Date of filing : 01/12/2016

Order No.  14  dt.  28/03/2018

          The case of the complainant in brief is that the complainant being the policy holder under o.p. LICI and the policy was issued in the name of the complainant. The complainant paid Rs.2 lakhs only to o.p. and obtained the Jeevan Akshay-VI Pension Scheme  for getting annuity for every month being policy no.494738048. LICI paid to the complainant annuity upto the month of October,2013. After the month of October,2013 the  o.p. insurance company failed to pay the legal dues to the complainant. The complainant made several representations before o.p. for payment of outstanding amount in respect of policy no.494738048. The complainant was asked to provide some documents to o.p. to which the complainant provided. The complainant was again asked to provide some documents which the complainant complied. As per the direction o.p. the complainant wrote a letter to CBI. Subsequently Manager, CRM of o.p. expressed his inability by sending a letter for releasing the amount in favour of the complainant. On the basis of the said fact the complainant filed this case praying for direction upon the o.p. for releasing the outstanding dues of the annuity and also prayed for compensation of Rs.50,000/- and litigation cost of Rs.15,000/-.

                The o.p. contested this case by filing w/v and denied all the material allegations of the complaint. It was stated that the subject insurance policy is involved in the list of 275 policies for which a case being no.RCO10102013A0035-CBI, ACB, Kolkatta has been registered by CBI subsequent to the detection of fraud for mis-utilization of huge fund of o.p. for issuing policy to different persons in collusion with various individuals. It was stated that the claim of the claimant is involved in a criminal conspiracy giving rise of criminal investigation by the CBI at the behest of o.p. Huge amount of public money appears to have been defrauded in the matter schematically. After detection of the fraud a complaint was lodged with the CBI and CBI started to investigate the case and they also asked the policy holders appear before the CBI and the questions were put by the CBI during the investigation to different policy holders. The complainant has claimed that he made the payment by cheque, but the complainant has miserably failed to disclose the encashment particulars of the payment of cheques. The complainant also avoided to disclose in his complaint petition regarding mode of payment of the 1^st premium i.e. whether the payment was made in cash or by cheque. But o.p. addressed to the Inspector, CBI, ACB, Kolkata the complainant has disclosed that he has made the payment of Rs.2 lakh in cash through the agent. The cheque of o.p. i.e. LICI was misused fraudulently for issuance of the policy no. 494738048 and therefore the policy stand void and the complainant is not legally entitled to receive any benefit under the void policies. During the investigation of the case it was found that a staff was also involved in the said fraud practiced upon the o.p. The complainant has taken step for suspending the said staff and the matter has been investigated by CBI and a charge sheet has already been submitted. Since this case relates to an extensive evidence is required for detection of fraud practiced by the complainant in collusion with the staff of o.p. therefore this Forum has got no jurisdiction to entertain into such dispute, thereby o.p. prayed for dismissal of the case.

      On the basis of the pleadings of parties the following points are to be decided:

1. Whether the complainant obtained the policy from o.p.?
2. Whether any fraud was detected by o.p.?
3. Whether there was any deficiency in service on the part of o.ps.?
4. Whether the complainant will be entitled to get the relief as prayed for?

Decision with reasons:

                All the points are taken up together for the sake of brevity and avoidance of repetition of facts.

                Ld. lawyer for the complainant argued that the complainant being the policy holder under o.p. LICI and the policy was issued in the name of the complainant. The complainant paid Rs.2 lakhs only to o.p. and obtained the Jeevan Akshay-VI Pension Scheme  for getting annuity for every month being policy no.494738048. LICI paid to the complainant annuity upto the month of October,2013. After the month of October,2013 the  o.p. insurance company failed to pay the legal dues to the complainant. The complainant made several representations before o.p. for payment of outstanding amount in respect of policy no.494738048. The complainant was asked to provide some documents to o.p. to which the complainant provided. The complainant was again asked to provide some documents which the complainant complied. As per the direction o.p. the complainant wrote a letter to CBI. Subsequently Manager, CRM of o.p. expressed his inability by sending a letter for releasing the amount in favour of the complainant. On the basis of the said fact the complainant filed this case praying for direction upon the o.p. for releasing the outstanding dues of the annuity and also prayed for compensation of Rs.50,000/- and litigation cost of Rs.15,000/-.

                Ld. lawyer for the o.p. argued that the subject insurance policy is involved in the list of 275 policies for which a case being no.RCO10102013A0035-CBI, ACB, Kolkatta has been registered by CBI subsequent to the detection of fraud for mis-utilization of huge fund of o.p. for issuing policy to different persons in collusion with various individuals. It was stated that the claim of the claimant is involved in a criminal conspiracy giving rise of criminal investigation by the CBI at the behest of o.p. Huge amount of public money appears to have been defrauded in the matter schematically. After detection of the fraud a complaint was lodged with the CBI and CBI started to investigate the case and they also asked the policy holders appear before the CBI and the questions were put by the CBI during the investigation to different policy holders. The complainant has claimed that he made the payment by cheque, but the complainant has miserably failed to disclose the encashment particulars of the payment of cheques. The complainant also avoided to disclose in his complaint petition regarding mode of payment of the 1^st premium i.e. whether the payment was made in cash or by cheque. But o.p. addressed to the Inspector, CBI, ACB, Kolkata the complainant has disclosed that he has made the payment of Rs.2 lakh in cash through the agent. The cheque of o.p. i.e. LICI was misused fraudulently for issuance of the policy no. 494738048 and therefore the policy stand void and the complainant is not legally entitled to receive any benefit under the void policies. During the investigation of the case it was found that a staff was also involved in the said fraud practiced upon the o.p. The complainant has taken step for suspending the said staff and the matter has been investigated by CBI and a charge sheet has already been submitted. Since this case relates to an extensive evidence is required for detection of fraud practiced by the complainant in collusion with the staff of o.p. therefore this Forum has got no jurisdiction to entertain into such dispute, thereby o.p. prayed for dismissal of the case.

                Considering the submissions of the respective parties it is an admitted fact that the complainant obtained the policyin the year 2013 issued by o.p. After detection of the fraud the payment of annuity was not provided to the complainant in respect of those policies. It is also found from the materials on record that the complainant prayed for challenging the said action of o.p. regarding not giving any effect of the policy issued by o.p. It is found from the materials on record that during the continuance of the policy o.p. noticed that a fraud was practiced in respect of 275 policy holders for which a staff of o.p. was also involved. On the basis of the said fact a complaint was lodged to CBI and CBI made an investigation and submitted charge sheet in respect of the said case. During the pendency of the investigation the complainant all on sudden rushed to this Forum stating inter alia that o.p. has not paid the annuity value. On perusal of the materials on record we find that the complainant has claimed that he paid the amount by cash, but he failed to produce the 1^st premium receipt. It is found from the materials on record that a fraud case was started on the basis of a complaint lodged by o.p. and the said investigation has been made by CBI and charge sheet has been submitted. It is an admitted fact that where the fraud has been alleged by o.p. and the complainant has stated that there was no fraud was committed by the complainant in collusion with the staff of o.p. thereby the said challenge and counter challenge by the parties can be considered by recording the evidence of both the parties at the time of hearing of the case before a competent Civil/ Criminal Court and the Consumer Forum cannot arrive at a finding of deficiency of service as reported in I (1993) CPJ 88 (NC). It is also found from the materials on record that 275 policies were manufactured by practicing fraud by the policy holders and the employee of o.p. for which the said fraud case has been started by CBI and the present complainant’s policy was also involved in the investigation of the said case. In view of the facts and circumstances as stated above, we hold that the case filed by the complainant has got no merit and the complainant while was asked to appear before CBI to have the investigation of the said case rushed to this Forum by filing this case to make himself absolve from any charge that he may have to face in respect of the case filed by CBI. Having regard to the facts and circumstance of the case we hold that the case filed by the complainant has got no merit and the complainant will not be entitled to get any relief as prayed for. Thus all the points are disposed of accordingly.

                Hence, ordered,

                That the CC No.499/2016 is dismissed on contest without cost against the o.p.