Order No. 14 dt. 13/08/2019
The case of the complainant in brief is that the complainant being a house wife and her husband being an unemployed person depended upon his retired father and they were misled by the broker, o.p. no.4 of the o.p. insurance company. The complainant after receiving the policies while found that she was cheated by o.p. no.4, he raised his objection and filed a complaint to ombudsmen and ombudsmen passed an award on 25/06/2017 directing the insurance company to cancel the policies bearing nos. 03114765, 03184966 and 03238594 and to covert the entire amount to a suitable ULIP policy. The complainant having no income of her own and had to depend upon his father-in-law and there cannot be any question of payment of further premium in respect of the new policies, but insurance company forcibly on or about 23/06/2017 took away the earlier three policy bonds from the complainant and compelled to sign on an application so that insurance company can transfer the entire amount of the earlier three policies in a policy mentioned “Ëxide Life Wealth Maxima”. The complainant after receiving the policy bonds came to learn that she will have to pay for 10 years with annual premium of Rs.68,000/- and the policy would mature on 04/07/2026. After going through the said policy documents the complainant found that insurance company failed to comply the order of ombudsmen and was asked to pay annual premium of Rs.68,000/- to be paid for next 10 years which was not feasible for the complainant, for which the complainant prayed for cancellation of the policy. The complainant within free look period sent the letter for cancellation of the policy but insurance company refused to accept the prayer of the complainant for free look cancellation, for which the complainant had to file this case praying for direction upon the o.ps. for refund of the amount of Rs.68,000/- as well as compensation and litigation cost .
The o.p. nos. 1 to 3 contested this case by filing w/v and denied all the material allegations of the complainant. It was stated that the complainant was provided with 3 insurance policies in her name with annual premium of Rs.25,000/-, Rs.18,000/- and Rs.25,000/- respectively with a premium term 7 years, 12 years and 10 years. Those policies were issued as per the desire of the complainant and she expressed for opening those policies. The o.ps. subsequently submitted an application stating that she opted for a single premium policy and as such sought for cancellation of above 3 policies and return of premium amounts. As the cancellation was sought for beyond the free look period, so insurance company repudiated the request for cancellation. On the basis of the said fact it was categorically stated that insurance company acted as per the direction of ombudsmen and there is no deficiency in service on the part of insurance company and accordingly, insurance company prayed for dismissal of the case.
In spite of receipt of notice the o.p. no.4 did not contest this case by filing w/v and as such, the case has proceeded ex parte against the o.p. no.4.
On the basis of the pleadings of parties the following points are to be decided:
- Whether the complainant had obtained the policies from o.ps?
- Whether o.ps failed to comply the order of ombudsmen?
- Whether there is any deficiency in service on the part of the o.ps?
- Whether the complainant will be entitled to get any relief as prayed for?
Decision with reasons:
All the points are taken up together for the sake of brevity and avoidance of repetition of facts.
Ld. Lawyer for the complainant argued that the complainant being a house wife and her husband being an unemployed person depended upon his retired father and they were misled by the broker, o.p. no.4 of the o.p. insurance company. The complainant after receiving the policies while found that she was cheated by o.p. no.4, he raised his objection and filed a complaint to ombudsmen and ombudsmen passed an award on 25/06/2017 directing the insurance company to cancel the policies bearing nos. 03114765, 03184966 and 03238594 and to covert the entire amount to a suitable ULIP policy. The complainant having no income of her own and had to depend upon his father-in-law and there cannot be any question of payment of further premium in respect of the new policies, but insurance company forcibly on or about 23/06/2017 took away the earlier three policy bonds from the complainant and compelled to sign on an application so that insurance company can transfer the entire amount of the earlier three policies in a policy mentioned “Ëxide Life Wealth Maxima”. The complainant after receiving the policy bonds came to learn that she will have to pay for 10 years with annual premium of Rs.68,000/- and the policy would mature on 04/07/2026. After going through the said policy documents the complainant found that insurance company failed to comply the order of ombudsmen and was asked to pay annual premium of Rs.68,000/- to be paid for next 10 years which was not feasible for the complainant, for which the complainant prayed for cancellation of the policy. The complainant within free look period sent the letter for cancellation of the policy but insurance company refused to accept the prayer of the complainant for free look cancellation, for which the complainant had to file this case praying for direction upon the o.ps. for refund of the amount of Rs.68,000/- as well as compensation and litigation cost .
Ld. Lawyer for the o.p. nos. 1 to 3 argued that the complainant was provided with 3 insurance policies in her name with annual premium of Rs.25,000/-, Rs.18,000/- and Rs.25,000/- respectively with a premium term 7 years, 12 years and 10 years. Those policies were issued as per the desire of the complainant and she expressed for opening those policies. The o.ps. subsequently submitted an application stating that she opted for a single premium policy and as such sought for cancellation of above 3 policies and return of premium amounts. As the cancellation was sought for beyond the free look period, so insurance company repudiated the request for cancellation. On the basis of the said fact it was categorically stated that insurance company acted as per the direction of ombudsmen and there is no deficiency in service on the part of insurance company and accordingly, insurance company prayed for dismissal of the case.
Considering the submission of the respective parties it is an admitted fact that the complainant obtained the policies from o.ps and the complainant applied for one time premium for obtaining such policies, but whenever the complainant found that she was asked to pay yearly premium of Rs.68,000/-, she became astonished and she lodged a complaint to Hon’ble ombudsmen and Hon’ble ombudsmen was pleased to direct the insurance company to convert the premium amount to a suitable ULIP policy. The complainant has annexed the award which has not been disputed by insurance company. the insurance company has categorically stated that after such order passed by Hon’ble ombudsmen the complainant applied for further policies and accordingly those policies were issued in her favour. It appears from the materials on record that the complainant is a housewife and she has no income of her own. She has to depend on her father-in-law’s income, therefore, it is hardly possible for her or her husband to pay the premium of Rs.68,000/- p.a. The insurance company did not follow the direction of the ombudsmen whereby the ombudsmen gave a direction to convert the entire amount to suitable ULIP policy, but insurance company opened three policies with a direction to the complainant for payment of annual premium of Rs.68,000/-. The complainant categorically stated that she was misled by o.p. no.4, agent of insurance company. The agent has not appeared. From the materials on record it transpires that o.p. no.4 deliberately did not appear before this Forum and did not contest this case in order to clarify the entire fact as alleged by the complainant. It is pertinent to mention here that insurance company instead of opening the policies by converting the entire amount to a suitable ULIP policy opened 3 policies which categorically flouted the order of Hon’ble ombudsmen. On the basis of the facts and circumstances as stated above, it is crystal clear that insurance company for the purpose of misleading the policies deviated the order passed by Hon’ble ombudsmen. Accordingly, we hold that there is deficiency in service and unfair trade practice on the part of insurance company and the complainant will be entitled to get relief.
Thus all the points are disposed of accordingly.
Hence, ordered
That the CC No.234/2018 is allowed on contest with cost against the o.p. nos. 1 to 3 and dismissed ex party without cost against the o.p. no.4. The o.p. nos. 1 to 3 are jointly and/or severally directed to refund the amount of Rs.68,000/- (Rupees Sixty Eight Thousand) only to the complainant along with compensation of Rs.10,000/- (Rupees Ten Thousand) only for harassment and mental agony and litigation cost of Rs.5,000/- (Rupees Five Thousand) only within 30 days from the date of communication of this order, i.d. an interest @ 8% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
