that deposit is forfeited by the Insurance Company and their capital shall be increased and in this regard very world famous nobellaureto John Tielero seriously observed that insurance company in the field are deceiving the poorer section of people by their agent and corporate agent knowing fully well that the said insured has not accepted to pay further amount and in the present case ops have adopted that deceitful manner of trade by engaging dishonest cheat agent and they are loitering and collecting premium by alluring insured and in the present case no doubt their agent mis-sold this product that complainant shall get benefit of loan if one time policy by paying single premium, they purchased a policy, in that case they shall not get loan.

In the present case it is clear that complainant was deceived by the agent and it is no doubt a mis-sale because we have gathered that complainant is not an income tax payee and he has no such income to pay Rs. 39,480/- per year.Probably many government officers having their monthly income of Rs. 50,000/- have their no capacity to purchase such a policy one after another and we are very much aware of the fact many high government officials have no such policy against payment of Rs. 39,480/- per year and for other mis-sold policies and fact remains that complainant never appeared before ops’ any office for medical test and all such papers are manufactured one.

Another factor is that op has failed to prove by producing any document or evidence that complainant’s income is so high that he has his capacity to pay Rs. 39,480/- along with other payment of the policy per year as premium and it can be continued for 15 years.On the contrary after considering the materials it is found that complainant is not an income tax payee, he has no income to pay Rs. 39,480/- per year for continuous 15 years and truth is that he is a very poor business man in the village and at his house complainant was allured by the ops’ men and they did everything, even the application formwas also filled up by that agent Geeta Singh and that Geeta Singh is no doubt appointed as corporate agent of the op.But op has not denied the allegation as made against its agent and about poor income of the complainant and about the mis-sale of the product, because ops are well aware of the fact that already the policy is lapsed.

So, they are not willing to pay the amount and refused.But fact remains that as and when complainant realized about the entire contents, they forthwith reported to the agent, but the agent somehow or otherwise misled them when complainant went to the ops, but ops did not bother to refund rather they tried to show that it was not mis-sold.But no doubt it is a mis-sale and another factor is that application form was not in Bengali language and it is in English form and it was filled by agent the dishonest and cheat agent of the op and collecting some material that Gita Singh submitted the same and there is connivance in between the agent and op Insurance Company for which op is silent about GeetaSingh’s activities and her misconduct and about the mis-sale.

Moreover after considering the materials, documents it is found that complainant is a poor business man, somehow passed his days and somehow he collected some amount what he tried to invest for the purpose of future improvement and realizing that this is onetime payment of insurance and if complainant would be aware of the fact, if he purchases that policy he shall be burdened with huge yearly amount, in that case invariably he must not have to purchase it, not even any idiot shall proceed to purchase.

But truth is that complainant is made an idiot at the hand of the agent of the op for overall mis-sale, misconduct, misrepresentation of the agent of the op, complainant was deceived and in fact overall evaluation of the materials, we are convinced that complainant was allured by the ops’ agent and she mis-sold but he failed to realise the future of that policy as that was not disclosed.

In the light of the above observation and also considering the IRDA guideline we are convinced to hold that the policy is lapsed and as per IRDA guideline, it is the duty of the insurance company to refund the entire deposited amount if it lapsed after deducting 5 to 10 percent as service charge, but that has not been followed and it shall not be followed only for the purpose for grabbing the money as the policy is lapsed and by that way the dishonest insurance company have already procured a huge capital, but their purpose for selling insurance policy to the poorer section of people is completely fake trade.

In this context we want to say that 74 percent people in India out of 120 crores of people are not only poor but they are below poverty line and out of the balance people out of 120 crores of people, 25 percent people are very poor and complainant comes under the purview of that 26 percent people and his monthly income is within the range of Rs. 5,000/- to 10,000/-.Then how such a person can pay yearly premium of Rs. 39,480/- with other payments.Op has tried to say that he verified the income of the complainant.But no such document is produced by the op, no such document was collected by the op to show that complainant has his good income to pay it but no such document is produced that the complainant has his huge amount deposited in savings or fixed deposit.

So, considering all the above fact, we are convinced that the present complainant is a poor business man having his income of Rs. 10,000/- and that his income is yearly of Rs. 1,20,000/-. Even an idiot cannot believe that a person having his income yearly Rs. 1,20,000/- is able to pay Rs. 39,480/- with other amount per year as premium.But no doubt complainant deposited Rs. 39,480/- that is hard earned money which was accumulated after long years’ collection and complainant thought that by depositing the same for one time against policy he shall have to get loan and at the same time he was convinced that he shall get hefty money after three years but all are hoax of the agent.

Truth is that this op in so many cases was compelled to refund the same even after contesting up to State Commission and also National Commission and they have complied this order before this Forum.When they already got such order why they have not followed that principle as already laid down by the State Commission and National Commission.But it simply proves that they have no intention to pay, their only intention is to grab money and by grabbing money op has been increasing their capital.Grabbing of money by the op is their only trade for which in West Bengal their business is going to be closed and their products are not being sold and that is the position of the insurance company in West Bengal.

Similar fate is found in respect of other private insurance companies like ChholoMondalam Life Insurance, Sun Life Insurance, Reliance Life Insurance and other private insurance companies only for theirsuchsort of deceitful manner of trade for mis-selling the product to the poorer insured.

In the light of the above observation and considering the above materials, we are convinced to hold that there is sufficient ground to believe that the item/product was mis-sold by the cheat agent of the op and at ops’ instance, but op has failed to prove the financial condition of the complainant and also has failed to prove that before accepting the proposal though agent, they talked with the complainant or they received the consent form as per IRDA guideline, no such consent form is produced by the op that complainant submitted a consent for purchasing their product and op specifically then informed the complainant that they are accepting and for the above reasons, we are convinced that there is no such ground to disbelieve that the negligence and deficiency are on the part of the ops and bymis-sale of item or product to the complainant and by deceiving the complainant and taking chance of their simplicity and lack of knowledge ops managed to deceive the complainant and truth is that complainant has been deceived by the op for which complaint succeeds.

Hence, it is

Ordered,

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

Ops are hereby directed to refund the entire deposited premium amount of Rs. 39,480/- after deducting 5 percent as service charge and also shall have to pay a sum ofRs. 5,000/- for harassing the complainant in such a manner and for mis-selling the articles/products and accordingly ops jointly and severally shall have to pay the entire decretal amount within one month from the date of this order, failing which for non compliance of Forum’s order, ops jointly and severally shall have to pay penal damages at the rate of Rs. 2,000/- per month till full satisfaction of the decree to this Forum.

Even if it is found that ops are reluctant to comply this order, in that case, penal action shall be started u/s 25 read with Section 27 of C.P. Act, 1986 shall be started against the ops for which further penalty and fine shall be imposed upon ops.