ORDER

06.11.2024

Sh. Rajesh, Member

1. The factual matrix of the present case is that the agent of OP approached the complainant and offered him certain policy/s including the Met Smart Plus and also informed the complainant that this is investment-cum-insurance market link policy and the complainant would get better returns from his investments. The premium to be paid was Rs.50,000/- per year and the complainant signed proposal for the policy and he was issued the aforesaid policy i.e. Met Smart Plus in the year 2007 and the premium for the first time was also paid for Rs.50,000/- on 22.11.2007 and since thereafter the complainant continued to pay Rs.50,000/- per year and by 2013 he had paid Rs.3,50,000/-. As per the terms of the policy the complainant claimed partial return and the in the year 2014 he got refund of Rs. Two Lacs out of his total amount deposited in the policy.
2. It is stated that at the time of opting for the policy the complainant was informed that the growth in the investment/income would depend upon the performance in the market and at that time when the policy was taken the Sensex was about Rs.16,000/- and in the year 2014 it was Rs.28,000/. Later on very recently the complainant was also informed that there are various charges like premium allocation charge, policy administration charge, mortality charge, fund management charge, service tax etc. which are levied towards the policy and same gets deducted from the fund value. This was seriously shocking and surprising that the business agent of the OP worked for the benefit and growth of the business of the company and how these charges are deductable from the fund value? Moreover, the complainant, his wife as well as his other family members had taken other policies also but in all these policies they found misrepresentation on behalf of the OP company and number of extra charges which are not at all justified and the complainant discontinued the said policies and filed cases before the Consumer Court for realization of their right and here also again he has been dealt with the same treatment finally he has lost faith in the company and does not want to continue with any policy with the company. He has also undertaken communication with the company and called for his money back. As per the payment scheduled he paid Rs.3,50,000/- by 2013. He got partial refund of Rs. Two Lacs in the month of May, 2014.
3. It is stated that when the complainant by way of email communication requested for refund of Rs.1,50,000/- alongwith interest and the benefits accrued so far on the said amount, however, he was informed that he was entitled only for Rs.89,000/-. It is beyond the understanding that against the clear cut representation of growth in the investment why his investment have gone down when his deposit of Rs.1,50,000/- is with the company how he is entitled for only Rs.89,000/-. Be that as it may he again communicated with the company and again request for his entire money back alongwith interest and benefit accrued on his investment and again by communication dated 23.12.2014 he was informed that his fund value in the company is Rs.1,02,656/-. At this juncture the complainant has lost faith in the company as well as in policies of the company. The business of insurance is based on utmost good faith and the same is reciprocal to both the parties whereas practically he has found that the reality is far from what it was represented to him at the time of selling of the policy. In any case the complainant is no more interested in continuing with the policy as categorically revealed by him in his earlier communication but since he did not get any response nor did he get his money back alongwith interest/other benefits accrued so far on his investment, therefore, he has left with no option but to initiate legal proceedings to realize his money.
4. It is stated that the complainant got issued a legal notice dated 06.02.2015 to the OP by speed post which has been duly served upon the respondent for doing the needful. The OP failed to comply with the terms of legal notice and sent a reply dated 25.02.2015, which is highly calculated, untenable and contrary to the representation and claim of the OP. The reply is of no consequence and does not evade the liability of the OP herein.
5. Complainant is seeking direction against OP to refund the remaining amount i.e. Rs. 1,50,000/- against the policy No. 1200700422506 alongwith interest @18% per annum as well as the damages and to pay Rs.1,00,000/- being the compensation for losses suffered  by complainant on account of inaction, carelessness of the OP, to pay cost of proceedings and any other order which this Commission deems fit and proper.
6. OP1 and 2 filed WS denying the allegations made in the complaint. It is stated that in the present case the dispute/cause of action firstly arose in 22.11.2007 when the said policy was issued to the complainant and on 30.11.2007 when policy documents were dispatched at complainant’s address through Pafex courier whereas the complainant has disputed the policy terms after a period of more than eight years from the date of issuance of the policy and filed the present complaint in the year 2015. Therefore, the present complaint being barred by limitation.
7. It is stated that complainant has not availed the benefit of free look period therefore, present policy is binding upon the complainant. It is stated that after completely understanding the terms and conditions complainant had voluntarily applied for a policy by voluntarily filling a proposal form bearing no. DLP115011129 for Met Smart Plus policy. The complainant after completing understanding the terms and conditions of product offered to pay a model premium of Rs. 50,000/- annually for a period of 72 years towards the premium under the said plan for a proposed sum assured amounting to Rs.12,50,000/-. The complainant has also signed up declaration form unit linked products and benefit illustration form for the above mentioned policy and therefore, he was well aware of all the terms and conditions pertaining to the given policy. It is stated that upon receipt of the duly filled proposal form alongwith the initial premium of Rs. 50,000/- against the application of the OP evaluated an processed the proposal form on the basis of information provided by the complainant and issued policy bearing no. 00422506 dated 22.11.2007 to the complainant for the premium paying term of 72 years.
8. It is stated that welcome letter clearly stated that in case the complainant was disagreed with the terms and conditions of the policy he should have returned the policy within fifteen days of receipt of the same and was entitled for cancellation available to the complainant pursuant to clause 6(2) of the terms and conditions of the policy. However, the complainant inspite of the receipt of the policy documents has not raised any objections during the free look period and hence it was presumed that the contract of insurance which OP had with the complainant was legally concluded.
9. It is further stated that complainant remitted the renewal premiums payments till 23.08.2011 amounting to Rs. 2,50,000/-. Thereafter on the basis of the retention calling partial withdrawal for an amount of Rs. 1,00,000/- was done and the same was accounted towards premium due for 22.11.2012 and 22.11.2013.
10. It is stated that on 01.05.2014 OP received a request from the complainant for the partial withdrawal of an amount of Rs. 2,00,000/-. Thus the said request of the complainant was duly considered by the OP and partial withdrawal was duly processed. Accordingly an amount of Rs. 2,00,000/- was credited to the complainant’s account through NEFT towards partial withdrawal amount in respect of the said policy as per the said request of the complainant. 
11. It is stated that on 22.11.2014 OP received an email from complainant seeking clarification on the amount which he could withdraw and accordingly the OP replied the complainant confirming the approximate amount payable.
12. It is further stated that on 28.11.2014 the OP received an E mail from the complainant disputing decrease in the fund value and the OP accordingly had duly explained to the complainant the deductions of the charges under the policy as per the terms and conditions which was also agreed and understood by him at the time of availing the said policy.
13. It is stated that the aforementioned policy was issued as per the consent of the complainant and the information provided by him in the proposal form and the documents given by him. The complainant had signed up declarations for Unit Linked Products which shows that he was very well been exp0lained about the terms and conditions and having satisfied with the terms and conditions he signed the proposal form. Thus the complainant is bound by the contents stated by him in the proposal form.
14. It is stated that the aforementioned policy was issued as per the consent of the complainant and the complainant read and then signed it. The complainant has also signed the Form Unit Linked Products which shows that he was very well been explained about the terms and conditions and having satisfied with the terms and conditions he signed the Proposal Form. Even then if he was not satisfied with the terms and conditions he could have applied for the cancellation of the policy within the free look period as all the policy documents were delivered to him. However the complainant refrained from applying for cancellation of the policy within the free look period. It is stated that complainant had signed a declaration in the proposal form thereof that he has read and the proposal form and after fully understanding the contents thereof and the terms and conditions of the plan have applied for the same. It is stated that upon giving consent only OP processed the said proposal form of the complainant and issued the said policy to the complainant and as such the complainant is estopped challenging the terms and conditions of the concluded contract.
15.  On merits also the OP has reiterated the submissions made in the preliminary objections. It is stated that on 14.11.2007 the complainant after completely understanding the terms and conditions of the product “Met Smart Plus had voluntarily applied for a Policy by voluntarily filling up Proposal Form bearing No. DLP115011129. It is stated that complainant offered to pay a Model Premium Rs. 50,000/- annually towards premium under the said Plan for a proposed sum assured amounting to Rs. 12,50,000/-. Upon receipt of the duly filled up Proposal Form along with the initial premium of Rs. 50,000/- against the application of the OP evaluated and processed the Proposal Form on the basis of the information provided by the complainant and issued Policy bearing No. 00422506 on 22.11.2007 to complainant for the premium paying terms of 72 years. Later the policy documents were sent to the complainant on the address mentioned on the proposal form.      
16. Complainant filed rejoinder to the WS of OP1 and 2 and denied all the allegations made therein and reiterated facts of the complaint.
17. Complainant filed his evidence and his wife named Ekta Goenka by way of affidavit and reiterated contents of complaint. Complainant relied on Insurance Policy Ex. CW1/A, acknowledgment slip dated 01.05.2014 Ex.CW1/B, Legal Notice dated 06.02.2015 Ex.CW1/C, Reply notice dated 25.02.2015 Ex.CW1/D.
18. OP1 and 2 filed evidence by way of affidavit of Motty John Manager Legal and reiterated contents of WS. OP1 and 2 relied on copy of proposal form dated 14.11.2007 bearing no. DLP115011129 Ex.OP-1, copy of partial withdrawal request form given by complainant alongwith supporting documents Ex.OP-3 and copy of emails exchanged between the complainant and OP Ex.OP-4.  Terms and conditions Met Smart Plus policy.
19. Written arguments filed by complainant as well as by OP1 and 2.
20. We have heard counsels for the both the parties and carefully perused the record.
21. In nutshell the complainant is aggrieved with the poor return on his investment with the OP and as such it is alleged that the complainant has lost faith in the company as well as in policies of the company. Therefore has approached this Commission for redressal of his grievances.
22. It is important to state that losing hope in a company or its services can be indicative of dissatisfaction, but it may not, by itself, constitute a legal definition of "deficiency in services" as defined under C.P. Act, 1986. Whereas the deficiency in services as defined under C.P. Act, 1986 typically refers to:-

1. Non-fulfillment of Contractual Obligations: If a company fails to provide services as per the contract or agreement (e.g., promised returns on an investment), it may be considered deficient.
2. Substandard Quality: Services or products provided do not meet the quality standards that a consumer is entitled to expect.
3. Lack of Transparency: Inadequate communication and unclear information that leads to consumer confusion or misrepresentation can also indicate deficiency.
4. Failure to Resolve Complaints: If a company does not adequately address complaints or concerns raised by the consumer, this can lead to a perception of deficient services.

23. In our considered opinion failure to provide high return on investment to consumer doesn’t amount to deficiency in services as defined under C.P. Act, 1986.
24. While emotional responses such as losing hope can reflect the consumer’s experience, for a legal claim of deficiency in services to be valid, it would need to be supported by clear evidence of failure in service delivery or breach of contract. If the company did not honor its commitments or failed to provide reasonable support in addressing concerns, then this could substantiate a claim of deficiency in services.
25. In conclusion, while losing hope is a serious issue for customers and may affect their decision to continue using a company's services, legal action would require specific evidence of how the company's actions (or lack thereof) constituted a deficiency in service under consumer protection laws. In the present case complainant has failed to establish deficiency in services against OP.
26. In view of above discussions and observations present complaint lacks merit and therefore is dismissed.  
27. Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving an application from the parties in the registry. 
28. The orders be uploaded on www.confonet.nic.in.

Announced in open Commission on  06.11.2024.

     SANJAY KUMAR                                                                        RAJESH

       PRESIDENT                                                                              MEMBER