BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.71 of 2022
Date of Instt. 10.03.2022
Date of Decision: 08.08.2023
S. Bishan Singh aged 78 years son of Hira Singh resident of 277/1, Abadpura, Jalandhar.
..........Complainant
Versus
1. PNB Metlife India Insurance Company Ltd., Registered Office 701 to 703, 7th Floor, West Wing, Raheja Tower, 26/27, M. G. Road, Banglore, 560001.
2. PNB Metlife India Insurance Company Ltd., Jalandhar Office: Model Town Road, Jalandhar through its Branch Manager.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Present: Sh. V. K. Sareen, Adv. Counsel for the Complainant.
Sh. B. B. Sekhri, Adv. Counsel for OPs No.1 and 2.
Order
Dr. Harveen Bhardwaj (President)
1. This complaint has been filed by the complainant, wherein alleged that in the month of January, 2019 a representative of the respondent company had approached the complainant with a proposal to take out an insurance policy being offered by the respondent company. The said representative of the respondent company then explained to the complainant that he would be require to a sum of Rs.1 Lacs every year for a period of 5 years and at the end of the aforesaid period of the insurance policy, he would be paid the entire amount contributed by him along with all the benefits which shall accrue to him by the end of the policy period. He also explained to the complainant that he can surrender the aforesaid policy at any time after the payment of first installment of Rs.1 Lac and at the time of such surrender of the policy, he shall be returned the amount paid by him till the date of the surrender of the police along with all benefits which may have accrued to him till the date of the surrender of the policy. He however, also told the complainant that the benefit which are going to accrue to him of the completion of the policy period, would be quite attractive and would be much more than the benefit which he would be entitled if the policy is surrendered prior to the expiry of its period. Believing the aforesaid representation of the respondent, the complainant had agreed to take out PNB Metlife Guaranteed Saving Plan Policy. On his agreeing to take out the policy, he had paid to the respondent a sum of Rs.1 Lac by way of premium for the 1 year and on the deposit of the said amount, policy no.22778130 dated 10.09.2019 had been issued in favour of the complainant. After taking out the aforesaid insurance policy the complainant had paid to the respondents three installments by way of premium each of Rs.1 Lacs, i.e. premium for period of 3 years. After the payment of the premium for the period of 3 years, the complainant has approached the respondent to surrender the aforesaid policy because he did not want to continue with the same. And in response to his request, he had received a letter dated 05.01.2022 wherein it had been mentioned that the respondent had already received the amount of Rs.1,95,694.16/- and that the next date for the payment i.e. 3rd installment was 08.01.2022, whereas in fact, the complainant has already given the premium for the 3rd year. Since the complainant did not want to continue with the aforesaid policy as such he insisted upon for the return of the amount already paid by him to the respondents along with the benefits which had already accrued to him but the respondents refuse to do so and instead insisted upon the complainant to continue with the aforesaid policy and to pay the remaining installments, while insisting upon the complainant to continue with the aforesaid policy, they even threatened that, in case he would not continue with the policy. The amount already paid by him shall be returned to him only after the expiry of period of 10 years. The aforesaid stance of the respondent is absolutely illegal because as mentioned above, at the time of the issuing of the policy, he has been told by the agent of the respondents that the complainant would be entitled to surrender the police at any point of time during the period of 5 years and that on such surrender, he would be immediately paid the amount paid by him along with the benefit which shall have accrued to him till the date of surrender. The respondent by refusing to pay the aforesaid amount to the complainant, has resorted to unfair trade practice and are taking a senior citizen for a ride and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to return the amount already paid by him under the aforesaid policy i.e. Rs.3,00,000/- and to pay all the benefits which had already accured to him till date. The details of such benefits to be disclosed by the respondent. Further, OPs be directed to pay Rs.50,000/- for causing mental tension and harassment to the complainant and Rs.22,000/- as litigation expenses.
2. Notice of the complaint was sent to the OPs, who filed written reply and contested the complaint by taking preliminary objections that the complainant is not entitled to any claim or to get any relief claimed therein. The complaint is not maintainable in law or on the true facts and circumstances of the matter and the same is liable to be dismissed in limine. It is further averred that the complaint is ex-facie misconceived, and devoid of any merits. The complainant has made this complaint in order to raise a false and frivolous dispute to harass the OP company. The correct factual position is as follows:-
i). The Complainant had applied for the one Policy with the Company under duly filed E-Application form no.228930743 on 7th January 2019 for an annual premium of Rs.1,00,000/- for a premium paying term of 5 years.
ii). Thereafter OP- Company then issued the policy on 10th January 2019 and dispatched the same through Speed Post No.EA1757880541N on 10th January 2019, which was delivered on the address as mentioned in the application Form on 16th January, 2019.
iii). That in order to ensure transparency that the subject policy was issued as per policyholder's choice, opposite party provide the policyholder with a copy of the application form along with the policy document; and that he was also provided with a free look cancelation option. Consequently, if on receipt of the policy document, the policyholder is not agreeable to the terms and conditions, he had the option to cancel the policy under the free-look i.e. 15 days from the date of receiving the policy document as mandated by the Insurance Regulator and Development Authority (IRDA).
iv). That OP-Company received a cancellation request from the complainant on 29th October 2020 i.e. after more than 20 months from the receipt of the policy documents, asking for cancellation and refund of premium on grounds of mis-selling and upon which the opposite party after detailed investigation, responded vide letter dated 2nd November 2020 informing the complainant that the said cancellation request has been declined by the company as it was well outside free look period of 15 days. It is further submitted that the subject Policy Contract was delivered to the Complainant's address (details stated above) and even it is assumed the said Policy Contract was mis-sold to the Complainant then complainant should have approached the Insurance Company within the Free Look Period of 15 days. It is important to mention here that the aforementioned facts itself speaks that the Complainant has filed the present complaint after thoughts and in order to extract money from the Insurance Company.
v) That the Company has not received any communication within the free look period of 15 days and it is further evident that the Complainant wants to walk away from the policy after enjoying cover and is deliberately creating the allegation of mis-selling to force the Company to cancel the policy and now has filed this case before this Commission with wrong, false allegations. It is submitted that the Complainant was completely aware of the plan details and features. It is submitted that the complainant in order harass and victimize the complainant has filled this baseless and false complaint.
vi) That upon the issuance of the subject policy Contract, the Policy contracts were dispatched to the complainant and the same were delivered at the address provided in the proposal form. It is submitted that the Insurance Company neither received any query nor a complaint during the Free Look period with respect to the above-mentioned policy. It was therefore presumed legally that the Complainant and life assured were satisfied with the policy issued. The Complainant is stopped from challenging the terms and conditions of the concluded contract and denying the contents of the Application Form.
vii) That the contract of insurance is a contract of uberime fide and as the Company has provided services and covered the risk of the life of the Complainant from the date of commencement of the policy, as such the Complainant is estopped from challenging the contract as such at such a belated stage. On merits, the factum with regard to issuance of policy No.22778130 to the complainant is admitted and it is also admitted that the complainant had paid three annual premium payments, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
3. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
4. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
5. We have heard the learned counsel for the respective parties and have also gone through the written arguments submitted by counsel for the complainant as well as case file very minutely.
6. It is admitted fact that the complainant got insurance policy from the OP with a premium of Rs.1,00,000/- every year for a period of five years. The complainant has proved the policy documents Ex.C-1, which shows that the policy was effective from 10.01.2019 and the premium was paid as Rs.1,00,000/-. The complainant has alleged that at the time of purchasing the policy, he was assured that after the payment of first installment of Rs.1,00,000/-, the complainant can surrender the policy at any time. At the time of surrendering the policy, he shall be returned the amount paid by him till the date of the surrender of the policy alongwith all benefits, which may have accrued to him till the date of the surrender of the policy.
7. The OP in his written reply has denied the above said fact and has alleged that the declaration form was duly signed by the complainant and as per the policy schedule, the premium paying term under the policy was of five years, therefore, the minimum period was five years and not any time as alleged by the complainant. The complainant has alleged that he had already paid three premiums for three years, whereas the OP has denied this fact and has alleged that only two year premium has been paid by the complainant. The complainant has proved on record the receipts showing that three premiums have been paid by the complainant. The complainant has alleged that he did not want to continue with the policy and requested the OPs to return the amount as he wanted to surrender the policy, but the OP again denied and refused to refund him the money taken by them and also refused to give him the benefits as alleged by the complainant.
8. The contention of the OP is that the complainant was well within the knowledge of the terms and conditions of the policy. He did not opt for free look cancellation after the receipt of policy. This clearly shows that he has accepted the terms and conditions, but this contention is not tenable. Perusal of the policy schedule shows that there is a mention of the fact of free look provision. Perusal of this provision shows that the policy could be cancelled by giving a signed written notice to insurance company within 15 days, if the consumer or purchaser has any objection to the terms and conditions of the policy, but in the present case, it is not so as the request for cancellation and refund of premium was made on the ground of mis-selling. This fact has been admitted by the OPs in the preliminary objections para No.3 (iv) of written statement. So, there was no objection to the terms and conditions of the policy, but there was some problem due to which the complainant wrote a letter that he does not want to continue with the policy.
9. The complainant and OPs have relied upon the policy schedule Ex.C-1. Perusal of the Ex.C-1 shows that at page No.14 of the policy schedule, in condition no.3.4, there is a clause under the heading of ‘Surrender’, which reads as under:-
You may surrender the Policy provided that all due Premium has been received in full and policy has acquired Surrender Value. We will pay a Surrender Value which is equal to the higher of the Guaranteed Surrender Value or Special Surrender Value.
Premium Payment Term of 5 and 7 years: If all premiums for at least 2 consecutive years have been paid, the policy shall acquire a Guaranteed Surrender Value.
On the next page against the condition No.3.4, it has been mentioned about the premium payment term of 10 years: if all the premiums for at least 3 consecutive years have been paid, the policy shall acquire a Guaranteed Surrender Value and the Guarantor Surrender Value has also been defined in this schedule. The case of the complainant is covered under the heading Premium Payment Term of 5 and 7 years. Against this condition, it has been mentioned that if all premiums for at least two consecutive years have been paid, the policy shall acquire a Guaranteed Surrender Value. The required condition for surrender is that the premium for at least two consecutive years should have been paid which the complainant has already paid. This fact has been admitted by the counsel for the OP in para No.3 of the written statement that the complainant has paid three annual premium payments. This clearly proves that the complainant has complied with the condition mentioned in 3.4 clause of the policy. By refusing the complainant to pay the amount, which he had already paid and he does not want to continue with its policy, is unfair trade practice and deficiency in service towards the complainant, who is the senior citizen, thus, the complainant is entitled for the relief as claimed.
10. In the light of above detailed discussion, the complaint of the complainant is partly allowed and OPs are directed to return the amount which was already paid by the complainant under the aforesaid policy and to give all the benefits which had already accrued to the complainant. Further, OPs are directed to pay a compensation of Rs.10,000/- for causing mental tension and harassment to the complainant and Rs.5000/- as litigation expenses. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
11. Copies of the order be sent to the parties, as permissible, under the rules. File be indexed and consigned to the record room.
Dated Jyotsna Dr. Harveen Bhardwaj
08.08.2023 Member President
