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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.304/2019
ROHITASH KUMAR
S/O SH. REHAM PAL SINGH
R/O A-120, STAFF QUARTER,
NIT RD, MEHRAULI,
NEW DELHI…..COMPLAINANT
Vs.
- CHAIRMAN/MANGER
PNB METLIFE INDIA INSURANCE COMPANY LTD.
7.8, SECOND FLOOR, VARDHWAN TOWER,
NEHRU PLACE, NEW DELHI- 110019.
- MS. SARITA- AGENT
PNB METLIFE INDIA INSURANCE COMPANY LTD.
C/O PUNJAB NATIONAL BANK, MEHRAULI BRANCH,
NEW DELHI. .…..RESPONDENTS
Date of Institution-20.12.2019
Date of Order- 10.05.2024
O R D E R
DR. RAJENDER DHAR-MEMBER
The complaint pertains to deficiency in service on the part of OP with respect to mis-selling of policy.
Brief facts as stated in the complaint are that OP2 i.e. Agent, Ms. Sarita had approached uncle Mr. Vijay Pal Singh of the complainant (now deceased) and complainant and told him about the Policy of PNB Metlife Insurance/Whole Life and Wealth Plan with the protection to cover the whole life risk and health insurance which will be valid for a period of five years.
It is further mentioned that OP2 on 11.03.2018 informed the uncle of the complainant to invest Rs.2,00,000/- in one time lump-sum amount for five years, OP2 also informed Mr. Vijay Pal Singh (now deceased) that he would get Rs.14,00,000/- in case of death and this policy will also cover the health insurance. This was assured by OP2 and also by Sh. Kothari, Manager of OP1.
It is further stated that uncle of the complainant had given Rs.2,00,000/- to the OP1 i.e. PNB Metlife Whole Life With Wealth Plan vide policy no.22513806 with life cover without any further installment or renewal as it was terms/object of the investment policy.
On 11.10.2019, uncle of the complainant, the policy holder was admitted to Medore Hospital, New Delhi and his nominee/ complainant namely Rohitash contacted the OPs and also Mr. Surender who is looking after the office of OP1 and told the complainant that “abhi tum apna paisa ilaaj main kharch kar lo bad main policy ka paisa tumko dilwa denge.”
It is further submitted that on 15.10.2019 policy holder Mr. Vijay Pal expired. Thereafter, complainant/nominee informed the OPs and other officials of the OP1 about the death of the policy holder and asked about the claim but OP told complainant that he is not eligible to get the insurance amount and medical amount because the policy has expired.
It is further submitted that Rs.2,00,000/- which were given at the time of taking policy was an one time investment and the policy covered life risk of the uncle of the complainant and it was for one time premium only.
It is further submitted that OPs never informed the complainant or his uncle, the policy holder about the renewal of policy.
It is further submitted that policy holder Mr .Vijay Pal Singh was a retired person and it is not possible or it could not have been assumed that he could be able to invest Rs.2,00,000/- per year. So, the OPs have played fraud and misrepresentation.
It is further submitted that OP1 released only Rs.1,51,613.88/- on 20.11.2019 to the complainant/nominee but the complainant has a right to claim the insurance amount of Rs.14,00,000/- and medical expenditure which were incurred by the complainant on the treatment of policy holder.
It is further stated that OPs have cheated complainant as they have not paid the death claim/insurance/medical amount to the beneficiary even when the complainant informed the OPs about the death of policy holder.
It is further submitted that OPs have illegally and unlawfully repudiated the claim of the complainant and repudiation is illegal and account and playing fraud upon complainant. It is further submitted that OPs did not fulfill with their services as promised by them i.e. called deficiency services. It is further submitted that the OP vide their letter dated 20.11.2019 for repudiating the claim as well as accident incurred on medical treatment on the ground that the policy had lapsed on 23.03.2019 due to non-payment of renewal premium and the death of the insured occurred after lapse of policy. However, it has also been informed that the fund value of Rs.1,51,613.88/- had occurred in the policy and the same has been transferred through electronic mode to the beneficiaries. Complainant has further stated that OPs are liable for fraudulent practice and deficiency in services. Complainant has also suffered financial loss and mental agony due to fraudulent practice adopted by OPs for giving false promise.
Complainant has prayed for a sum of Rs.14,00,000/- paid to the complainant as premium by paid for life cover insurance with interest @12% till date, Rs.1,00,000/- for suffering mental pain and agony due to this harassment and Rs.10,000/- cost of litigation.
OP1 i.e. PNB Metlife India Insurance Company Ltd. in its reply has stated that the present complaint is not maintainable and is liable to be dismissed.
OP1 has stated that complainant created a false story in his complaint to harass and humiliate the OP1 and mislead the Hon’ble Commission by concocting and distorting the facts and circumstances of the present case and as such complaint is liable to be dismissed on this ground.
OP1 has also stated that uncle of the complainant had approached to OP1 for the purchase of the life insurance policy and had submitted a Customer declaration form and application bearing no.216966558 dated 21.03.2018 and declared that he had duly provided true, correct and accurate details in the proposal form and also signed the terms and conditions and contents of the proposal form.
OP1 has stated that the information furnished in the application/proposal form, the proposal form, was processed by the OP1’s company and thereafter the said police was issued to the life assured as per the details mentioned below:
Product/Plan | PNB Metlife Whole Life Wealth Plan |
Policy Number | 22513806 |
Date of Issue | 31.03.2018 |
Date of commencement of Risk | 22.03.2018 |
Name of Policy Holder/Life Assured | Mr. Vijay Pal Singh |
Sum Assured | Rs.14,00,000/- |
Policy Term | 39 Years |
Premium Playing Term | 8 Years |
Premium Amount | Rs.2,00,000/- |
Premium Frequency | Annually |
Name of Nominee | Mr. Rohitash (Nephew) |
OP1 has further submitted that it had sent the policy document dated 19.04.2018 to the address mentioned in the proposal form by policy holder, stating the policy terms and documents and a forwarding letter stating the free look provision along with a copy of proposal form. After the delivery of the policy, a welcome call was also made successfully by the OP1 to the policy holder regarding the policy and its terms and conditions. After, the issuance of policy and delivery of policy documents, free look period for the said policy expired and no concerns were raised by policy holder.
On 07.11.2019, complainant has intimated OP1 that the life assured has died on 15.10.2019 due to septic shock and being the nominee he had lodged the death claim but it was found that policy wad lapsed/expired due to non-payment of the renewal premium by the deceased/policy holder.
OP1 has further stated in its reply that 4.2 clause of the terms and conditions of the policy states that if the policy is discontinued during the first five years company will send a notice within a period of 15 days from the date of expiry of grace period to exercise the option to revive the policy or to exercise the option of complete withdrawal and if the same is replied then in that case total fund value after deduction of discontinuance charges will be paid out.
In this case there was discontinuance of premium and therefore, the policy was discontinued and a sum of Rs.1.51.613.88/- which accrued after deduction of proportional expenses was paid as full and final settlement amount and the claim was closed, OP1 has also placed on record claim decision letter. The action of OP1 is in total compliance and conformity of the terms and conditions of the insurance policy. No relief will travel beyond the terms and conditions of the insurance policy, hence, there is no deficiency in services or breach of terms and conditions of insurance policy.
Insurance policy is a contact of insurance between the two parties and both the parties are bound by its terms and conditions. The complainant has presented a distorted and twisted picture with an intention to misguide the Commission to extract favourable decision. OP has also contended that the complainant after receiving the insurance policy was very well aware of its terms and conditions, ignorance for gaining relief of policy is totally unwarranted.
In the end, OP1 has prayed that the complaint is false and should be dismissed with cost.
Notice was sent to OP2 which was returned back. The complainant did not file amended address of OP2.
Complainant has filed rejoinder in which he has contradicted the contents of the reply to OP1 and has reiterated his complaint.
Complainant has filed evidence by way of an affidavit and has exhibited the following documents:
- Copy of Aadhar Card is exhibited as Ex.CW-1/1 (OSR),(Colly)
- Copy of Policy no.22513806 of PNB Metlife Insurance Company of deceased Mr. Vijay Pal is exhibited as Ex.CW-1/2.
- Bank account statement of Punjab National Bank of deceased/Vijay Pal is exhibited as Ex.CW-1/3.
- Copy of Bank statement of the complainant is exhibited as Ex.CW-1/4.
- Copy of hospital record of the deceased/ Vijay Pal is exhibited as Ex.CW-1/5(Colly)
- Copy of death certificate of deceased/Vijay Pal is exhibited as Ex.CW-1/6.
- Copy of request/information sent to the OP is exhibited as Ex.CW-1/7.
OP1 also has filed evidence by way of an affidavit and has exhibited the following documents:
- Copy of power of attorney is annexed as Annexure-R1.
- Copy of application and agent declaration form and proposal form bearing is annexed as Annexure R2.
- Copy of welcome letter dated 19.04.2018 along with policy are annexed as Annexure R3.
- Copy of claim intimation form is annexed as Annexure R4.
- Copy of the claim decision letter is annexed as Annexure R5.
- Copy of the discontinuation letter is annexed as Annexure R6.
Complainant has filed his written arguments but no written arguments were filed by OP1.
OP1 has merely, mentioned that they have sent a letter regarding discontinuance to the complainant. However, they have made no efforts to ensured whether the same has been delivered to the policy holder/ complainant or else they could also have informed the complainant by messenger, also about the premium to be paid for continuance of the scheme. Needless, to mention that OP generally makes extra efforts to woo the customers, and sell the insurance scheme to them but in this case OP1 seems made no attempt and efforts to reach out to the complainant with regard to payment of premium and also regarding discontinuation of scheme.
Based on the material on file, submissions of complainant and OP1 and the documents filed by them this Commission is of considered opinion is a case of mis-selling of Insurance policy wherein the complainant was not informed about that policy especially about the payment of annual premium to keep the policy alive. It is also seen that OP1 although, claims that they have sent the letters with regard to discontinuation of the policy and also with regard to payment of premium but no documentary proof as such has been attached. Under these circumstances it cannot be presumed that the policy holder was fully aware about the details of the policy especially its premium which keeps the policy renewed.
Hence we find OP1 guilty of deficiency in service and unfair trade practice. Therefore, OP1 is directed to pay:
- To pay Rs.14,00,000/- as the sum insured against the death of the uncle of the complainant to the complainant/nominee within 30 days from the date of this order failing which it shall carry interest @7% per annum till payment is made.
- To pay Rs.25,000/- towards mental pain, agony and harassment suffered by the complainant.
- To pay Rs.5,000/- towards cost of litigation.
Order to be uploaded and to be complied with within 30 days from the date of the order. File consigned to record room.
