Haryana

Ambala

CC/106/2021

Ashok Kumar - Complainant(s)

Versus

Edelwise Tokiolife Inss Co Ltd - Opp.Party(s)

Anupam Sharma

02 Feb 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	106 of 2021
Date of Institution	:	23.02.2021
Date of decision	:	02.02.2023

 

Ashok Kumar, age 49 years, son of Sh. Chanda Lal, resident of House no.7, Ambika Vihar, Mahesh Nagar, Ambala Cantt.

          ……. Complainant.

                                                Versus

1. Edelwise Tokio Life Insurance Company Ltd. Regd. Office Edelwise House, office C.S.T Road, Kalima , Mumbai - 40098, Through its Managing Director.
2. Edelwise TokioLife Insurance Company Ltd, corporate office: 3^rd and 4^th , Tower 3, Wing R, Kohinoor city, Kiral Road, Kurla (W), Mumbai -400070, Through its authorized signatory.
3. Edelwise TokioLife Insurance Company through its Branch Manager. 2nd floor SCO 2447-48 Sec 22-C Chandigarh 160017

                                                    

 ….…. Opposite Parties

Before:         Smt. Neena Sandhu, President.

                             Smt. Ruby Sharma, Member,

           Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Anupam Sharma, Advocate, counsel for the complainant.    

                         Shri Rajiv Sachdeva, Advocate, counsel for the OPs.              

Order:        Smt. Neena Sandhu, President.

1.                Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

1. To restore the policy no.50086133E dated 14.02.2018 as continue.
2. To pay Rs.2,00,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.
3. To pay Rs.33,000/-, as litigation expense.                                                             OR

Grant any other relief which this Hon’ble Commission may deems fit.

2.             Brief facts of the case are that the complainant purchased life insurance policy No. 50086133E on 14.02.2018 for which the basic sum assured was of Rs.50,00,000/- with a premium of Rs.38822/- payable per annum for a period of 25 years having maturity date as 08.02.2043. The complainant paid annual installment regularly without any default.  In the month of January, 2020 complainant came to know that the qualification of the complainant is mentioned as BA in the policy document being sent by the OPs after obtaining the said policy cover by the complainant. The complainant immediately intimated about the said mistake to the OPs through email dated 14.01.2020 and requested for correction of the same as the complainant is having educational qualification -SSC. The OPs vide email dated 28.02.2020 asked the complainant to submit his matriculation certificate and accordingly complainant submitted the same with the OPs. Vide letter dated 06.04.2020 the OPs sent the corrected/updated document to the complainant. The complainant deposited the annual premium amount as per terms and conditions of the policy. It was great shock and surprise to the complainant on receiving email dated 02.06.2020 vide which the OPs intentionally and deliberately without any reason and prior intimation to the complainant cancelled the said policy and thereafter refunded the amount of Rs.1,16,466/- in the account of complainant on 28.05.2020 being deposited by the complainant in the shape of annual premium. The complainant immediately approached the official of OPs and asked the reason of cancellation of the policy but they did not pay any heed. Due to above said negligent act and conduct on the part of OP's, a great cloud has been cast upon the legal right of the complainant and he suffered mental agony, harassment and monetary loss at the hands of OPs. Hence this complaint.
3.           Upon notice, the OPs appeared and filed written version and raised preliminary objections with regard to jurisdiction and not come with clean hands and suppressed the material facts, etc. On merits, it has been stated that the complainant had proposed for an insurance Policy by duly signing the Proposal Form. However, as per the product underwriting guidelines of the OPs, the complainant did not fulfill the education criteria. In the proposal form, the complainant mentioned his educational qualification as Graduate (B.A). Therefore believing the information provided by the complainant regarding his education qualification to be true; the policy was issued to the complainant. Vide e-mail dated 19 February 2020, the complainant approached the OPs and requested for change in his educational qualification from BA to SSC. On the request of the complainant, the OPs updated its record and changed the educational qualification in the Company's records and sent the updated information to the underwriting department. On perusal of the updated information by the underwriting department, it was observed that the complainant was not eligible for the insurance coverage as the customer did not fulfill the education criteria as per the product. Hence, the policy was declared null and void vide letter dated 02.06.2020 and the premium paid under the policy was refunded to the complainant. Under section 45 of Insurance Act, 1938, the Insurance Company can challenge the policy on the ground of concealment of material facts by the Insured within three years from the date of commencement of the policy. In the present case, the subject policy was issued on 08 Feb 2018 and the OPs were well within their rights to declare the policy null and void and have thus rightly, legally and in accordance with the terms and conditions of the policy declared the policy null and void vide an email dated 02 June 2020 on the ground of intentional non-disclosure of material facts by the Life Assured. However, upon re-evaluation of the complainant's case, it was observed that the complainant's income showed an increasing trend and the complainant had paid the premium amount under the policy without any lapse. Hence, even though the complainant was not eligible for the insurance coverage by virtue of not being a Graduate, as an exception the OPs decided to reinstate the policy from inception on the same terms and conditions subject to payment by the complainant of Rs.1,55,288/- towards premium for the period from February, 2018 till February, 2021. The OPs vide letter dated 01 July 2021 communicated to the complainant to reinstate the policy on the same terms and conditions subject to receipt of premium from the complainant. Rest of the averments of the complainant were denied by the OPs and prayed for dismissal of the present complaint with exemplary costs.
4.           Complainant tendered his affidavit as Annexure CA alongwith documents as Annexure C-1 and C-31 and closed the evidence of the complainant. Learned counsel for the OPs tendered affidavit of Shri Nilesh Ramchandani, Chief Manager-Legal of Edelweiss Tokio Life Insurance Company as Annexure OP-1/A alongwith Annexure R-1 to R-6 and closed the evidence on behalf of OPs.
5.           We have heard the learned counsel for the parties and have also carefully gone through the case file and also gone through the written arguments filed by the learned counsel for the OPs.
6.           Learned counsel for the complainant submitted that though the complainant himself had brought to the notice of the OPs with regard to correction of his educational qualification in the record maintained by them in respect of the policy in question, from Graduation to SSC, yet the OPs cancelled the policy in question, on the bald ground of fraud/misrepresentation of material facts regarding information of his education.  
7.           On the other hand, learned counsel for the OPs submitted that since the complainant suppressed material information regarding his education qualification as a result of which his policy stood cancelled by the OPs, however, still the OPs are willing to reinstate the policy on the same terms and conditions from the date of inception i.e. February 2018 on payment of the pending premium. 
8.           It is not in dispute that the complainant had obtained the insurance policy namely “Simply Protect Plan” from the OPs, on making payment of Rs.38,822/- for a period of 25 years on annual premium frequency. The risk commencement date was 08.02.2018 to 08.02.2042. The fact that at the time of obtaining the policy in question, the complainant had got recorded his qualification as “Graduation” is also not in dispute. It is also an admitted case of the parties that the complainant kept on making premium in respect of the policy in question regularly, however, in the month of January 2020, it was noticed by the complainant that the qualification mentioned in the policy in question was “Graduation”,  whereas, he was Matric Pass, as a result of which, he wrote email dated 14.01.2020, Annexure C-15 to the OPs to correct his qualification in the said policy, which was done by them and intimation in that regard was sent vide letter dated 06.04.2020.  However, the dispute arose, when the OPs vide email dated 02.06.2020, Annexure C-16/C-17 informed that his policy has been cancelled and the premium amount of Rs.1,16,466/- paid by him in installments was refunded to him on 28.05.2020.
9.           Under above circumstances, the moot question which falls for consideration is, as to whether, the OPs were justified in cancelling the policy in question or not? It may be stated here that we have gone through the E-mail dated 02.06.2020, Annexure C-16/C-17 and found that the policy in question was cancelled on the ground that there has been misrepresentation of material facts on the part of the complainant with regard to wrong disclosure of his educational qualification as Graduation, whereas he was SSC. It is significant to mention here that it is not the case of the OPs that they have themselves found later on that the complainant has committed fraud and misrepresented regarding his educational qualification at the time of obtaining the policy in question, whereas, on the other hand, admittedly, it is the  complainant who, when came to know that his qualification has been mistakenly recorded as graduation instead of matric that he made written request to the OPs vide document Annexure C-15 to correct the same. Even otherwise, once the OPs themselves have ignored to carry out physical verification of the education certificates of the complainant at the time of issuance of the policy in question, they themselves were negligent and as such, under similar cases of inadvertent mistakes, they cannot blame the insured on this score, especially, when the said inadvertent mistake has been brought to the notice of the insurer by the insured himself. Thus, the component of fraud or misrepresentation or wrongful disclosure is missing in the present case. Secondly, it is also proved from the own act of the OPs that such an inadvertent mistake, which was got rectified by the complainant, was not material because the OPs themselves wrote letter dated 01.07.2021, Annexure C-18 (during pendency of this complaint) wherein they have candidly admitted that they have evaluated the case of the complainant and are willing to reinstate the policy on the same terms and conditions from the date of inception i.e. February 2018 on payment of the pending premium. This fact has been reiterated by the OPs in their written version also. Under these circumstances, we are of the considered opinion that by cancelling the policy in question, the OPs were deficient in providing service to the complainant.
10.           In view of the aforesaid discussion, we hereby partly allow the present complaint and direct the OPs, in the following manner:-
    1. To reinstate/restore the policy in question in favour of the complainant on the same terms and conditions as were provided at the time of its inception on 08.02.2018. However, it is made clear that the policy in question shall be assumed to be continued from 08.02.2018 carrying all the benefits from the said date i.e. 08.02.2018
    2. To pay Rs.3,000/- as compensation for the mental agony and physical harassment suffered by the complainant.
    3. To pay Rs.2,000/- as litigation costs.

 

At the same time, the complainant is also directed to pay the premium @ Rs.38,822/-, per year from 08.02.2018 onwards, within the period of 30 days, from the date of receipt of the certified copy of the this order.

                The OPs are further directed to comply with the aforesaid directions mentioned at serial No.(i to iii) within the period of 45 days from the date of receipt of due premium amount from the complainant, failing which the OPs shall pay penalty @ Rs.50/- per day, till restoration of the policy in question and also pay interest @ 6% per annum, on the awarded amount mentioned at serial No.(ii and iii) for the period of default, till realization. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

       Announced:- 02.02.2023

 

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President