Order-14.
Date-31/08/2017.
Shri Kamal De, President.
This is an application u/s.12 of the C.P. Act, 1986.
OP1 is an insurance company. OPs2, 3 and 4 are officials of OP1. OP4 is an agent of OPs1 to 3. Being influenced by OP4 that there is a system of one time premium of life insurance policy amount of which can be drawn after completion of 3 years the complainant handed over two cheques bearing No.070471 and 749812 of Rs.1,50,000/- each on 30-06-2009 as against two life insurance policies from OP Company in the name of himself and nominee being wife of the complainant to the said agent. On 15-07-2009 the insurance company sent the original insurance policy certificate with first premium receipt for the life insurance bearing no.00171093 and the first premium receipt vide memo being no.50427873/00171093/KOL dated 28-03-2014. On 29-07-2009 the company also sent the original insurance policy certificate along with first premium receipt for the life insurance bearing No.00176422, the commencement date was 14-07-2009 and risk commencement date started from 29-07-2009. It is stated that at the time of paying for the policy the agent informed that the policies of insurance would be one-time payment. In the year 2013 after passing of 3 years the complainant required some money for personal needs, accordingly he approached the company at Kolkata for withdrawal and refund of the dues for these two policies but surprisingly he was informed by the company that the policies were of regular nature and those two policies are not single premium policy and every year Rs.1,50,000/- each was to be paid for each policies for 10 years. In spite of repeated appeal insurance policy did not take any action. The complainant also made various correspondences with the company for cancelling the two policies and to pay but OPs did not take any action. It is stated that as per the premium discontinuance clause 5.5.1 of Life Insurance of IRDA, the company was to give a notice if the premium is not paid after the due date i.e. after one year but company and other parties did not give any notice informing the complainant that one year has elapsed and premium needed to be paid for both the policies. The complainant has prayed for refund of Rs.3 lakhs towards premium paid to the OPs along with other reliefs in terms of prayer in the petition of complaint.
OPs have contested the case by filing written version contending, inter alia, that the complainant had applied as a proposer and life to be insured for the future guarantee ULIP Plan through two duly filled and signed proposal forms bearing application No.FG0013904 and FD00129805 dated 01-07-2009 and 14-07-2009 respectively. The complainant also provided declaration in the proposal forms and in the benefit illustrations that he understood the sales literature, benefit illustrations statements before entering into the contract etc. etc. Company relying upon the statements, answers and declarations provided by the complainant issued life insurance policies in question. It is stated that the policies had been issued strictly in accordance with the proposal forms. Moreover, the complainant was well informed that in case of any dissatisfaction and disagreement with any of the terms and conditions of the policy the complainant shall have the option to cancel/withdraw and return the policies within 15 days from the date of receiving the documents stating therein the reason of such dissatisfaction and disagreement but no policy cancellation request was ever preferred by the complainant within the freelook period. It is also stated by the OPs that the present complaint is barred by limitation and complainant has not annexed any document which goes to show that the cause of action has arisen between the parties within two years from the date of filling of the instant complaint. The OPs have prayed for dismissal of the case.
Point for Decision
- Whether the OPs have mis-sold the subject insurance policies being Unit Linked Insurance Plan to the complainant?
- Whether the case is hit by limitation?
- 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 Pan Card, Xerox copies of voter card, Xerox copies of money receipts, Xerox copies of policy certificates, Xerox copies of letters dated 14-08-2014 addressed to the complainant, Xerox copy of letter dated 23-05-2013 addressed to the complainant by the insurance company.
The question is whether the OPs mis-sold the policies to the complainant to say it otherwise, whether the OPs bagged the policies in question from the complainant through misrepresentation? It is stated by the complainant that complainant was lured by the promise that the subject policies are single premium policies. We find from the proposal forms that the complainant had applied as proposer and life to be assured for the future guarantee ULIP Plan through two duly filled up and signed proposal form being application No.FG0013904 and FD00129805 dated 01-07-2009 and 14-07-2009 respectively. The said proposal forms were signed in English and the complainant had mentioned his profession as a Scientist, thereby indicating he was sufficiently educated and was in a position to read and understand the contents of the proposal form. The said proposal forms mentioned that an instalment premium of Rs.1,50,000/- is payable at an yearly basis for 10 years with the policy maturing after 10 years as a whole. The complainant also provided declaration in both the proposal forms that he understood the questions in the proposal form and he was also provided the sales literature and benefit illustration in relation to the product being purchased by him and the contents of the proposal forms have been fully explained to him. The complainant had also signed in English in each page of the benefit illustrations dated 01-07-2009 and 14-07-2009 respectively. Moreover, the complainant had option to cancel/entry and returned the policies within 15 days from the date of receiving the policy documents stating therein the reasons for such dissatisfaction or disagreement but we find that no policy cancellation request was every preferred within the freelook period. We also find from the documents on record that for policy no.00171093, the policy documents were despatched on 16-07-2009 through Express IT Courier Airway Bill No.2784261001 and delivered to the complainant on 23-07-2009. Hence, the free look period had expired on 06-08-2009. Further for policy No.00176422, the policy documents were despatched on 30-07-2009 through Blue Dart Courier Airway Bill No.32594531686 and delivered to the complainant on 31-07-2009. Hence, the freelook period expired on 14-08-2009.
It is pertinent to note that complainant has not denied signing the proposal form and benefit illustrations. Moreover, it is difficult to fathom that the complainant being an educated person and a scientist had applied for the subject policies without reading or understanding the contents of the proposal forms and benefit illustrations. So, it can be safely inferred that complainant had on his own volition and accord obtained both the policies being fully aware about the subject policies. It becomes increasingly difficult to presume that complainant did not go through the terms and conditions of the policies within three years from obtaining subject policies. Moreover, we find that in the first premium receipt and policy schedule, the next premium due date has been clearly mentioned and it has been mentioned that premiums of Rs.1,50,000/- are payable yearly for 10 years. We also find that the complainant approached the Company with the policy cancellation request for the first time on 17-05-2013 i.e. in the 4th policy year. It appears that the complainant preferred cancellation after a lapse of more than 4 years after expiry of free look period. It would not be out of place to mention here that it has been held by Hon’ble Apex Court in catena of judgments that an insurance policy is to be construed strictly as per the terms and conditions of the policy document and no deviation from the same is permissible.
Considering the facts and circumstances and having regards to the materials and proposal forms on record it becomes increasingly difficult on our part to hold that the OPs mis-sold the subject policies to the complainant or OPs through misrepresentation to the complainant bagged the policies in question for ulterior gain with mala fide motive.
The argument on the point of limitation as advanced from the side of the OP is not sustainable because we find that the OPs made correspondences with the complainant vide letters dated 23-05-2013, 14-08-2014 and even vide letter dated 09-07-2014 and even vide letter dated 23-05-2013.
Consequently, the case merits no success.
Hence,
Ordered
That the instant case be and the same is dismissed on contest against the OPs.
The complainant, however, reserves the right to get any deducted sum against the policies if permissible under the terms and conditions of the subject policies from the OP-Insurance Company.
No order as to cost.
