MRS. FIROZA KHATOON, PRESIDENT
The case of the complainant is that the opposite party no.1 the Life Insurance Corporation of India has a plan namely ‘Jeevan Amar (855)’ which contains three different facilities and benefits depending upon different amount of premium as follows:
- Sum Assured (SA) Option: Level Sum Assured Premium Paying Option: Regular Premium Annual Premium with Tax Amount: Rs.26,762.00.
- Sum Assured (SA) Option: Level Sum Assured Premium Paying Option: Regular Premium (With Accident Benefit Rider).
Annual Premium with Tax Amount: Rs.28,532.00.
- Sum Assured (SA) Option: Increasing Sum Assured Premium Paying Option: Regular Premium Annual Premium with Tax Amount: Rs.43,082.00.
It is stated that under advice of opposite party no.4 the complainant opted for [Jeevan Amar (855) ‘increasing sum assured] and issued a cheque dated 16.12.2019 for sum of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only, HDFC Bank Limited, C. R. Avenue Branch, Kolkata as premium amount in favour of Life Insurance Corporation of India and handed over necessary documents and signed in the proposal form. Thereafter, the complainant undergone some medical examinations as per terms and conditions of the policy and the medical reports were also submitted with the opposite parties. The opposite parties assured that once the medical tests are approved by the concerned department, the policy of the complainant shall be activated and she will received the policy document at her residential address and in case of disapproval of policy by the concerned department, the said premium of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only would be refunded and automatically be credited in the account of the complainant. Despite prolonged period having passed, the complainant neither received the insurance policy nor the opposite party no.1 has refunded the premium paid by the complainant. In the month of February, 2020 the opposite party no.4 informed the complainant that some additional documents are required to be furnished for which the policy was still pending for approval of the superior authority. In the month of July,2020 opposite party no.4 took the complainant and his son Mr. Rahul Agarwal to opposite party no.3 and both of them were told that the policy will be approved within a short period, but to no effect. Thereafter, the complainant sent a legal demand notice dated 13.07.2021 to the opposite parties to provide her the policy documents. The opposite parties sent a reply dated 27.07.2021 wherein it was stated that the opposite parties are ready to refund the premium amount paid by the complainant and also asked the complainant to make a fresh proposal along with fresh deposit of premium amount and medical examination reports for issuance of a policy. Complainant alleges that the Divisional Manager, Life Insurance Corporation of India, KMDO-I also over phone requested her to apply afresh for a policy and to pay premium and assured her that the previous paid premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only shall be refunded to the complainant. Trusting once again, the complainant immediately handed over necessary documents along with a cheque for paying premium and signed the proposal forms and also handed over Rs.1,000/- (Rupees one thousand) only in cash to the opposite parties in order to get the policy done. For this policy on 07.08.2021 the complainant had undergone medical tests. On 02.09.2021 the complainant was informed that the policy has been approved and the premium amount is Rs.31,081/- (Rupees thirty one thousand eighty one) only (inclusive of tax) and the policy number is 409345730 but till the filing of the case the complainant has not received the hard copy of the policy and returned of entire paid premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only.
The complainant further states that finding the amount of premium of Rs.31,081/- (Rupees thirty one thousand eighty one) only unreasonable for the same policy, the complainant once again called the opposite party no.4 and came to know that the opposite parties had wrongly issued the ‘level sum assured, under plan (855)’ instead of ‘increasing sum assured, under plan (855)’ which was actually opted by the complainant. The complainant alleges that she was handed over with a inferior policy in very whimsical manner and that too without any policy document till date. In spite of repeated request the opposite parties have failed to provide the insurance policy as opted by the complainant i.e. ‘increasing sum assured, under plan (855)’ as such the opposite parties are liable for deficiency in service and unfair trade practice.
In the above circumstances, the complainant has been compelled to file this case before this Commission on the prayer for a direction upon the opposite parties to replace policy from ‘Level Sum Assured’ to ‘increasing sum assured’ under Plan (855) for the said premium amount which has been paid in the year 2019 and the period of the policy be considered and counted from December, 2019 inter alia on other reliefs.
Opposite party nos.1 and 2 filed written version in this case. Opposite party nos.1 and 2 deny and dispute the averment made in the complaint application. The opposite parties admit that the complainant submitted a proposal form vide proposal No.6152 (2019-20) on 11.12.2019 and paid sum of Rs.41,374/- (Rupees forty one thousand three hundred forty seven) only vide BOC No.900810 dated 11.12.2019. As per terms and conditions of the policy some medical tests of the complainant were done. Due to non submission of the Income Tax Return (ITR) of the complainant for the year 2017-2018, the opposite party no.1 was unable to issue Policy Bond in favour of the complainant. It is stated that an auto generated SMS was sent to the complainant as well as to her concerned agent and development officer in order to enable the complainant to submit the required documents and Income Tax Return (ITR) for the financial year 2017-18 but as the complainant not submitted the same, her proposal form could not be converted into a policy. The opposite parties alleged that the complainant intentionally did not comply with the same and also not submitted any NEFT details in order to enable the opposite parties to refund the premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only which was paid by her. The opposite parties received the legal notice dated 13.07.2021 sent by the complainant.
In reply dated 27.07.2021 the opposite parties requested the complainant to submit fresh proposal, fresh deposit, mandatory medical papers and financial requirement for issuing a fresh policy. The opposite parties categorically state that as per Rules and Regulations, any proposal deposit remains valid for adjustment for 6 (six) months only. As in this case, the validity period of 6 (six) months expired, the opposite parties by their letter dated 27.07.2021 requested the complainant to submit fresh proposal, fresh deposit, mandatory medical papers and financial requirement for issuing a fresh policy. Vide this letter dated 27.07.2021, the opposite parties also informed the complainant that the opposite party no.1 is ready to refund the premium deposit amount lying at their end. After receiving the reply of the opposite parties, the complainant submitted a proposal form opting ‘Jeevan Amar (855)’ for a term of 22 years and sum assured Rs.30,00,000/- (Rupees thirty lakhs) only. In the said proposal form, the complainant preferred the option of ‘Open Level Sum Assured’ and accordingly, paid a sum of Rs.1,000/- (Rupees one thousand) only as token deposit and underwent medical tests as per Rules and Regulations of Life Insurance Corporation of India. Thereafter, on receipt of all documents and the balance amount of the premium, the opposite party/Life Insurance Corporation of India issued a Policy bearing no.409345730 in favour of the complainant. According to the opposite parties, it is clear from the proposal form submitted by the complainant that she opted ‘Level Sum Assured under Plan (855)’ and paid the requisite premium amount for it. The opposite parties requested the complainant to provide NEFT details to refund the proposal amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only but the complainant has not provided the same. So, the opposite party/Life Insurance Corporation of India could not refund the same. However, opposite party/Life Insurance Corporation of India is ready to refund the same to the complainant. According to the opposite parties the prayer made by the complainant being misconceived cannot be allowed and liable to be rejected.
Considering the rival pleadings of the parties the following issues are framed:
Points for decision
- Is the complainant a consumer in terms of Consumer Protection Act, 2019 ?
- Is the case barred by limitation ?
- Are the opposite parties liable for deficiency in service as alleged ?
- Is the complainant entitled to get relief or reliefs as prayed for ?
Decision with Reason
On scrutiny of the record we find that in spite of service of notice opposite party nos.3 and 4 had not appeared in the case to contest the same.
The complainant on 19.04.2022 by submitting a petition on affidavit prayed for considering her complaint application and the documents annexed thereto as evidence without filing any evidence in terms of Section 38(9)(c) of the Consumer Protection Act, 2019. Though, there was no evidence of the complainant, the opposite party nos.1 and 2 submitted questionnaires and the complainant filed reply on 20.05.2022 but the same was neither verified nor supported by any affidavit.
We have no hesitation to hold that the petition dated 19.04.2022 and reply dated 20.05.2022 of the complainant by no stretch of imagination can be considered as evidence of the complainant in terms of Section 38(9)(c) of the Consumer Protection Act, 2019.
On further scrutiny of the record we find that after obtaining leave from the Commission, the complainant filed affidavit in chief as her evidence. The opposite party nos.1 and 2 cross examined the complainant by filing questionnaire and the complainant filed affidavit in reply.
The documents filed in evidence are market as follows :
- Document No. 1 series :- Whatsapp chat.
- Document No. 2 :- Bank statement of complainant showing payment of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only to opposite party No.1.
- Document No. 3 :- Letter dated 13.02.2020 by complainant.
- Document No. 4 :- Advocate’s letter dated 13.07.2021 of the complainant.
- Document No. 4/1 :- Photocopies of postal receipts.
- Document No. 5 :- Letter dated 27.07.2021 of opposite party No.1.
For the sake of brevity and convenience both the points are taken up together for consideration and discussion.
Considering the material on record and evidence of both the parties it appears that the complainant is a consumer in terms of Section 2(7) of the Consumer Protection Act, 2019.
Therefore, Point No.1 is decided in favour of the complainant.
Having considered the pleadings and evidence of both parties we find the followings are admitted facts :
- The complainant through opposite party nos.3 and 4 opted for a policy of opposite party no.1 under plan ‘Jeevan Amar (855)’ for option ‘increasing sum assured’ and submitted duly signed proposal form along with relevant documents and a cheque dated 16.12.2019 for sum of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only drawn on HDFC Bank Limited, C. R. Avenue Branch, Kolkata and the amount was duly debited from the account of the complainant in favour of the opposite party no.1. (Document-2).
- The complainant sent a legal notice dated 13.07.2021 calling upon the opposite parties to provide her the policy documents for paid premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only vide cheque dated 16.12.2019. (Document-4).
- The opposite party no.1 in its reply dated 27.07.2021, intimated the complainant its readiness to refund the amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only and requested the complainant to submit a fresh proposal, fresh deposit along with all mandatory medical documents. (Document-5).
- The complainant submitted fresh proposal form on 06.08.2021 and paid a sum of Rs.26,340/- (Rupees twenty six thousand three hundred forty) only as premium along with medical reports and other documents. Accordingly, policy bearing no. 409345730 commencing on and from 30.8.2021, under Plan ‘Jeevan Amar (855)’ had been issued by opposite party no.1 in favour of the complainant.
- In course of argument it has been admitted by the complainant that the hard copy of the aforementioned policy bearing no. 409345730 is received by her after institution of this case.
- The premium paid by the complainant for sum of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only by cheque dated 16.12.2019 is still lying in the custody of the opposite party no.1.
The complainant in her complaint application and evidence stated that Plan ‘Jeevan Amar (855)’ has three categories depending upon the amount of the premium. The policy plan of the lowest premium is mentioned as ‘Level Sum Assured’. Thereafter, the second Level is termed as ‘Level Sum Assured’ with Accident Benefit rider and the highest category is termed as ‘Increasing sum assured premium paying option’.
The complainant filed this case on the prayer for directions upon the opposite parties to replace the fresh policy ‘Jeevan Amar (855)’ ‘Level Sum Assured’ i.e. policy bearing no. 409345730 to ‘Increasing Sum Assured under Plan Jeevan Amar (855)’ for which the premium amount is Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only for the said policy which has already been paid by the complainant in the year 2019 and it is still lying with the opposite party no.1 inter alia on other reliefs.
The complainant submits that vide her letter dated 13.02.2020 (Document-3) she claimed for issuance of the policy bond under Plan ‘Jeevan Amar (855) Increasing Sum Assured option’ on payment of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only as premium. No document has come forth in proof that this letter dated 13.02.2020 (Document-3) has ever been served upon the opposite parties.
The opposite party nos.1 and 2 in their written version as well as in evidence categorically stated that after payment of premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only, the proposal form submitted by the complainant could not be accepted for want of Income Tax Return document of the complainant for the financial year 2017-18. According to the opposite party nos.1 and 2 an auto generated SMS was sent to the complainant as well as to opposite party nos.3 and 4 for requirement of the said Income Tax Return for financial year 2017-18 but the complainant has not submitted the same. Due to non-submission of the Income Tax Return of the complainant for the financial year 2017-18 opposite party no.1 was unable to issue the policy bond in favour of the complainant. It is categorically stated by the opposite party nos.1 and 2 that as per Rules and Regulations, any proposal deposit remains valid for adjustment for six months only. As the said period lapsed, the opposite party no.1 vide its letter dated 27.07.2021 informed the complainant its readiness to refund the amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only with a request to submit a fresh proposal along with fresh payment of premium for fresh policy.
The above evidence of the opposite parties has not been categorically denied by the complainant during cross examination by way of filing questionnaire. However, we find the contents of the ‘auto generated SMS’ in the name of complainant is enclosed with written version as Annexure-‘A’ wherein the ‘Date of Decision’ appears ’25.02.2020’ and the official printout of the said SMS was taken out on 30.11.2021. It has also not been denied by the complainant that there was no provision of sending auto generated SMS by the opposite parties in case of any requirement to be complied with by the proposer and his/her agents.
Having considered the discussion made above, we can safely presume that the complainant received the SMS from opposite party no.1. No evidence has come forth that the complainant submitted her Income Tax Return for the financial year 2017-18 with the opposite party no.1 in time. It has also not denied by the complainant that as per Rules and Regulations any proposal deposit remains valid for adjustment for six months only.
It appears from the record that after lapse of the above mentioned period in its letter dated 27.07.2021, opposite party no.1 explained its readiness to refund Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only to the complainant but has not asked for the bank details of the complainant. We do not find any evidence that the complainant sent any reply to this letter dated 27.07.2021 (Document-7) of opposite party no.1. On the other hand it appears that considering the request letter dated 27.07.2021, the complainant submitted a fresh proposal with fresh premium to the tune of Rs.26,340/- (Rupee twenty six thousand three hundred forty) only being the lowest premium amount for the basic policy plan ‘Jeevan Amar (855)’.
Therefore, this fresh policy cannot be taken as continuation of the proposal from and premium paid in the month of December, 2019, as the same attained its natural death on expiry of six months as per Rules and Regulations.
It is admitted fact that till date the said proposal premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only is lying with opposite party no.1 and opposite party no.1 has not made any endeavour to refund the same to the complainant.
Therefore, it is evident that opposite party no.1 is liable for deficiency in service as no effective steps has been taken to return the amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only after lapse of six months from its payment. Such act of the opposite party no.1 has caused harassment to the complainant for which she is entitled to get refund of the aforementioned amount along with compensation and litigation cost.
Thus, the case of the complainant succeeds in part.
It appear that vide letter dated 27.07.2021 (Dcocument-5), the opposite party no.1 expressed its willingness to refund the premium amount of Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only and the complaint case has been filed on 28.09.2021 within the period of limitation.
Therefore, point No.2, 3 and 4 are decided in favour of the complainant.
Hence, it is
O R D E R E D
that the complaint case be and the same is allowed in part on contest against opposite party nos.1 and 2 and ex-parte against opposite party nos.3 and 4 with cost.
The opposite party nos.1 and 2 is directed to refund Rs.41,347/- (Rupees forty one thousand three hundred forty seven) only to the complainant either jointly or severally within 60 (sixty) days from the date hereof, in default to pay simple interest @ 9% p.a. from 27.07.2021 till the date of payment.
The opposite party is directed to pay a sum of Rs.50,000/- (Rupees fifty thousand) only as compensation to the complainant for harassment within 60 (sixty) days from the date hereof, in default to pay simple interest @ 9% p.a. till the date of payment.
The opposite party shall pay a sum of Rs.10,000/- (Rupees ten thousand) only as litigation cost to the complainant within 60 (sixty) days from the date hereof.
Dictated and corrected
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President
