Order-17.
Date-12/09/2016.
This is an application u/s.12 of the C.P. Act, 1986.
Complainant’s case, in short, is that he is the holder of three insurance polices with OP Life Insurance with Policy Nos. 140714152331, 141014228284, 150314361281 under the plan Aegon Religare Educare Advantage Insurance Plan. It is alleged by the complainant that in policy No.140714152331 the signature of the proposer is blank in the proposal form of the policy document. Even the column of the relationship between the proposer and life to be assured/insured is blank in the policy document. It is also alleged that nothing is mentioned regarding the relationship between the proposer and life to be assured/insured under Section 1 personal details. It is also stated that on policy No.150314361281, the signature of the life to be assured/insured is blank in the policy document. It is also stated that there is specific portion in the policy form for the signature of the life to be assured/insured. It is stated that the agent did not guide the complainant to sign there. It is also alleged that there is no mention regarding relationship between the proposer and life to be assured/insured under Section 1 . Personal Details. It is stated that this non-mentioning of relationship has rendered the proposal incomplete and the said policy has become invalid. It is also stated that the insurer deliberately overlooked the said matter during verification and issued the said policy keeping those loopholes in the policy document for their personal interest so that the insurance company can reject any future claim for this incompleteness. It is also stated that the complainant has received the hard copy of the renewal premium receipt on 16-02-2016, almost two months after call logging via IVRS system of the insurer on 18-12-2015. It is alleged by the complainant that his signature has been forged in four places of the policy document (Proposal forms) in all three policies. It is also stated that in three places his fake signature has been put on an angle of 90 percent with all other writings. It is stated that his signature has been tampered inside the proposal forms. It is also stated that the handwriting in the proposal form in the policy documents for all the three policies do not belong to him. The complainant has stated that he has lost complete faith on OP and he has been compelled to discontinue with the said policies and has prayed for refund of the entire paid amount along with interest.
OPs have contested the case in filing written version contending, inter alia, that the present complaint is false, frivolous and vexatious. It is stated that the complainant has not approached the Forum in clean hands and has suppressed the material facts. It is alleged that there was no deficiency of service or negligence on the part of the OPs. It is stated that in accordance with Clause No.6(2) of the Insurance Regulatory and Development Authority Regulations 2002 every policy document sent by it is accompanied by forwarding letter which clearly mentions that in case policy holder is not satisfied with the features or the terms and condition of the policy he can withdraw/return the policy within 15 days that is under the freelook period provision. It is alleged that the complainant has never approached the OPs during the freelook period raising any objection on the policy terms and conditions. It is stated that in three policies issued to the complainant it is evident that the life assured and the proposer is one and the same person because the life assured himself availed the said insurance policies and therefore, signature of the complainant as ‘life assured’ or as ‘proposer’ would not invalidate the contract of insurance entered between the complainant and the company. It is also stated that allegations are made against some independent agent/broker and the OPs are not answerable for the same. It is stated that the request for cancellation of the policies could not be entertained by the OPs as the complainant has approached OPs after the expiry of the ‘freelook’ period. The OPs have prayed for dismissal of the case.
Point for Decision
- Whether the OPs have been deficient in rendering services to the complainant?
- Whether the complainant is entitled to get the relief as prayed for?
Decision with Reasons
We have travelled over the documents on record namely copy of the proposal form of all the policies, copy of the complaint letter dated 20-01-2016 to Kasba Office, Salt Lake and Mumbai Head Office of OP Company by the complainant, copy of the complaint letter dated 23-12-2015, copies of receipts against the payment of first premium and renewal premium for all the three policies, copy of bank statement supporting document of premium amount of all the three policies and other materials on record.
From Annexure I we find that the signature of the proposer is blank in the proposal form of the policy document being No.140714152331. We know that the proposal form becomes incomplete without signature of the proposer. Moreover, from annexure III it appears that the signature of the life to be assured/insured is blank in the policy document being No.150314361281. The signature of the complainant is not appearing in such portion of the document. We also find that there is no mention regarding the relationship between the proposer and the life to be assured/insured under Section 1 . Personal Details in the policy document being No.150314361281. Even in Policy No.140714152331 we find that the column regarding relationship between the proposer and life to be insured/assured under Section . Personal Details is remaining blank. We find that the insurer overlooked those omissions/laches during verification and issued the policies with all such loopholes in the policy document. Top of all it is alleged by the complainant that his signature has been forged in four places of the policy documents in all the three policies. It appears that the signatures in all the policies vary as stated to be endorsed by the complainant. We have perused page 5 of Annexure 1, Page 2 and 4 of Page Annexure 2 and Page 9 of Annexure 3. The signatures as it appears are tampered. It is also alleged that the handwriting in the proposal forms in the policy documents for all the three policies are not belonging to the complainant. It is also alleged that the signatures on the proposal form have been changed and distorted. We also find that the personal information in the proposal forms in the policy documents are different in three policies . the height of the complainant is written at one place 5’8’’ and in another policy 5’5’’. It appears that the complainant has got three different heights varying from 5’4’’ to 5’8’’ in the three different policies – in policy no.140714152331 which is issued on 15-07-2014, the height of the complainant is shown as 5’4’’. In policy no.141014228284 which is issued on 30-10-2014, the height of the complainant is shown as 5’8’’ and in policy no.150314361281 which is issued on 19-03-2014 the height of the complainant is shown as 5’5’’. So, we find that within a span of 8 months the complainant has got three different heights varying from 5’4’’ to 5’8’’. It also appears that family history details in the proposal forms of the policy documents in the three policies also vary. In policy no.140714152331, the age of the father of the complainant is shown as 79, whereas in the policy no.141014228284 the age of the father of the complainant is shown as 68 years and in policy no.150314361281 the age of the father of the complainant is shown as 78 years. So, we find that the father of the complainant has got three different ages varying from 68 to 79 years in the said policies. We find that insurer has issued the policies with improper information and we also find discrepancies in the proposal forms in respect of signatures, family details and personal details of the complainant.
On appreciation of the materials on record we find that the OP insurance company has been deficient in rendering services to the complainant and there are discrepancies regarding information furnished in the policy documents. Moreover, the signatures of the insurer as we find are not made by the self-same person on the policy documents. We find that OP insurance has issued those policies with lot of loopholes and discrepancies and omissions.
Accordingly, we think that the complainant will face consequences and troubles for such anomalies and discrepancies in the policy documents. The issue of free look period gathers no meaning when the policy documents and proposal form suffer from inherent defects and discrepancies and when the signatures of the complainant are also appearing to be fake and manipulated and distorted at some places. We think that the complainant is entitled to get the relief as prayed for.
In result, the case succeeds.
Hence,
Ordered
That the instant complaint case be and the same is allowed on contest with cost of Rs.5,000/- each.
OPs are directed to refund the entire paid amount along with interest at the rate of4 percent p.a. with effect from the date of passing this order to the complainant within one month henceforth.
OPs are also directed to pay compensation to the tune of Rs.30,000/- to the complainant within the said period for causing harassment.
Failure to comply with the order will entitle the complainant to put the order into execution u/s.25 read with Section 27 of the C.P. Act and in that case OPs will be liable to pay penal damages at the rate ofRs.3,000/- to be paid to this Forum.
