FINAL ORDER/JUDGEMENT

SHRI ASHOKE KUMAR GANGULY, MEMBER

This is an application U/s.12 of the C.P. Act, 1986.

The petitioner was issued a life insurance policy bearing No.03027108 dated 30.04.2014 from the OP Insurance Company with the premium of Rs.51,545/-  for a sum assured of Rs.4,17,402/-. The petitioner submits that he was allured by the OP that the premium is only for one time payment. With the said expectation the complainant signed the blank proposal form and handed over the premium amount. After receiving all the documents the complainant understood that it is not the one time payment policy rather it is a recurring premium deposit for various years more than 10 years which is not possible for him to continue. He requested the OP to cancel the said policy and refund him the deposit amount. But the representative of the OP remained silent over the request. The complainant thereafter wrote to the OP on several occasions within the FREE LOOK PERIOD of 15 days. Inspite of receiving the letters the OP did not respond including his last registered letter dated 09.08.2019. Thereafter Advocate’s Notice dated 24.08.2019 was sent. But both the letters of the complainant and that of the Advocate remained unanswered.    Since the complainant informed the OP within the Free Look Period the complainant is entitled to get back the amount of Rs.51,545/- with interest and compensation and cost. The cause of action arose on 24.08.2019 in respect of advocate’s letter as well as complainant’s letter dated 09.08.2019 served upon the OPs. The OPs time to time contacted the complainant for assurance of settlement even on 26.08.2019 and as such the case is not barred by law of limitation and in view of that the complainant approached the commission for justice with the prayers as mentioned in the complaint petition.

The OP 1 has contested the case by filing their WV and submits that the OP received the duly filled in proposal form along with the benefit illustration and other requisite documents and premium and thereafter the policy was issued. The complainant also signed a declaration in the proposal form that “ I/We confirm that I/we am/are submitting this proposal Form after having read and understood the product features, benefits and risk factors, structure of charges, terms and conditions of the proposed plan as set forth in the related brochure(s) and I/We submit the duly acknowledged sales illustration confirming my/our understanding of the plan for which this proposal form is being submitted.”

On the basis of information and disclosures the risk was assessed and thereafter the said policy was issued. The policy document was dispatched through Blue Dart  Courier which was received by the complainant on 05.05.2014. After that  one verification call on behalf of the OP was made from the centralized verification center and an elaborate insight on the policy details was provided . However, during the said call the complainant did not raise any concern about mis- selling of the subject policy.  Moreover the OP in accordance with the applicable clause 4.1 and 6.2 of the IRDA Regulation, 2002 had sent the complainant the policy document along with proposal form and a welcome letter which clearly mentions that in case the policy holder is not satisfied with the features or the terms and conditions of policy he / she can review / withdraw / return /alter the details of the policy within 15 days of free look period. However no such request was received by the OP within 15 days from the date of receipt of the policy contract. The first complaint was raised by the complainant on 03.03.2016 which is around 02 years from the date of issuance of the policy and much beyond the free look period. That apart the complainant opted for two more policies after the issuance of this impugned policy dated 30.04.2014. The other two policies are dated 24.09.2014 and 26.09.2014 with annual premium of Rs.2,00,000/- and Rs.1,00,000/- respectively. So question of mis-selling does not arise in the particular case. The policies were sourced  by the father of the complainant Mr. Sukumar Halder  who also happens to be the nominee of all the three policies.  Mr. Sukumar Halder is working as agent under the said Insurance Company since 24.02.2017. The legal notice dated 24.08.2019 sent by the complainant was received by the company on 22.10.2019 which was replied with elaborate clarification on 17.12.2019

The letters dated 15.05.2014 & 29.06.2014  as referred by the complainant were not served upon the OP and no proof of  sending those letters were furnished by the complainant  and no acknowledgement of receiving those letters by the OP is produced by the complainant. Hence the plea is not accepted by the OP.

It is further submitted by the OP that the policy is a legal contract between the policy holder and the insurer and parties to it are bound by its terms and conditions. Admittedly the proposal form was signed by the complainant and on the basis of the proposal form the subject policy was issued.  The Ld. Advocate of the OP has cited the Judgement of the Apex Court in the matter of United India Insurance Co. Ltd. Vs Harchand Rai Chand Rai Chandal Lal I( 2003) CPJ 393 where the observation of the Hon’ble Court is “ An Insurance Policy is to be construed strictly as per the terms and conditions of the policy document which is a binding contract between the parties and nothing can be added or subtracted by giving a different meaning to the words mentioned therein.

The complainant has enjoyed the insurance cover from 30.04.2014 to 30.04.2015 and thereafter praying for refund of the premium after enjoying the insurance cover is bad in the eye of law. The Judgment of the Hon’ble National Commission in the matter of LICI Vs Siba Prasad Dash reported as IV ( 2008) CPJ 156(NC) is absolutely relevant. “ If after the policy lapsed, under no provision of terms of the policy or law, could any Fora  direct for refund of any premium for the simple reason, as already stated, that the risk stood covered for the period for which premium had been paid.”

The complainant was issued multiple notices to pay the subsequent premium  on 31.05.2015 and 31.08.2015 but he failed to pay the premiums within the revival period as a consequence the policy was foreclosed by the OP vide letter dated 30.04.2017.

Points for Determination

In the light of the above pleadings, the following  points necessarily have come up for determination.

1) Whether the OPs are deficient in rendering proper service to the Complainant?
            2)  Whether the OPs have  indulged in unfair trade practice?

           3)  Whether the complainant is entitled to get relief or reliefs as prayed for?

Decision with Reasons

Point Nos. 1 to 3 :-

The above mentioned points are taken up together for the sake of convenience and brevity in discussion.

We have travelled over the documents placed on record.

While perusing the records it is observed that the complainant Mr. Subhasish Halder was issued the subject policy bearing No. 03027108 with annual premium of Rs.51,545/- and sum assured of Rs.4,17,402/- . The term of the policy was 15 years. The said policy dated 30.04.2014 was received by the complainant on 05.05.2014 through Blue Dart Courier. There is no controversy on the point of receiving the policy document. The complainant has enclosed copy of letters dated 15.05.2014 and 29.06.2014 addressed to the OP with the complaint petition thereby proving that the complainant had informed the OP within the FREE LOOK PERIOD. But on perusing the record we do not find any proof of acknowledgement of those letters by the OP. Nor any postal registration slip of sending those letters have been furnished by the complainant. So the standpoint taken by the complainant in the matter of refusing the subject policy within the free look period is not acceptable. The legal notice dated 24.08.2019 which has been acknowledged by the OP is appeared to be the only lawful  communication on the part of the complainant. Even no proof of sending the letter dated 09.08.2019 to the OP has also been furnished by the complainant. It is also very much surprised to note that the policy number mentioned in the said letter is different from that of the subject policy and also the sum assured mentioned in the said letter is also different. The subject policy No. is 03027108 whereas the policy number mentioned in the said letter is 03057108 and the sum assured of the subject policy is Rs.4,17,402/- whereas the sum assured mentioned in the said letter dated 09.08.2019 is Rs.10,00,000/- . This shows a very casual approach and serious mistake on the part of the complainant in the matter lodging complaint to the OP. In view of the factual error no cognizance is given to that letter dated 09.08.2019 addressed to the OP. Even the letter of the complainant dated 03.03.2016 as mentioned by the OP is also not found  enclosed  in the record by either of the parties. So that letter is also not cognizable. The only letter which stands as valid communication is dated on 24.08.2019 sent by the Advocate of the complainant.  The  so called other letters dated 15.05.2014, 29.06.2014, 03.03.2016 and 09.08.2019 are not proved cognizable in the eye of law. As such the complainant has failed to establish the fact of raising his objection against issuance of the subject policy before the OP within the statutory period of 15 days as per directives of the IRDA. Incidentally, we are very much surprised to note that how an aggrieved policyholder can apply and obtain policies from the same Insurance Company against  whom he has got serious allegation of mis-selling his earlier policy for which he has been forced to approach the Commission for justice. The complainant has obtained two other policies bearing No.03057095 dated 24.09.2014 and 03057108 dated 26.09.2014 i.e. after the issuance of the subject policy. It appears to be a self contradiction on the part of the complainant.

In a nutshell, the complainant has failed to raise his objection in the matter of refusal of accepting the policy within the statutory period which has  a binding effect on either of the parties. Ld. Advocate for the OP has cited the case laws as mentioned above in their Written Version which are very much relevant and effective in the present context. The policy was received by the complainant on 05.05.2014 and formal letter by way of legal notice was sent vide letter 24.08.2019 which appears to be an incidence of more than five years. As such the communication is of no use and beyond the scope of consideration as per the terms and conditions of the policy which are strictly binding upon the parties in the contract. In view of that,  the complainant has miserably failed to establish his case. In this context we are forced to comment that the complainant has willfully filed the case knowing fully well the demerits of the case. In our opinion the present complaint is nothing but an  abuse of the process of law and the complainant has wasted the valuable time of the Commission.

 All the points under determination are answered accordingly.

In the result, the Consumer Complaint fails.

Hence,

Ordered

That the consumer complaint be and the same is dismissed on contest against the OPs without any cost.

Copy of the Judgment be delivered to the parties free of cost as per C.P.Act and the

Judgment be uploaded to the website of the Commission forthwith for perusal of the parties.