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

          Complainant by filing this complaint has submitted that he bought three policies being G.O. Name JM 109, Policy No.855304523, G.O. Name JM109, Policy No.830355681 and G.O. Name JM 109, Policy No.859121360 from Max New York Life Insurance Company Ltd.  The complainant paid the premiums in respect of 855304523 and 830355681 through Shri Anjan Debnath (OP7).  But in spite of sending premium, the OP1 set two letters one on 06-03-2013 and other on 12-03-2013 seeking clarification regarding policy No.855304523.

          The complainant paid premium for the first term in respect of Policy No.855304523 amounting to Rs.15,262/- bearing receipt dated 18-2-2012 and in respect of policy No.830355681 amounting to Rs.20,000/- only for the due date 17-01-2013 but the Max New York Life Insurance Company reportedly raised allegation of non-payment of the premiums.  So, this complaint is lodged.

          The complainant was told to produce documents regarding payment of premiums.   The complainant also told the office to check their documents and inform him but they did not inform the complainant of those payment.  They told the complainant to regularize the premiums.  For the repeated persuasion the complainant opened another policy being G.O. Name JM Policy No.859121360 on 22-05-2013.  The complainant did not take risk of giving next premium on 22-05-2013 because he failed to know the fate of those earlier two policies.  Rather the insurance authority denies the payment of the premium.  So, the complainant lost confidence in the service of the company.  The complainant sent an Advocate’s letter demanding the amount of two earlier policy and also the third policy.  The complainant is told to show the payment proof.

          The complainant also informed Insurance Ombudsman for getting back the policy amount the Ombudsman wrote to the company but with no result.  On 18-09-2013, Max New York Life Insurance Company asked for all policy documents, receipt letter issued by Insurance Company and the receipt of the premium etc.  The complainant sent all the documents on 05-10-2013.  Further on December 30, 2013, the Ombudsman sent a letter expressing their wish to act as a mediator and thereby asked to send for all necessary documents within 10 days from the receipt of the letter.  The complainant sent all the necessary documents but no action has been taken by the insurance Company.

          The refund of policy amount and premium amount cannot be denied in accordance with law.  In case of not satisfying the customer it will be deficiency of service and the complainant is liable to get refund of the entire deposit with interest @18% p.a.   The complainant demands Rs.1,15,200/- and deposited to the company as policy amount and premium amount.  He also prays for Rs.20,000/- as litigation cost.

          In the written version OPs1 and 2 submit that the above complaint is not maintainable under law and is liable to be dismissed.  The same dispute is pending before Insurance Ombudsman.  The Hon’ble Supreme Court has held in an appeal titled Oriental Insurance Co. Ltd. vs.                 Pawel 2006 (IV) CPJ  1 that in case of complex factual position the matter should be examined by an appropriate court of law and not by the commission.

          It was mentioned in the policy document that any payment must be made at any of Company’s General Offices only, may be handed over to the Agent.  The complainant informed that he has paid all the premium on 12-03-2013 but even then he was told to produce all documents pertaining to premium.  The complainant informed that he paid the premiums in respect of the policy 855304523 and 830355681 to Mr. Anjan Debnath, the authorized agent of the company.  It was informed to the complainant that the said policy of the complainant lapsed due to non-payment of premium.

          That a legal notice dated 18-07-2013 was received by the OP in reference to the policy 855304523 and 830355681 stating that the premium was paid but the same was not deposited against his policies.  The complainant was again told to produce valid documents regarding payment of the premium.  The first premium amounting to Rs.20,000/- for the policy No. 855304523, Rs.15,000/- for the Policy No.830355681 and Rs.45,000/- for the policy No.859121360 were received by OP.  Apart from the abovementioned payments no other payments have ever been received by the OP in respect of the said policies.  The details of other receipts, submitted by the complainant did not bear the stamp of the OPs.  Moreover, there was no compulsion from any corner to open another policy.  The complainant paid only one premium against three policies.  So, the policies stand lapsed.

          For these reasons, mentioned above the reliefs sought by the complainant is not sustainable.       

          OP6 states that the complainant got instruction from the OPs to open those policies for which OP6 discussed various aspects of freelook period with the complainant.  The complainant had option to rectify or stop the policies during free look period, but he did not do so.  So, OP6 denies and disputes the allegations brought against him.

Decision with Reasons

On proper evaluation of the materials on record including the argument as advanced by the Ld. Lawyers of both the parties and also after proper assessment of the fact of the complainant including the defence of the OPs it is clear that OPs1 and 2 the Insurance Company had admitted that based on the information and declaration made in the proposal form along with receipt of the initial premium amount three policies bearing No.855304523 for yearly premium of Rs.19,694-82 with date of effect from 17-01-2012, 830355681 with annual premium of Rs.14844-74 with date of effect of the policy on 04-05-2011 and 859121360 with annual premium of Rs.43,630-47, date of effect of the policy was 22-05-2012 were received along with the initial premium and policy document were issued and delivered at the address of the complainant.

          It is also admitted by OPs1 and 2 that on 04-03-2013 complainant went to the branch office of OPs1 and 2 and informed that he had already paid the premium to the agent and got the receipt on 12-03-2013 and requested the complainant to provide the cash payment proof or acknowledgement receipt and vide letter dated 10-05-2013 complainant informed the OPs1 and 2 that he paid the premiums in respect of the policy No.855304523 and 830355681 to one Mr. Anjan Debnath, the authorized agent of the company and said notice was received by the OP.

          OP asserted that on 28-05-2013 it was informed to the complainant that the said policy of the complainant had lapsed due to non-payment of the premium.  Further it was also stated that if any amount has been deducted from the Bank Account of the complainant then the complainant must provide the same. 

          It is also admitted by the OP that a legal notice dated 08-07-2013 was received by the OPs 1 and 2 in reference to the policies No. 855304523 and 830355681 wherein it was stated that renewal premium was paid to the agent but same was not deposited to the Insurance Company.  Further it is specifically mentioned by the OPs that the acknowledgement receipt produced by the complainant does not bear the stamp of the OPs and that receipt was not valid receipt issued by the OPs and moreover policy number mentioned on that receipt does not matches with any of the three policies issued to the complainant and further the complainant in the month of January, 2014 filed a complaint before Insurance Ombudsman, raising allegations bearing complaint No.KOL-L-032-1314-1195 which is still pending.  So, considering this above fact as alleged by OPs1 and 2 we shall have to consider whether actually the premiums as claimed to have been paid by the complainant to the agent of the OPs i.e. Anjan Debnath is correct or not.  In this regard we have gone through the complaint wherefrom it is found that complainant has specifically mentioned that one Anjan Debnath, OP7 is the staff and officer of OP6 and admittedly OP6 is the corporate agent of OPs1 and 2 and that corporate agent OP6 and the status of OP6 with the OPs 1 and 2 has not been denied by the OPs1 and 2.  So, we shall have to consider the defence of OP6 the corporate agent of OPs1 and 2 and in this regard from the written version of OP6 it is found that it is his defence being satisfied complainant purchased the said policies who received that policy documents but did not cancel those policies within freelook period and complainant had his option to stop or rectify the policy during freelook period but what he did not do and complainant purchased the policy from OP2 and complainant is liable to pay premium to the OPs 1 and 2 and OP6 never received any amount from the complainant and OP6 never misguided the complainant and alleged allegation of payment of subsequent premium amount to the agent or the officer of OP6 is designed one and so, the allegation of the complainant is false.  But considering that written version of the OP and the argument as advanced by the OP’s Ld. Lawyer it is clear that the OP6 has not denied the status of OP7 with the OP6 and also has not denied that Anjan Debnath, as officer of the OP6 at any point of time did not receive such sort of money on behalf of the OP6 and in fact, OP6 has not challenged the version of the complainant to the effect that receipt was granted by OP7 as officer of OP6 in the receipt form of OPs1 and 2 and in this regard complainant has submitted that he paid Rs.15,262/- against policy No. 830355681 and Rs.20,000/- and against policy no.855304523 for due payment of 04-05-2012 and 17-01-2013 but from the Annexure of the complaint it is clear that Anjan Debnath received Rs.15,262/- on 18-12-2012 in the receipt of Max New York Life Insurance Company as payment collection and also Rs.20,000/- of Annexure P in similar receipt of Max New York Life Insurance Company and receipt number in both the cases are 872808407 and 875640336.  On the other hand, it is also proved that on 16-01-2012 a sum of Rs.20,000/- was received by Sandip Sarkar vide Max Life receipt No.855304523 and Principal Officer and Agent Advisor name is Sandip Sarkar having code no.9800089720 and from another receipt issued by Sk. Md. Suhil it is found Rs.45,000/- was received by Max New York Life Insurance Company as initial payment vide receipt No.859121360 and these two receipts marked as Annexure M and N respectively.  Practically in the present case disputed receipts are 872808407 and 875640336 which were received by the Anjan Debnath and, in fact, OPs 1 and 2 or OP6 have denied the receipt of the said amount received by OPs1 and 2 or by OP6.

          Peculiar factor is that in respect of the earlier receipt for the amount of Rs.20,000/- and Rs.45,000/- by Sandip Sarkar and Sk. Md. Suhil are not denied by the OPs1 and 2 but in that case also (Annexure M and N) the agent received amount from the complainant and that were deposited but in respect of those receipts OPs1 and 2 and OP6 have not challenged but peculiar factor is that subsequent receipt in same type of form of Max New York Life Insurance Company signed by Anjan Debnath has been denied by the OPs 1 and 2 and 6 but truth is that in all cases agent received the money and issued such receipts in earlier occasion by Sandip Sarkar and Sk. Md. Suhil and in disputed transaction Anjan Debnath signed in the said receipt as agent and received the money but OPs 1 and 2 have tried to convince that they never received entire cash and Anjan Debnath never deposited the sum for which the policy of the complainant was declared lapse.  Now, the question is whether Anjan Debnath had any right to receive such premiums or not but in this regard it is proved beyond any manner of doubt that Anjan Debnath is the employee and officer of OP6 and admittedly, the OP6 is the corporate agent of OPs1 and 2 but OP6 has not denied the fact by receiving the amount by their employee/Anjan Debnath then it is clear that OP6 received the said amount of Rs.15,262/- on 18-12-2012 and Rs.20,000/- subsequently through their officer Anjan Debnath.  Anjan Debnath is also a party in this case as OP7 but he has not contested the case and most interesting factor is that OP6 has not denied the status of OP7 with the OP6 as officer of OP6.  So, considering all the above facts it is clear that the three policies were opened through OP7 and that is admitted by OP6 in his written statement and at the time of opening these policies the premium was granted by the OP6 officer and invariably OP6 has not denied that matter and that amount was deposited to OPs1 and 2’s to cash collection centre so policy was issued but it is known to all the insured always rely upon their agent who are appointed by the insurance company and in the present case OP6 is admittedly the corporate agent of OPs1 and 2 so, OP6 has his liability as agent of OPs1 and 2 and at the same time OPs1 and 2 are also liable for any overact of their appointed agent.  It is also proved that OP7 is the employee or officer of OP6 and that officer received the amount as officer of OP6 and receipt was issued by Anjan Debnath and admittedly the liability of the OP6 to deposit said premium against the policy of the complainant but that was not done by the OP6 then it is proved that that premium amount was completely grabbed by OP6 when his appointed employee or officer received the same by issuing similar receipt of Max New York Life Insurance Company when that is the fact then it is clear that due to agent’s negligence and deficient manner of service and also the deceitful manner of act of OPs6 and 7 complainant’s all the policies were lapsed.  Then invariably it was the duty of the OPs1 and 2 forthwith to take action against his appointed corporate agent OP6 that has not been done.  Truth is that no private insurance company has their such spine to take any action.  In view of the fact all the private insurance company are running their business sitting on the shoulder of the corporate agent and for deceitful act of the corporate agent private insurance company has no courage to take any action against such corporate agency and in this case same incident happened for which OPs1 and 2 have not even after receipt of the complaint from the complainant did not take any step against corporate agent OP6.  Similarly, the OP6 also did not take action against the Officer OP7 that means there are connivance in between OPs1 and 2 including OP6 and practically for negligent and deficient manner of service of the agent of the OPs1 and 2 the complainant’s policy was lapsed and at the same time OP6 has already grabbed a sum of Rs.35,262/- through their officer Anjan Debnath.  So, considering all the above facts and circumstances, we are convinced to hold that directly for the laches and negligent manner of service on the part of the corporate agent of OPs1, 2 and 6 and for direct connivance in between OPs1 and 2 and OP6 three policies these entire policies were lapsed though premiums were paid by the complainant to the corporate agent of OPs1 and 2 but same were not deposited but grabbed by the OP6.  So, considering all the above facts and circumstances, we are convinced to hold that directly it is the liability of the OP6 to refund the same to the complainant because his officer Anjan Debnath received the amount and admittedly Anjan Debnath was the officer of OP6 at the relevant time. 

So, it is proved that OP6 had not discharged his liability as corporate agent of OPs1 and 2 and for which we are convinced to hold that oP6 is bound to repay the amount of Rs.35,262/- to the complainant along with interest of 8% over the same from the date of its receipt and till its full payment to the complainant. 

At the same time for laches of the OPs1 and 2 and his corporate agent OP6 the three policies of the complainant were lapsed.  So, in that situation for negligent and deficient manner of service rendered by the corporate agent of the OPs1 and 2 and also corporate agent OP6 no doubt all the policies when already lapsed, OPs1 and 2 shall have to refund the entire deposited premium amount after taking 5% as service charge out of the total deposited premium amount to the complainant as per guideline of IRDA of the year 2010 and 2012 and it is the mandatory position because it is settled by law that deposited premium amount in respect of lapsed policies cannot be forfeited, in view of the fact that policies does not cover the life risk of the insured and in the eye of law that policy is treated as dead policy and when the three policies are dead then the premium amount cannot be a capital of the insurance company but it is the legal duty on the part of the insurance company to refund the said premium also treated same are dead policy after deducting 5% as service charge as per IRDA Rules so, OPs 1 and 2 are hereby directed to refund the entire premium amount of three policies of the complainant after deducting 5% without any fail. 

Further considering the harassment of the complainant caused by OP6 directly and indirectly by OPs1 and 2 and for his further sufferings and loss of huge interest over the said amount OPs1, 2 and 6 shall have to pay a compensation of Rs.20,000/- to the complainant jointly and severally and the entire amount shall be paid to the complainant within 15 days from the date of this order failing which for disobeyance and non-compliance of the Forum’s order the penal interest @Rs.200/- shall be assessed against OPs1,2 and 6 jointly and severally.

          If the above order is not complied with by the OPs in that case penal action shall be started against them u/s.27 of the C.P. Act and as per said order the present complaint is allowed on contest with a cost of Rs.5,000/- each against OPs1,2 and 6 and same is allowed ex parte against other OPs but without any cost and the cost shall be paid by the present OPs within 15 days from the date of this order.

          Accordingly, as per ordering portion as made in the body of the judgment the order shall be complied with by the OPs very specifically and to satisfy the decree within 15 days from the date of this order and the direction of payment of cost, compensation, refund of money etc as noted in the of body of judgment is also the part of this order which shall be complied by the OPs.  Thus the complaint is allowed against OPs1, 2 and 6 on contest and same is allowed ex parte against other OPs but without any cost.