- Policy was issued in the name of her daughter whose details were made available for nomination purpose only.
- Policy was issued as Super Saver Plan which neither provides any medical cover not it ensured guaranteed addition.
- Instead of sum assured of Rs.10,00,000/- policy was issued only for sum of Rs.4,00,226/-
- On 16.09.2020 OP No.3 was once again called to meet at her house to understand the basic differences what she assured and what insurance policy document reads. Still to mislead her, the OP No.3 in his own writing furnished the complainant false details which reads health insurance available for Rs.5,00,000/- (instead of Rs.1000000), sum insured for Rs.10,00,000/- and guarantee addition for 4%(instead of 800%).
- The application document which was filled in by Business Manager i.e. OP No.3 has been filled in such a way that did not bear complete details and also it included ECS of Rs.1,00,000/- without her consent.
Further, observing all these anomalies policy was surrendered on 17.09.2020 within look up period to avoid future loss and avert the fraud. On 30.09.2020, the complainant received a refund of Rs.99,385.01 against paid premium of Rs.1,00,000/-. The OPs informed the complainant through the said cancellation letter informed that an amount of Rs.614.99 has been deducted. It is further alleged that the complainant approached to OP No.1 official on various dates for refund of charges deducted illegally and unlawfully but of no avail. The matter was taken up through IRDAI by the complainant and only then the OP No.1 sent a letter dated 25.11.2020 intimating the deduction only and on other points remained silent. From the above act and conduct of the OPs it is clear that OPs are indulged in unfair trade practice and deficient in services and the complainant has suffered financial loss, mental agony and harassment; hence, the present complaint.
2. Upon notice, OPs No.1 to 3 appeared through counsel and filed written statement raising preliminary objections qua complaint is not maintainable being baseless and false; no cause of action. On merits, it is alleged that the complainant has submitted to the OPs, a declaration for submission of E-Application bearing no.512157452 dated 08.08.2020 alongwith online proposal form, suitability assessment form and cheque of the first premium for the purchase of the liked insurance policy for Ms.Avi Arora and the complainant has signed declaration that she had duly provided true, correct and accurate details in the proposal form after understating the contents of the same. Accordingly, after understanding all the terms & conditions of the policy, the proposal form was duly signed by the policy holder/life assured to that effect. On believing the details given by the complainant, the Ops has issued the policy to complainant The Ops had sent/dispatched the policy document on 26.08.2020 through speed post which was duly delivered on 11.09.2020. During the free look period on 17.09.2020, the complainant has raised the grievance/request for cancellation of the policy and accordingly, on 29.09.2020 the OPs has accepted the request and processed the request for the cancellation of the policy. It is stated that the refund of the premium amounting to Rs.99,385.01 has been made to the complainant in her SBI bank account after the deduction of Rs.614.99 which include proportionate risk premium for the period of cover, stamp duty charges and the expenses as per the provision of free look period and the contract of insurance and Clause 10 of the IRDAI(Protection of Policyholder’s) Regulation, 2017. On 06.10.2020, the OPs has sent the policy cancellation letter to the complainant stating her that policy stands cancelled w.e.f.27.09.2020 and payout details of the policy. It is further stated that the complainant has addressed his grievance/concern for the deduction of charges of Rs.614.99 from the premium amount which was not refunded to her and accordingly the OPs has replied through e-mail dated 06.11.2020. The policy was issued with consent of the complainant and only after agreeing to the same, it was duly signed by the complainant. Thus, there is no deficiency in service on the part of the OPs No.1 to 3 and prayed for dismissal of the present complaint.
3. To prove her case, the complainant has tendered affidavit as Annexure C-A along with documents Annexure C-1 to C-12 in evidence and closed the evidence by making a separate statement. On the other hand, the learned counsel for the OPs No.1 to 3 has tendered affidavit Annexure R/A alongwith documents as Annexure R-1 to R-8 and closed the evidence.
During the course of arguments, the complainant has submitted a summary of details of the amount of Rs.15,148/-,which is taken on record as Mark ‘A’ for the proper adjudication of the case.
4. We have heard the complainant and the learned counsel for the OPs No.1 to 3 and have gone through the entire record available on record including the written arguments filed by the complainant as well as OPs No.1 to 3, minutely and carefully.
5. Admittedly, a sum of Rs.99,385.01 out of Rs.1,00,000/-,which was paid by the complainant qua insurance policy bearing no.23402369(Annexure C-3), has already been refunded to the complainant on her request during the free look period. The grievances of the complainant are that the OP No.1 while refunding the aforesaid amount has wrongly deducted a sum of Rs.614.99 as the said policy was sold to her by misrepresenting the facts. The contentions of the complainant are that she was induced to invest a sum of Rs.1,00,000/- in the insurance policy by OPs No.2 & 3 by misrepresenting the facts that her risk pertaining to health problem would be covered for a sum of Rs.10,00,000/- instead of Rs.5,00,000/- and that the insurance policy would carry a benefit of guaranteed addition upto 800% and that sum assured would be Rs.10,00,000/- in place of Rs.4,00,226/-. The complainant during arguments reiterated the averments as contained in the complaint as well as in her affidavit(Annexure C-A) and prayed for acceptance of the complaint by directing the OPs to refund the amount as prayed for vide Para No.19 of the complaint.
6. The OPs has resisted the complaint on the ground that a refund of the sum amounting to Rs.99,385.01 was made to the complainant after making deduction of Rs. 614.99, which included proportionate risk premium for the period of cover, stamp duty charges and the expenses as per the provision of free look period.
During arguments, the learned counsel for the OPs contended that a sum of Rs.614.99 was deducted as per clause 10 of the IRDAI (Protection of Policyholder’s Interests) Regulations, 2017, which provides that the insured, in the case of return of the policy for cancellation during the free look period of 15 days, is entitled to a refund of premium paid subject to a deduction of proportionate risk premium for the period of cover and expenses incurred by the insurer on medical examination of the proposer and stamp duty charges. In support of his contentions, our attention was drawn towards the free look provision as contained in welcome letter(Annexure R-5) which reads as under:
Free look Provision:- Please go through the terms and conditions of your policy very carefully. If you have any objections to the terms and conditions of your policy, you may return the Policy for cancellation by giving a signed written notice to Us within 15 days(30 days in case of distance marketing) from the date of receiving your policy, stating the reasons for your objection and you will be entitled to a refund of the premium paid including rider premium, if any, subject to a deduction of proportionate risk premium for the period of cover, stamp duty charges and the expenses incurred on medical examination(if any).
It is further contended that there was no misrepresentation on the part of OPs No.2 & 3 qua the details of the insurance policy and that the complainant had opted to avail the policy in question voluntarily out of her free will and consent and thus, prayed for dismissal of the complaint being baseless and meritless.
7. We have perused Annexure C-1, Annexure C-2 and Annexure C-4 minutely and carefully. As per Annexure C-1, which is a hand written paper having the details of visiting card of OP No.3 i.e. Upendra Yadav, Chief Business Manager, PNB Metlife Insurance Company Ltd., C. back has been shown as 1.25%. The C.back, as per complainant was stated by OPs No.2 & 3 as cash back. The said Annexure C-1 also finds mention of the facts to the effect i.e. 3.25% alongwith the mobile number 8284979449-Rekha. Annexure C-2 is the blank cheque issued in favour of the complainant, Smt. Tripta Arora, by Rekha, i.e. OP No.2. As per Annexure C-4, which is hand written paper by OP No.3 containing various details qua the health cover, insurance cover etc., the health cover was assured for Rs.5,00,000/-(36 months) and insurance cover was shown for Rs.10,00,000/-.On the basis of Annexure C-1 and C-2 it may, legitimately, be concluded that the complainant was assured the cash return out of the Commission to be received by OPs No.2 & 3 from OP No.1 in lieu of sale of the policy in question. As per insurance policy, the assured sum is Rs.4,00,226/- whereas the complainant was assured the insurance cover of Rs.10,00,000/- as per Annexure C-4. A conjoint reading of Annexure C-1, C-2, C-4 vis-à-vis the insurance policy shows mismatch and vital differences among them qua the health cover as well as the assured sum. The Ops have not disputed the genuineness and correctness of Annexure C-1, C-2 & C-4. In view of the aforementioned facts, it is clear that several benefits qua the health cover, insurance cover and cash back etc. contrary to insurance policy in question were represented and promised to the complainant at the time of selling of the policy in question to her and thus, it is a case of mis-selling of the policy misrepresenting the entirely different benefits as compared to the policy issued.
8. In view of the above discussion, we conclude that the OPs No.1 to 3 are liable to compensate the complainant jointly and severally as there was lapse and deficiencies on their parts while delivering the service to the complainant; hence, the complainant is entitled to relief.
9. Coming to the relief, it is found that, as per complaint, a refund of sum of Rs.614.99 +59 alongwith interest @ 12% per annum has been claimed, w.e.f. 17.08.2020 and 05.09.2020 respectively apart from interest on the amount of Rs.99,385.01 @12% per annum w.e.f. 17.08.2020 to 30.09.2020. In addition to above, a sum of Rs.20,000/- on account of mental agony and harassment and a sum of Rs.20,000/- on account of litigations expenses has been claimed. During the course of arguments, the complainant has also submitted a summary of details of the amount of Rs.15,148/-, which is taken on record as Mark ‘A’, claiming that the OPs be directed to refund the said amount to her. In the facts and circumstances of the present case, it would meet the ends of justice, if a sum of Rs.614.99 is ordered to be refunded alongwith interest @9% per annum from the date of filing of the complaint till its realization and it is ordered accordingly. Further, the prayer of the complainant about payment of interest over a sum of Rs.1,00,000/- w.e.f. 17.08.2020 to 30.09.2020 is also found reasonable and justified as she was prevented the proper utilization of the sum of Rs.1,00,000/- during the said period; hence, the Ops are directed to pay the interest over the amount of Rs.1,00,000/-w.e.f. 17.08.2020 to 30.09.2020 @9% per annum to the complainant. Further, the OPs are directed to pay a lump sum amount of Rs.10,000/- on account of mental agony, harassment and litigation charges.
10. The OPs No.1 to 3 shall comply with the order within a period of 45 days from the date of communication of copy of this order failing which the complainant shall be at liberty to approach this Commission for initiation of proceedings under Section 71/72 of CP Act, against the OPs No.1 to 3. A copy of this order shall be forwarded, free of cost, to the parties to the complaint and file be consigned to record room after due compliance.
Announced on:26.04.2022
Dr.Sushma Garg Dr. Pawan Kumar Saini Satpal
Member Member President
Note: Each and every page of this order has been duly signed by me.
Dr. Pawan Kumar Saini
Member
