Before the District Consumer Disputes Redressal Commission, Rohtak.

                                                                             Complaint No. : 450.

                                                                             Instituted on     : 13.10.2020.

                                                                             Decided on       : 05.04.2022.

Dinesh Kumar Chahal s/o Sh. Yagpal Singh r/o House No.288/9, Jasbir Colony, Near Shiela Bye Pass, Rohtak presently posted in the O/o Superintendent of Police, State vigilance Bureau, Rohtak.

                                                                             .......................Complainant.

                                                Vs.

1.   Tata AIA Life Insurance company Regd Office : 14^th floor, Tower A, Penisula Business Park, Senapati Bagpat Marg, Lower Parel Mumbai 400013 through its Manager/Owner/Proprietor.
2.   Health Assure Private Limited-Service Partner with Tata AIA Life Insurance Company 1^st floor, Excom House, North Wing, 7 Saki Vihar road, Sakinaka, Andheri(E), Mumbai-400072 through its Manager/owner/Proprietor.
3.   Tata AIA Life Insurance Company 1^st & 3^rd Floor, SCO 254, 1^st Floor, Part 1, Secor-12, Karnal(Haryana), through Shri Abhishek Saxena, Branch Manager.
4.  Tata AIA Life Insurance Company 1^st & 3rd Floor, SCO 254, 1^st Floor, Part-1, Sector-12, Karnal(Haryana), through Shri Pawan Sehgal, Assistant Branch Manager.
5.  Aroma Diagnostic & Wellness Centre, Shop No.817/9, Near Bhim Gauda Chowk, Sanoli Road, Panipat-132103(Haryana).
6.   Tata AIA Life Insurance Company

1^st & 3rd Floor, SCO 254, 1^st Floor, Part-1, Sector-12, Karnal(Haryana), through Shri Neeraj Sharma, Advisor.

7.   Tata AIA Life Insurance Company

1^st & 3rd Floor, SCO 254, 1^st Floor, Part-1, Sector-12, Karnal(Haryana), through Navneet Chokkra, Advisor.

                                                                             ……….Opposite parties.

          COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.

BEFORE:  SH.NAGENDER SINGH KADIAN, PRESIDENT.

                   DR. TRIPTI PANNU, MEMBER.

                   DR. SHYAM LAL, MEMBER.

Present:       Complainant in person.

                   Sh. Gulshan Chawla, Advocate for opposite party No.1,3,4,6

                   and 7.

                   Opposite party No.2 and 5 exparte.

                                      ORDER

NAGENDER SINGH KADIAN, PRESIDENT:

1.                Brief facts of the case are that complainant applied for a term Plan on the request of an agent/advisor of Tata AIA Life Insurance Company i.e. respondent no.1. The advisor suggested by giving various illustrations, that it would be better for him to go for a Sampoorn Raksha Plan of the respondent no.1 i.e. Tata AIA Insurance Company and this company will provide protection cover to the complainant and his family for the sum assured Rs.One Crore for a period of next 40 years and in case of survival till then, the complainant will get his installment money back without any gain or interest after deduction of GST amount. The advisor of the respondent company also clarified that no documentation and no health check up or any other formality is required for issuance of policy.  The officials of the opposite party approached the complainant on 23^rd day of June 2020 and asked him to apply for the Term insurance before his birthday on 24^th day of June because the premium of the Term Plan will increase on the increase of his age. The complainant submitted all the documents e.g. copy of Aadhar Card, PAN card, Cancelled cheque, live photo from mobile and a hand written page containing the details required by the company officials. Complainant also handed over a cheque no.000029 dated 23.06.2020 drawn at Kotak Mahendra Bank, Panipat amounting to Rs.86108/- as premium and opted for 12 pay option.  The cheque no.000029 dated 23.06.2020 was debited from the account of the complainant and credited to the account of respondents. At the time of applying for the policy, the complainant was told by the officials of opposite party that it is a zero botheration policy and complainant has nothing to do, not even to fill up a form. But after making the payment, it was told that some medical tests are required and after some days, the respondent company started sending mails about medical appointment at different labs without getting consent from the complainant. They fixed the appointment at Rohtak for his medical check up on 03.07.23020, 05.07.2020 and at Panipat for 08.07.2020,  09.07.2020 & 11.07.2020 despite the fact that the complainant was working at Rohtak. Just to end the long pendency of the issue, the complainant finally went to Panipat at the lab of opposite party No.5 i.e. Aroma Diagnostic and Wellness centre for health checkup but he was asked to go to another hospital for performing Tread Mill Test in the peak period of Corona Pandemic when the people don’t even want to expose themselves to hospitals, even if they are ill. Opposite party also denied to provide a copy of the report of medical tests to the complainant, which is very much right of the complainant. In the meantime respondents started asking about the income proof, which is not initially required by the respondents. Thereafter they asked for Income Tax return, for salary slip and also called the complainant for live photo at Panipat.  The complainant was harassed by the respondents by asking of these documents/formalities which were neither mentioned in the brouchers of the company nor stated to be required by the officials of the respondent company. Even after completing all the formalities by the complainant, policy was not issued by the respondents. After waiting for more than two and a half months, opposite parties made a phone call to the complainant and told that his medical reports were not ok, so he will have to pay Rs.17661/- more for the alleged insurance. This is pure unfair trade practice and deficiency in service on the part of respondents. Hence this complaint and it is prayed that opposite parties may kindly be directed to refund the amount of Rs.86108/- alongwith interest, compensation and litigation expenses to the complainant as explained in relief clause.

2.                After registration of complaint, notice was issued to the opposite parties. Notice issued to opposite party No.2 & 5 through registered post received back served, which was proved from Tract reports but none appeared on behalf of opposite party No.2 & 5 and as such opposite party No.2 & 5 were proceeded against exparte vide order dated 19.11.2020 of this Commission.  Opposite party No,1,3,4,6 & 7 filed their written reply and has submitted that on the request of the complainant, the premium payment has already been refunded vide NEFT UTR No.N296201283959596 dated 22.10.2020 an amount of Rs.86108/- was refunded. Hence present complaint be dismissed being infructuous. On merits, it is submitted that the complainant applied for the insurance policy under the plan “Sampoorna Raksha+” offered by the opposite party company. However, it is denied that complainant was conveyed that there is no documentation or health check up required for the issuance of the policy.  The answering opposite party issued policy under guidelines of IRDA. The medicals are required before issuance of the policy on case to case basis as per the plan and amount opted for. In the present proposal the requirement of medical tests were raised by the underwriting Department of the company and accordingly it was informed to the complainant. The medicals are conducted through the medical centers which are impaneled by the opposite party company for such purposes and therefore the appointments were fixed for the medicals of complainant. However, it is pertinent to mention here that the complainant always missed the appointments therefore re-appointments were fixed which were done with prior consultation of complainant itself and at the location which the complainant himself desired. The income proof is required to be collected from the payer/insured under the PML Act, which was told to the complainant but the complainant did not provide the same initially therefore the same was asked again to process the application further. It was necessary to undergo medical tests for the plan and coverage that the complainant had applied for. The complainant himself delayed the matter and undertook the tests belatedly. However, the complainant had always had an option to withdraw his application for insurance if he had hesitated for undergoing any kind of medical tests. The premium of the policy of the complainant was as per the medical test outcome. Initially at the time of submission of proposal standard premium as per age, coverage amount etc. is taken from the applicant. Thereafter on case to case basis and on the outcome of medical examinations the premium may increase. The allegations of the defect/default/negligence and/or deficiency in service are wholly misconceived, groundless, false and untenable in law. It is prayed that complaint is not tenable in the eyes of law and the complainant is not entitled for any relief. As such it is prayed that complaint may kindly be dismissed with costs.  

3.                Ld. Counsel for the complainant in his evidence has tendered his affidavit Ex.CW1/A, documents Ex.C1 to Ex.C7 and closed his evidence on dated 16.03.2021. Ld. Counnsel for opposite parties No.1,3,4,6 & 7 has tendered affidavit Ex.R1/A, documents Ex.R1/1 to Ex.R1/3 and closed his evidence on dated 13.07.2021.

4.                We have heard learned counsel for the parties and have gone through the written arguments as well as material aspects of the case very carefully.

5.                In the present case, it is not disputed that complainant has opted a Sampoorn Raksha Plan of the respondent no.1 i.e. Tata AIA Insurance Company for himself and his family for the sum assured Rs.One Crore for a period of next 40 years. As per the complainant, the advisor of the respondent company clarified that no documentation and no health check up or any other formality is required for issuance of policy and that it was a zero botheration policy and complainant has nothing to do, not even to fill up a form. Complainant handed over a cheque no.000029 dated 23.06.2020 drawn at Kotak Mahendra Bank, Panipat amounting to Rs.86108/- as premium. But after making the payment, it was told that some medical tests are required and started sending mails about medical appointment at different labs without getting consent from the complainant. Complainant got health checkup and also submitted the documents as required by the opposite parties but despite completing all the formalities and even after passing of  more than three months  no policy was issued to the complainant and it was told the complainant that he had to pay Rs.17661/- more per year as his medical tests were not OK. To prove his case complainant has placed on record copy of cheque dated 23.06.2020 amounting to Rs.86108/- which was issued in favour of opposite party. Ex.C6 is the letter dated 12.09.2020 issued by the insurance company for directing the complainant to pay the balance premium as the revised premium was Rs.103769/-.

6.                As per the written statement filed by the respondent in preliminary submissions, it is submitted that on the request of complainant, the premium payment has already been refunded vide NEFT UTR No.N296201283959596 dated 22.10.2020 an amount of Rs.86108/- was refunded. But the respondents have failed to place on record any document to prove that complainant has ever demanded his premium amount from the respondents. They also failed to place on record any document they have ever received any request from the complainant for refund of premium amount.

7.                After going through the file and hearing the parties it is observed that the premium was paid by the complainant on dated 23.06.2020 but the policy has not been issued by the opposite parties till date. It there was any need of medical examination or requirement of documents, the same formalities would have been got completed by the opposite parties before taking the premium from the complainant. The complainant was asked to go from one hospital to another for performing the tests in the peak period of Corona Pandemic causing mental harassment and threat of life to the complainant. Even passing of more than 3 months of deposit of premium, opposite parties demanded revised premium and did not issue the policy. As per letter Ex.R1/2, opposite party has re-evaluated the application of the complainant for the reason-Elevated levels of liver enzyme(s). In this regard it is observed that the premium for the policy was deposited by the complainant on 23.06.2020 and the tests were conducted upto 11.07.2020 but this letter has been belatedly issued on 12.09.2020. If there was any need of re-evaluation of application of the complainant, it should have been done within time i.e. within a week but opposite party has issued the letter belatedly on 12.09.2020. Hence there is deficiency in service on the part of opposite parties and opposite parties No.1,3,4,6 & 7 are jointly and severally liable to compensate the complainant.

8.                In view of the facts and circumstances of the case we hereby allow the complaint and direct the opposite parties No.1,3,4,6 & 7 to pay interest @ 9% p.a. on the amount of premium paid by the complainant i.e. Rs.86108/- from the date of deposit of premium i.e. 23.06.2020 till its payment i.e. 22.10.2020 and shall also pay Rs.50000/-(Rupees fifty thousand only) as compensation on account of deficiency in service  and Rs.5000/-(Rupees five thousand only) as litigation expenses to the complainant. Order shall be complied within one month from the date of decision.  

9.                Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.

Announced in open court:

05.04.2022.

                                                          ................................................

                                                          Nagender Singh Kadian, President

                                                          ………………………………..

                                                                        Tripti Pannu, Member.

                                                          ………………………………..

                                                                        Shyam Lal, Member.