JUDGEMENT

          Complainant by filing this complaint has submitted that being approached by the agent of ING Vysya Life Insurance Co. Pvt. Ltd.(op) who insisted to take and avail of their policy and its relating services and to open two life insurance policy sometime in the year 2006 with a promise of good prospect of the said investment of the complainant and for better service from the company in maintaining both the portfolios.  The complainant being convinced opened two life insurance policies trusting upon him and his promises and to that effect complainant being influenced by the sweet talks of the said representative, has compelled to take two life insurance policies vides Policy No. 00505758 and 00505763 under product New Fulfilling Life Anticipated Whole Life Plan and to that effect the ops have issued policy certificate in favour of the complainant on payments of requisite fees and all formalities.  Date of opening of the policy was 28.09.2006 and in respect of one policy premium was Rs. 5,000/- per quarter or 16 years term and in respect of another policy premium was Rs. 25,000/- per quarter and term was for 16 years.  Accordingly complainant after getting document of the above policy had duly paid the 1^st premium and it is pertinent to mention here that the original policy agreement and other relevant papers and documents relating to the said policy are in the custody of the ops and it was kept by the ops after execution of the same and the same has not been delivered to the complainant till date in spite of several requests.

Complainant as per terms and conditions of the policy has started to pay the premiums in favour of the ops on due date and time.  There was no delay or laches on the part of the complainant to pay the premium in favour of the ops and it is pertinent to mention that due to mistake of the agent the second premiums was not deposited before the office of the ops and accordingly the complainant subsequently deposited the said premium with late fine and interest over the said due premium and it was accepted by the ops.  Thereafter complainant paid the premiums in favour of the ops on due date and time and there was no delay or laches on the part of the complainant to pay the premium in favour of the ops.

In such fashion the complainant has paid the regular premium till June, 2009 and the same was accepted by the ops.  But at the time of depositing the premium for the month of September, 2009 op has informed the complainant to conduct a medical test of complainant to continue with the said policy and accordingly complainant as per direction of ops has done the said medical test ops selected centre Sanjibani Health Centre, Salt Lake City, and complainant got the reports and after getting such medical report when the complainant tendered the next premium to the ops but it was informed to the complainant that the policy has been lapsed in the year 2007.  But ops had regularly received the premiums from complainant and issued the receipt against the same.

Soon after knowing this complainant again approached the Branch Office and other offices, but till date they had not been taken any positive step and for lack of transparency and neglecting and overlooking attitude of the ops, complainant prayed for return of his hard earned money and by adopting illegal and immoral act, the ops have realized extra money from complainant to fulfill their  wrongful gain and by adopting unfair trade practice on the part of ops, ops has harassed the complainant mentally, physically and also financially and no doubt there was a gross negligence and deficiency of service on the part of the ops for which complainant has suffered and in the above circumstances complainant has prayed for redressal either for reinvestment of the policy in default to refund all the amount along with interest.

On the other hand op nos. 1, 2 & 3 by filing written statement submitted after receipt of initial premium op had issued no doubt two policies on 08.12.2008 along with terms and conditions as noted in the policy and also a welcome letter to the complainant.  The policy schedule which was sent to the complainant at the address provided by him in the proposal form on 11.12.2006 and which was duly delivered to the complainant on 13.12.2006.  It is further submitted that complainant being fully satisfied with the policy which were issued to him paid the renewal premium for the year 2007, 2008 and 2009 respectively but not regularly.  Complainant since did not pay the renewal premiums for March-28, 2008 and September-2008 in time, neither within grace period the policies acquired lapsed status.  Accordingly op had sent the letter dated 17.07.2008 and 06.11.2008 asking the complainant to undergo medicals in order to reinstate the policies.

As per medical report ops’ underwriter’s reviewed and assessed the risk under the policy and it was revealed to the op that the complainant was suffering from diabetes and was a smoker, for which policies were declined and the said information was clearly communicated to the complainant vide letter dated 24.12.2009 and returned the excess premium cheque after adjusting the premium due towards 28.06.2009.

Op further submitted that op acted bona fide and in the best interest to give proper relief and by adjusting complainant till 28.06.2009 in order to provide the benefit of the policy by continuing the policy with reduced paid up status without any future bonus and as per clause 5.2.1 op was informed but op did not allow to reinstate.  Had it not been given such benefit to the complainant by the op he would have suffered financial loss which was taken into the consideration by the op and acted as customer friendly organization and subsequently on 16.01.2010 complainant had approached the op and paid Rs. 10,000/- towards policy bearing No. 00505758 due for month of September-2009 and December-2009 and after ascertaining the record it had reversed the amount to complainant on 29.01.2010 which was duly communicated vide letter dated 01.02.2010.

Further it is submitted by the op that complainant once again in the month of March-2013 approached the op for reinstating those policies and same was declined vide their letter dated 20.03.2013.  Subsequently, complainant had lodged the complaint before the op grievance cell with was duly registered its complaint vide ID No. ING100053289 and accordingly its representative Mr. Bazil talked with the complainant and final resolution was sent to the complainant vide letter dated 17.04.2013.  It is further submitted that op had not acted contrary to any terms and conditions of the policy has entered between the parties.  So, there was no deficiency of service or unfair trade practice by the op.  Since the op had declined the policies due to medical reason and same cannot be reinstated at this point of time.  However it has covered the life risk with reduced paid up status and alternatively if complainant is not satisfied with the policy he had the option to cancel the same and thus the ops are not liable to pay compensation and accordingly they prayed for dismissal of this case.

                                             Decision with reasons

After in depth study of the complaint and written version including the documents as filed by the complainant and also the terms and conditions of the policy, it is clear that complainant purchased two policies bearing Nos. 00505758 on 28.09.2006 with payment of Rs.5,000/- and mode of payment of the policy was quarterly and term was for 16 years and similarly he also purchased another policy bearing No. 00505763 on 28.09.2006 on payment of premium of Rs. 25,000/- and mode of payment of premium was quarterly and term was 16 years.

Op has admitted that fact in his written statement that complainant opened the same on payment of premium.  Op has also admitted that complainant has paid premium up to 2009 and admittedly op has further admitted that they received the sum up to September-2009.  After that op sent letter to the complainant for his medical check up and complainant appeared at their Medical Board for check-up where he was checked up and report was submitted.  Thereafter op declined vide their letter dated 20.03.2013 for continuation of the same stating that complainant has been suffering from diabetes and he is a chain smoker.

Most interesting factor is that if actually the policy had already been lapsed, then there was no scope on the part of the op to receive any premium after 2007 or 2008.  But it is peculiar that against so called lapsed policy, ops just like money grabber, receive the premium month by month up to 2009.  But never reported at any point of time that policies had already been lapsed.  Then it is clear that there was negligence and deficiency on the part of the op and truth is that op admitted in his written version that they regularly received the same but never reported about the status of the policy that same had been lapsed.  Then it is no doubt an unfair trade practice on the part of the op.  When op was aware of the fact always that the policies had already been lapsed in that case, it was the duty of the op to report to complainant to that effect and as per provision of law and as per guide line of the IRDA 2010-12, it is the bounden duty on the part of the insurance company to refuse the subsequent premiums but there is no scope to keep such amount in their account when no benefit would be given by the op in respect of that policy to the insured when it is lapsed.

Admittedly in this case ops have stated that this policy had been cancelled by them considering his health condition.  When the policy had been cancelled by the ops, then it is the bounden duty of the ops to refund the entire amount which has been deposited as premium.  Then what is the necessity to file prayer for cancellation by the complainant.  So, it is clear that ops are trying to say hot and blow in respect of one instant that policies were cancelled by the ops on the health ground so there was no necessity on the part of the complainant to file any application for cancellation of the policies.

Most interesting factor is that in such a fashion most of the private insurance companies are enjoying the huge capital of the insured where in such a fashion policies have been cancelled by the ops or policies are found lapsed and that is their business and truth is that ING Vysya Life Insurance Co. Pvt. Ltd. being one of the model in the field of insurance business because they are cheating the public by so many manners and deceives the insured in so many manners and it has become their practice to cancel the policy in such a fashion.  When they have already received huge premiums from the customer because they have their no capacity to refund the maturity amount ultimately so in such a manner ING Vysya Life Insurance Co. Pvt. Ltd. has adopted this procedure to cancel the policies.

Whatever it may be fault was not on the part of the complainant.  Complainant time to time paid the premium up to 2009 and op swallowed the premium month by month up to 2009 and in between the 2006-09, op never reported to the complainant that their policy had already been lapsed or they are not willing to accept the policy to be continued or no such letter was sent to the complainant and no such information was given to the complainant.  But suomoto op placed the complainant for medical test at their fixed nursing home or hospital and, report was received and policy was cancelled.  Then what is the necessity to file an application for cancellation of the policy.  When op has cancelled the policy, then it is the legal and bounden duty on the part of the op to refund all the deposited premium amount along with simple bank interest but that has not been done. 

 Moreover ops have tried to say that complainant has not received the amount but it is false.  But op has failed to prove that it was received by the complainant.  But at the time of argument ops’ Ld. Lawyer stated that it was informed that it shall be returned.  Most interesting factor is that how long the private insurance companies shall have to continue such sort of malpractices by adopting unfair trade practices and shall have to deceive the customers in such a manner and in this case deficiency and negligence on the part of the op is proved beyond any manner of doubt and it is proved by the op by their own written version and at the same time their conduct is proved a dishonest practice and in fact op should be penalized for that because they have adopted unfair trade practice and they have eaten huge premium for 3 years from the complainant without informing the status of the said policies and ultimately cancelled the policies.  When it has been cancelled on the part of the op, it is legal duty and bounden duty, legal responsibility and social and moral responsibility to return the same by sending such letter.  But it has not been done and the very plea is that complainant did not file any application for cancelation which is completely a false accusation because ops have cancelled it.

It is to be mentioned that in the eye of ops their customers must be Saint/Sages otherwise general public can not be insured because in 30% cases general public smoke and 40% general public are habituated with alcohol and balance 30% people have their no capacity to open any policy and they it can safely be said that only exceptional people who also are only entitled to purchase ops’ insurance policy but in our view the Sages/Saints shall also be deprived by the ops because they also take ganjas or Babar Prasad (Alcohol).  So, cent percent (insured) people shall be deceived by the ops for some minor vices and if this method is adopted by the ops in that case it is found that all policies of the insured shall be cancelled by the ops for some vices and thus ops shall have no liability to pay their maturity amount and shall have to get interest from so far cancelled premium and this is the present business tactics of the ops to deceive the insured.

In the light of the above observation, it is found that ops have collected premium from the complainant from 2006-09 as per two policies and policies were cancelled by the ops.  So ops are bound to refund entire amount without deducting any further amount from the same because they have cancelled it.  They have enjoyed a profit from the said amount for many years up to this stage because the same were cancelled in the year 2009 but that was reported subsequently and that amount is in the belly of the ops.  Ops are enjoying the said total amount of the complainant investing it for their business for earning profit but complainant has been deceived by the op which is proved.

In the light of the above observation we are convinced to hold that there is no other alternative on the part of the op but to refund the entire premium as accepted by the op from the complainant from 2006-09 in respect of the present two cancelled policies at once.  But we have gathered that this insurance company is in habit to create pressure upon the customers to sign in the document.  But this practice is followed in some other cases also by some private insurance companies.  So, considering that fact we find that necessary order shall be passed by this Forum so that complainant shall not be further harassed by the ops.  But anyhow complainant’s allegation is proved against and practically the unfair trade practice as adopted by the ops by their own act and their own written version.

In the result, the complaint succeeds.

Hence, it is

                                                      ORDERED

That the complaint be and the same is allowed on contest with cost of Rs.10,000/- against those ops.

Ops jointly and severally are hereby directed to refund the entire received premium in respect of the two policies by issuing demand draft or bank draft in the name of the complainant and to submit it before this Forum within one month from the date of this order and on receipt voucher shall be made by the complainant before this Forum after receipt of the said demand draft, if so required on the very date handover that demand draft before this Forum and op may submit such final voucher on payment which shall be signed by the complainant in the open Forum.

For harassing the complainant and for deceiving the complainant in such a manner and also for adopting unfair trade practice by the ops and also for causing mental pain and agony and financial loss, the ops jointly and severally shall have to pay a sum of Rs. 35,000/- as compensation to the complainant which shall also be paid by demand draft or bank draft before this Forum by issuing the same in the name of the complainant.

Considering the adoption of unfair trade practice and also for deceiving the complainant in such a manner and only to check such sort of immoral practices, op/insurance company, ops are imposed punitive damages to that extent of Rs. 20,000/- which shall be paid to this Forum’s account by op by demand draft or bank draft.

Ops are jointly and severally directed to comply the order and to pay the entire amount as awarded including punitive damages and litigation cost etc. within one month from the date of this order failing for which for non-compliance of the Forum’s order and till full satisfaction of the decree, ops jointly and severally shall have to pay penal interest @ Rs. 250/- per day till full satisfaction of the decree and even if it found that they are reluctant to comply the order in that case proceeding u/s 27 C.P. Act shall be started and that shall be imposed further penalty and fine.