Punjab

StateCommission

A/11/988

Reliance General Insurance Company Ltd. - Complainant(s)

Versus

Hem Raj Goyal - Opp.Party(s)

Rajneesh Malhotra

06 Jul 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL COMMISSION, PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

                   First Appeal No.998 of 2011

 

 

                                                                                                                              Date of Institution: 30.06.2011                                                                                                                                                                         Date of Decision : 06.07.2015

 

 

Chaman Lal son of Shri Pishori Lal, resident of 304/5, Factory Area, Patiala.                                                                                                                                                                                                                                                                                                                                                                                …..Appellant/Complainant

         

                                      Versus

 

1.       Max New York Life Insurance Company Limited, 11th and 12th   Floor, DLF Square Building, Jacaranda Marg, DLF, Phase 11,        Gurgaon (Haryana) - 122002 through its Managing Director.

 

2.       Regional Office, Max New York Life Insurance Company Limited, SCO No.7th and 8th Floor, Leela Bhawan Market, Patiala through  its Regional Manager.

 

3.       Branch Office, Max New York Life Insurance Company Limited, Patiala Gate, Nabha, Tehsil Nabha, District Patiala through its      Branch Manager.

 

                                                                                                                           … Respondents/Opposite Parties.

 

 

First Appeal against order dated 17.05.2011 passed by the District Consumer Disputes Redressal Forum, Patiala

Quorum:-

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri. Harcharan Singh Guram, Member

 

Present:-

 

          For the appellant              :         Sh.Mohit Jaggi, Advocate  

          For the respondents        :         Sh. Rajneesh Malhotra, Advocate

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

J.S KLAR, PRESIDING JUDICIAL MEMBER :-

         

          The appellant of this appeal (the complainant in the complaint) has directed this appeal against the respondents of this appeal (the opposite parties in the complaint), challenging order dated 17.05.2011 of District Consumer Disputes Redressal Forum Patiala, dismissing the complaint of the complainant. The instant appeal has been preferred against the same by the complainant now appellant in this appeal.

2.      The complainant Chaman Lal has filed  the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that  he is policy holder of the policies no.489686113, 491011417 and 705628030 issued by Max New York Life Insurance Company/OP. Sh. Avneet Singh Pathania is the authorized agent of the insurance company, who filled the policy proposal form no. 489686113 on 30.06.2008 for Rs.50,000/- per annum, policy proposal form no.491011417 on 30.06.2008 for Rs.s10,000/- per annum and policy proposal form no.705628030 on 26.08.2008 for Rs.20,000/- per annum. All information about the above said policies was given by the complainant to the above-referred authorized agent of the insurance company. After collecting the information from the complainant, the Territory Manager namely Sh. Vikas Mittal, Branch Manager at Nabha and Mr. Sunil Bagga of Nabha Branch and the above-said agent of the OP/Company namely Avneet Singh Pathania of Nabha Branch assured the complainant to send the original policy to the complainant. After one month, the complainant contacted Avneet Singh Pathania, authorized agent of the insurance company about the policy, but he delayed the matter on one pretext or the other. The complainant visited the office of the OP/Company at Patiala on 26.09.2008 and delivered his first policy no.489686113 and after opening the envelope, it was found that the terms chosen by the complainant was Rs.50,000/- per quarter instead of Rs.50,000/- per annum. Fraud has been committed by the OP/Company and its employees on the complainant. It was so discovered by the complainant on 26.09.2008. The complainant visited the office of insurance company at Patiala on  many occasions, but nothing has been done by the OPs. No amount was refunded to the complainant, which was paid to the insurance company towards policies i.e. Rs.50,000/- plus Rs.10,000/- plus Rs.20,000/- totaling Rs.80,000/-. The complainant sent a legal notice dated 25.11.2009 through registered cover, vide postal receipts no.2633, 2634 and 2639 dated 25.11.2009 requesting the insurance company to return the policy amounts of Rs.80,000/- along with interest @ 18% per annum within 15 days period. Visits of the complainant on a number of occasions proved futile. The complainant has, thus, filed the present complaint directing the OPs to pay Rs.80,000/- along with interest @ 18% per annum and to pay further compensation of Rs.20,000/- for mental harassment and Rs.11,000/- as costs of litigation.

3.      Upon notice, OPs appeared and filed written reply raising preliminary objections that the complaint is malicious and malafide and is an abuse of process of law and merits dismissal under Section 26 of the Consumer Protection Act 1986. Any negligence or

deficiency in service on the part of OPs was vehemently denied in the written reply. It was further averred that the complaint is based on mere surmises and conjectures. It was further pleaded that in the preliminary objections by the OPs that  the complainant himself was an authorized agent of the OPs and was fully aware about the free look period clause of 15 days for opting out of the policy. It was further averred that when there are allegations of fraud and cheating, the Consumer Fora cannot determined the dispute in it in summary proceedings. It was further pleaded that based on the information provided in the proposal form and after receipt of the initial premium amount, the OP/Company issued said policy no.1 dated 30.07.2008, which was dispatched by the OPs on 01.08.2008 to its general office, Patiala  and thereafter the policy was collected by the complainant through himself, who was an agent with Max New York Life Agency Code 232482, Patiala Branch. It was further averred that on understanding all terms and conditions of the policy, the complainant filled another proposal form bearing no. 491011417 for "Life Invest Unit Linked Investment 5 Pay Plan"  in the name of the Jasbir Kaur as life insured, giving all relevant details and information in the prescribed form for an assured sum of Rs.2,00,000/- . Under the said policy, a premium of Rs.10,000/- was to be paid semi-annually. The OPs received letter from the complainant requesting the OPs to cancel the policy. The OPs in pursuance of the letter dated 27.03.2009 conducted an investigation and after confirming from its Branch Office, Patiala, it was found that complainant himself was an agent of the insurance company and collected the policy documents in time from the branch office and hence his request was declined to cancel the policy, vide letter dated 30.03.2009. The complaint was also contested even on merits by the OPs. It was stressed that complainant was fully aware of the fact that proposal form is filled and signed only by the proposer. The allegations contained in the complaint were alleged to be false by the OPs. It was further averred that OPs have not received any letter dated 26.09.2009 from the complainant. The OPs controverted the averments of the complaint and, thus, prayed for dismissal of the complaint.

4.      The complainant tendered in evidence the affidavit of complainant Ex.C-A,  copy of letter dated 26.09.2008 Ex.C-1, copy of letter dated 17.04.2009 Ex.C-2, copy of legal notice Ex.C-3, copy of postal receipts Ex.C-4 and Ex.C-6.   As against it, OPs tendered in evidence affidavit of Ritu Yadav, Deputy Manager (Customer Care) of Max New York Life Insurance Company Ltd Ex.R-1, affidavit of Avneet Singh Pathania agent of Nabha Branch Nabha Ex.R-2,  copy of proposal form Ex.R-3, copy of letter dated July 2008 Ex.R-4, copy of policy documents Ex.R-5, copy of proposal form Ex.R-6, copy of letter for sending policy Ex.R-7, copy of proposal form Ex.R-8, copy of letter for sending policy along with policy documents Ex.R-9 and Ex.R-10, copy of letter of complainant Ex.R-11, copy of letter dated 16.2.2009 Ex.R-12, copy of letter of complainant Ex.R-13, copy of letter dated 30.03.2009 Ex.R-14, copy of letter dated 21.04.2009 Ex.R-15, copy of letter dated 27.04.2009 Ex.R-16. On conclusion of evidence and arguments, the District Forum, Patiala, dismissed the complaint of the complainant by virtue of order dated 17.05.2011. Dissatisfied with the order of the District Forum Patiala dated 17.05.2011, the complainant now appellant has preferred this appeal against the same.   

5.      We have heard learned counsel for the parties and have also examined the record of the case. We have also considered the written submissions placed on record by the parties. We refer to evidence on the record to settle the dispute between the parties in this case. The affidavit of the complainant in support of his case is Ex.C-A on the record. The complainant stated in this affidavit that the proposal form was filled up by Avneet Singh Pathina and he paid the premium for the above policy. When he received the envelope of the original policy, he found that the terms chosen by him was Rs.50,000/- per quarter instead of Rs.50,000/- per annum and he sent reminders to the OPs for cancellation of the above policy, but OPs failed to respond thereto. He further stated that there is cutting under the column "coverage term" and the figure "0" has been added, after over-writing on the figure "five" i.e. from figure "15 years", it has been converted to figure "10 years" and the signatures of the complainant has been forged on the said form. Ex.C-1 is letter addressed by the complainant on 22.03.2010 to OP regarding receipt of the policy, Ex.C-2 is the letter by the complainant to Max New York Life Insurance for cancellation of the policy, Ex.C-3 is the legal notice sent by the complainant to OPs on 25.11.2009 and Ex.C-4 to Ex.C-6 are postal receipts, Ex.C-7 and Ex.C-8 are the acknowledgements of the Income Tax report of the complainant, Ex.C-9 to Ex.C-11 are schedule of payment. The complainant's case is based on the above-referred documents on the record.

6.      The OPs tendered in evidence affidavit of Ritu Yadav, Deputy Manager (Customer Care) of Max New York Life Insurance Company Ltd. She stated  in her affidavit that no negligence or deficiency in service is involved on the part of the OPs. It is further stated in her affidavit that complainant is an agent of the OPs and is duly aware of free look period clause contained in the insurance policy. She further stated that request for cancellation of the complainant is beyond free look period of 15 days and hence it was rightly denied by OPs. She further stated that complex question of fraud and cheating are involved in this case as per allegations of the complainant, which cannot be determined in summary proceedings by the Consumer Forum. She stressed on free look period concession clause contained in terms of the policy, as insured may opt to return the original policy with written request for cancellation of the policy within 15 days from  the date of premium paid, adjusted for any adverse movement in Fund Value less charges incurred on medical examination and on account of stamp duty to be refunded without interest. She further stated that the complainant who himself was an agent of the insurance company duly understood all the terms and conditions of the policy and also filled up the proposal form bearing no. 705628030 for a "Life Invest Unit Linked Investment 3 Pay Plan" (hereinafter referred to as the "policy no.3") giving all relevant details and information in the prescribed form, for an assured sum of Rs.6,00,000/-, vide proposal form Ex.R-8. She further stated that on the basis of the information supplied in the proposal form and after receipt of the initial premium amount, the OPs issued the said policy no.3 dated 7.09.2008, which was dispatched by the OPs on 09.09.2008 to General Office, Patiala and thereafter the policy was collected by the complainant  who himself was an agent with Max New York Life Patiala Branch. She proved copy of the said policy Ex.R-9. She further stated that the OPs received letter on 05.02.2009 from the complainant to cancel the policy and to refund the initial premium, vide letter Ex.R-11. She further stated that the complainant himself is an agent of the insurance company and collected the policy documents in time from the branch office, as same was resorted to outside the free look period and copy of letter dated 30.03.2009 is Ex.R-14. The OPs declined to cancel the policy and to refund the premium amount. Vide letter dated 27.04.2009, vide Ex.R-16 on the record. Similarly, affidavit of Avneet Singh Pathina, who is an agent of Nabha Branch, Nabha of New York Life Insurance Company Limited is  Ex.R-2 on the record. He categorically stated in his affidavit that request of the complainant to cancel the policy was beyond the free look period of 15 days, as provided under the free look period in the policy document. He further stated that on 30.06.2008 after understanding, all the terms and conditions of the policy, the complainant himself filled up the proposal form bearing no.489686113 for a "Life Invest Unit Linked Investment 5 Pay Plan" (hereinafter referred to as the "Policy No.1") giving all relevant details and information in the prescribed form, for an assured sum of Rs.10,00,000/-. Under the said policy, a premium of Rs.50,000/- was to be paid quarterly, vide proposal form Ex.R-3. He denied the contention of the complainant that he filled up the proposal form of the complainant, rather he stated vehemently in his affidavit that complainant filled up another proposal form. The complainant himself filled up the proposal form, who is also an agent with Max New York Life insurance Company. Ex.R-3 is photocopy of the proposal form of the complainant, Ex.R-4 is letter sent to the complainant by the OPs, Ex.R-5 is policy document as placed on record by the OPs. Ex.R-6 is Unit Linked Proposal Form bearing NO.491011417. Ex.R-7 is the letter addressed to the complainant by the OPs dated 23.07.2008.  The other documents of the OPs have also been examined by us on the record. Ex.R-10 is policy document containing terms and conditions of the policy Clause 27 pertaining to Policy Review Period, as policy holder could opt to return the policy document to the company with a written request for cancellation of the policy within fifteen days from the date of receipt of the policy.  Ex.R-11 is letter of the complainant for cancellation of the policy and it is dated 05.02.2009, Ex.R-12 is letter sent by OPs to complainant regarding cancellation of the policy. The complainant has alleged tampering with the original policy documents by Avneet Singh Pathina, the authorized person of the OPs at the instance of the OP/company in this case. There are allegations of the fraud and forgery leveled by the complainant in this case. Even from the perusal of the photocopy of the proposal form no. 489686113 Ex.R-3, it is evident that digit "0" in the column of the premium payment details is overwritten and changed. Even from the perusal of the proposal Ex.R-8, we find the overwriting on the date 26.08.2009. We hold that complex facts are involved in this case because it is a seriously disputed fact whether complainant himself filled up the proposal form or it was filled up by Avneet Singh Pathina, the authorized agent of the OP/Company at the instance of the complainant. This dispute cannot be adjudicated in summary proceedings by the Consumer Fora, as it will entail abundant evidence involving cross examination and re-examination of witneses. The complainant has alleged the fraud and cheating on the part of the OPs in this case. We hold that when there are allegations of fraud and cheating, then generally the Consumer Fora does not take cognizance of the matter because voluminous evidence is required to examine this matter. The Apex Court has held in case titled as "Oriental Insurance Company Ltd… Vs Munimahesh Patel, 2006 (IV) CPJ Page-1 (SC)" that "proceedings before the Commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be carried out."

7.      In view of the complex and disputed facts of the case, we have come to the conclusion that complaint of the complainant has been rightly dismissed by the District Forum in this case.  The order of the District Forum under challenge in this case dated 17.05.2011 is clarified on this point by adding that the parties are at liberty to get their matter settled from the competent court of jurisdiction.

8.      As a result of our above discussion, we find that there is no merit in the appeal, as such; appeal of the appellant is dismissed with the above-referred observations of giving liberty to approach the competent court of law for redressal of the grievance.

9.      Arguments in this appeal were heard on 01.07.2015 and the order was reserved. Now the order be communicated to the parties.

10.    Copies of the order be communicated to the parties as per rules.

11.    The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

                                                                          (J. S. KLAR)

                                                             PRESIDING JUDICIAL MEMBER

                       

                                                         

                                                          (HARCHARAN SINGH GURAM)

                                                                             MEMBER

 

July 6,    2015.                                                               

(ravi)