Order-15.
Date-27/04/2017.
Shri Kamal De, President.
This is an application u/s.12 of the C.P. Act, 1986.
The case of the complainant, in short, is that, OP is an insurance company and OP2 is a corporate broker. In the month of October, 2014, complainant got proposals from OP2 who claimed itself as an authorized agent of OP1 for obtaining the policy in question.Being lured by and after prolonged persuasion by OP2. Complainant took the policy in question by issuing cheque No.141499 dated 15-10-2014 for Rs.31,000/-. The broker lured the complainant that policy in question one time investment policy and if complainant avails the policy in question by paying Rs.31,000/- he will be eligible to get several benefits and that it was time time policy. It is alleged that the OPs were reluctant to deliver the policy certificate after receiving the said amount from the complainant.On enquiry the agent had conveyed to the complainant that due to official procedure it was getting late and complainant will get the same very soon. But after lapse of considerable period the complainant suddenly received the questioned policy being No.5012507447 sometime in the year 2015 and came to know that the policy in question is not at all one time policy and it was, in fact, was for 15 years and regular premium has to be paid for 5 years at the rate ofRs.31,000/-. The complainant also found that the signatures of the complainant in the policy bond are forged and the income of the complainant had also been shown in an inflated manner as Rs.5 lakhs instead of Rs.2.5 lakhs. It is also alleged that the signatures on the policy bond and illustrations are also forged and the phone number of the proposer was also wrong. The complainant ultimately wrote a letter to the Manager of the OP dated 07-10-2015 stating all the misdeeds done by the agent and men of the OPs and requested for refund of his hard earned money. The OPs assured that the matter would be resolved within 15 days but in reality OPs have not done anything till date. Complainant has alleged mis-selling of the policy and also unfair trade practice and deficiency in service against the OPs. The complainant has prayed for refund of the amount of Rs.31,000/- along with other reliefs. Hence, this case.
OP1 has contested the case in filing written version contending, inter alia, that the case is not maintainable in fact and in law. It is stated that the policy holder signed and submitted the proposal form for insurance and obtained a policy for a term of 15 years with premium payment term for 5 years, rate of premium being Rs.30,597-33. The company had also effected PIVC and had given a call to the policy letter on his registered mobile number and the complainant did not raise any concern or issue in the said call and was in complete agreement with the terms and conditions of the policy. It is also stated that based on the information provided by the complainant in the documents furnished at the proposal stage including proposal form, benefit illustrations and others and after verification by PIVC, the company had issued the policy on the Life of the Insured bearing No.501-2507447. It is also stated that the complainant received the policy document and did not invoke the free look option and did not revert within 15 days alleging any discrepancies thereby implying that he had agreed to whatever information was provided in proposal form and was also in agreement with the policy terms and conditions mentioned for the policy documents. It is alleged that the present complaint is false, frivolous, fictitious and is liable to be dismissed. This OP has also denied deficiency in service or unfair trade practice or forging of documents or signature. The allegation of mis-selling is also denied. This OP has prayed for dismissal of the case.
OP2 has also contested the case in filing written version contending, inter alia, that the present complaint is mis-conceived, groundless and is liable to be dismissed. It is stated that OP discussed and operated each and every benefits, terms, returns, payment made frequency for the payment of the aforesaid policy of Bharati AXA Life Insurance Company to the complainant and, thereafter, the complainant decided to invest in the policies in question. It is also stated that OP2 forwarded the details of the complainant along with the selected policies to their concerned Pre Login verification team where the complainant was duly called to verify every minute details of the policy. It is also stated that OP2 also duly discussed about the free look period to the complainant. The complainant on receipt of the policy bond had not chosen to exercise the free look period which aptly shows his acceptance of the said policy terms and conditions including the premium paying term. It is denied that OP2 lured the complainant that the policy in question is a one-time policy. It is also denied that complainant had received the policy documents after a considerable period sometime in 2015. It is stated that the complainant himself was inclined to purchase a new policy and he signed the proposal forms, received the policy documents and did not avail free look period. It is also denied that OP2 forged documents to show the income of complainant as Rs.5 lakhs. This OP is prayed for dismissal of the case.
Point for Decision
- Whether the OPs have mis-sold the policy in question to the complainant?
- Whether the OPs have indulged in unfair trade practice?
- Whether the OPs are deficient in rendering services to the complainant?
- Whether the complainant is entitled to get the relief as prayed for?
Decision with Reasons
We have perused the documents on record i.e. Xerox copy of welcome letter, Xerox copy of premium receipt, Xerox copy of policy documents, Xerox copy of illustration of benefits, letter alleging fraud addressed to Manager, BharatiAxa, Kolkata dated 07-10-2015, Xerox copy of letter addressed to Ombudsman by the complainant dated 21-12-2015 and other documents on record.
The main allegation of the complainant is that OPs have mis-sold the subject policy to the complainant and complainant received the questioned policy being No.5012507447 sometime in the year 2015 and that the complainant as per the assurance of the OPs agent took the policy by issuing cheque no.141499 dated 15-10-2014 for Rs.31,000/- and the policy certificate was delivered in the year 2015. It is also alleged that OPs were reluctant to deliver the policy certificate and on asking the corporate agent, the said agent ad given out that due to the delay in official procedure it was getting late and ultimately complainant received the questioned policy sometime in the year 2015 and was astonished to see that the policy in question is not at all one time policy and the term of the policy in question was for 15 years and regular premium was to be paid up to 5 years at the rate ofRs.31,000/-. OPs., on the contrary, has stated that the policy along with policy bonds proposal form, benefit illustrations along with covering letter mentioning 15 days free look period was sent to the complainant immediately but the complainant did not avail the opportunity of 15 days time of free look period.
The welcome letter (covering letter) as we find does not bear any date. It is not dated. So, it becomes increasingly difficult on our part to ascertain when the covering letter along with signed benefit illustration proposal forms and policy bonds were sent to the complainant.Immediately after the issuance of policy or on which date the policy documents, certificate were sent to the complainant O.Ps. have produced any document to establish on which date complainant received the policy certificate along with other documents. So, we endorse the case of the complainant that after a lapse of considerable period the complainant received the questioned policy sometime in the year 2015. We also find that the complainant also alleged fraud to the Manager, BharatiAxa vide letter 07-10-2015 against the representation of the insurance broker. The complainant also alleged fraud addressing letter to the Ombudsman, Kolkata dated 22-12-2015. It is also alleged that the signatures in the policy bond were forged and the signatures on the illustrations are also forged. It is also stated that the income of the complainant has also been shown inflated as Rs.5 lakhs instead of Rs.2.5 lakhs. So, onus also shifts upon the OPs to disprove that the signatures appearing in the policy bond and also on the illustrations are not forged. It is also alleged that the phone number of the proposer was also wrong. So, we find that the insurance broker proposed a policy of single premium but actually it was a 15 year policy with paying term of 5 years. Moreover, we find that the complainant is a retired person. It is argued from the side of the complainant that he is a retired person and living on pension and under no circumstances, it can be accepted that he will invest in a policy term of 15 years. Considering the facts and circumstances having regard to the materials on record we think that the OPs have mis-sold the subject policy to the complainant. No question of availing free look period arises because the covering the letter of the policy documents does not contain any date and it appear that the policy documents were served upon the complainant long long after obtaining the policy by the complainant and the complainant got no chance to go through the policy documents including policy certificate illustrations etc. So, we are constrained to hold the OPs mis-sold the subject policy to the complainant.
In result, the case merits success.
Hence,
Ordered
That the instant case be and the same is allowed on contest against the Ops.
OPs are jointly and severally directed to refund the premium amount to Rs.31,000/- with 15 percent deduction thereto on non-standard basis to the complainant within one month from the date of this order apart from litigation cost of Rs.10,000/-.
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.
