Date of filing: 04/09/2018
Judgment date: 19/01/2023
Mrs. Sashi Kala Basu, Hon’ble President
This complaint is filed by the complainant namely Amit Sen U/s. 12 of the Consumer Protection Act, 1986 alleging deficiency in service on the part of the opposite parties (referred as O.P.s herein after) namely (1) Richa Singh (2) Suman Adhikary and (3) Health Relationship Manager CIGNA T.T.K. Health Insurance Company Limited, alleging deficiency in service and unfair trade practice on the part of the opposite parties.
Case of the complainant in short is that on getting a call from D.M.A. Wealth Creator that he had won a gift as promotional activities, he alongwith his wife went to the office of D.M.A. Wealth Creator at Diamond Harbour Road, under Thakurpukur Police Station on 09/06/2018. On reaching there O.P. No. 2 convinced him by describing lot of benefits to purchase Excide Life Insurance Policy. So being convinced he purchased the Life Insurance Policy by paying premium of Rs. 6,200/- The money receipt was issued and he was told by O.P. No. 1 namely Richa Singh that he would get the Life Insurance Policy within one week. Within 10 days he received the policy documents. But he was surprised to see that the policy bond was Health Insurance Police and not Life Insurance Policy. So he called customer care of O.P. No. 3 who told him that they only deal with the Health Insurance and not Life Insurance. So he immediately met with O.P. No. 1 to know why his policy was changed to the Health Insurance Policy. He also found in those policy documents, his signature was manufactured as he had not signed in any documents for Health Insurance. He thus requested the O.P. No. 1 to cancel the Health Insurance Policy for which he was told by O.P. No. 1 that he would know within 4/5 days. He thereafter on 12/07/2018 went to the office of customer care of O.P. No. 3 and submitted a letter highlighting all the facts stating thereby to cancel the Health Insurance Policy and to return the premium paid by him. On 08/08/2018 he received a mail from Sigma Customer Care that they have already started the process of cancellation and within 10/15 days the money will be refunded in his bank account. But he found O.P. No. 3 had only refunded 50% of the amount paid by him i.e. Rs. 3,105/-. On his enquiry the customer care sent a mail that he was entitled to 75% only if the cancellation was done within one month. Since he was misrepresented by O.P. No. 1 & 2, present complaint has been filed by the complainant praying for directing the O.P.s to return Rs. 4,000/- along with interest, to pay compensation of Rs. 12,000/- and Rs. 4,000/- as litigation cost.
O.P. No. 3 is contesting the case by filing the written version denying and disputing allegation stating specifically that the complainant did not raise any objection against issuance of Health Insurance Policy within free look period. The cancellation request was submitted by the complainant on 23/07/2018 and accordingly O.P. No. 3 duly cancelled the aforesaid policy and refunded Rs. 3,105.60/- which is 50% of the premium amounts as per the terms and conditions of the policy. Since cancellation request was made beyond period of one month, the 50% premium amounts was refunded. So the O.P. has prayed for dismissal of the complainant.
O.P. No. 1 & 2 in spite of service of notice did not take any step neither filed any written version so the case has been heard exparte against them.
During the course of the hearing, both the parties have filed their respective examination in chief on affidavit followed by filing of questionnaire and reply thereto. Ultimately argument has been advanced. Brief notes of argument have also been filed by the complainant and the contesting O.P. No. 3.
So the following points require determination:-
- Whether there has been deficiency in service or unfair trade practice on the part of the opposite parties?
- Whether the complainant is entitled to the relief as prayed for?
DECISION WITH REASONS
Both the points being inter-related are taken up together for discussion. In order to substantiate his claim that he was approached by Excide Life Insurance and he had visited the said office on 09/06/2018 and met O.P. No. 1 & 2, complainant has filed the receipt showing payment of Rs. 6,419/- as premium which clearly indicates that the said sum was paid towards the proposal for Life Insurance. Admittedly no Life Insurance Policy was issued instead complainant received Health Insurance Policy from O.P. No. 3. So the contention of the complainant that there was mis-selling of policy or that he was misrepresented by O.P. No. 1 & 2, cannot be ruled out. In the written version filed by the O.P. No. 3, it has been stated that a insurance agent generally provided their services to many insurance companies at a time. The said statement in the written version by O.P. No. 3 clearly suggest that the insurance agents O.P. No. 1 & 2 instead of issuance of Life Insurance Certificate proposed to be purchased by the complainant was fraudulently sold Health Insurance Policy of O.P. No. 3. So there remains no doubt that unfair trade has been practiced by the O.P.s.
Now coming to the cancellation of policy and refund thereby, as per the own statement of the opposite party No. 3, they received the proposal form dated 11/06/2018 and the policy document alongwith terms and conditions were delivered to the complainant on 18/06/2018 through speed post. So it is but natural that complainant learnt about the policy being a Health Insurance Policy and not Life Insurance Policy as proposed by him only on 18/06/2018. In such a situation, period of one month will only start from 18/06/2018. If that be so than it is evident from the mails filed by the complainant dated 12/07/2018 that the complainant had categorically asked for cancellation of policy and to return the premium amount paid by him. Said mail dated 12/07/2018 if taken into consideration than it is evident that the cancellation has been done within the period of one month from the date of delivery of the policy by the O.P. No. 3 to the complainant. So the complainant was entitled to 75% of refund but the O.P. has refunded only 50% which again is a deficiency in rendering service on the part of the O.P.s. Thus complainant is entitled to the refund of further 25% alongwith compensation for harassment and litigation cost as prayed by him.
Hence
ORDERED
CC/535/2018 is allowed on contest against O.P. No. 3 and exparte against O.P. No. 1 & 2. Opposite parties are directed to pay jointly and severally Rs. 1,544/- (further 25% of the premium amount) to the complainant within 60 days from this date. O.P.s are further directed to pay Rs. 12,000/- as compensation and Rs. 4,000/- as litigation cost to the complainant as prayed, within the aforesaid period of 60 days, in default of payment the entire amount shall carry interest @ 9% p.a. till realization.
