Before the District Consumer Dispute Redressal Commission [Central], 5th Floor ISBT Building, Kashmere Gate, Delhi
Complaint Case No.23/29.01.2014
Ritika Jain daughter of Sh Ajay Jain
Ro A-681, Shastri Nagar,
New Delhi - 11005 ...Complainant
Versus
OP1. Life Insurance Corporation Of India (LIC)
12/56, Desh Bandhu Gupta Road,Karol Bagh,
New Delhi-110005
(through its Principal Officer/Branch Manager)
OP2. Ms Alka Jain R/o H.No. 1/5549,
Gali No.16, near MCD School, Balbir Nagar,
Shahdara, Delhi-110032 ...Opposite Party
Order Reserved on: 01.02.2023
Date of Order: 13.03.2023
Coram: Shri Inder Jeet Singh, President
Shri Vyas Muni Rai, Member
Ms. Shahina, Member -Female
Inder Jeet Singh
ORDER
1.1. (Introduction to case of parties): The complainant/Insured makes allegations of deficiency of services, unfair practice, negligence, unholy connivance against OP1/Insurer and its registered agent/OP2 that on 29.3.2013 proposal form in duplicate was filled in for sum assured of Rs.30,00,000/- against immediate payment of premium of Rs.56.398/- for a policy, for which receipt dated 29.3.2013 was issued. Later, it was revealed that instead of one policy, the OPs prepared and issued two insurance policy of Rs.15 lakhs each, firstly in the month of April 2013 and another in August 2013. When she requested its cancellation and refund of amount, it was assured but then declined by OP1. She seeks refund of premium amount with interest paid besides damages and costs of litigation, since she has applied for single insurance policy and also paid single premium for a policy of Rs.30,00.000/- and had not applied or consented for two policy of Rs.15 lakhs each nor premium was separately paid for two policies.
1.2: On the other-side, the allegations are opposed by OP1 that there are two separate proposal forms for two policies, complainant is a student of law, she had read it. Accordingly, two policies were requested and issued to complainant. There was covenant of cooling period of 15 days from the date of receipt of insurance policy, since it was over, that is why its cancellation was rightly declined.
1.3: It is relevant to mention that the complainant and the OP1 have put their pleadings in composite form of narration of facts, evidence and arguments apart from their own conclusions. That is why in the matrix of case facts in detail will be mentioned, since the complainant and the OP1 had filed their respective evidence and then written arguments on same pattern.
2.1 (Matrix of case of complainant ): The Complainant was approached by Mrs Alka Jain-OP2 [having agent code 0204111K] an agent of OP1 and she persuaded the complainant and her father to purchase a Life Insurance policy. Thus, complainant was advised and she paid a sum of Rs 56,398/- towards first year premium by account paying cheque bearing no. 0071646 drawn on HDFC, Shastri Nagar, Delhi, for her life insurance policy for sum assured of Rs 30,00,000/- (copy of receipt no. 9482964 dated 29.03.2013 is now Annexure C-1). Then OP1 through its agent OP2 issued a First Premium Receipt no. 0080209 an annual premium of Rs 28,7491- (Annexure-C2) bearing policy no. 126991568 for a sum assured of Rs 15,00,000/-, which surprised the complainant and her father as policy was taken for sum assured of Rs.30,00,000/- against premium paid. When the complainant and her father enquired from the OP2. about this lapse/mistake on the part of OP1, no satisfactory reply was given by the OP2. Then complainant and her father enquired about the balance amount of premium paid to the O.P No. 1 and it was told by the OP2 that OP1 will cancel this issued policy and OP1 will issue a new policy for sum assured of Rs 30,00,000/-. However, the OP2 kept on delaying the matter on one pretext or the other. But it was not left by the complainant and her father, thus after much persuasions of the complainant and her father, then it was month of August 2013, when OP2 gave another deposit receipt no. 334164 for Rs 605/- dated 14.08.2013 (Annexure C-3) to the complainant and another First Premium Receipt bearing no. 0009136 showing policy no. 126997451 (Annexure C-4) for a Sum Assured of Rs 15,00,000/- having an annual premium of Rs 28.249/- with date of risk w.e.f 01.04.2013. The OP2 told the complainant that she had paid Rs 605/- in cash from her own pocket and with great difficulty she got issued this new life insurance policy no. 126997451 from the OP1. The date of risk is 01.04.2013 in First Premium Receipt dated 01.04.2013, is earlier in period to the Proposal Deposit Receipt dated 14.08.2013. Moreover, the two life insurance policies nos. 126991568 and 126997451 with same Sum Insured of Rs 15,00,000/- and same mode of payment of yearly basis and same year of 2054 of maturity, issued in the name of same person/complainant but with different amount of premium payable by the complainant Rs 28,749/- & Rs 28249/- respectively. These facts surprised and created serious doubts in the minds of the complainant and her father that there is something wrong. This was clearly showing unholy connivance of OP2 with the officers/employees of O.P No. 1 who deliberated to miss-sell the life insurance policies for unfair gains for themselves and to trap innocent citizens like the complainant. The OP1 was supposed to issue one insurance policy for a sum assured of Rs.30 lakhs, as applied for, whereas the OP1 through its agent OP2 managed and issued two policies, which was never consented by the complainant or her father and this was conveyed by the complainant to the OPs number of times. The OP1 or its agent OP2 never issued the original insurance policy bond to the complainant. The OP2 got sold two life insurance policies to the complainant due to obvious reasons.
2.2 Initially both the officers/employees of OP1 as well as OP2 assured the complainant and her father that policies issued will be cancelled and they will refund the premium amount paid by them but they keep on delaying the matter on one pretext or the other. Then complainant wrote a letter dated 22.11.2013 (Annexure-C-5) to the OP1 to cancel the above-said policies and to return the premium amount paid. The OP1 replied it by reply dated 28.11.13 (Annexure-C-6) that policy no. 126997451 cannot be cancelled, since original policy was handed over to its agent on 19.08.2013. It manifests clearly that policy bonds with terms and conditions were never issued/handed over to the complainant and she was not make aware of either terms and condition of policy or occasion for cooling off terms and conditions or to avail for cancellation of policy within prescribed 15 days to be from the receipt policy bonds. Since both OPs did not take any action, then complainant sent again a letter dated 07.12.2013 to the OP1 (Annexure-C7) but OP1 again refused to cancel the said policies by its reply letter dated 20.12.13 (Annexure-C-8). The OP1 and OP2 are bent upon to usurp the hard earned money of the complainant and her father by their foul means.
2.3:The complainant and her father had put his money to secure the future of the complainant but because of OPs acts, the same started with a nightmare and has caused harassment and mental agony to them. They personally visited in the office of OPl, they also enquired telephonically about the fate of the life insurance policies wrongly issued by them and politely requested the officials/employees of the OP1 that their conduct/practice is not only improper but also unlawful but they dismissed it with a "who cares gesture" and none of them gave satisfactory reply to cancel insurance policies and refund of paid amount.
2.4 It is a clear-cut case of faulty and deficient service, and negligence on part of OP1-LIC by not giving the proper and agreed services assured by its agent OP2. OP1 is vicariously liable for the acts, omissions and commissions of its agent/OP2.
Since OPs are guilty of deficiency in service and the complaint was filed to direct OP 1 & OP2 to refund jointly or severally (1) a sum of Rs 56,998/- being paid premium amount to the OP1-LIC- through its agent OP2, (2) interest @ 18% per annum from the date of payment of premium amount till its realization, (3) compensation on account of mental torture, untold mental agony, harassment and hardship to the tune of Rs.2,00,000/- meted upon the complainant and her father and (4) litigation expenses to the tune of Rs.25,000/-.
3.1 (Matrix of case of OP) : The OP1 has filed the reply to complaint, it also contains narration of facts as admixture of pleadings, documents and its logics & arguments to counter the case of complainant. But contents of allegations of individual paragraphs of complaint are not replied specifically, instead they are grouped together ( as reply to paragraphs 1-5, 6-9, 10-11, 12-16), therefore, keeping in view in this form reply, the matrix of case of OP1 will be narrated with reference of documents annexed.
3.2. The complaint is opposed vehemently that it is not maintainable and the same is a gross misuse and abuse of process of law. It is the case of complainant that she opted for a single policy for sum assured Rs. 30.00,000/- but she was wrongly issued two separate policies for Rs. 15.00,000/- each being wrong illustration, however, the complainant is totally misrepresenting this. In fact, she submitted two separate proposal forms for two separate policies of Rs. 15,00,000/- each [copies of said proposal form dated 29.03.2013 and Proposal form dated 11.06.2013 are respectively Annexures-R1 & R2 to reply). Consequently, she was issued two separate policies bearing No. 126991568 & 126997451. Moreover, policies bonds were handed over to the complainant by OP2, who is agent of OP1. A communication was also written by the agent Smt. Alka Jain to OP1 [it is Annexure-R3 written manually but without date]. As per communication (Annexure-R3), the subject policy bonds were given to the complainant on 12.04.2013 and 28.08.2013 and complainant sent her first letter on 22.11.2013 to OP1. The complainant was also informed from time to time that as per the terms and condition of cooling off, a policy can be cancelled only within a period of 15 days of receipt of policy bond. So basically, the only motive of the complainant is to get those policies cancelled at a belated stage on the plea that she had been issued wrong policies, which is not at all possible to cancel the policy.
It is admitted position the complainant approached the OP1 in March, 2013 and she has been issued a receipt dated 29.03.2013 (filed as Annexure-C-1). So for six months is concerned, the complainant slept over the matter.Subsequently, after six month, she came with a plea that she had been issued wrong policies with wrong illustration. It would further be pertinent to mention here that as per the proposal forms, complainant was a law student (Annexure-R1 & R2, while referring column 2 on page 5 thereof ) at the time of purchasing the subject policy and as per clause 14 of said proposal form, she also said that she had fully understood the terms and conditions of the plan but subsequently, with oblique motive and mala-fide she concocted a story that she had been issued wrong policy. Thus, in the entire scenario, there was no negligence or deficiency in service on the part of opposite party and basically it is the claimant herself who has concocted a false and frivolous story. As such all the plea taken by the complainant are totally false to reject the complaint.
3.3. The receipt dated 29.03.2013 for a sum of Rs. 56,398/- was issued because the complainant made payment in respect of two policies by a single cheque. The first premium receipt for Rs. 28,749/- was in respect to one policy. However, complainant and her father never made any enquiry at point of time because said receipt (Annexure C-2) was only in respect to one policy. Subsequently, there was some requirement of ITR for 2nd year and some medical tests, then second policy was issued later on in the month of August, 2013. There is difference of premium amount as Rs. 28,749/- and Rs. 28,249/- as for first policy, the premium was Rs. 28,749/- because as per terms of subject policy, the insured was given double accident benefits for which an addition amount of about Rs. 500/- was payable and as one person can claim this benefit only in one policy for a particular amount therefore, said benefit (of double accident benefit) was not applicable in the second policy , that is the premium of second policy was Rs. 28,249/- lesser than the first policy premium.
Hence, the complainant is misrepresenting the facts only with a motive to mislead the Commission. The OP1 was not supposed to issue one policy for a sum of Rs. 30 Lakhs, when complainant herself opted for two separate policies of Rs. 15 Lakhs each by submitting two separate proposal forms., therefore, the plea taken by her is totally false and misconceived. The OPs never assured the complainant and her father that the policies will be cancelled and premium amount will be refunded to them. Since two policies were demanded and they have been issued, therefore, no question arises of its cancellation. The contents of Annexure C-5 are totally false and concocted apart from wrong policies with wrong illustration have been issued as the complaint does not depict what plan she opted and for what plan policies were issued instead. It was first time when complainant in her communication dated 22.11.2013 uttered that wrong policies with wrong illustration were issued to her but she nowhere explained as to what was wrong in the impugned policies. Further, non-receipt of original policy bond was also raised first time in November 2013, however, she took this plea only to manipulate that her fifteen days cooling off period could not be started because she has not received the policy bonds. If she made the payment in March, 2013, then why slept over the matter for eight months. In fact, both the policies bond were duly given to the complainant as detailed in Annexure R-3. As far as question of securing the future of the complainant is concerned, same was duly secured as per the policies purchased. It is not the case of the complainant in entire complaint that she had chosen a particular plan and she was given some different plan. So basically, the present complaint filed by the complainant is totally mala-fide and mischievous and she has misused the process of law. The OP1 also denies other allegations of the complaint with prayer to dismiss the complaint.
4.1 (Replication of complainant) : The complainant filed rejoinder to the reply of OP1 and she denies all allegations of reply. OP1's agent Ms Alka Jain/OP2 had got filled in the proposal forms in duplicate from the complainant and proposal forms show premium amount of deposit as Rs 56,398/- with date of deposit as 29.03.2013. Moreover, it is admitted by OP1 the policies were issued in the month of April, 2013 and second in the month of August, 2013 respectively. Moreover, all the supporting documents ITR's, medical tests, proposal form etc were found satisfactory by the OP1-LIC, a first instance, then why one policy was issued in the month of April, 2013 and other one was not issued simultaneously if it was case of two polices?. This clearly shows that the OP2 has collected the premium on behalf of OP1 and has misrepresented the complainant about issuing of policy and its terms and conditions and has wrongly sold two insurance policies in question by adopting unfair trade practices. The other proposal form filed by OP1 bears the date 11.06.2013 and also bears the signatures of OP2 and it clearly establish proposal form was not submitted in the office of OP1-LIC by OP2 and has been misused/belatedly submitted in order to get unfair gain for themselves due to unholy connivance of officers/employees of the OP1 & the OP2. The OP2 wrote explanation/letter (Annexure-R-3) to OP1 in the month of December, 2013. The OP1 miserably failed to file and prove a single document of showing receipt of Insurance policies to the complainant, which shows their shoddy and negligent working and of OP2 for which OP1 is vicariously liable for the acts, omissions and commissions of its agent/OP2. The facts and circumstances clearly show a clear-cut case of faulty and deficient service apart from negligence on part of OPs.
4.2. OP2 was served with the notice on complaint. She was supplied with the record, however, no reply was filed by her.
5.1 (Evidence) : Complainant Ms. Ritika Jain, file her detailed affidavit of evidence coupled with documentary record and similarly OP1’s witness Shri D.K. Joshi, Manager (Legal) filed his affidavit of evidence, while relying upon the documents referred in the reply. It does not need any detail, since reason has already been mentioned in paragraph no. 1.3 above.
5.2.1: Ld Predecessors had, during the proceeding, inquired about the date on which policy documents were handed over the complaint, then OP2 had first brought affidavit without details of dates sought for but then another affidavit dated 27.11.2015 was filed with specific dates that she had handed over the policy bonds to complainant 12.04.013 and 28.08.2013 but without acknowledgement of its receipt from the complainant side.
5.2.2: Since cooling in period was issued, then during the proceedings, it was 29.04.2016 when the OP1 had filed photocopy of first insurance policy dated 8.4.2013, they are two pages, at first page there is printed serial no.931 and second page is of conditions/clause no.11 and 12, the in between pages are not filed by OP1. Similarly, OP1 had also filed photocopy of second insurance policy dated 19.8.2013, they are two pages, at first page there is printed serial no.917 and second page of conditions/clause no.11 and 12, in between pages are not filed by OP1.
6.1 (Submission of Parties) : Complainant filed a written arguments through her counsel, it is replica of complaint and affidavit of evidence, while narrating the facts and features with her logics. Similarly, OP1 also filed written arguments, which are on the lines of reply to the complaint with reference to the documents filed.
6.2: The parties were also given opportunity to make oral submission and the same was availed by the parties, Shri L.R. Goyal, Advocate for complainant and Shri Sunil Mittal, Advocate for OP1 made their oral submissions, while highlighting their respective case.
6.3: The OP1 has produced certain documents during the proceedings which were also recorded, the same has already been referred in paragraph no. 5.2.2 above.
6.4: OP2 had not filed her reply to complaint, however, during the proceedings she had filed an affidavit specific to the handing over of insurance bond to the complainant, it has already been referred in paragraph no. 5.2.1 above. Precisely, she declares that first policy was handed over to the complainant on 12.04.2013 and second policy was handed over on 28.08.2013 but without acknowledgement from the complainant or from her father.
7.1 (Findings) : The contentions of both the sides are considered and assessed, keeping in view the material on record. By taking stock of them, there are some admitted facts like, the OP2 is an insurance agent of OP1, the complainant along with her father approached the OP2 for insurance policy, proposal form was provided by OP2 and it was filled in for seeking insurance policy. The complainant had paid insurance premium of Rs. 56,398/- on 29.03.2013 through a/c payee cheque to OP2, consequently receipt (Annexure-C1) was issued followed by other receipt handed over to the complainant. The correspondence exchanged that complainant had written letter dated 22.12.2013 (Annexure-C5), which was responded by OP1 by reply dated 28.11.2013 (Annexure-C6) that the second policy was handed over by OP1 to OP2 on 19.08.2013, then complainant’s letter dated 07.12.2013 (Annexure-C7) to OP1 and then OP1’s reply dated 20.12.2013 (Annexure-C8) that the policy was delivered to the complainant on 28.08.2013.
7.2: But there are other disputed issues between the parties. Before proceeding to those issues, it is also relevant to mention that OP1 raised an objection vehemently that complainant alleges that wrong policies with wrong illustrations were issued to her, however, she failed to mention as to for which insurance plan was opted by her but under which other plan the policy was issued. Simultaneously, in same reply the OP1 itself argues that it was never the case of complainant that policy was opted for a particular insurance plan but policy was issued for another insurance plan. This kind of reply and argument are made when attention is to be diverted elsewhere, instead of on the core issue. The OP1 itself is making this logic to self-serve the purpose, an argument was raised and then by its own other argument, itself reply the same, it demolished own plea of OP1. It was not an issue raised by the complainant but it is creation of the OP1 itself and OP1 also answers to itself. Thus, it is neither an issue nor requires adjudication by this Commission.
7.3: The core issue is that complainant opted for a single policy for a sum of Rs. 30,00,000/- for which advised premium was also paid on 29.03.2013 but the OP1’s case is that complainant had opted two policies of Rs. 15,00,000/- each, for which separate proposal forms were given. There are other allied issues with regard to delivery or non-delivery of policy bonds. It is appropriate to first decide the allied issue, then main issue will be taken.
7.4: According to OP1, two insurance policies were issued. The first insurance policy bond no. 126991568 was handed over to the complainant on 12.04.2013 and other insurance policy bond no. 126997451 was handed over to the complainant on 22.08.2013 (based on OP's undated letter Annexure-R3). Whereas according to complainant, she never received insurance bonds either from OP1 and OP2 on these dates or otherwise.
This needs to scrutinize and assess the documents of the insurance policies filed by the OP1, affidavit of OP2, the correspondence between the complainant and OP1 (viz. Annexure-C5 to Annexure-C8). The complainant complained that policies were issued wrongly and she sought cancellation of policies. But OP1 replies that cooling period of 15 days have elapsed since policy was handed over on 19.08.2013 to the agent/ OP2. When complainant again protested it by another letter, the OP1 again responded by letter dated 20.12.2013 (Annexure-C8) that policy was delivered to the complainant on 28.08.2013. The OP2 had written undated letter (Annexure-R3) that she had handed over the policy on 28.08.2013 to the complainant and then OP1 had first time mentioned date of delivery of second policy on 28.08.2013 in letter dated 20.12.2013 (Annexure-C8) as in the earlier letter 28.11.2013 (Annexure-C6) the OP1 just mentioned the policy was handed over to the agent on 19.08.2013. It is obvious that OP1 relies upon Annexture-R3, which was written by OP2 and then OP1 is writing that policy was handed over to complainant. However, the OP2 in her affidavit dated 27.11.2015 declares that policy no. 126997451 was handed over to complainant on 28.08.2013 and the previous policy no. 126991568 was handed over to the complainant on 12.04.2013. OP2 simultaneously declares that she had not obtained acknowledgment of receipt of either of the policy from the complainant or her father.
As per policy documents, filed by OP1, the policy no. 126991568 was issued on 08.04.2013 and other policy no. 126997451 was issued on 19.08.2013, the OP1 and OP2 are claiming that the respective policies were delivered on dates 12.4.2013 & 29.9.2013, which are subsequent to date of issue of the said policies; it is also appearing to be very natural. However, the OP1 in its letter dated 28.11.2013 (Annexure-C6) writes that policy no. 126997451 was handed over to the insurance agent/ OP2 on 19.08.2013, there is no other fact mentioned in Annexure C-6 as to when the policy no. 126991568 was actually handed over to the agent nor there is any assertion in the said letter dated 28.11.2013 (Annexure-C6) as to when actually the other policy was handed over to the complainant. The OP1 had not filed any record of its office [either of Receipt & Issue Cell or other Diary Section] as to against which serial number or mode the policy was handed over to its agent / OP2. OP2 had written letter (Annexure- R-3, undated) that policy was handed over to the complainant on 28.08.2013, thereafter OP1 in its letter dated 20.12.2013 (Annexure-C8) writes to complainant that policy was handed over to the complainant on 28.08.2013. This suggests that OP1 wrote this letter and mentions date 28.8.2013 of handing over to complainant on the basis of undated letter of OP2 (Annexure-R3), otherwise the OP1 has not filed or proved its own official record of dates and actually handing over insurance policy bonds to the OP2. In case OP1 was having record of dates and handing over of insurance bonds to its agent/ OP2 but it has not been proved in this case, it amounts to with-holding the records intentionally to suppress factual position and in another eventuality that the record of dates and handing over is not being maintained, it also amounts to serious negligence & deficiency of services on the part of OP1.In both situation it is fatal to plea of OP1. There is also contradictory plea of OP1 that policy was handed over to OP2 on 19.08.2013 but OP2 in her letter/Annexure-R3 states that she had received the insurance bond on 22.08.2013 from the office of OP1; this contradiction is material and it does not inspire confidence in the plea of OPs.
Otherwise, it is admitted case of OP2 that she had not taken acknowledgement of receipt from the complainant or from her father of handing over the insurance policies to them. The material contradiction in the plea of the OP1 and the OP2, want of maintaining the record or production of such record by OP1 that policies were actually handed over to OP2 and also want of proof of any acknowledgement of receipt of handing over the policies to complainant, proves the case of complainant that policies were not handed over to the complainant and that is why the complainant was writing to the OP1 of her grievances. Accordingly, this issue stands disposed off against the OPs that policy bonds were not delivered to the complainant. It is not out of context to mention that there is legal obligation on LIC/OP1 to ensure that insurance policy document are provided to the insured being a contract between the Insured and the Insurer for its compliance. OP1 failed to discharge this duty in this case.
7.5: The other issue is relating with the cooling period of 15 days to be computed from the date of receipt of insurance policy. The OP1 had not considered the request of complainant in cancelling the two policies as a single policy was not opted by the complainant vis a vis the OP1 also contends that there is cooling period of 15 days from the date of receipt of policy and that cooling period had expired, consequently the complainant could not get cancelled the second policy.
The answer of this rival plea lies in the record filed by OP1. It is record of policy issued on 08.04.2013 and other policy issued on 19.08.2013. Each of the policy cover filed is in two pages by the OP1. The first page gives the details in tabular form with details of policy number, date of commencement, date of commencement of risk, name of insured etc. and the second page is containing conditions of policy no. 11 & 12 and none else. These conditions no. 11 [participation in profits] and no. 12 [normal requirement of claim] are not in respect of cooling period. The onus was on the OP1 to prove cooling period of 15 days, however, it has failed to prove it and the plea taken in the reply and evidence remained a hollow plea of the OP1. Secondly, the 15 days of cooling period is to be computed from the date of receipt of policy bond, it has already been held in paragraph no.7.4 above that OP1 could not prove delivery/handing over of policy bonds to the complainant. Therefore, when OP1 failed to prove that the insurance bonds were delivered, then from which date cooling period begin?, it means it has not commenced as yet. The plea of OP1 fails on both count and complainant has succeeded to prove its case and OP cannot invoke cooling period clause vis a vis that for want of delivery of insurance policies, plea of OP1 fails that there was cooling period to be considered.
7.6: Now the core issue is taken. The dispute is 'is it a case of single policy or two polices? To determine this, it needs to analyse the material documentary record as it is, consisting of proposal form & its contents, premium receipts (either proposal premium receipt or first premium receipt, briefly Annexure-C1 to Annexure C-4).
The OP1 claims that two insurance policies dated 8.4.2013 and 19.8.2013 were issued consequent to two proposal forms of complainant, the complainant is student of law and as per contents of proposal form, she would have read the form carefully. The premium was received initially, however, some formalities of TPA, medical test and ITR return were to be completed, then subsequent policy was issued at the option of complainant.
The complainant denies all these allegations of OP1 that a single proposal form in duplicate was given to OP2, being agent of OP1 and it has been kept and then used for ulterior gains. It become an admitted case of OP1 that the second copy of form was retained by OP2 with connivance of OP1 and second policy was got issued on the basis of that second copy of form. The complainant had issued one premium cheque because one policy of Rs. 30,00,000/- was opted, she never opted & consented for two policies of Rs. 15,00,000/- each nor she can be compelled to accept two polices, when single policy was opted. By taking consolidated stock of these circumstances with the documentary record, the following conclusions are drawn:-
(i). There are two proposal forms, each proposal form is of 6 pages, signature part of the complainant ends at page no. 4. The other two sheets of page nos. 5 and 6 are agent’s confidential report about the detail of proposer and her income. In the first proposal form date is not mentioned but in other proposal form date 11.06.2013 is mentioned. There are material contradictions in both the proposal form, which are as under:-
(a). The majority of information from page no. 1 to 4 in the first proposal form and in the second proposal form are same, inclusive of the amount of premium Rs. 56,398/-, BOC no. 17739, date 29.03.2013, income Rs. 1,91,800/-. But, in the second form date 11.06.2013 is mentioned at the end;
(b). One of personal information of complainant is mentioned on page no. 3 of the first proposal form (of March 2013) in the column meant for, it is date of last menstruation, which is duly filled in. However, same date is also mentioned in the third page in the second form of 11.06.2013;
(c). The complainant's income is mentioned as Rs.1,91,800/- on page no. 1 and 5 of first proposal form and similar income of Rs.1,91,800/- is also mentioned on page no.1 of other proposal form but Rs. 2,40,700/- on page no. 5 of other proposal form being report of OP2. If the proposal forms were filled in on different dates and income was also different at such different dates, then how income of Rs.1,91,800/-could be mentioned on page 1 and income of Rs. 2,40,700/- at page no. 5 of second proposal form vis-à-vis if the second form was filled in at different time/subsequently, then there could not be same date of last menstruation as mentioned in the first proposal. It is not the case of OP1 there is some medical reasons or report of such irregularity;
(d). Similarly, had the proposal form being at different time, the premium amount and dates in form could not be same and
(e). In both the proposal form there is endorsement for TPA [at its top] and medical test case [at page 3/column 12], the complainant had also signed the proposal at all those points meant for signature including for consent for medical test. Thus, it does not convince the plea of OP1 that at the time of second proposal form of 11.06.2013, there was just requirement of TPA, Medical test and ITR and other policy was to be issued; which has also not been proved by OP1.
(ii). Now other related and relevant record of premium receipts are taken in the following manner:-
(a). There is no dispute of Annexure-C1/Proposal Deposit Receipt is of Rs. 56,398/- paid on 29.03.2013. But on this printed receipt of Rs.56.398/- a figure of Rs. 600/- is added and written manually, mentioning manually the total premium amount of Rs. 56,998/-. This figure of Rs. 56,998/- is not mentioned in the proposal forms but amount of Rs. 56,398/-. The proposal deposit receipt is issued prior to acceptance of risk and premium receipt is issued on/after acceptance of risk.
(b) Moreover, the other receipt is of 29.03.2013 for first premium receipt of Rs. 28,749/- [ mentioning policy no. 126991568, date of risk 28.3.2013, proposal no. 017615 date 29.3.2013 for sum assured Rs.15 lakhs].
(c) The third receipt is Annexure-C3 being proposal deposit receipt of 14.08.2013 of Rs. 605/-.[ it is of the same date, when receipt Annexure-C4 was issued]. Meaning thereby there was premium of Rs. 600/- apart from dating back interest of Rs. 5/- mentioned in Annexure- C4 and this receipt of Rs. 605/- was issued.
(d) The fourth receipt is Annexure-C4 for Rs. 28,249/- of 14.08.2013 [the date of receipt is over printed on terms and conditions of acceptance, which is clearly visible with bare eyes and more visible with magnifying glass] being First Premium Receipt policy no. 12699745, date of risk 01.04.2013, proposal no. 018140 date 30.3.2013 for sum assured Rs.15 lakhs]. The receipts of 14.08.2013 are after four & half months from receipt dated 29.03.2013.
(e). Moreover, the receipt Annexure-C4 of 14.08.2013 is bearing certain remarks which are relevant, showing additional premium is 'Nil' but dating back interest Rs. 5/-.
(f) By reading (c), (d) and (e) above, it is clear that there was balance amount of premium from original deposit amount of receipts (Annexure C1 & C2) but there was deficient amount of Rs. 600/- and Rs.5/- dating back interest made it Rs. 605/- which was deposited as proposal deposit receipt (Annexure-C3) on 14.08.2013. It is repeated here that the 'proposal deposit receipt' is issued prior to acceptance of risk and 'premium receipt' is issued on/after acceptance of risk.
Thence first premium receipt dated 14.04.2013 for Rs.28,249/- (Annexure-C4) was issued. It also culls out that figure of Rs. 600/- was written manually (on receipt Annexure-C1) about the amount of Rs. 600/- discussed hereinbefore. Who and Why it was written, it is not disclosed? However, complainant had explained in the complaint that OP2 emphasized that she deposited Rs.600/- from her own pocket to managed with great difficulty the subsequent policy.
(g). The proposal form of 11.6.013, does not mention premium amount of Rs. 28,249/- but Rs. 56,398/-, which was originally deposited and
(h). As per contents of receipt dated 14.08.2013 (Annexure-C4), it is of policy no. 126997451 and date of risk commences on 01.04.2013. In case the proposal form was of 11.06.2013, then how OP1 issued the policy with effect from 01.04.2013 against such proposal form of 11.06.2013. The receipt dated 14.08.2013 also mentions proposal no.18140 dated 30.3.2013 with dating back interest of Rs.5/-, but there was no such request by complainant to issue her policy from back date. Apart from, insurance bond dated 19.8.013 also mentions this proposal no.18140 dated 30.3.2013 but commencement of risk date 14.8.2013, The receipt dated 14.8.2013 mentions the date of risk of 01.0.2013 but policy bond dated 19.8.2013 mentions date of risk 14.08.2013. Why? Is it not unfair practice on the part of OP1? It is.
(iii). Many times, it happens that document speaks a lot about the existing facts, the insurance policies filed in the present case are example thereof. The first policy bears date 08.04.2013 of issue, it mentions on its first page the proposal date of 29.03.2013. Similarly the other policy bears date 19.08.2013 of its issue, it mentions the proposal date of 30.03.2013. In case the proposal form was of 11.06.2013 as per own case of OPs, then what was the reason for OP1 to mention proposal date of 30.03.2013 in the policy issued on 19.8.2019? What was the reason that premium receipt (Annexure-C4) was issued on 14.08.2013 in case proposal form was of 30.03.2013 and why not receipt and policy was not immediately issued after proposal form 11.06.2013 or on 30.3.2013?.
All these circumstances they are explaining that OP1 was indulging in issuing two policies as well to shield its negligence, but there is deficiency of services on the part of OPs towards the complainant.
(iv). Now the picture is crystal clear that the complainant had furnished proposal form in duplicate to OP1’s agent OP2 and premium amount for sum insured Rs. 30,00,000/- was advised and consequently that amount of Rs. 56,398/- was paid by the complainant, which was also deposited by way of 'proposal deposit receipt (Annexure-C1 of 29.03.2013)'. The complainant or her father was not knowing the premium amount, it was on the advices of OPs. However, a receipt for policy of Rs. 15,00,000/- was issued. Had there been a case of policy for Rs. 15,00,000/- by the complainant, she would not paid premium against sum insured of Rs. 30,00,000/-. Why complaint would pay approximately double the amount of annual premium?. Simultaneously, had it been not the case policy of Rs. 30,00,000/- but of Rs.15,00,000/- then OP1 would have refunded the extra premium amount or at least wrote and return to the complainant of excess premium paid as policy was of Rs. 15,00,000/- but premium was paid for sum assured of Rs. 30,00,000/-. It was intentionally not written or returned by OPs to the complainant, because of the reasons drawn in aforementioned paragraphs. OPs are at fault and it is unfair on the part of OP1 to say that complainant's acts seeking cancellation of polices are mischievous. She was within her right to ask for cancellation of two policies issued [of Rs.15 lakhs each] against the basic cannon of fair contract of seeking one policy [of Rs.30 lakhs].
(v). In insurance contract the principle of utmost good faith applies, according to it the insurer and the insured both must be transparent and disclose all the essential information and material facts required before signing up the insurance policy, the OPs failed to pass this test in this case.
7.7: The conclusions drawn above, after detailed reasoned analysis, clearly show that the complainant has proved her case against OPs of deficiency in services and of unfair practice on the parts of OPs. She proved her complaint against OPs that she had requested a single insurance policy of Rs.30 Lakhs and first annual premium was paid accordingly. The complainant cannot be compelled by OPs nor OPs can impose two policies of Rs.15 lakhs each, in place of one policy of Rs.30 lakhs for which she had paid premium, against her will and volition as well as against the terms of contract. There is also misuse of second copy proposal form by the OPs for preparing second policy, however, the contents of this second proposal form are themselves speaking that the form is of contemporary period of around 28/29 March 2013. On the other side, the OPs could not prove that complainant was issued two policy of Rs.15 lakhs each at her request or she had ulterior motive to get them cancelled under the false plea of request for one policy.
8.1. Thus, complainant is held entitled for refund of premium amount of Rs.56,998/- from OP1. The complainant has sought interest @18% pa, however, considering facts & features of case as well as she was deprived of her money to utilize it, interest @ 6%pa would be justified for both ends, interest will be from the date of complaint till realisation of amount against the OP1.
8.2.The complainant has also sought compensation of Rs.2,00,000/- towards harassment, mental torture, untold mental agony, hardship; considering totality these circumstances including the breach of trust, confidence, faith to the complainant, are quantified as Rs 56,000/- (being approximate to refund amount), apart from cost of litigation of Rs.10,000/-in her favour and against the OPs,.
8.3. Accordingly, the complaint is allowed in favour of complainant and against the OP1 to pay/refund a sum Rs.56,998/- along-with simple interest @ 6%pa from the date of complaint till realization of amount; apart from OP1 and PO2 to pay jointly or severally damages of Rs.56,000/- & costs of Rs.10,000/- to complainant. OPs are also directed to pay the amounts within 30 days from the date of receipt of this order. The policies bearing policy no. 126991568 issued on 8.4.2013 and policy no. 126997451 issued on 19.08.2013 stand cancelled.
8.4. Copy of this Order be sent/provided forthwith to the parties free of cost as per rules and for necessary compliance.
9: Announced on this 13nd March, 2023 [फागुन 22, साका 1944]. It is appropriate to record that this Commission is facing great difficulty in day to day of its functioning for want of regular PA and stenographer, since only one stenographer Gr-III is posted for all work.
[Vyas Muni Rai] [ Shahina] [Inder Jeet Singh]
Member Member (Female) President
