Sri Shyamal Gupta, Member

This Appeal is directed against the Order dated 26-08-2015 passed by the Ld. District Forum, Kolkata-II (Central) in C.C. No. 170/2015.

Brief facts of the complaint case are that he took three insurance policies from the OP Insurance Company and paid due premiums in respect of the said policies for three continuous year.  However, due to some financial constraints, he could not continue the said policies.  Once he stopped payment of premiums, one agent of the OP Insurance  Company approached him and informed that the Complainant would get Rs. 7,76,000/- from the company, including interest for which he would have to keep a sum of Rs. 1,00,000/- with the Insurance Company as security deposit.  The agents of the OP Insurance Company called on the Complainant several times and out of good faith, the Complainant issued three cheques bearing nos. (1) 30060 dated 18-12-2013 for a sum of Rs. 15,000/- (2) 30067 dated 30-01-2014 for Rs. 10,000/-; (3) 30073 dated 24-05-2014 for Rs. 45,000/- and (4) 30075 dated 21-07-2014 for Rs. 30,000/-.  After receipt of said cheques, the agents did not turn up again.  It is further stated that the OP Insurer sent a cheque without date through its agent, who came and took the signature of the Complainant at its back on the plea that it was for verification purpose.  Afterwards, neither the agents turned up nor the OP Insurance Company was willing to assist the Complainant.  When he visited the office of the OP Insurer, he was asked to fill up the surrender form and informed that he would receive only a sum of Rs. 1,20,000/-.  However, later on he found that the OP Insurance Company only remitted a sum of Rs. 98,632/- directly to his bank account through ECS.  Against such backdrop, the complaint was filed.

By submitting a WV, it is stated by the OP that it was not privy to what the agents of the OP Insurance Company allegedly stated to the Complainant and hence, it is not responsible for the same.  The policies were issued based on the duly filled and signed proposal forms.  All transactions between the Insurance Company and the Insured are based on the terms and conditions of the policy contract.  The OP did not claim/request through its officers or agents to seek deposit for release or issuance of surrender amount.  Accordingly, it prayed for dismissal of the complaint.

Decision with reasons

Heard both sides on the issue and perused the material on record carefully.

On going through the petition of complaint vis-à-vis other documents, we notice several inconsistencies in the statement of the Respondent.  First, in Sl. No. 3 of the petition of complaint, it is stated by the Respondent that he took three life insurance policies from the Appellant; whereas in Sl. No. 5, he has stated that due to financial problem, he stopped payment of premiums of all the four policies.

Again, it is claimed by the Respondent in his petition of complaint that he paid regular premiums in respect of the concerned policies for three consecutive years.  Given that Policy Nos. being 0310419347, 0314823883 and 0315672615 commenced w.e.f. 28-12-2013, 18-04-2014 and 09-07-2014, respectively, and the instant complaint was filed on 16-04-2015, it is unbelievable that the Respondent paid full premiums for three consecutive years.  Significantly, the Respondent has not filed all the premium receipts to substantiate his claim. 

It is alleged in the complaint that some unidentified/unnamed agents of the Appellant Insurance Company informed that he would get a sum of Rs. 7,76,000/- against the concerned surrendered policies.  On going through the available documents on record, we notice that total outgo in respect of the aforesaid policies stood at Rs. 77,427/- [Rs. 14,466 + (Rs. 9,700 x 2) + Rs. 43,651/-] plus statutory taxes.  Any person of reasonable prudence would appreciate that no Insurance Company on earth would pay Rs. 7,76,000/- in respect of lapsed policies within 1½/2 years of commencement of the same against the deposited premium of Rs. 1,00,000/- (approx.).  Significantly, the Respondent happens to be a physician by profession. 

It is further alleged that although the Respondent issued four cheques for a total sum of Rs. 1,00,000/- on different dates in between the period from December, 2013 and July, 2014, after receiving the said cheques, the concerned agents did not turn up.  It is indeed strange that although there was no show of the first agent to whom the Respondent handed over the cheque of Rs. 15,000/- on 18-12-2013, the Respondent did not learn any lesson and repeated the same mistake thrice in a row and all the times, the concerned agents allegedly after receiving the cheques from him faded away from the scene; yet the Respondent did not lodge any police complaint against any of them.

Similarly intriguing is the fact that although one agent of the Appellant obtained Respondent’s signature on the reverse side of an undated cheque purportedly issued by the Appellant, the said agent also did not turn up again.  In this regard too, the Respondent did not lodge any FIR or any official complaint with the Appellant.

We also fail to understand as to why the Respondent at all issued those cheques.  While the first policy being no. 0310419347 started w.e.f. 28-12-2013, there was no reason for him to issue another cheque on 18-12-2013.  Similarly, while the second policy being no. 0314823883 commenced w.e.f. 18-04-2014, the reason for issuing the second cheque for an amount of Rs. 10,000/-  on 30-01-2014 is not understood.  Likewise, while the third policy being no. 0315672615 commenced w.e.f. 09-07-2014, the reason for issuing two cheques totaling a sum of Rs. 75,000/- also raise eyebrows.  More so, all the four cheques stated to have been issued to facilitate refund of surrender value of the policies in question.  Issuing cheques for getting back the surrender value of policies before commencement of the policies itself is akin to putting the cart before the horse.  We afraid, the allegation of the Respondent is not at all believable.  Be it mentioned here that although the Respondent, by submitting a letter dated 05-10-2015 claimed that he sent a copy of bank statement to the Appellant in order  to prove the bona fide of his claim that the disputed four cheques were indeed encashed by the Appellant, he did not submit any copy of purported bank statement to the Ld. District Forum.  Needless to say, the Respondent has not furnished any bank statement before this Commission.

It appears the Ld. District Forum did not make any endeavour to carefully go through the documentary proof on record in order to verify the authenticity of allegations of the Respondent.  No wonder, its findings are totally in disarray vis-à-vis material proof on record.

According to the Ld. District Forum, “as per IRDA guideline of the year 2014 if any policy is found lapsed after 3 years, in that case out of total deposited premium amount 5% to 10% shall be deducted as service tax and balance amount shall be returned to the insurer and that is the position of law” (sic).

Clearly, the Ld. District Forum made a complete mess of appreciating the difference between service tax and service charge, as also that of an Insured and the Insurer. Be that as it may, while three years did not pass in respect of any of the disputed policies, question of refunding lion’s share of the deposited premium amount does not arise at all in the first place.

It is rightly pointed out by the Appellant that extent of refund of the premium amount in respect of a lapsed policy solely depends on the specific terms and conditions contained in the policy document.  The basis of figuring out the settlement amount was duly clarified to the Respondent by the Appellant vide its settlement letters.  Noticeably, the Respondent could not pick any hole into such calculation.  Mere allegation does not suffice; it is the tangible proof/evidence that holds the key that put a case on strong footing which is sorely missing here. 

In the light of foregoing discussion, we see no reason to see eye to eye with the impugned order which to our mind, suffers from several legal infirmities.  Accordingly, we deem it fit and proper to set aside the same.

The Appeal succeeds as such.

Hence,

O R D E R E D

That the Appeal stands allowed on contest.  The impugned order is hereby set aside.  No order as to costs.