Order No. 14 dt. 13/08/2019
The case of the complainant in brief is that the complainant was approached by o.p. no.4 being the agent of o.p. insurance company and he was convinced for opening the policies of o.p. insurance company in the name of himself and his wife. The complainant on receiving the policies found that o.p. no.4 cheated him and he contacted the insurance company. The complainant requested the insurance company to cancel the policies but insurance company did not take any action, for which the complainant moved to ombudsmen for redressal of his grievance. After contesting hearing Ld. Ombudsmen passed the award dated 19/03/2017 whereby insurance company was directed to cancel the policies bearing nos. 03022907 and 03021884 and convert the entire premium amount to a single premium policy within 5 years lock in period. The o.ps thereafter obtained the policies from the complainant and the complainant was compelled to sign on an application so that o.ps can transfer the entire premium amount of the earlier 2 policies in a policy mentioned “Ëxide Life Prospering Life Plus SP”. Subsequently on receipt of the policy bond it was found that the signatures appearing in the application were not of the signatures of the complainant which was also confirmed by the report of the handwriting expert. The complainant, thereafter, received the said policy bond on 27/07/2017 bearing no. 03590310 for a term of 10 years with single premium of Rs.3,34,756/- to be matured on 21/06/2027. After going through the said policy documents it was found that the complainant would have to pay the yearly premium of Rs.3,34,756/- and the due date was mentioned 21/07/2018. The complainant after receiving the said policy documents opted for cancellation of the policy within free look period, but o.ps did not take any step, for which the complainant had to file this case praying for direction upon the o.ps. for refund of the amount of Rs.3,34,756/-as well as compensation and litigation cost .
The o.p. nos. 1 to 3 contested this case by filing w/v and denied all the material allegations of the complainant. It was stated that the complainant has made allegations against the o.ps of forgery which is a criminal offence and the complainant should file a criminal case against the o.ps. The complainant for the purpose of getting sympathy has falsely manufactured such story. It was further stated that the complainant was provided with 4 policies in his name and the period of premium term was mentioned 7 years, 15 years and 7 years and the yearly premium was mentioned of Rs.90,000/- , Rs.1,00,000/-, Rs.20,000/- and Rs.25,000/- respectively. The above policies were issued based on the proposal form submitted by the complainant. However, the complainant alleged that he opted only for a single premium policy, as such, sought for cancellation of those policies. As the cancellation was sought for beyond the free look period of 15 days, therefore, insurance company repudiated the request for cancellation. Being aggrieved by the said decision the complainant preferred an application before Hon’ble ombudsmen and an award was passed for converting the policies’ entire amount to a single premium policy with 5 years lock in period. The complainant was advised to run the policy nos. 03151865 and 03188448. Accordingly, insurance company obtained application form and the complainant opted for “Ëxide Life Prospering Life Plus SP” with single premium of Rs.3,34,756/-. Therefore, as per the direction of Hon’ble ombudsmen insurance policies were issued. As per order of Hon’ble ombudsmen it was directed to issue the policy with maturity period of 5 years with a lock in period of 5 years. There is difference between maturity period and lock in period. The lock in period means the period of 5 consecutive years from the policy commencement date with neither any partial withdrawal nor the proceeds of the discontinued / surrendered policies paid to the policy holder. The complainant has failed to make out a prima facie case against the o.ps and thereby it stated by o.ps that it is a fit case to dismiss the case against the o.ps.
In spite of receipt of notice the o.p. no.4 did not contest this case by filing w/v and as such, the case has proceeded ex parte against the o.p. no.4.
On the basis of the pleadings of parties the following points are to be decided:
- Whether the complainant had obtained the policies from o.ps?
- Whether o.ps failed to comply the order of ombudsmen?
- Whether there is any deficiency in service on the part of the o.ps?
- Whether the complainant will be entitled to get any relief as prayed for?
Decision with reasons:
All the points are taken up together for the sake of brevity and avoidance of repetition of facts.
Ld. Lawyer for the complainant argued that the complainant was approached by o.p. no.4 being the agent of o.p. insurance company and he was convinced for opening the policies of o.p. insurance company in the name of himself and his wife. The complainant on receiving the policies found that o.p. no.4 cheated him and he contacted the insurance company. The complainant requested the insurance company to cancel the policies but insurance company did not take any action, for which the complainant moved to ombudsmen for redressal of his grievance. After contesting hearing Ld. Ombudsmen passed the award dated 19/03/2017 whereby insurance company was directed to cancel the policies bearing nos. 03022907 and 03021884 and convert the entire premium amount to a single premium policy within 5 years lock in period. The o.ps thereafter obtained the policies from the complainant and the complainant was compelled to sign on an application so that o.ps can transfer the entire premium amount of the earlier 2 policies in a policy mentioned “Ëxide Life Prospering Life Plus SP”. Subsequently on receipt of the policy bond it was found that the signatures appearing in the application were not of the signatures of the complainant which was also confirmed by the report of the handwriting expert. The complainant, thereafter, received the said policy bond on 27/07/2017 bearing no. 03590310 for a term of 10 years with single premium of Rs.3,34,756/- to be matured on 21/06/2027. After going through the said policy documents it was found that the complainant would have to pay the yearly premium of Rs.3,34,756/- and the due date was mentioned 21/07/2018. The complainant after receiving the said policy documents opted for cancellation of the policy within free look period, but o.ps did not take any step, for which the complainant had to file this case praying for direction upon the o.ps. for refund of the amount of Rs.3,34,756/-as well as compensation and litigation cost .
Ld. Lawyer for the o.p. nos. 1 to 3 argued that the complainant has made allegations against the o.ps of forgery which is a criminal offence and the complainant should file a criminal case against the o.ps. The complainant for the purpose of getting sympathy has falsely manufactured such story. It was further stated that the complainant was provided with 4 policies in his name and the period of premium term was mentioned 7 years, 15 years and 7 years and the yearly premium was mentioned of Rs.90,000/- , Rs.1,00,000/-, Rs.20,000/- and Rs.25,000/- respectively. The above policies were issued based on the proposal form submitted by the complainant. However, the complainant alleged that he opted only for a single premium policy, as such, sought for cancellation of those policies. As the cancellation was sought for beyond the free look period of 15 days, therefore, insurance company repudiated the request for cancellation. Being aggrieved by the said decision the complainant preferred an application before Hon’ble ombudsmen and an award was passed for converting the policies’ entire amount to a single premium policy with 5 years lock in period. The complainant was advised to run the policy nos. 03151865 and 03188448. Accordingly, insurance company obtained application form and the complainant opted for “Ëxide Life Prospering Life Plus SP” with single premium of Rs.3,34,756/-. Therefore, as per the direction of Hon’ble ombudsmen insurance policies were issued. As per order of Hon’ble ombudsmen it was directed to issue the policy with maturity period of 5 years with a lock in period of 5 years. There is difference between maturity period and lock in period. The lock in period means the period of 5 consecutive years from the policy commencement date with neither any partial withdrawal nor the proceeds of the discontinued / surrendered policies paid to the policy holder. The complainant has failed to make out a prima facie case against the o.ps and thereby it stated by o.ps that it is a fit case to dismiss the case against the o.ps.
Considering the submission of the respective parties it is admitted fact that the complainant being enticed by the agent of insurance company purchased the policies. The complainant has also categorically stated that in the application for obtaining policies the signatures appearing in those documents were not signed by the complainant. It has been corroborated by the handwriting expert. The complainant after obtaining the policies found that the policies provided to the complainant was not in conformity with the assurance given by the agent and the agent for the purpose of misleading the policies adopted such tactics and fraudulently incorporated the facts in the application for obtaining the policies. The complainant after receiving the policies came to learn that the policies which were assured by the agent was not of the same, for which the complainant made a complaint to Hon’ble ombudsmen and Hon’ble ombudsmen passed an order whereby it was directed that the premium paid by the complainant is to be converted into one policy with a lock in period of 5 years but o.ps did not abide by the direction of Hon’ble ombudsmen and issued several policies asking for further payment of premium of Rs.3,34,756/-. The complainant raised his objection and within the free look period he prayed for cancellation of those policies, but insurance company for the purpose of accepting the proposal of the complainant for cancellation of those policies and stated that the cancellation of the policies was not made within the free look period. The complainant has filed documents to show that he sent those policies within the free look period and he has substantiated the same fact by filing documentary evidence. The o.ps for the purpose of denying the claim of the complainant have repudiated the prayer of the complainant for cancellation of those policies without any cogent reason whatsoever. It appears from the materials on record that the complainant in the application form had allegedly mentioned that his annual income was of Rs.2 Lakh but insurance company filed documents showing that the yearly premium to be paid by the complainant to the tune of Rs.3,34,756/- which is totally an absurd thing and which can hardly be borne by the policy holder with the annual income of Rs.2 Lakh. The complainant all through made allegations against the o.ps but o.ps failed to comply the order of the ombudsmen as well as demanded further premium, though in the order itself, the ombudsmen categorically stated that insurance company to cancel the policy nos. 03022907 and 03021884 and the entire premium to a single policy with 5 years lock in period. The o.ps did not comply the direction of the ombudsmen and further issued policies asking for further payment of premium to the tune of Rs.3,34,756/- which is not at all possible for the complainant to bear such huge payment of premium whenever the complainant has disclosed that his annual income was of Rs.2 Lakh at the relevant point of time. In view of the facts and circumstances of the case we hold that there is deficiency in service and unfair trade practice on the part of insurance company and the complainant will be entitled to get relief.
Thus all the points are disposed of accordingly.
Hence, ordered
That the CC No.233/2018 is allowed on contest with cost against the o.p. nos. 1 to 3 and dismissed ex party without cost against the o.p. no.4. The o.p. nos. 1 to 3 are jointly and/or severally directed to refund the amount of Rs.3,34,756/- (Rupees Three Lakh Thirty Four Thousand Seven Hundred and Fifty Six) only to the complainant along with compensation of Rs.30,000/- (Rupees Thirty Thousand) only for harassment and mental agony and litigation cost of Rs.5,000/- (Rupees Five Thousand) only within 30 days from the date of communication of this order, i.d. an interest @ 8% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
