| Final Order / Judgement | CONSUMER DISPUTES REDRESSAL COMMISSION – X GOVERNMENT OF N.C.T. OF DELHI Udyog Sadan, C – 22 & 23, Institutional Area (Behind Qutub Hotel) New Delhi – 110016 Case No.171/2012 - SMT. LAXMI DEVI
W/O. SHRI OM VEER SINGH - OMVEER SINGH
S/O. SH. TEJ VEER SINGH R/O. 61-B, HARI NAGAR, JAITPUR ROAD, BADARPUR, NEW DELHI-110044 …..COMPLAINANTS Vs. - THE MAX NEW YORK LIFE INSURANCE Co. LTD.
THROUGH ITS MANAGING DIRECTOR 11th FLOOR, DLF SQUARE, JACARANDA MARG, DLF PHASE- II, GURGAON – 122002 - SHRI SHESH NATH PANDEY
R/O. H.NO. N-1/30, AMAR MARKET, SAURABH VIHAR, JAITPUR, BADARPUR, NEW DELHI. …..RESPONDENTS Date of Institution-09.05.2012 Date of Order- 04.11.2022 O R D E R RASHMI BANSAL– Member The present complaint has been filed by the complainants against OP1 and OP2 for deficiency in services and unfair trade practice on their part and claimed for the reimbursement of the amount of insurance as promised by the agent of OP1, compensation for mental agony, torture and harassment along with litigation cost with interest. - It is the case of the complainants that OP2, the agent of OP1, a life insurance company, has approached him and proposed for insurance plan, i.e., Max New York Life Smart Invest Pension Plan Super and fraudulently and deceitfully allured them to take the said plan representing that this plan is very beneficial and covers many risks as hospital expenses, medi-claim, house fire, theft, family wellness pension including cash return of Rs. 70,000/- at the end of 5 years and in all cases money will be paid by the company. The complainants were also told that policy plan is for 5 years only and the premium will be paid after 5 years. Believing upon OP2, they took two policies bearing number 763521796 and 775622830, Ex. CW1/A and CW2/A, respectively.
- Complainants submitted that they were also told that they will have to make payment quarterly of Rs.5000/- for each policy and yearly total Rs.20,000/-. The complainants made payment of Rs.20,000/- to OP2 in cash. The complainants were assured that Rs.10,000/- each will be adjusted in both policy plans.
- The complainants further submitted that after few days getting of the above said plans the complainant no.1 became seriously ill and she was admitted in a hospital New Delhi and got a treatment for a week. After discharge from the hospital the complainant no.2 contacted OP2 and handed over the bills and medical papers for sanction of the medi-claim, which were duly received by OP2 and also again deceitfully taken a cheque from complainant no.1 of Rs.5000/- for misc. expenses. On 16.01.2010, the complainant enquired to his claim, to which OP2 replied that an amount of Rs. 54,800/ sanctioned and will be delivered to them through courier within a week. After one week OP2 handed over a parcel bag of Max New York life Insurance Co Ltd to the complainant no.1 stating that it was delivered to his house. The parcel bag was containing one account payee cheque of Rs. 4800/- bearing number 151243 of the Indus land bank Ltd, Gurgaon branch, Haryana in favour of complainant no.1 including Mediclaim detail dated 16.01.2010, Nationalised Electronic Transfer Mandate form dated 04.02.2010, ECS mandate dated 05.02.2010, exhibited as CW1/B, C and D. However, the said cheque was bounced and returned back with the remarks ‘funds insufficient’ on 06.02.2010, Ex. CW1/E. The complainants immediately approached the OP1 branch at New Delhi with all papers including cheque bounced and enquired about papers to its officers and came to know that all papers are fake and OP2 has cheated complainants by preparing fake documents and deceitfully cheated of Rs. 20,000/- and Rs.5000/- taken towards the miscellaneous expenses. The complainants lodged a complaint, Ex. CW1/F, to this effect on 25.02.2010 to the Managing Director, Max New York Life Insurance Company Limited which was received by the OP1 but no action has been taken against the OP1. A legal notice dated 13.05.2010, Ex. CW1/G sent to OP through registered ID thereby calling upon the OP to pay a sum of Rs.1,14,800/- to the complainant, however, despite notice OP have failed to make the payment to the complainant. The complainants further submitted that due to the said act of the OP1 and OP2, the complainants were under great shock and trauma and suffered mental harassment, pain and agony and the same amounts to unfair trade practice and deficiency of services on the part of OP1. The OP1 has also not informed the complainants about the cancellation of their policies. The complainant has prayed for the payment of a sum of Rs.1,14,800/- to the complainant along with the compensation with interest for causing mental torture and agony due to arbitrary and unreasonable conduct of OPs.
- OP1 contested the case and has filed his reply, evidence by way of affidavit contending that complainants have failed to establish any deficiency in services and unfair trade practice on the part of OP1 and the complaint is liable to be dismissed. The OP1 has admitted the above said policies and stated that the same were the pension plans and there was no benefit of medi-claim, i.e., reimbursement of medical expenses or any other form of risk cover against medical exigencies. The policy documents containing clear and explicit terms of the policy contract were duly provided to the complainants upon issuance of the said policies. The complainant no.1 after fully understanding and deliberating upon the terms and conditions of the plan submitted the duly signed proposal form number 763521796, Ex. RW1/A, dated 26.11.2009, pursuant to which an insurance policy bearing number 763521796, Ex. RW1/B, was issued to him on 30.11.2009, under which an annual target premium of Rs. 20,000/- was to be paid quarterly.
- Complainant no 2 also submitted the duly signed proposal form number 775622830 dated 28.01.2010, Ex. RW1/C, after fully understanding and deliberating upon the terms and conditions of the plan, pursuant to which an insurance policy bearing number 775622830, Ex. RW1/D, was issued to him on 31.01.2010 on an annual target premium of Rs.20,000 to be paid quarterly.
- Vide renewal premium notice dated 31.03.2010, exhibit RW1/E, the complainant no.2 was informed that the premium amount of Rs.5000/- is due towards the policy number 7756 2830 as on 30.04.2010 and vide policy lapse intimation dated 10.05.2010, exhibit RW1/F, the complainant was informed that policy number 775622830 has lapsed on account of non-receipt of premium due on 30.04.2010. OP1 further submitted that vide policy lapse intimation dated 31.05.2010, exhibit RW1/G, the OP1 again intimated the complainant no.2 regarding non-receipt of premium for policy number 775 56 2830 that was due on 30.04.2010. The complainant no.2 was requested to pay the net amount due to reinstate the policy. The OP1 further submitted that in the meantime the answering OP1 was served with a legal notice dated 13.05.2010, Ex. RW1/ /H, alleging that complainant was provided with some purported cheques from the Max life Insurance Company. OP1 submitted that it has duly investigated matter with regard to the medi-claim for complainant no.1 and duly conversed telephonically to understand the grievance of the complainant suspected the case to be mis-selling, therefore, the policy number 763521796 was cancelled by OP1 and provided the complainant with refund of the initial premium paid. Vide letter dated 21.07.2010, Ex. RW1/ I, the complainant no.1 was informed of the same and provided with the refund cheque number 889811 dated 26.07.2010 and on account of the same there exist no liability towards OP1. It is further submitted by OP1 that no cheque as alleged by the complainant has at any time been issued by the OP1.
- OP1 further submitted that complainant has opted for the policy after 15 days policy review period and the OP has duly dispatched the policy document containing the terms and conditions of the policy to the complainant and despite being aware of the policy terms, the complainant did not approach regarding wrongful selling of policy. Therefore as evident there is no cause of action or subsisting liability with regard to the above said policies as well hence the present complaint is liable to be dismissed.
- OP2 chose not to appear despite service of summons and was proceeded ex-parte vide order dated 20.08.2013.
- Both the parties have filed their respective documents, evidence by way of affidavit and written arguments.
- We have carefully perused the documents available on record. There is no dispute with respect to the issuance of the policy in favour of complainant on the terms and conditions as provided by the parties. There is no denial on the part of OP1 that OP2 is not its agent. The policy documents as filed by OP1 with respect to both the policies bear signature of OP2 in the place of ‘name of agent’. The policy premium receipt, policy owner data dated 30.11.2009, acknowledgement of receipt of policy, also bearing name of OP2 for policy no the policy no. 763521796, with agent code 357115 and phone no. 9891265645. Similarly policy premium receipt, policy owner data dated 31.01.2010, acknowledgement of receipt of policy, insurance policy no. 775622830 bears name of OP2. The renewal premium notice dated 31.03.2010, 10.05.2010 for policy 775622830 with due date on 30.04.2010 also have name of OP2. The cheque no. 151243, dated 16.01.2010 of an amount of Rs. 4800/- drawn on Indusind Bank, in favour of Laxmi Devi also bears stamp of OP1 signed by authorised signatory. The above sated documents are sufficient to establish that OP2 is agent of OP1. OP1 also failed to clarify how the signature of his authorised representative put on the said cheque.
- This is further case of OP1 that it cancelled the policy 763521796 treating it a case of mis-selling. It is beyond our understanding how a policy can be mis-selled when it is duly authorised by OP1 itself. Since complainants are misled by the OP2 and fraudulently were sold the above said policies, OP1, is found deficient in its services in providing safe and secure transactions and information to the complainants and therefore being the principle of OP2, is liable, for all actions of agent done during the course of his employment in the capacity of its agent. Moreover, in the welcoming letter dated 01.12.2009 by OP1 to the complainants, the OP1 has suggested the customers to stay in touch with them through their agent advisor, therefore, complainants committed no mistake in relying upon the words of OP2. Further, OP2 is under obligation to honour the policies in toto, and the policy no. 763521796 cannot be cancelled unilaterally by OP1. Also, OP2 stated that the policy number 775622830 lapsed on account of non-receipt of premium but when complainants were in contact with OP2, who has collected money from complainants, therefore, the lapse of policy due to non-payment of premium is not due to fault of complainants. The redressal for the bouncing of above stated cheque is beyond the area of CPA, 1986, for which complainants have to initiate proceedings before appropriate court.
- In view of the above discussion, we are of the firm opinion that OP1 is liable severally and jointly in law for the acts of its agent OP2. If OP2 is not traceable by OP1, the consumer cannot be made to suffer for compliance of the order. In that eventuality, OP1 is directed to comply with the order of the Commission. OPs are directed to refund the premium paid for the lapsed policy 775622830 with interest at rate of 6% p.a. from the date of filing of the complainant till the date of actual realisation, a compensation of Rs. 50,000/, along with litigation cost of Rs. 20,000/-. Further, since this is not stated by the complainants or OP1 whether the amount of the premium refunded to the complainants by OP1 vide cheque no. 889811 dated 26.07.2010 has been encashed or not. If the same has not been encashed by complainant no.1, then in that eventuality, OP1 is directed to issue fresh cheque to the complainant of the same amount along with the interest accrued on such amount from 26.07.2010 till the date of the order. The above said order be complied with within three months from the date of passing of the order, failing which the said amount of the cheque shall carry an interest @ 9% p.a. till its actual realisation.
- No order as to costs.
- The complaint could not be decided within time due to heavy pendency of the cases with commission.
- The file be consigned to Record room after providing the copy of the order to the parties in terms of the CPA, 2019.
- The order contains 9 pages, each bears my signature.
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