ORDER

SRI.H.R. SRINIVAS.  PRESIDENT

1.     This is the Complaint filed by the Complainant against the Opposite Party (herein referred to as OP) under section 35 of the Consumer Protection Act 2019 for the deficiency in service in not refunding (premium amount received) by OP in respect of the 4 policies issued and for refund of the same along with interest 18% per annum on the said premiums and for compensation of Rs.1,00,000/- each in respect of the said four policies and further direct OP to pay Rs.1,25,000/- towards first policy, Rs.3,00,000/- for 2^nd policy, and Rs.1,56,350/- in respect to 3^rd policy and Rs.3,00,000/- in respect of fourth policy and further direct OP to pay Rs.3,00,000/- for not giving promised business as compensation with interest at 18% per annum, and also Rs.70,000/- with up-to-date interest at 18% per annum received by the agents and employees of the OP and to refund Rs.1,53,376/- received through ECS facility towards the premium and Rs.30,000/- as legal expenses and to remove the blockage of his agency and to pay salary and other dues   and for such other reliefs as this Hon’ble District Commission deems fit.

2.     The brief facts of the complaint are that; with an intention to provide business to the complainant Op employees at HSR layout branch namely Bindu, Shishir, Mrs.Kalpana Sharma, Suprith lured him to make him as agent and that they would provide business to him worth Rs.2,00,000/- in the first year of business, and Rs.4,00,000/- during the 2^nd year and made him to purchase four insurance policies. The same was purchased by him in order to help one Kalpana Sharma the agent of OP by providing her a policy of annual premium of Rs.1,25,000/- to meet the target and to go abroad after reaching the target which she did not do.  The four policies issued was for 59 to 60 year term rendering useless for him as he is already 81 years old and no chance of living for 142 years . the matter was taken up with one Philip of head office and 2 to 3 times the meeting was held but the matter was not decided. By issuing four policies, OP has pocketed Rs.8,75,000/- as premium but did not cancel inspite of request. 

3.     All the above agents lured him to purchase the policies.  They have not kept the promises made by them at the time of selling the insurance policies.  After his demise (policy holder) the four policies legally will become property of the heirs. The insured would be at mercy of legal heirs to get the benefit of the policies. It do not become a direct gift to the insured. An insured has to go to the court to claim the policies. It further takes away purpose of the policies i.e. free from legal complications.  OP is totally responsible for issuing such an absurd, illegal policy though they have expert team of underwriters and lawyers.  The insurance Company get business through agents and employees and they give false assurance to the persons who wanted to purchase the insurance but do not fulfill the promises.  The same has put the complainant who is of 84 years of age to a great loss. 

4.     Further the said persons demanded Rs.50,000/- in addition to the Rs.20,000/- already paid to create a team of agents to work for the complainant. OP has used ECS facility in respect of the two policies when the same was protested, they agreed to return the same but still did not refund the same.  Instead of trying to solve the problem, OP has become more vindictive and blocked his agency, stopped his salary, commission and other dues, not carrying the guidelines issued at the time of pandemic COVID 19, and his salaries and dues cannot be stopped. He is the senior citizen of 84 years and he is a major premium contributor and awarded agent of the company and his agent code must be activated and prayed the commission to allow the complaint.

5.     Upon service of notice, OP appeared before the commission and contend that the complaint is not maintainable either on fact or on law and the same is filed with mala fide, dishonest, intention with twisted and distorted facts to suit his convenience and to mislead the commission and liable to be dismissed as the same is filed by misrepresenting the material fact.

6.     It is contended that the complainant is himself a direct insurance agent with OP with deep knowledge of various plans of insurance available in company and he wanted to provide the said policies as a gift to a grandson. Himself being the agent earned respective commission and was a part of event of the company which are held in luxuries properties for the purpose of facilitation of the top performers and was given him a laptop for qualifying in a context.  Complainant was an agent for three policies out of the four policies, which he purchased. He was also working as insurance agent for various other companies and well versed with the policies of issuing insurance and underlying features of the various insurance schemes.  The allegations made in this regard are all baseless or illogical. He has deliberately suppressed the material facts and as an agent of the OP misguided the commission.

7.     Complainant obtained Life Insurance Policies and he is the policy holder and executed proposal forms, benefit illustration and the associated declaration wherein the life assured is his grandson by name Shubh Dubey. They proposal forms clearly mentioned the plan opted and the number of premiums the customer has to pay, and the policy terms and period.  Further he being a self-sourced policies, the life assured was completely aware of the features of the plan opted by him. Thus the allegations of the complainant questioning the policy terms on the ground of his age and life expenstency are completely baseless and merely afterthought and procure cancellation policy because the risk is on the life of the life assured and the policy holder or the complainant.  In accordance with clause 10(1) and 8(1) of the Insurance Regulatory and development authority (protection of policy holders interest) Regulation 2017 every policy document sent by the OP is accompanied by the copy of the proposal form signed by the applicant /complainant with a forwarding letter clearly mentioning that in case the policy holder is not satisfied with the feature or terms and conditions of the policies he can withdraw or return the policy within 15 days from the date of receipt of the said policy under the Free Look cancellation period.       The same has not been exercised by the complainant.

8.     Further there is a clause of vesting on attaining majority, wherein if the policy is issued on the life of a minor, the policy shall become automatically vest on him or her (minor) from the date of completion of 18 years of age and the life insured would be holder of the policy from such date subject to assignment if any and the company shall thereafter enter into all correspondences directly with him or her. Death benefit shall be payable to the policy holder in case of death of the minor life insurance.  In case of death of policy holder during the policy when the life insured is still minor, the benefit shall be payable to the legal guardian of the minor life insured. 

9.     The policies issued to the complainant is under auto vesting which would have occurred within a period of three years from the commencement of the policy irrespective of the status of the policy holder.  The complainant being an agent is fully aware of the same and had self-sourced the policy after understanding the terms and conditions of the policy and further the same was also explained to him during the pre-insurance verification call in respect of the policy No.09256214 .  In view of the same, OP company cannot be held responsible for the negligence of the complainant.  There is no negligence on the part of OP or unfair trade practice which can be held liable in respect of the allegations made by the complainant. 

10.   Though the complainant received the policies and other documents in respect of the said insurance, he did not approach OP during free look period. Only at the time of renewal of the policy, he approached the OP with his concern. Since it is a self-sourced insurance obtained by himself which is very clear on perusal of the proposal form and the policy , the same cannot be changed  and cannot be altered and there is no discrepancies in the said policies. The insurance policy is a contract between the insured and the insurer and the terms and conditions of the policy are strictly binding on the parties. The proposal form submitted at the time of obtaining the insurance is not merely a document to be signed and submitted for formality. It is the basis of contract of insurance. It is the mode of providing the insurer the information so as to enable them to exercise a lawful right. OP has proceed to issue the policy on the basis of the information provided in the proposal form duly filled singed by the complainant himself with supporting documents.

11.   The prayer of the complainant is bad and in contravention of the interest of justice. The prayer regarding cancellation of four policies and refund of the premium paid towards the same with interest and compensation is neither permissible nor feasible as per the terms and conditions of the policy issued.  The complainant has paid only the subscription premium but has failed to pay the 1^st year policy premium. It is the sole responsibility of the policy holder to pay the premium well in time /within grace period. As a goodwill gesture, OP sent SMS and communicated the policy holder to pay the premiums whereas in this case complainant failed to make the future payment under the policy.  Complainant has to pay the premiums regularly including that of the previous year premiums, in case to regulariz and keep the insurance policy in force to avail and enjoy the full benefits under the policy.

12.   The complainant has failed to make out and demonstrate any kind of deficiency in service or attributed to any fault imperfection, shortcoming, or inadequacy in the matter of nature and performance which is required to be carried by it.

13.   Further before filing of this complaint before this commission, he had approached insurance ombudsman in the month of Feb 2021 and OP had filed its reply before the ombudsman and the ombudsman on 22.04.2021 dismissed the prayer of the complainant stating that OP has acted on the terms and conditions of the policy.

14.   The present complaint do not disclose any cause of action against the OP and since there is no deficiency of service which can be attributable to OP, prayed the commission to dismiss the same by denying all the allegations made in each and every para of  the complaint. 

15.   In order to prove the case, both the parties have filed their affidavit evidence and produced documents. Arguments Heard. The following points arise for our consideration:-

1) Whether the complainant has proved deficiency in service on the part of the Opposite Party?

2) Whether the complainant is entitled to the relief prayed for in the complaint?

16.   Our answers to the above points are:-

POINT NO.1 & 2 :    IN THE NEGATIVE.

                                For the following.

REASONS

POINT No.1 & 2:-

17.   On perusing the complaint, version, documents, evidence filed by  both the parties, it becomes clear that, the complainant obtained four insurance policies bearing No.09166838, 09203918, 09256214 and 09373805 for period of 60 years period (Policy term) agreeing to pay a premium for 12 years (Premium paying term).  The insured is his grandson by name Shubh Dubey who was a minor (15 years) at the time of purchasing the aforesaid four policies.  The four policies were delivered to the complainant by Blue Dart Courier which was handed over to the complainant on 14.03.2019, 19.04.2019, 04.06.2019 and 02.11.2019 respectively. Bonus option selected by the complainant was cash payout for policy No.09166838 and paid up Addition in respect of other policies. On survival of the life insurance till the end of policy terms, provided all the due premium on the date of maturity of the policy and the following shall be payable under cash payout option basic sum assured, plus cash bonus if any plus terminal bonus. Under paid up additions basic sum assured plus cash bonus plus accrued paid up additions plus terminal bonus and once the maturity benefit under the policies is paid the policy stands terminated.  The due date for the payment of the policy is also mentioned.  On perusing the complaint, there is no allegation of deficiency in service or unfair trade practice or imperfection in carrying out the services that the OP has provided to the complainant. 

15.   It is to be observed here that the complainant had made a complaint to the insurance ombudsman, Karnataka on the similar lines as averred in this complaint and the ombudsman has passed an award stating that “taking into consideration the facts and circumstances of the case, and the submissions made by both the parties during the course of personal hearing, the Forum finds that the Respondent Insurer (RI) acted as per the terms and conditions of the policy, and hence the complaint is disallowed” and rejected the complaint of the complainant. 

16.   It is to be noted here that, the complainant has obtained insurance in the name of his grandson Shubh Dubey who is aged about 15 years (minor) who is the actual beneficiary of the policies if the same is continued up to 60 years. That means, at the age of 75, his grandson would get the benefits of the policies provided he is alive at that time and the policy in force at that time. Further it is to be noted here that the premium payment period is only for 12 years and the policy period is for 60 years.  That means premium has to be paid for 12 years only.  In respect of policy No.09166838 the annual premium payable is Rs.1,24,999/- per annum  and the basic sum assured is Rs.13,55,428/-. In respect of policy No.09203918 premium payable Rs.2,99,999/- per annum and the basic sum assured Rs.32,53,043/-, in respect of policy No.09256214 premium payable in Rs1,56,750/- per annum and the basic assured Rs.16,99,715/- and in respect of policy No.09373805 premium payable in Rs.3,13,500/- per annum and the maturity amount is Rs.33,92,897/-. 

17.   Probably, not able to pay the premium or do not want to continue the insurance policies after purchasing, the complainant has filed this complaint.  On perusing the evidence adduced by both the parties, we are of the opinion that no deficiency in service or unfair trade practice has been made out agaisnt OP by the complainant.  So as to held the OPs responsible for ordering refund of the premium paid so far, the compensation as claimed and also the interest. Absolutely , no averment regarding deficiency in service, unfair trade practice, imperfection or miss-selling of the insurance policy. He himself is the agent and proposer and the policy holder. Whereas the beneficiaries /life insured is his grandson Shubh Dubey. Hence we answer POINT NO.1 IN THE NEGATIVE and the complainant is not entitle for any of the reliefs claimed. In case, the complainant do not want to proceed with the insurance he can as well surrender the same and receive the amount from OP as per the terms and conditions of surrendering the insurance policy. The option is left to the complainant. In case he wants to proceed with the insurance policies he has to pay the arrears of premiums along with the interest and penal interest and other charges regarding revival of the policies.  Further OP is directed to consider the request of the complainant in respect of his continuing agency sympathetically. With this, we answer POINT NO.2 IN THE NEGATVE and pass the following :

ORDER

1. The complaint is dismissed with cost.
2. Complainant is directed to pay cost of Rs.25,000/- towards legal and miscellaneous expenses to the OP.

3. Send a copy of this order to both parties free of cost.

Note: You are hereby directed to take back the extra copies of the Complaints/version, documents and records filed by you within one month from the date of receipt of this order.

(Dictated to the Stenographer over the computer, typed by him, corrected and then pronounced by us in the Open Commission on this day the 14^th day of SEPTEMBER 2022)

MEMBER         MEMBER       PRESIDENT

ANNEXURES

1. Witness examined on behalf of the Complainant/s by way of affidavit:

Copies of Documents produced on behalf of Complainant/s:

Ex P1: Copy of the Email correspondence.

Ex P2: Copy of the letter issued by the office of the insurance ombudsman.

Ex. P3: Copy of the email correspondences.

2. Witness examined on behalf of the Opposite party/s by way of affidavit:

RW-1: Metaiah Raghavendra, Manager-Branch of OPs

Copies of Documents produced on behalf of Opposite Party/s

Ex R1: Copy of the authority letter issued by the company.

Ex R2: Copy of the agent appointment letter.

Ex R3: copy of the agent confidential report.

Ex R4: Copy of the IRDAI agency portal print screen.

Ex R5: Copy of the Print screen of interview.

Ex R6: Copy of the proposal form.

Ex R7: Copy of the policy documents.

Ex R8: Copy of the reply.

Ex R9: Copy of the letter dated 08.02.2021.

Ex R10. Copy of the letter issued by OP.

Ex R11: Copy of the proceedings.

Ex R12: Copy of the letter written by OP to complainant.

MEMBER         MEMBER       PRESIDENT

RAK*