DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

C.C. No. 303/2021

QUORUM:

Judgment By: Shri S.S. Malhotra (President)

JUDGMENT

By this judgment the Commission shall dispose of the complaint of the complainant against OP w.r.t. deficiency in service in mis-selling the product /policy.  

Complainant has filed the present complaint against OP1 the insurance  Co., OP3 its branch office, as well as against OP2, a private bank who also acted as  a service provider and through whom the policy of respondent No.1 in question was purchased.

Brief facts as stated by the complainant in the complaint are that complainant purchased an insurance policy namely ICICI Prudential Elite Life Super on 25.06.2018 having policy number 23522911 from the branch office of OP1 i.e. OP3 and at the time of purchase of the policy she was mislead and was given to understand that she had to pay only one time premium of Rs.5,00,000/-.  It is further stated that terms and conditions of the policy were not supplied at the time of executing the documents.  However the complainant came to know when the next payment of the premium was demanded and the OP3 directed the complainant to pay the premium of Rs.5,00,000/- next year, where after she approached the branch manager/OP3 and gave a representation on 10.07.2019 stating all such facts that she was under the impression that policy had only ‘One time premium deposit scheme’ and asked the respondent to cancel the policy and refund the principal amount where after the OP1 assured to review the representation made by complainant and on 17.07.2019 the OP1 sent a reply to the letter dated 10.07.2019 thereby informing that the aforesaid policy was issued on 26.06.2018, the document of policy was dispatched on 29.06.2018 and the same was delivered to the complainant on 30.06.2018 along with the terms and conditions and free look period of 15 days was granted to the complainant and even SMS communications were sent at the registered mobile number of complainant i.e. 9717410484, thereby sharing the policy details like premium amount, policy term, sum assured, next premium due, policy dispatch details, and free look option period but the complainant highlighted this fact only after one year of the policy issuance, and in view of that they are unable to comply with the request of the complainant regarding cancellation of the policy and thereafter certain terms and conditions of the policy were explained in the letter itself inter alia stating that as per the scheme of the OP there are certain deductions for the first year which are upto Rs.6,000/- for the first year, upto Rs.5,000/- for the second year, Rs.4,000/- if the refund is requested on third year and so on and so forth and it was also informed by the OP that in case resolution provided by OP is not upto the expectation of the complainant, then she may approach to the Grievance Redressal Officer (GRO). The complainant then again wrote a letter on 22.07.2019 explaining herself to  be an  Hindi  Teacher and not well versed with the English language but she was under the impression that she has to pay the premium only once as the relationship manager guided her and she followed the same blindly and as such there was no promptness on her part for looking into the free look period clause but she again submitted that the OP should not make fool of innocent people as the complainant has done a mistake by investing money in this policy whereas she does not have sufficient funds to pay Rs.5,00,000/- every year being a teacher and this request was also not accepted by the OP however it was assured to the complainant that fund value after the lock  in period of 5 years will be transferred to the discontinued policy after deductions of applicable of discontinue charges as described in the policy itself and the interest credited during the discontinue period would be payable subject to minimum of the interest applicable to saving bank account and in nutshell it is stated that she has been sold the policy by OP3 and the OP may after deducting the reasonable amount should return the balance amount to the complainant and it is also  contended that policy per se is illegal and is against the public policy and is violative to the principal of natural justice and ultimately it  is prayed that OP be directed to refund Rs.5,00,000/- from the date of  deposit along with the interest @ 12% p.a. and also pay compensation of Rs.1,00,000/- alongwith litigation charges.

OP1 and OP3 have filed the detailed written statement whereas OP2 has filed the separate reply.

Coming to the written statement of OP1 and OP3 first, it is  inter alia stated that the present complaint is barred  by limitation as policy under dispute was issued on 22.06.2018, it apparently discontinued on 26.06.2019 due to non-payment of renewal premium and in any case the  complainant has come to know that the policy was not under the scheme of ‘one-time payment’ and when she made representation in July 2017 to the office of the OP, whereas complaint has been filed on 09.08.2021 which is barred by law under section 69 of CPA-2019 and further it is submitted that the complainant who is an educated person had taken the policy after due diligence and copy of the proposal form signed by the applicant forwarding letter which clearly mentions that in case the policy holder is not satisfied with the terms and conditions of the policy then she can withdraw or return the policy within 15/30 days under free look period/cancellation period and since complainant have  not exercised that option and has approached the insurance company after the gap of one year, she is not  entitled for  any benefit under the policy as policy was issued to the complainant as per  the mandate of IRDA where she has to pay Rs.5,00,000/- premium for a term of 7 years having sum assured of Rs.50,00,000/- commencing from 26.06.2018 and maturing on 26.06.2024 with the premium payment term of  7 years (not 5 years as is being alleged). It is further submitted that complainant had opted for an annual  premium of Rs.5,00,000/- under the subject policy for 7 years and the obligation to continue to paying the premium was breached by complainant and she stopped paying premium and also failed to avail the option of reviving the policy for the reason best known to her and therefore as per applicable policy terms and conditions the fund value has been credited to ‘discontinued policy fund’ (DP fund) as mentioned in clause 16 of the policy, keeping in view  the lock in period of 5 years and it is further submitted that the OP has sent the premium reminders and policy lapse intimation via SMS to the complainant on her registered mobile number but she has neither paid the premium nor has revived the policy and therefore company is not bound to give the reminder /further messages to the complainant who is a post graduate and is a knowledgeable  individual and not only this she had to pay the policy premium for 7 years and she ought to appreciate that insurance policies are standard form of contracts and are strictly governed by terms and conditions and the onus was upon the policy holder to check the documents before signing and reading the terms and conditions as is being held  in various judgments. It is also denied that some person from OP2 office namely Ms. Bhawna had given her the proposal of depositing one time premium and since Ms. Bhawna is not a party, the complaint is bad for mis-joinder and non-joinder of parties and in any  case OP1 and OP3 has nothing to do with this aspect and since the OP3 has sold the policy and sent the policy documents to the complainant which are attached by the complainant herself along with the complaint there is no deficiency against OP1 and OP3 nor there is no cause of action against them and as such complainant of the complainant be dismissed. 

As far as merits are concerned the contents of preliminary objections are reiterated and reaffirmed and the details of text messages sent to the complainant on her registered mobile number on 01.07.2019, 05.07.2019, 06.07.2019, 10.08.2019, 30.08.2019, 12.09.2019 running upto 16.06.2021 were sent and thereafter it is mentioned that the fund value under the subject policy has already been transferred to the discontinuation policy fund (DP fund) and it was duly intimated to the complainant that in order to receive back the benefits under the policy, the renewal premium needs to be paid which the complainant failed to pay and it is further submitted that as per applicable terms and conditions of the policy the fund value  has been credited to the ‘discontinued policy fund’ after deduction of applicable charges, which will be paid out after the lock in period of 5 years and therefore it is prayed that there is no deficiency on the part of  OP1 and OP3 and it is prayed that complaint of the  complainant be dismissed. 

OP2 has filed its separate written statement inter alia stating that the complaint case against OP2 is not maintainable and is liable to be dismissed, as, all the allegations in the complaint are against OP1 and OP3 and apart from the single sentence that OP2 was service provider in getting the policy, there is no other averment in the complaint against OP2 and therefore there exists no consumer dispute from these facts in between complainant and OP2 and therefore it is prayed that complaint of the complainant be  dismissed. 

OP2 and OP3 both have also filed an application seeking  condonation of delay in filing the written statement but vide order dated 20.12.2022 application of OP1 and OP3 as well as of OP2 seeking condonation of delay were dismissed and written statement of OPs was ordered not to be taken on record.  In fact there is no written statement of the party on record for the purpose of their defence. 

The complainant accordingly has filed her evidence and since there is no written statement of OPs they were not given any opportunity to file evidence however both the parties have filed their written submission.

The Commission has heard the arguments and perused the record.

The allegation of mis-selling the policy by some employee of OP2 have not been proved by the complainant nor there is any consideration paid by the complainant to the OP2 or its employee for taking such services and therefore as far as OP2 is concerned complainant is not the consumer of OP2 under CPA-2019 and since the complainant is not a consumer of OP2 there is no deficiency of service under the provision of CPA-2019 by OP2. Complaint of the complainant against OP2 is therefore dismissed forthwith.

As far as OP1 and OP3 are concerned the complainant although has mentioned in the complaint that she is not well educated and not well versed with the English language and policy has been sold to her by misrepresentation but this fact is also not worth appreciating as complainant in her own complaint has mentioned that she is a teacher and by now has retired meaning thereby that she is a well educated person, who has  to understand the contents of each agreement/contract which  she signs so  as to protect her interest. She also submits the copy of the terms and conditions were not supplied to her but simultaneously she herself has placed the copy of such terms and conditions on record and therefore this contention of complainant is also not well found. The written statement of OP1 and OP3 was although ordered as not to be taken on record yet it had raised the question of law w.r.t. limitation stating that policy was sold in June 2018 and even as per the admission of the complainant the  next premium was asked from her in June 2019 whereafter she made representation in July 2019 which was appropriately answered yet complaint has been filed in August 2021 and therefore complaint is barred by law. This contention of OP may be well found on the face of it but is not appropriate as the policy is for 5 years, the policy had a lock in period of 5 years, the complainant had to pay the premium for 7 years and policy cover is for 10 years against sum assured of Rs.50,00,000/- and OP has kept the amount of policy in discontinuation policy fund (DP fund) and has neither forfeited the amount as per the policy nor has returned the amount and therefore until  and unless the OP conveys to the complainant that the  amount has been forfeited, the cause of action would not start and therefore the complaint is not barred by law. 

The only question therefore is now as to whether the complainant is entitled for refund of the entire amount with interest as prayed for.  This fact can be considered in view of the admission of the OP in the written arguments where OP1 and OP3 have admitted that amount was kept in discontinuation policy fund (DP fund) for a period of 5 years i.e. the lock in period which lock in period has been completed on 26.06.2023 and now the lock in period is over and the money from DP fund has moved to the main fund account and at present an amount of Rs.4,29,380.95/- is due to the complainant as per the terms and conditions.  This fact is a relevant fact as the written statement filed by OP1 and OP3 on 26.07.2022 and at that time, lock in period was not over, whereas written arguments has been filed on 13.12.2023, and by then the lock in period has been over. This is also another ground where the contention of the OP w.r.t. time barred becomes nullified but the fact is that irrespective of the fact that written statement of the OP cannot be read, but the admission made by the OP towards the amount due to the complainant can definitely be considered even if the written statement is not supposed to be read for the appreciation of defense of the OP.  Although, the complainant has not been able to prove any deficiency on the part of OP1 and OP3 but since OP1 and OP3 have also not forfeited the amount and have admitted that an amount of Rs.4,29,380.95/- is due to the complainant, and is lying in this main account , then not returning the amount by the OP amounts to deficiency in service by the OP and therefore, keeping in view the admission of the, OP1 and OP3 they are directed to refund the amount of Rs.4,29,380.95/- to the complainant with interest @ 9% p.a. from the date when it was kept in DP Fund upto 26.06.2023 and @ 12% interest from 26.06.2023, i.e. when lock in period was over  till the actual payment. 

In these circumstances complainant is not entitled  for any compensation and litigation charges. The OP is directed to make the payment along with interest within 30 days.   

However, if the OP would not pay the amount within 30 days than it would pay the interest @ 15% p.a. on this amount and would also pay compensation of Rs.15,000/-. 

This order be complied with within 30 days from the date of receipt of the der.

Copy of the order be supplied/sent to the parties free of cost as per rules.

File be consigned to Record Room

Announced on 22.04.2024.