MR LAXMI NARAYAN PADHI, PRESIDENT…             The brief history of the case is that, the complainant had subscribed to one Life Gain Plus 20 under participating plan with the OP.no.3, to which the OP.2 & 3 are Executives through their corporate agent Axis Bank represented by the OP.1, vide policy no. 843025412 on dt.24.06.2011, paying the first annual premium of Rs.1,00,000/-. But owing to scarcity of funds and continuous ailments, the complainant suffered thereafter, she could not pay the next succeeding annual premiums. Hence, on dt.02.04.15, she wanted to surrender the policy through notice to the OP.s but, the OP.s never responded to her claim. She had continuous transactions with the OP.1, and when OP.1 approached and allured her with different benefits of the policy, and out of good gesture, she had signed the proposal form, without being acknowledged or explained that, it is to be annually paid and that, if she discontinue, would lapse and benefits would be forfeited. It was also not explained by OP.1, if she discontinues no cash values would be assessed against the policy, only on the markings of the OP.1 on the forum, she signed, and was assured that after three years she could surrender the policy and realize for money, as it stands. The form was filled by the OP.1, basing on the KYC available with the bank, being she was a regular customer. She further submitted that, she is a farmer and her only source of income was agriculture.

2.         For the refund of her premium she approached the OP.1, who never came up for a settlement, instead made her frequently to his bank, which adversely affected her social status, and thus humiliated, had to inflicted of great financial hardship and mental tension, for which she prays the forum to allow the complaint against OP.s directing the OP.s to refund her premium amount with usual interest inter alia compensation of Rs.2,00,000/- and cost of Rs.10,000/-. The complainant has filed a letter dt.02.04.15 written to ombudsman of Max New York Insurance Company at Bhubaneswar and copies of policy, along with affidavit in support of her claim.

3.         The OP.no.1 entered appearance on dt.10.06.2015 and filed his counter, contending that, as per Sec.230 of ICA, the OP.1 is only an agent and cannot enforce performance of contract executed between the principal and it’s customer, hence, the complaint shall be dismissed against him. He acted only as a referral agent/ facilitator, and the request of withdrawal of the complainant was duly forwarded by him to the principal, i.e. OP.2 & 3 on dt.08.04.15, hence any deficiency of service cannot be accorded against him. In support of his contentions, he referred judgment of AP SCDRC in F.A. 86/2008 in the matter of Andhra Bank, credit card Division Vs Mrs Dinas Vervatwala & Anr.

4.         On dt.10.08.15, the OP. 2 & 3 appeared and filed their counter contending that, the complainant has duly signed the proposal form bearing no. 843025412 for Max Life Gain Plus 20 years 6 pay plan giving all relevant details and information relating to policy was made her understood, and sum assured amounting to Rs.7,25,376/- on dt.19.05.2011. That the policy acquires cash value, it has been in force for continuous three years and of 3 annual target premiums have not been paid the policy will lapse and no cash value will be acquired. The complainant never approached the OP.s during the free lock period of 15 days after the policy document dispatched to her for surrendering of the policy. She was intimated of the lapse of policy by OP.3 on dt.26.07.12. She had signed the declaration in the policy stating that, she has understood all the contents in the policy. The counsel for OP.2 & 3 has filed copy of list of document dt.28.09.15 along with copy of two citations. Submissions considered.

5.         It reveals from the contentions of OP.2 & 3 are that, after lapse of policy of the complainant the OP issued a letter i.e. lapse intimation on dt.26.07.12, but the complainant did not pay any heed to it. However it is seen that the complainant has sent a letter on dt.02.04.2015 to the Ombudsman of OP.2 & 3 and also copy to the OP.1 requesting that, due to ailments and fund scarcity she could not able to deposit the subsequent premium, hence she want to surrender the said policy. But neither the OP.1 nor others replied to her application. The complainant preferred the insurance policy to secure her life and when she suffered from medical treatment, and prior to her application the OP.s neither settle the claim nor replied to her application and kept the complainant in dark. The OP.2 & 3 being reputed insurance company guided by the I.R.D.A of Govt. of India, despite requests by the complainant in ailment period, failed to render any service to the complainant. Though there is free locking period of 15 days but the complainant never thought that she will discontinue to deposit the policy premium and the same happened due to her ill health and poor financial condition. Hence we feel that the OP Company being a multinational insurance brand carrying business throughout country shall pay the accumulated dues of the complainant to save natural justice. Hence we found deficiency in service on the part of OP.2 & 3 and the complainant shall get her legitimate dues.

6.         We have further observed that, undoubtedly an attractive insurance policy has floated by the OP Company, and the complainant subscribed to the scheme paying Rs.1,00,000/- in the policy under the OP. No doubt the policy has a maturity ceiling of 20 years, but the OP cannot take stand that, the beneficiary/policy holder, in changed circumstances can not dilute the amount to meet her worst while needs of the time, and it is more so, when the need is concerned with medical emergence. The OP was required to deal with the application of the complainant more attentively and expeditiously, failing through negligence to delay to settle the claim, is nothing but deficiency in service, and the OP cannot be escaped compensating the damage, caused as thus to the complainant couple with agony and mental harassment.

7.         Hence in our view the OP.s being a big corporate refute the application made by the complainant forfeiting the insurance premium of the complainant in dilly dallying tactics, hence the complainant sustained financial losses and mental agony. In our view, the OP. 2 & 3 are at deficiency in service with ulterior motives, hence they found guilty of deficiency in service, as thus the complainant is entitled for relief.

                                                     O R D E R

i.          The OP.2 & 3 are here by directed to pay the complainant 75% of the insurance premium paid against the policy deposited by the complainant. Inter alia to pay a sum of Rs.25,000/- (Twenty five thousand) as compensation and a sum of Rs.5,000/- (Five thousand) as cost of the litigation to the complainant.

ii.         The above awarded sum shall be paid within 30 days of dispatch of this order, failing which, the total amount will carry 12% interest per annum till its realization.

            Pronounced in the open forum on 14th day of December’2015.

  Sd/-                                 Sd/-                              Sd/-

MEMBER                 MEMBER              PRESIDENT, DCDRF,

                                                                       NABARANGPUR.