O R D E R

Sri. P. Satheesh Chandran Nair (President):

                The complainant filed this complaint u/s.12 of the C.P. Act 1986 for getting a relief against the opposite parties.

                2. The brief facts of the complaint is as follows:  The complainant was a good customer of M/s. ICICI Prudential Life Insurance Co. Ltd.  He had invested good amounts with the company and one of his investments performed very well.  An authorized sales executive of the company approached the complainant and made to believe the complainant regarding a unique one time investment, life coverage and even better returns.  It is also assured that for the above said reasons for this investment a growth of 12% can also be expected.  Anyway, the complainant invests Rs.5 lakhs as per Policy No.13397793 on 11.02.2010.  The opposite parties misrepresented the complainant to the effect that this investment is a one time investment and he was not inform that it was regular premium policy.  The representative of the opposite parties however manage to get the complainant’s signature on the proposal form and other papers and it is understood that the representative filled them up later.  The complainant has not even unknown the name of the plan, so he could not pay the regular premium.  The complainant again contended that on May 2014, he received a letter asking him to receive Rs.1,20,186.56/- as foreclosure pay out and asking him to provide the company with an Electronic Payout form.  The complainant felt that it is an unjust gesture and refused to accept the cheque.  The company did not explained as to how an amount which is less than ¹/₄^th of the invested amount is arrived at.  When the complainant approached the opposite parties, they answered that it may be due to first year charges, surrender charges and lapse of the policy.  The company never communicated these facts to the complainant.  It is clear that the opposite parties were not acting good faith and customer accountability, but only bent on collecting premiums with the malicious intent of cheating the public.  Exorbitant and unfair deductions are made and no authentic policy conditions to be provided to the complainant and his policy was not properly followed up.  The complainant sent a legal notice to the opposite parties and the opposite parties sent a reply with frivolous and untenable argument.  The complainant further stated that he invested his hard earned money only believing words of the sales people of the opposite parties and the goodwill of the company.  He is entitled to get 12% interest to Rs.5 lakhs on 11.02.2010 till date and future interest at 12% also and the complainant is also entitled the claim of Rs.1 lakh as damage of the opposite parties and cost of the case against the opposite parties.  The acts of the opposite parties caused irreparable loss, mental agony, financial loss and hardship to the complainant. 

                3. The complainant filed this above complaint before the Forum, this Forum entertained the complaint and issue notice to all the opposite partiers and their appeared before the Forum and filed their joined version in this case.  The contents of the version is briefly stated as follows:  The main contentions of the opposite parties in this case is that it is not maintainable before this Forum.  According to the opposite parties, the complaint is baseless and devoid of any merit.  The opposite parties seriously contended that there is no deficiency of service on the part of opposite parties and they always maintained the quality and performance which is required to be maintained in pursuance as a contract.  The opposite parties again contended that the filing documents given to the complainant, i.e. the proposal form, policy document, Benefit illustration etc. given clearly mentioned on their fact that “In this policy, the investment risk in investment portfolio is borne by the policy holder”.  The opposite parties are not responsible for the volatility of the market fluctuations.  According to the opposite parties, in this policy the policy holder has get “Free Look Period” provision.  If he has any disinterest over the policy he can very well redress it by this provision.  If a policy holder not opted the “Free Look Period” the policy documents become bindings on both the parties and the contents their in are also binding on both of them.  According to the opposite parties, this is the settled position of the law portion.  According to the opposite parties, the complainant has not disclosed any cause of action against opposite parties and the allegation put forward by the complainant those which are not supported by any documentary evidence to substantiate their contention.  The opposite parties again contended that this Forum has no jurisdiction to adjudicate this matter under summary proceedings and this can only be adjudicated in a Civil Court and also stated that this complaint is bad by non-joinder of necessary parties.  The contention of the opposite parties in Para 13 to 15 narrated the nature of the policy, the details of the contract between the parties and the features of the policy etc.  The opposite parties stated that even though the complainant received the policy certificate and other documents on 11.07.2010 he did not approach the opposite parties with any discrepancies regarding the premium payment, benefits, foreclosure, surrender and the policy terms and conditions or non-receipt of policy document.  The complainant did not approach the company for the cancellation of the policy even during the “Free Look Period”.  In Para 17 and 18 the opposite parties explained the policy terms and conditions on the basis of the policy certificate.  The company was intimated the complainant to revive the policy before the end of revival period in order to avoid foreclosure of the policy.  The complainant did not utilize this opportunity also.  As per Para 22, the opposite parties explained the risk of investment in the fund and the details of different Policy Nos.13651659, 13651660, 14306787, 01324720 and 06773772.  The company categorically stated that the complainant was well aware of the policy details and chose not paid his renewal premium on due date, so that his policy is foreclosed in accordance with the terms of the policy conditions.  As per Para 25 of the version, the opposite parties deny the contents of Para Nos.5 to 8 of the complaint.  According to the opposite parties, the complainant has failed to demonstrate any deficiency in service of the opposite parties as far as the opposite parties are concerned.  The complainant is not entitled to any relief from the Forum as prayed by the complaint.  Hence the Forum may be dismissed the complaint with the compensatory cost to the opposite parties.    

                4. When the Forum perused the complainant and the documents filed at the time of the presentation of the petition and version filed by the opposite parties, this Forum raised the following issues: 

1. Whether this petition is maintainable before this Forum?
2. Whether the complainant proved his grievances as per the C.P. Act?
3. Whether the complainant is eligible for any relief sought for?
4. Regarding cost if any?

                5. Point Nos. 1 to 4:-  On the side of the complainant he himself examined as PW1 and marked Exts.A1 to A5.  At the time of cross-examination Ext.B1 and B1(a) are also marked.  Ext.A1 is the

Foreclosure notice issued by the opposite party to the complainant.  Ext.A2 is the legal notice dated 24.06.2014 sent by the complainant’s advocate to the opposite parties.  Ext.A3 is the postal receipts.  Ext.A4 is the acknowledgment cards.  Ext.A5 is the letter dated 30.07.2014 sent by the 4^th opposite party to the complainant.  Exts.B1 is the office copy of the letter dated 22.01.2013 of the complainant and B1(a) is the office copy of the reply letter dated 23.01.2013 to the complainant. On the side of opposite parties no oral evidence adduced in this case.  After the completion of evidence on both side we heard the parties.

                6. In the light of the evidence on both sides we can come to a conclusion that the complainant in this case was a good investor of the opposite party’s company.  According to the complainant, he invested the money with this opposite parties as a unique one time investment.  The complainant is a good customer of the opposite party’s company is an admitted fact.   The complainant’s definite case is that he was misrepresented by the representative of the opposite parties that the policy in question was a one time investment policy and as a result of this assurance PW1 invested Rs.5 lakh as per Policy No.13397793 on 11.02.2010.  It is come out in evidence that PW1 is a good customer of opposite party and already 4 policies were taken from the opposite party.  If it be so the plea of ignorance regarding the terms and condition of the disputed policy has not been sustained.  It is to be noted that the complainant is an experienced Engineer who served in India as well as in abroad.  We cannot take a view that the complainant is a layman and he took the disputed policy only on the basis of the assurance of an agent of opposite parties.  If a man of such experience and education nobody can imagine that he paid Rs. 5 lakhs to the agent of the opposite party without verifying any documents.  It is also pertinent to see that he has invested Rs. 5 lakhs on 11.02.2010.  But it is interesting to see that he has complained regarding the non receipt of the policy certificate and terms and condition only in 2014.  If the contention of ignorance of the terms and condition of the disputed policy was unknown to the complainant what prevented him to send a notice to opposite parties in proper time.  It is seen from the record that on 24.06.2014 the complainant issue lawyers notice to the opposite parties and it is seen that the complaint filed before this Forum on 05.09.2014.  On the side of the complainant it is claimed that a lawyers notice has been sent to the opposite parties regarding the non receipt of the policy certificate etc.  It is also interesting to see that nowhere in Ext.A2 no murmuring regarding non receipt of the policy certificate etc. are explained.  The purpose of the Ext.A2 notice was only for realizing the amount paid on 11.02.2010 etc.  The opposite parties cited 2 decisions with regard to this point i.e. (1) Revision Petition No.634/12 of our Hon’ble National Commission and (2) (2010)10 SCC 567 and (3) Revision Petition No.211/09 of Hon’ble National Commission.  In the above Hon’ble National Commission case (Revision Petition No.211/09) it was hold, “Since the insurance between the insurer and the insured is a contract between the parties the terms of the agreement including the applicability of the provision and also its exclusion had to be strictly construed to determine the extent of the liability of the insurer”.  On the basis of the above cited finding of our Hon’ble National Commission the plea of the complainant to the effect that he has no knowledge regarding the character of the policy at the time of investment did not sustain even for a movement. 

                7. On the other hand, this opposite parties are not adduced any oral evidence except Ext.B1 and B1(a) marked through PW1 at the time of cross-examination.  In this case, the main question to be considered is what is the terms and conditions of the disputed policy and on whose fault the policy is terminated.  It is to see that even the complainant or the opposite parties not take any steps to produce the terms and conditions of the disputed policy before the Forum.  It is an admitted case that complainant (PW1) remitted Rs.5 lakhs for the said policy and as per Ext.A1 it is to see that the said policy was foreclosed.  The learned counsel appearing for the opposite parties argued that the foreclosure of the said policy was duly intimated to PW1 as per the provisions of law.  But the opposite parties are failed to produce the said document before the Forum in order to convince this point.  The opposite parties mainly relying on Ext.B1 and B1(a).  In cross-examination, PW1 replied that, “Ext.B1-Â fund ഇല്ലാഞ്ഞതിനാലാണ് അടയ്ക്കാഞ്ഞത് എന്ന് രേഖപ്പെടുത്തിയിട്ടുണ്ട് . ഇതിന് കമ്പനി നല്കിയ reply ആണ് v Ext.B1(a)”.   We peruse B1 and B1(a) and find that the B1 document has been sent on 22.01.2013 and on 23.01.2013 the opposite parties has been replied to it as Ext.B1(a).  The complainant given stress on the conditions of the policy and his inefficiency to raise fund for remitting premium as per Ext.B1.  Ext.B1(a) of the insurer gives only an inference of considering the grievances of the complainant as per Ext.B1.  No other inference can be available from Ext.B1(a).  At this juncture, we have to rely the available evidence before the Forum.  It is so pertinent and interesting to see that either side of this case not produced the terms and conditions of the disputed policy.  The opposite parties in this case only issued Ext.A1 foreclosure notice and Ext.B2 reply to the complainant.  As per the Sec.5 of IRDA (Treatment of discontinue linked insurance policies) Regulation 2010 Sec.5 it is clearly stated that, “whether a policy is discontinued, the insurance shall take the following steps to enable the policy holder to exercise the option as available in terms of Regulation 4”.  (1) without sent a notice within a period of 15 days from the date of expiry of grace period to such a policy holder to exercise the said options within a period of 30 days of receipt of such notice provided that for the policy holder does not exercise the option within a stipulated period of 30 days.  The policy holder shall be deemed to have exercised the option mentioned at sub Regulation (ii) i.e., complete withdrawal from the policy without any risk cover (Sec.iv (ii) ).  The said notification is very clear to see that if an insured defaulted any policy it is the primary duty of the insurer to issue a notice to the insured regarding the said default.  In this case, the opposite party has not adduced any evidence to see that the opposite parties comply the above said notification as stated above.  When we look into the available evidence before this Forum we can safely come to a conclusion that the opposite parties are miserably failed to comply the Regulations issued by the insurance regulatory and development authority dated 1^st July 2010 and the terms and condition of the disputed policy which was also not produced before the Forum.  It is the parament duty of the opposite parties to show sufficient cause for the issuance of Ext.A1 foreclosure notice to the complainant.  If it be so, the foreclosure notice issued by the opposite parties cannot be treated as a notice taken as per the provision of law.  The above laches, irresponsibility and clear violation of the provisions of IRDA Regulation of 2010 are clear evidence of deficiency in service on the part of opposite parties in this case.  The opposite parties are jointly and severally liable for all the defects found against them.  In the light of the above evidence we found Point No.1 to 4 are proved in favour of the complainant (PW1).

                8. In the result, we pass the following orders:

1. Opposite parties are directed to return Rs.5 Lakhs (Rupees Five Lakhs only) as per policy No.13397793 which was invested by the complainant on 11.02.2010 within one month from the date of receipt of this order.
2. The opposite parties are directed to pay a compensation of Rs.10,000/- (Rupees Ten Thousand only) within one month from the date of receipt of this order.
3. The complainant is also eligible to realize Rs.2,000/- (Rupees Two Thousand only) as the cost of this case.
4. The complainant is eligible to realize 10% interest for the above relief on date of order onwards till its realization from the opposite parties, if the opposite parties do not comply the order within one month as specified above.

        Declared in the Open Forum on this the 30^th day of June 2015.

                                                                         (Sd/-)

                                                        P. Satheesh Chandran Nair,                          

                                                                     (President)

Smt. K.P. Padmasree (Member – I)       :     (Sd/-)

Smt. Sheela Jacob (Member – II)          :     (Sd/-)

Appendix:

Witness examined on the side of the complainant:

PW1  :  Mathew Oommen

Exhibits marked on the side of the complainant:

A1 : Foreclosure notice issued by the opposite party to the  

       complainant. 

A2 : Legal notice dated 24.06.2014 sent by the complainant’s  

       advocate to the opposite parties. 

A3 :  Postal receipts.

A4 :  Postal acknowledgment cards.

A5 :  Letter dated 30.07.2014 sent by the 4^th opposite party to the  

        complainant.

Witness examined on the side of the complainant:  Nil

Exhibits marked on the side of the complainant:

B1 :  Office copy of the letter dated 22.01.2013

B1(a) :  Office copy of the reply letter dated 23.01.2013. 

                                                                       (By Order)

                                                                                         (Sd/-)                         

                                                                          Senior Superintendent.

Copy to:- (1) Mathew Oommen. A, Retd. Engineer,

                   Arikupurathu Medayil, Parumala.P.O.,

                   Pin – 689 626

2. Managing Director & CEO, ICICI Prudential Life-   

     Insurance Co. Ltd., ICICI Pru Life Towers,

           1089 Appasaheb Marathe Marg, Mumbai – 400 025.

            (3) EVP – Legal, Compliance, Secretarial & Internal Audit-

             and Senior Grievance Redressal Officer,

                     -do.   –do.

                (4) VP – Customer Services & Operations

                     And Grievance Redressal Officer,

                            -do.   -do.

                (5) Senior Manager – Customer Services &

                     Operations and Grievance Redressal Officer,

                            -do.     -do.

                (6) Customer Grievance Redressal Division,

                           -do.    –do.

                (7) Grievance Redressal Committee,

                     Customer Service Desk,

             ICICI Prudential Life Insurance Co. Ltd.,

             Stream House, Kamla Mills Compound,

             Building ‘A’ Senapati Bapat Marg,

             Lower Parel, Mumbai – 13.

                (8) Grievance Redressal Officer for Kerala,

                     ICICI Prudential Life Insurance Co. Ltd.,

             ICICI Pru Life Towers,

            1089 Appasaheb Marathe Marg,

            Mumbai – 400 025.

                (9) Branch Manager, ICICI Prudential Life Insurance

                     Co. Ltd., Pathanamthitta Branch.      

              (10) The Stock File.