Order by:

Sh.Amrinder Singh Sidhu, President

1.       Sh.Atma Singh complainant  has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (as amended upto date) on the allegations that he had purchased a policy bearing No. 52759360 of PNB Metlife and deposited a sum of Rs.6000/- under the said policy. The complainant alleges that in the year 2016, he received a telephonic call from Bimal Bhatia, Phone No.087508-15237 that they have deposited a sum of Rs.24,000/- in PNB Metlife Company. The complainant requested to make payment and then it was informed that the amount will be paid through Aegon Life Insurance Company and the complainant has to send Rs.20,000/-. The amount was sent through courier. Then the complainant was told that the company will pay Rs.60,000/- through Aegon company. The Ageon Life Insurance has issued a policy in the name of Laftain Singh son of the complainant. After about 6 months, the complainant came to know from the agent of the Opposite Parties that there is an amount of Rs. 6 lakh in the name of the complainant and he was requested that he should pay a sum of Rs.60,000/-. The complainant was told that fine has been imposed upon by the said company. One another agent has been colluded and complainant received a phone call from one Sushair that a cheque of Rs.6,00,000/- has been prepared  by the  company of Opposite Parties and no amount is to be deducted. They shall make payment of Rs.80,000/- through Reliance Nippon Insurance. Then a phone was received from Reliance Nippon Insurance, Ludhiana that they will issued a new policy. The complainant requested their agent that the complainant has to pay excess tax so the complainant should pay Rs.15,000/-. The complainant got prepared D.B. and sent through courier. Then complainant received a telephonic message that a cheque has been prepared for Rs.24,000/- in the name of daughter in law of complainant. The complainant  has sent the same. The complainant requested not to issue any policy. The complainant was paid a sum of Rs.24,000/- with interest of Rs.1000/- in the month of March, 2018.  The agent of the ops asked the Complainant to deposit Rs.80,000/- by way of cheque, in order to get Rs.6,00,000/- encashed.  The complainant has deposited a sum of Rs.80,000/- through cheque drawn on PNB Badhni Kalan. The complainant is entitled to get the amount of Rs.80,000/- with interest thereon upto date. The complainant was told to send the following documents:-

i.        Bank Payment Certificate

ii.       KYC document and relationship proof.

iii.      Bank statement last 6 months

iv.      Statement identify proof.

v.       Bank pass book.

vi.      Copy of original policy document.

vii.     Bank Statement (initial premium payment)

The complainant forwarded the abovesaid documents to the opposite parties. Thereafter, the complainant received a last letter on  October 4^th , 2016, but no amount was received. Due to the aforesaid act and conduct and deficiency in service of opposite parties, the complainant has suffered mental tension, harassment and financial loss. Vide instant complaint, the complainant has sought the following reliefs.

1. To direct the Opposite Party to pay Rs.80,000/- of the insurance policy.
2. Further the Opposite Parties be directed to pay Rs.20,000/- to complainant as compensation on account of mental tension, harassment suffered by the complainant.
3. And any other relief may kindly be granted as this Forum may deem fit and proper. 

2.       Upon notice, opposite party appeared through counsel and contested the complaint by filing written reply taking certain preliminary objections therein inter alia that the complaint being frivolous and vexatious is liable to be dismissed under section 26 of the Consumer Protection Act as the complainant has failed to make out a case of ‘Deficiency of Service’ as alleged; that the complainant has concealed and suppressed the material and relevant facts of the case. The complaint has been filed with malaifde and dishonest intention and has not only concealed the material facts from this Forum but also twisted and distorted the same to suit their own convenience and to mislead this Forum and the complainant has approached the Forum with unclean hands; that the contract of the insurance between the opposite parties and the complainant is governed by its Policy Terms and conditions and as per law laid down by Hon'ble Supreme Court of India. As such, the complaint is liable to be dismissed; that the complaint is devoid of any material particulars and has been filed merely to harass the gain undue advantage and unjustified monies from the opposite parties. The complaint has been filed with ulterior motive and malafide intention; that the complainant has failed to setup nexus between the damages claimed in the present complaint and the damages suffered by him. The damages claim is arbitrary, without basis and is an abuse of process of law. It has been further submitted that based on the answers, statements, premium amount, premium paying term opted and declarations made in the proposal form duly executed and submitted by the complainant, the opposite party company had issued the following policy alongwith the terms and conditions governing the policy and a Welcome Letter. The details of the same are reproduced herewith for kind perusal of this Forum;

The above policy document was dispatched through speed post at the given address in the proposal form and the same was admittedly duly received by the complainant. The complainant has also signed the declaration and authorization contained in the proposal form. Meaning thereby the proposer was explained all the terms and conditions of the policy and only after his satisfaction he provided the details in the proposal form and signed the same in English language after accepting the terms and conditions mentioned therein. The policy schedule itself states the premium paying term under the policy was of 10 years and he was fully aware of the minimum premium paying term and also about the premium payment being regular in nature. The complainant had received the policy documents and all the applicable charges, Premium paying terms, benefits etc. are duly mentioned in the policy and as such she was fully aware about all the terms and conditions and benefits. Further as per section 6(2) of the Insurance Regulatory and Development Authority (Protection of Policyholders interests) Regulations, 2002 insured can avail free look cancellation or modifications within 15 days of the receipt of the policy document. The said clause is duly mentioned in the policy document and the complainant had duly received the policy document and therefore was fully aware with the terms and conditions governing the policy but did not opt for free-look cancellation after the receipt of policy meaning thereby she has accepted the terms and conditions of the policy. Hence the present complaint is liable to be dismissed. On merits, it is submitted that the complainant submitted the proposal form no.WA211512 dated 24.09.2016 and proposed for Reliance Guarantee Money Back having policy plan. The term of the policy was 15 years and Premium Paying term as 10 years for an amount of Rs.80,000/-. The son of the complainant Laftain Singh was insured under the said policy for an amount of Rs.5,96,505/-. The complainant paid the premium of Rs.80,000/- through cheque. The complainant and his son Laftain Singh signed the proposal form after admitting the contents thereof to be correct. On the basis of the proposal form and documents submitted by the complainant, the opposite parties issued the policy no.52759360 dated 04.10.2016. The said policy was sent through registered post and the same was duly received by the complainant which is proved from the fact that the complainant himself placed on record the policy schedule alongwith the present complaint. As per clause 6(2) of IRDA, if the complainant was not satisfied with the policy, then he can opt for the cancellation of the policy with a period of 15 days. The said clause is duly mentioned on the policy document. But despite the receipt of the policy, the complainant did not opt for the cancellation of the policy, meaning thereby he has agreed with the terms and conditions of the policy. All other averments regarding the payment of Rs.24,000/- as false and concocted. All other allegations made in the complaint have been denied and a prayer for dismissal of the complaint has been made.

3.       In order to  prove the case, complainant tendered in evidence his duly sworn affidavit Ex.C1 in support of the allegations made in the complaint and also produced copies of documents Ex.C2 to Ex.C6 and closed the evidence.

4.       On the other hand, to rebut the evidence of the complainant, the Opposite Parties tendered into evidence the affidavit of Sh.Surinder Kumar, Branch Manager, Ex.OPs1 and copies of documents Ex.OPs2 to Ex.OPs15 and closed the evidence.

5.       We have heard the  complainant as well as  ld. counsel for the Opposite Parties and have carefully gone through the evidence on record.

6.       During the course of arguments, the complainant has mainly reiterated the facts as narrated in his complaint and contended that in the year 2016, he received a telephonic call from Bimal Bhatia, Phone No.087508-15237  to purchase the policy from the Opposite Party and on his allurement, the complainant purchased policy bearing No. 52759360 of PNB Metlife and deposited a sum of Rs.6000/- under the said policy. Again on the asking of said agent of Opposite Parties, the complainant also deposited  Rs.24,000/- in PNB Metlife Company. Lateron the  complainant requested  the Opposite Parties to make payment and then it was informed that the amount will be paid through Aegon Life Insurance Company and the complainant has to send Rs.20,000/- which he sent through courier. Then the complainant was told that the company will pay Rs.60,000/- through Aegon company. The Ageon Life Insurance has also issued another  policy in the name of Laftain Singh son of the complainant. One another agent has been colluded and again on his allurement, the complainant also deposited a sum of Rs.80,000/- through cheque drawn on PNB Badhni Kalan. Thereafter, the complainant has come to know that the agents of the Opposite Parties are grabbing his hard earned money and then, he requested time and again to the officials of the Opposite Parties and at last  he received  Rs.24,000/- in the name of daughter-in-law of complainant alongwith with interest of Rs.1000/- in the month of March, 2018. At that time, the complainant also requested that he has not to continue any of the policy and made the request to  refund his amount of Rs.80,000/- alongwith with interest thereon upto date. Thereafter, the  complainant was told to send the following documents:-

i.        Bank Payment Certificate

ii.       KYC document and relationship proof.

iii.      Bank statement last 6 months

iv.      Statement identify proof.

v.       Bank pass book.

vi.      Copy of original policy document.

vii.     Bank Statement (initial premium payment)

Accordingly, the complainant forwarded the abovesaid documents to the opposite parties, but no amount was received. Due to the aforesaid act and conduct and deficiency in service of opposite parties, the complainant has suffered mental tension, harassment and financial loss. The complainant further contended that he was not aware the terms and conditions of the policy in question, neither any  alleged terms and conditions were ever conveyed or supplied to him at the time of issuing such policy. Moreover, on the allurement of the agent of the Opposite Parties, he deposited the amount with the Opposite Parties, but he never asked the officials/ agents of the Opposite Parties to issue such long term policy because the complainant was at present having the age of 79 years, copy of the PAN card issued by Income Tax Department, Government of India is placed on record by the Opposite Parties themselves as Ex.Ops6 which clearly shows that Atma Singh  is having the age of 79 years at present,  with date of birth 15.07.1940.  The complainant further contended that at this old stage i.e. in the year 2016, he will never think to purchase the alleged long term policy for 15 years by making such hefty amount of Rs.80,000/- yearly.  However, at that time, the agents/ officials of the Opposite Parties took so many signatures on some blank papers.  In this way, the officials of the Opposite Parties have committed mischievous acts with an old retired Army Personnel. The complainant has further contended that due to the extreme stress and strain, he is suffering due to financial crunch in these old days.  

7.       On the other hand, ld.counsel for the Opposite Parties has repelled the aforesaid contention of the complainant on the ground that  the complainant himself has purchased the policy in question after admitting its terms and conditions.  The detail of the policy terms are mentioned herewith. 

The above policy document was dispatched through speed post at the given address in the proposal form and the same was admittedly duly received by the complainant. The complainant has also signed the declaration and authorization contained in the proposal form. Meaning thereby the proposer was explained all the terms and conditions of the policy and only after his satisfaction he provided the details in the proposal form and signed the same in English language after accepting the terms and conditions mentioned therein. The policy schedule itself states the premium paying term under the policy was of 10 years and he was fully aware of the minimum premium paying term and also about the premium payment being regular in nature. The complainant had received the policy documents and all the applicable charges, Premium paying terms, benefits etc. are duly mentioned in the policy and as such she was fully aware about all the terms and conditions and benefits. Further as per section 6(2) of the Insurance Regulatory and Development Authority (Protection of Policyholders interests) Regulations, 2002 insured can avail free look cancellation or modifications within 15 days of the receipt of the policy document. The said clause is duly mentioned in the policy document and the complainant had duly received the policy document and therefore was fully aware with the terms and conditions governing the policy but did not opt for free-look cancellation after the receipt of policy meaning thereby she has accepted the terms and conditions of the policy. Hence the present complaint is liable to be dismissed. On merits, it is submitted that the complainant submitted the proposal form no.WA211512 dated 24.09.2016 and proposed for Reliance Guarantee Money Back having policy plan. The term of the policy was 15 years and Premium Paying term as 10 years for an amount of Rs.80,000/-. The son of the complainant Laftain Singh was insured under the said policy for an amount of Rs.5,96,505/-. The complainant paid the premium of Rs.80,000/- through cheque. The complainant and his son Laftain Singh signed the proposal form after admitting the contents thereof to be correct. On the basis of the proposal form and documents submitted by the complainant, the opposite parties issued the policy no.52759360 dated 04.10.2016. The said policy was sent through registered post and the same was duly received by the complainant which is proved from the fact that the complainant himself placed on record the policy schedule alongwith the present complaint. As per clause 6(2) of IRDA, if the complainant was not satisfied with the policy, then he can opt for the cancellation of the policy with a period of 15 days. The said clause is duly mentioned on the policy document. But despite the receipt of the policy, the complainant did not opt for the cancellation of the policy, meaning thereby he has agreed with the terms and conditions of the policy.

8.       It is not denial of the case that the  policy bearing No. 52759360, with policy issue date 30.09.2016, premium amount of Rs.80,000/- per annum with policy term 15 years was issued in the name of Atma Singh complainant by the Opposite Parties. It is also not disputed that the payment of Rs.24,000/- deposited by the complainant with the Opposite Parties has already been refunded to him alongwith interest of Rs.1000/- in the account of his daughter-in-law and now the dispute only remains with regard to  amount of Rs.80,000/- deposited by the complainant on the allurement of the agent of the Opposite Parties to pay handsome interest, copy of the bank statement  from which the amount has been withdrawn by the Opposite Parties on 27.09.2016  is placed on record as Ex.C2.  The only defence taken by the Opposite Parties is that if the complainant was not satisfied with the policy in question and if he wants to get the policy in question cancelled,  then as per the terms and conditions of the policy, the complainant was having lock-in-period of 15 days for this purpose and at this stage, the complainant can not get cancel the policy, but we are not agree with the aforesaid contentions of the Opposite Parties because  no such terms and conditions were ever conveyed or supplied to the complainant at the time of issuing such policy.  Moreover, no  record of dispatch of such terms or conditions are placed on record by the Opposite Parties.

9.       Hence, bare perusal of the documents placed on record and on hearing arguments of both the sides,  the only question for refusing to refund the payment of Rs.80,000/- to the complainant is that  the complainant has violated the terms and conditions of the policy in question  and not lodged his claim within 15 days i.e. within free look period to cancel his policy and hence, the complainant is not entitled to the claim as claimed.  But the Opposite Party could not produce  any evidence to prove that terms and conditions of the policy were ever supplied to  the complainant insured, when and through which mode? It has been held by Hon’ble National Commission, New Delhi in case titled as The Oriental Insurance Company Limited Vs. Satpal Singh & Others 2014(2) CLT page 305 that

‘the insured is not bound by the terms and conditions of the insurance policy unless it is proved that policy was supplied to the insured by the insurance company. Onus to prove that terms and conditions of the policy were supplied to the insured lies upon the insurance company.”

From the perusal of the entire evidence produced on record by the Opposite Parties,  it is clear that Opposite Parties have failed to prove on record that they did supply the terms and conditions of the policy to  the complainant insured. As such, these terms and conditions, particularly the exclusion clause of the policy is not binding upon the insured. Reliance in this connection can be had on Modern Insulators Ltd.Vs. Oriental Insurance Company Limited (2000) 2 SCC 734, wherein it is held that

 “In view of the above settled position of law, we are of the opinion that the view expressed by the National Commission is not correct. As the above terms and conditions of the standard policy wherein the exclusion clause was included, were neither a part of the contract of insurance nor disclosed to the appellant, the respondent can not claim the benefit of the said exclusion clause. Therefore, the finding of the National Commission is untenable in law.” 

Our own Hon’ble State Commission, Punjab, Chandigarh in First Appeal No.871 of 2014 decided on 03.02.2017 in case titled as Veena Mahajan (Widow) and others Vs. Aegon Religare Life Insurance Company Limited in para No.5 has held that

“Counsel for the appellant argued that copy of insurance policy was not supplied to the appellant and hence, the exclusion clause in the contract of the insurance policy is not binding upon him. He further argued that no proof of sending of insurance policy was ever produced by the respondent despite specific contention raised by the complainant that the insurance policy was never received by him. He argued that though there is an averment of the OP that the policy in question was delivered through Blue Dart Courier to the complainant. In order to prove their contention, no affidavit of any employee of Blue Dart was produced who would have made a statement to have the effect that the policy was delivered to the complainant nor any acknowledgement slip for having received the article by the complainant through courier company was produced by the insurance company. He argued that since no policy document was received by the insured and argued that the terms and conditions as alleged to be part of the insurance policy were not binding upon the insured. He argued that policy was issued in the name of deceased Sh.Vijinder Pal Mahajan with his wife Mrs.Veena Mahajan as beneficiary and the same was never refused by the OP and the proper premium for insurance was paid by late complainant. He argued that as per the specific allegations made in the complaint in para No.4, no rebuttal to that contention was specifically there in their written reply in para No.2 and para No.4 in the reply filed by OP in the District Forum. He argued that Hon'ble National Consumer Disputes Redressal Commission, New Delhi in case of "Ashok Sharma Vs. National Insurance Co. Limited", in Revision Petition No. 2708 of 2013 held in para No.8 to the point of non-delivery of terms and conditions of the policy. He also cited Hon'ble Supreme Court's decision given in the matter of "United India Insurance Co. Limited Vs. M.K.J.Corporation" in Appeal (civil) 6075-6076 of 1995 (1996) 6 SCC 428 wherein the Apex court held that a fundamental principle of Insurance Law makes it that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, "similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured and further argued that since the terms and conditions were not supplied even on repeated requests the same cannot be relied upon by the opposite party in order to report to repudiate the genuine claim of the wife of the deceased policy holder.”

10.     The further contention of the  complainant is  that on the allurement of the agent of the Opposite Parties, he deposited the amount with the Opposite Parties, but he never asked the officials/ agents of the Opposite Parties to issue such long term policy because the complainant was at present having the age of 79 years, copy of the PAN card issued by Income Tax Department, Government of India is placed on record by the Opposite Parties themselves as Ex.Ops6 which clearly shows that Atma Singh  is having the age of 79 years at present,  with date of birth 15.07.1940.  The complainant further contended that at this old stage i.e. in the year 2016, he will never think to purchase the alleged long term policy for 15 years.  In this way, the officials of the Opposite Parties have committed mischievous acts with  a retired Captain from Indian Army.  Hence, keeping the aforesaid facts and circumstances, it is clear that old army officer was speaking truth as  nobody at the age of 79 years will purchase such long term policy for 15 years. Moreover, at the time of arguments, the complainant has placed on record the copy of appreciation letter 7^th July, 1977 (Mark ‘X’) issued in his favour by Deputy Secretary to the Government of India, Ministry of Defence, under the signatory of  Hon’ble President of India, vide which the services of Atma Singh complainant who is retired as Captain from Indian Army, have been appreciated by giving good remarks  that “To, Atma Singh, Greeting: I reposing special Trust and confidence in your Fidelity, Courage and good conduct, do by there Presents Constitute and Appoint you to be a Junior Commissioned Officer in the Regular army in the Rank of Naib Subedar.  Hence, we can not expect that such person can twist the facts in his favour by deposing wrongly, as alleged by the Opposite Parties in their written reply. Moreover, from different sects of society and religions, the complaints about the agents of investment companies are being filed on the ground that they (agents) sold the policies by mis-representation in order to get their commission.    

11.     In such a situation the refusal to refund the hard earned money of the complainant  by Opposite Party regarding genuine claim of the complainant appears to have been made without application of mind. It is usual with the insurance company to show all types of green pesters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.  The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

12.     Resultantly, we allow the complaint  of the complainant. The Opposite Parties are jointly or severally directed to cancel the policy in question and  refund the amount of Rs.80,000/- (Rupees eighty thousands only) to the complainant alongwith interest @ 9% per annum from the date of its deposit i.e. 27.09.2016 till its realization.  Opposite Parties are also directed to pay the lump sum compensation to the complainant to the tune of Rs.15,000/- (fifteen thousands only).  Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.

13.     Reason for delay in deciding the complaint. This complaint could not be decided within the prescribed period because the government has not appointed any of the two Whole Time Members in this Forum since 15.09.2018. Moreover, the President of this Forum is doing additional duty at District Consumer Forum, Barnala and Administration Duty at District Consumer Forum, Sri Muktsar Sahib. There are only two working days in a week when the quorum of this Forum remains complete.  

Announced in Open Forum

Dated: 17.05.2019.       

(Parampal Kaur)                      (Amrinder Singh Sidhu)

                           Member                                       President