ORDER

01.05.2024

Sh. Sanjay Kumar, President

1. In brief facts of the present case are that complainant are residing at AG-317, Shalimar Bagh, New Delhi and run their own IAS Coaching Institute. It is stated that complainant Naresh Kumar Vaid purchased  a life  insurance  policy for his son Mr. Ashtam Neelkanth vide policy no.129536993 on 27.07.2009 from Bajaj Allianz and regular payment of premium paid and policy completed 5 years on 10.07.2013. It is further stated that in July 2013 Mr. Raj Dixit  an insurance  advisor with Bajaj Alllianz called the complainant Naresh Kumar Vaid first from a landline number with the help of two female assistants and later from his mobile no.8425899254 asking complainant to close his previous policy and  purchase a new policy from Bajaj Allianz.
2. It is stated that Raj Dixit told the complainant that he is an official  of Bajaj Allianz and calling on its behalf and the new offer is given to remove the role of agents and also assured that terms of new policy will not be altered to the complainant’s disadvantage and also insisted that complainant pay two or more installments. It is further stated that on Mr. Raj Dixit’s assurance the complainant purchased the new policy and paid two initial installments vide cheque no.832272 on 21.08.2012 and receive the new policy document no.0304703113 on 22.08.2013. It is stated that to the dismay of complainant there were many discrepancies in the new policy and it was apparent that complainant was taken for a ride by Mr. Raj Dixit in connivance with other officials of Bajaj Allianz.
3. It is stated that the terms of the new policy were not favourable to the complainant instead in the previous policy the annual premium was Rs.10,000/- for 20 years i.e total payable premium for sum assured of Rs.4,00,000/- and Rs.2,00,000/-. It is further stated that in the new policy annual premium is double i.e Rs.20,000/- for 15 years i.e total payable premium for sum assured of Rs.2,00,000/- is Rs.3,00,000/-. It is further stated that in the new  policy the complainant is forced to pay higher premium than the total sum assured just not possible. It is stated that Mr. Raj Dixit had assured that the purpose of issuing the new policy is to remove the role of the insurance agent i.e this policy was directly done by Bajaj Allianz and the benefits going to be agent will be deposited in the account of complainant which is blatant lie and till date no such amount has been deposited in the account of complainant.
4. It is stated that even the personal information furnished in the policy document is incorrect and will not allow the complainant to reap the benefits of the new policy as the new policy is issued in the wrong name i.e Mr. Ashtam Neelkanth Naresh Kumar Vaid whereas the name is Mr. Ashtam Neelkanth. It is further stated that no medical check up was conducted for the insured and postal address mentioned on the policy document is also incorrect. It is further stated that on 27 August immediately after receiving the policy document the complainant raised the issue with the officials of Bajaj Allianz and a formal complaint was lodged with Mr. Pawan Mahajan, Head Customer Services Bajaj Allianz and Ms. Nivedita, Head Grievance Manager, Bajaj Allianz but no action was taken to rectify the fraud. It is stated that instead all these officials have nexus and are working in close connivance to cheat innocent policy holder and cover  up their fraud. It is stated that initially the officials has hesitant in accepting alleged fraud and tried to convince  the complainant to take back his complaint.
5. It is stated that after 27 August insurance company has adopted tactics to delay the investigation  and peruse the complainant to take back his complaint which is evident from email communication between the complainant and OP from 27 August to 18 October. The complainant also  lodged a complaint with IRDA. It is further stated that the officials of Bajaj Allianz are  working in connivance with agents to fool innocent policy holder and Mr. Pawan Mahanjan and Ms. Nivedita assured the complainant that they would lodged FIR against the agent, however, till date no such complaint is lodged. It is further stated that they also assured the complainant that they will be filing a legal case against the agent and Bajaj Allianz will engage a lawyer for the complainant to assist him but no action has been taken in this regard.
6. It is stated that vide mail dated 07 September from Arun Menon complainant was conveyed that his policy will be cancelled and requested to produce  the documents i.e original policy documents, id and bank account proof of the policy holder. It is further stated that this is impossible as the name on the policy is incorrect. It is stated that officials of Bajaj Allianz are party to this alleged fraud as no agent could have got the personal information of a policy holder without the support of an insider. It is stated that Bajaj Allianz in its communication dated October 5 and October 8 have accepted their mistake and assured that they will help in suing the agent and lodged and FIR which does seem to be tactic to delay the matter and divert the complainant attention from the real issue.
7. It is stated that due to the negligent acts of the OP the complainant has suffered heavy loss both financially as well as emotionally and complainant has completely lost trust in the  company and suffered mental agony for which OP is liable to compensate. It is further stated that complainant has been running from pillar to post to get justice and punish the guilty and a complaint has also been lodged with IRDA dated 02.11.2014 which has been registered as Grievance Application no.11-13-011887. It is further stated that till date no action has been taken on that complaint and justice delayed is justice denied. It is stated that if an early action is not taken against such companies many more innocent policy holders will be fooled and cheated and lose faith in insurance companies.
8. It is stated that OP is liable to compensate  for criminal breach of contract as it has not complied with the terms of contract and has acted negligently in handling the complaint of complainant and also liable to compensate the complainant for the loss and injury caused to him. The complainant is seeking direction against OP to  pay Rs.10,00,000/- as compensation and Rs.25,000/- as cost. OP further be directed to cancel both the polices and refund the premium amount with interest as the complainant can no longer trust Bajaj Allianz and pass any other  order which this Hon’ble Forum may deem fit and proper.
9. OP1 to 3 filed WS and taken preliminary objections that no cause of action has arisen in favour of the complainant against the answering OPs as the OPs after considering the complaint of the complainant offered to cancel the policy vide e-mails dated 05.09.2013 and again on 07.09.2013 as a good will gesture. The complainant was therefore, requested to submit the Original Policy Bond, ID proof and Bank Account to details for processing the cancellation of the policy but despite having received the offer for cancellation of the policy, the complainant failed to submit the desired  documents to any nearest branch for processing the payment. Thus, there is no deficiency in service on the part of the answering OPs as defined under section 2(1)(g) of the Consumer Protection Act, 1986. The complaint is as  such, prima-facie liable to be dismissed.
10. It is stated that the complaint is legally not maintainable as the complainant have leveled allegations of fraud and cheating which are criminal in nature and can not be tried in the summary trial before this Hon’ble Forum. Thus, the allegations level in the instant complaint do not fall within the ambit of the Consumer Protection Act, 1986. Further, as held by this Hon’ble State Consumer Disputes Redressal Commission, Union Territory, Chandigarh in the First Appeal No.297 of 2011 Bajaj Allianz Life Insurance Co. Ltd. Vs. Bhupinder Singh, the complex, disputed the complicated matters involving allegations of fraud and forgery can be adjudicated by the Civil Court of competent jurisdiction. Hence, the complaint is not legally maintainable and merits dismissal. Reference in  this regard may be made to the case titled as Oriental Insurance Company Ltd. VS Munimahesh Patel 2006 (2) CPC 668, Reliance Industries Ltd. Vs. United India Insurance Co. Ltd. I (1998) CPJ 13 and M/s Singhal Swaroop Spark Ltd. Vs. United Commercial Bank III 1992 CPJ 50. It is stated that this Hon’ble forum has no jurisdiction to try and entertain the complaint therefore, liable to be dismissed.
11. It is stated that the complainant is estopped to file the instant complaint due to his own act and conduct as complainant was requested to submit the documents to any branch for processing the cancellation of policy but he failed an leveled false allegations against the officials of the company. It is further stated that allegations against the officials of the company  expeditiously handled and allegations alleged by complainant just to mislead this Hon’ble forum due to ulterior motive and present complaint is malicious and liable to be dismissed.
12. It is stated that present complaint is bad for misjoinder and non joinder of all necessary parties. It is further stated that complainant has leveled allegations against the Mr. Raj Dixit whereas the policy in question was sourced by a corporate agent named “Destiny Enterprises” who was licensed by IRDA to source the insurance business and the said corporate agent has not been impleaded in the arrays of parties, therefore, present complaint is liable to be dismissed. The OP referred the judgment of SCDRC Odisha at Cuttak in FA No.492/2013 tilted as The Regional Manager, Bajaj Alliaz Life Insurance Co. Ltd. Vs. Parshant Kumar Behra decided on 30.10.2015.
13. It is stated that the complainant has leveled allegations against Mr. Raj Dixit whereas the policy was  sourced by corporate  agent named Destiny Enterprise who was licensed by IRDA. It is further stated that the agents are independent contractors licensed by IRDA to source the insurance business and OP1 to 3 never authorized any person to make any commitment beyond the terms and conditions of the policy as approved by IRDA. It is stated that the role of insurance agent is clearly defined in the terms and conditions of the policy and he/she is not authorized to make any commitment beyond the approved terms and conditions of the policy. It is stated that complainant himself opted for a regular premium policy having premium payment term 15 years, therefore, present complaint has been filed due to some ulterior motive and to deny illegal financial gains.
14. It is stated that complainant has not submitted any documentary evidence to prove that OP1 to 3 have made any alleged commitments or are party to sourcing the policies. It is further stated that OP1 to 3 upon receipt of complainant acted swiftly and offer for  cancellation of policy. It is stated that there is no deficiency or commitment by the insurance company. The OP referred the judgment of M/s Iviva Life Insurance Co. Ltd. Vs. Shally Sharma RP no.2356 of 2013. It is stated that present complaint is liable to be dismissed.
15. It is stated that complainant is estopped  to file the present complaint due to his own act and conduct as he being a prudent person himself  proposed for the regular premium non linked “cash gain economy policy” after fully understanding the features, benefits, charge and terms and conditions and submitted a proposal form on 14.08.2013 duly signed by complainant in English language wherein opted to pay yearly premiums for 15 years without any coercion or force. It is further stated that the proposal of complainant was accepted by insurance company in normal course of the insurance business strictly in accordance with the proposal form signed and submitted and a policy bearing no.0304703113 was issued to complainant with the date of commencement as 22.08.2013 for risk cover of Rs.192686/-. It is stated that original policy bond containing express terms and conditions of the insurance contract was sent to complainant through Bluedart courier POD no.43568593084 dated 24.08.2013 which was admittedly delivered to complainant. It is stated that yearly regular premium of Rs.19401/- (excluding service  tax) was stipulated to be paid for premium payment terms of 15 years without any obligation on OP1 to 3 to issue any notice thereof.
16. It is stated that complainant was given 15 days free look cancellation period from the date of receipt of the policy bond by the complainant to review the terms and conditions of the contract as per the policy holders protections regulations 2002 and if complainant is dissatisfied with the said terms and conditions of the policy the complainant would have given written notice to OP1 to 3 to cancel the policy within the said 15 days from the date of receipt of the policy bond. It is further stated that complainant approached the insurance company with certain allegations of misrepresentation by the sourcing agent and the company offered cancellation of the policy vide email dated 05.09.2013 and then on 07.09.2013 the complainant himself did not comply the requirements for cancellation of policy, therefore, present complaint is infractous in view of non submission of documents by the complainant. It is stated that complainant has not approached this Hon’ble forum with clean hands as he neither submitted the documents for cancellation of the policy nor did he discharge his contractual obligations. The complainant did not pay yearly premiums due 22.08.2014 and onwards despite  having opted pay yearly premiums @ Rs.19401/- (excluding  service tax) without any obligation on the insurer to issue any notice thereof. The policy as such lapsed without acquiring any  paid  up value and he has not even got the revived the policy  till date though revival period of 5 years is applicable under the policy. Thus, the complainant is not a consumer as defined section 2(1)(d) of the Consumer Protection /act and the question of deficiency in service of he answering OPs does not arise. Accordingly,  his complaint is liable to be dismissed at the outset, having filed after the receipt of full and final payment under the policy.
17. It is stated that complaint of the complainant is legally not maintainable as the complainant has filed an instant complainant at this belated stage challenged the terms of the contract which attained finality due to the act and conduct of the complainant.
18. It is stated that complaint of the complainant is not legally maintainable as the OPs have acted strictly in accordance with the terms and conditions of the contract of insurance. Further, the terms and conditions of Non linked “Cash Gain Economy” policy are standard for all customers through out India and are strictly in accordance with the approvals as obtained from Insurance Regulatory Development Authority. Admittedly, the complainant has not raised any grievance as regards non incorporation in the policy terms, of any alleged promise made at the time of solicitation of insurance business. Hence, the allegations as regards certain promises made at the time of initial solicitation of insurance business cannot be sustained particularly when the said allegations is against the express terms of the policy document in the possession of the complainant, which clearly mentions that the insurance policy is a regular premium policy having premium payment and benefit term of 15 years. The complainant has leveled vague and false allegations just to cover up his own lapses thus, the complaint is liable to be dismissed at the outset.
19. It is stated that the OPs have maintained complete transparency and has provided to the complainant the terms and conditions of the policy of insurance with an option to review the terms within 15 days of the date of receipt of the policy document. The answering OPs have acted strictly in accordance with the terms and conditions of the contract of insurance as expressly detailed in the policy bond received by the complainant. The complaint has been filed in concocting a false story to illegally enrich himself contrary to the mutually agreed terms and conditions of the policy as nothing is liable to be even towards any surrender value upon termination of the contract. It is stated that the complainant has enjoyed the risk cover to the tune of Rs.192686/- for 13 months from commencement of the policy.
20. It is stated that complainant has no locus-standi to file the instant complaint as the answering OPs have acted strictly in accordance with the terms and conditions of the policy. OP referred the judgment of Hon’ble Supreme Court of India in the cases “The Oriental Insurance Co. Ltd. VS. Sony Cheriyan reported in (1999) 6 SCC 451 an insurance was taken out under the Motor Vehicles Act, 1988 and in case of General Assurance Society Ltd. Vs. Chandumull Jain and Anr. Reported in (1966) 3 SCR 500 the Constitution Bench has observed that the policy document being a contract and it has to be read strictly.
21. It is stated that the present complaint is not maintainable as the OPs dispute and deny their  liability to pay any amount and compensation to the complainant as alleged. It is stated that policy is a legal contract between the policy holder and the insurance company and the parties to the said contract are bound by its terms and conditions. That the terms of the policy are in the nature of the contract and their  representation has  to be made in accordance with the strict construction of the contract. Thus, the words in an insurance contract must be given paramount importance and interpreted as expressed without any addition, deletion or substitution. The law in this regard is very well settled and OP referred recent judgment of the Hon’ble Apex Court in a case of Surajmal Ram Niwas Oil Mills Pvt. Ltd. Vs. United India Insurance Company Ltd. reported in 2010 (10) SCC 567, the same has been clearly stated in the case of Reliance Life Insurance Company Ltd. Vs. Madhavacharya (Revision Petition No.211 of 2009), wherein it was held by the Hon’ble National Commission that since the insurance between the insurer and the insured is a contract between the parties, the terms of the agreement including applicability of the provisions and also to its exclusion had to be strictly construed to determine  the extent of the liability of the insurer.
22. It is stated that the law in this regard is very well settled that the policy holder does not pay premium at due time his policy gets lapse automatically as per term and conditions of the policy. The OP has referred judgment of Hon’ble National Commission in the case  of Life Insurance Corporation of India and others vs. Shiva Prasad Dass (Dr.) and others 2008 (4) CPJ, 157 NC.
23. On merit all the allegations in the complaint are denied by OPs and reiterated contents  of preliminary objections and submission.
24. Complainant filed rejoinder to the WS of OP and denied all the allegations made therein and reiterated content of complaint. It is stated that Mr. Raj Dixit an Insurance Advisor indulged in misselling and misrepresentation of facts and connected with M/s Bajaj Allianz Life Insurance Company Ltd. The said agent acted out of greed and lust for fast money. It is further stated that OP offered to cancel the policy vide email 05.09.2013 and 07.09.2013 but it was just as façade to cover up the alleged fraud and misrepresentation. It is stated that complainant is entitled  for  all the reliefs claimed in the complaint.
25. Complainant filed evidence by way of his affidavit. Complaint relied on copy of policy Ex.PW1/1, copy of bank statement Ex.PW1/2, copy of bank statement reflecting the transaction Ex.PW1/3, copy of new policy issued by OP1 Ex.PW1/4, copy of email dated 27^th August addressed to OP2 and 3 Ex.PW1/5, copy of email dated 27^th August-18^th October 2013 (Colly.) Ex.PW1/6, copy of emails dated 05.10.2013 and 08.10.2013 Ex.PW1/7 and PW1/8, copy of email dated 10.10.2013 and 18.10.2013 Ex.PW1/9 and PW1/10 and copy of complaint made to IRDA Ex.PW1/11.
26. As per record OP failed to file evidence despite given opportunity, therefore, OP was proceeded ex parte vide order dated 04.01.2017.
27. Written Arguments filed by complainant. OP failed to file written arguments.
28. We have heard Ms. Roma Bhatra counsel for  complainant, Sh. Nitin Disodya counsel for OP Life Insurance and Sh. Dinesh Kumar counsel for OP General Insurance and perused the record.
29. It is admitted case  of the parties that complainant no.1 Sh. Naresh Vaid purchased insurance  policy for his son Sh. Ashtam Neelkanth on 27.07.2009 having policy no.129536993 and premium paid on 10.07.2013 regularly. The complainants alleged that in July 2013  one Mr. Raj Dixit alleged insurance advisor of Bajaj Allianz approached him and gave false assurances and got issued a new policy on 22.08.2013. The complainants handed over two installments vide cheques dated 21.08.2012 but later on found that new policy was not favorable. The complainant lodged complaint with OP no. 2 Pawan Mahajan and alleged fraud. The complainant no. 1 remained agreived as no action taken on the complainant lodged with Bajaj Allianz and IRDA although assurance given by OP 2 Pawan Mahajan and OP3 Nivedita Chakravorthy for lodging FIR and case against agent OP4 Raj Dixit. The complainant alleges that fraud has been played, cheated and there is criminal breach of contract. The complainant specifically alleged the cause of action arose when fraud discovered.
30. The substance of allegations of the complaint are of fraud, cheating and criminal breach of contract by OPs. The law is well settled that consumer commission has no jurisdiction to adjudicate the allegations of fraud, cheating and criminal breach of contract. The reliance can be placed on Ravneet Singh Bagga vs. KLM Royal Dutch Airlines and Another (2000) 1 SCC 66, Branch Manager, Indigo Airlines Kolkata and Another Vs. Kalpana Rani Debbarma and others (2020) 9 SCC 424 and The Chairman and Managing Director, city Union Bank Ltd. & Anr. Vs R. Chandramohan in civil appeal no.7289 of 2009 decided on 27.03.2023 (Supreme Court).
31. It is pertinent to mention here that the OP Bajaj Allianz admitted the fact that since 27.08.2013 complainant lodged several complaints with OPs and the new policy issued on 22.08.2013 i.e within 15 days of free lookin period. It is admitted by OPs that on receiving complaints they offered for cancellation of the policy, however complainant did not fulfill the requirements  by submitting documents. In these  circumstances where OP Bajaj Allianz admitted to cancel the policies of complainant  we are of the considered opinion that OP1 Bajaj Allianz shall refund the premium received from complainant for new policy no.0304703113 dated 22.08.2013 and also refund the premium on maturity of the policy which matured on 10.07.2013 having policy no.129536993 dated 27.07.2009 alongwith 6% interest from the date of filing of complaint till realization. We further direct OP1 Bajaj Allianz to pay compensation of Rs.25,000/-.
32. In case OP1 Bajaj Allianz failed to comply the order within 30 days then  we direct to pay interest @ 9% per annum on refund on amount of new policy no. 0304703113 and on maturity amount of the policy no.129536993 matured on 10.07.2013 till realization. File be consigned to record room.
33. Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving an application from the parties in the registry. The orders be uploaded on www.confonet.nic.in.

Announced in open Commission on  01.05.2024.

SANJAY KUMAR                                                                 RAJESH

       PRESIDENT                                                                   MEMBER