M. Vasantha Krishna Case of:- Mr. Natarajan Sivasurya V/s ...

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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, AHMEDABAD State of Gujarat and Union Territories of Dadra, Nagar Haveli and Daman & Diu

(Under Rule No: 16/17 of The Insurance Ombudsman Rules, 2017)

Ombudsman: M. Vasantha Krishna Case of:- Mr. Natarajan Sivasurya V/s HDFC Life Insu. Co. Ltd.

Complaint Ref No. : AHD-L-019-1718-0246 Award No. IO/AHA/A/LI/0004/2018-2019

1 Name and address of

the Complainant

Mr. Natarajan S Sivasurya,

99/591, Vijaynagar

Opp: Verai Mata Mandir,

Naranpura, A’bad-380013

2

Policy No:

Type of Policy

D.O.C

18483145

HDFC Life Personal Pension Plus

30/05/2016

3 Name of the L.A

Name of the Proposer

Mr. Natarajan Sivasurya

Mr. Natarajan Sivasurya

4 Name of the insurer HDFC Life Insu. Co.Ltd.

5 Date of Repudiation Not applicable

6 Reason of repudiation Not applicable

7 Date of receipt of complaint 16/06/2017

8 Nature of complaint Mis-sale;

request for policy cancellation rejected

9 Amount of relief sought Rs.94,880/-

10 Date of receipt of VI-A / SCN 27/06/2017 / 14/06/2018

11 Complaint registered under Rule. Section 13 (1) (d) of the I.O. Rules, 2017

12 Date of hearing/place 30/11/2018 / Ahmedabad

13

Representation at the hearing:

For the Complainant

For the Insurer

Mr. Natarajan

Ms. Shikha Dedhia

14 Complaint how disposed Award

15 Date of Award / Order 29/03/2019

16. Brief facts of the case:

The Complainant claims that he received a call from New Delhi, promising pension from 6th year

on purchasing a life insurance policy and after paying premium for 5 years. Being convinced

with the proposition, he took the policy but received the policy with premium paying term of 10

years He then understood that he had been cheated. He had sent complaints to the Insurer

alleging malpractice and unfair business practices. He also requested the respondent insurer to

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convert the policy to one with 5 years premium paying term or cancel the policy and refund the

premium but the same was rejected. He has therefore requested this Forum to intervene and

get the premium refunded.

17. Arguments during the Hearing:-

A. Complainant’s contention:

The complainant submitted that the respondent insurance company canvassed with him for

the sale of a pension benefits policy through telephone calls from their Delhi Office with lot

of misrepresentation/suppression of material facts/fraudulent promises, while taking care to

ensure that no records were available with the customer to establish such

misrepresentations / suppression of material facts / fraudulent promises / assertions etc. He

was cunningly convinced to purchase the policy with the promise of pension from 6th year

after 5 years of premium payment. The caller managed to collect the cheque towards first

year premium and his signature in haste and did not allow him time to study the documents.

The insurance company had issued him a policy totally contrary to the discussions /

promises given. When the policy was posted to his address, he was out of station. Hence

he was not able to return the policy for cancellation within 15 days / one month, as he had

found that the premium paying term was 10 years instead of 5 years. He wrote to Grievance

Manager of the insurer on 03/01/2017 to get the policy converted in to one with 5 years

premium paying term or alternatively for cancellation of the policy and refund of premium.

But his efforts were deceptively and deviously evaded by the insurance company. He was

frustrated with the amount of lies and deception the insurance company was indulging in to

cheat the customers and deprive them of their hard earned money. His request was

declined by the insurance company through e-mail dated 21/05/2017 on the ground that

cancellation request was not received within free look period. He once again wrote to the

Grievance Manager of the insurer on 19/06/2017 for cancellation of the policy to which the

insurer was yet to respond. Since the sale was done through fraud & false promise, he

requested the Forum to direct the respondent insurer to refund the premium along with

interest and penalties.

B. Insurer’s contention:

The representative of insurance company submitted that after receipt of the duly filled and

signed proposal form along with the other relevant documents and the subscription premium

amount, the Company had issued the subject policy in favor of the complainant. The same

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was delivered to the complainant’s registered address through courier on 10/06/2016. She

confirmed that complaints were received by them from the complainant regarding

malpractices and unfair business practices and that the Insurance company had denied all

the allegations and averments made by the complainant. She added that the Insurance

Company was in receipt of a request for cancellation of policy from the complainant which

was refused on the ground that the said request was made after expiry of free look period of

15 days. Therefore, the Company could not find any ground to accede to the request for

cancellation of the policy & refund of premium. The complainant had approached

Ombudsman and had also raised his concerns vide letter dated 14/09/2017. The Insurance

Company as a matter of goodwill gesture had proposed for refund of premium vide letter

dated 15/09/2017 and the complainant had submitted the requisite documents on

18/09/2017. The Insurance Company had cancelled the policy and an amount of

Rs.95,000/- was refunded through NEFT on 22/09/2017. But now the complainant is

claiming interest which is an afterthought. It is pertinent to mention that the complainant is

not entitled to receive any such interest as the premium was refunded after his consent

which was received on 18/09/2017. She also added that the Pre- Issuance Verification Call

clearly mentions premium payment term as 10 years and not 5 years as alleged by the

complainant. It was also the contention of the insurer that the policy had been sourced by

an independent insurance broker, namely, S.B. Insurance Brokers and that the insurer

neither privy to nor bound by any communication/assurances/transactions made/taken or

given between the complainant and the broker. Under the circumstances, it is submitted that

the complaint is devoid of any substance and is without merit.

18. Result of hearing (Observation & Conclusion):

1. After the complainant approached this Forum, the respondent insurer had offered to refund

the premium to the complainant as a goodwill gesture which was accepted by the

complainant. He also signed a declaration accepting a refund only of the premiums paid by

him in full and final discharge of all liabilities by the insurer, based on which the policy was

cancelled and the premium amount of Rs. 95,000 was refunded by the insurer on

22/09/2017.

2. The Forum is of the view that having accepted the amount of Rs. 95,000 in full and final

settlement, discharging the insurer from any further liability, the complainant is not entitled

to any interest as claimed by him.

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AWARD

Taking into account the facts & circumstances of the case and the submissions

made by both the parties, The Forum finds no merit in the complainant’s claim for

interest.

Hence the complaint is not admitted.

19. In case the complainant is dissatisfied with the decision of the Forum, he may approach any

other forum or appropriate court of law, as thinks fit.

Dated at Ahmedabad on 29th March, 2019.

M. Vasantha Krishna

Insurance Ombudsman


(Under Rule No: 16/17 of The Insurance Ombudsman Rules, 2017) Ombudsman : M. Vasantha Krishna

Case of:- Mr. Anandkumar R Tadvi V/S Future Generali India Life Ins. Co. Ltd Complaint Ref No. : AHD-L-017-1718-0265

Award No. : IO/AHD/A/LI/0002/2018-2019 1 Name of the Complainant & Address

of the complainant.

Mr. Anandkumar R Tadvi,

27, Niranjan Park, B/H Rangvatika, Nr Old

Bapod Jakat Naka, Waghodia Road, Baroda

2 Policy No:

Type of Policy

D.O.C

1309605

Future Generali Assured Money Back Plan

30-08-2016

3 Name of the L.A


Mr. Anandkumar R Tadvi


4 Name of the insurer Future Generali India Life Ins. Co. Ltd.

5 Reason of repudiation Request for cancellation of policy

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not within free look period


7 Nature of complaint Refusal of request for free-look cancellation

8 Amount of Claim Rs 100000/-

11 Amount of relief sought Rs 100000/- plus Rs 20000 for

mental harassment and interest

12 Date of receipt of Consent/SCN 05/07/2017 / SCN not received

13 Complaint registered under Rule No. Rule13-1-b of IO Rules, 2017

14 Date of hearing/place 30/11/2018/Ahmedabad

15 Representation at the hearing:

For the Complainant

For the Insurer


Mr Nitesh Jain


17 Date of Award/Order 29/03/2019


The complainant was insured under the Future Generali Assured Money Back Plan Policy of the

respondent insurer. The policy was canvassed by the complainant’s father Mr. Ramanbhai Tadvi as

he was having agency with the insurer. The complainant returned the policy for cancellation to the

local office of the insurer within the free look period. The insurer did not consider his request within

free look period though he had produced the proof of dispatch of his request for cancellation by

speed post. Thus he was cheated by the insurance company by considering the application for

cancellation as being made after three months and not within the free look period. The complainant

has therefore approached the Forum seeking justice.

19. Arguments of the Complainant:

The complainant submitted that he was insured under the policy as mentioned above. The policy

was placed through the agency of his father. After receiving the policy, he was not satisfied with the

terms and the conditions mentioned therein. Hence he made a request to the insurer within the free

look period to cancel the policy. The request for cancellation was sent by speed post to the local

branch office of the insurance company which was not responded to by the company. Later he

represented the case to the Grievance Redressal Officer (GRO) of the insurer. The insurer

considered the said representation to be the application for cancellation and denied the request on

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the ground it was made beyond the free look period. Aggrieved with the decision of the insurer, the

complainant has approached this Forum for justice.

20. Arguments of the Respondent:

The insurer’s representative submitted during the hearing that although the complainant had sent

the policy bond through speed post, it was not accepted as it was sent in the name of Manager,

Future Generali, Vadodara Branch and the Branch runs with multiple channels and with multiple

Managers.

21. Result of hearing (Observations & Conclusion):

1. The request for the cancellation was made within free look period. The complainant has

produced the evidence thereof by way of speed post receipt which shows that request for

cancellation along with policy bond was sent on 10.9.2016, within 15 days from date of coverage of

30.08.2016.

2. The respondent insurer admitted to the fact that the complainant sent the policy bond for

cancellation by speed post. However he argued that it was not properly addressed and since the

local branch of the insurer runs with multiple channels with multiple managers, the request of the

complainant was not acted upon. This argument of the insurer is unconvincing and untenable. The

speed post receipt submitted by the complainant reveals that his communication was properly

addressed to the insurer’s Vadodara office and it was up to the insurer to ensure that the

communication was forwarded to the right channel/manager for necessary action. They utterly

failed to do so.

3. The Forum therefore concludes that the request for cancellation of policy was made by the

complainant well within the free look period. The insurer should therefore honour the request,

cancel the policy and refund the premium to the complainant. The Forum has no jurisdiction to

award compensation for mental harassment as claimed by the complainant.

4. The Forum regrets to note non-submission of SCN by the insurer and records its strong

disapproval over the same.

AWARD

Taking into account the documents submitted to the Forum and the submissions

made during the hearing the Forum, hereby, directs the Respondent Insurer to cancel

the policy and refund the premium Rs 100000/- to the Complainant along with interest

as provided under Rule 17(7) of the Insurance Ombudsman Rules, 2017.

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22 The attention of the Complainant and the Insurer is hereby invited to Rules 17(6) and 17(8) of the Insurance Ombudsman Rules, 2017 as follows. a) According to Rule 17(6) of Insurance Ombudsman Rules, 2017, the Insurer shall comply with

the award within thirty days of the receipt of the award and intimate compliances of the same to the Ombudsman.

b) According to Rule 17(8) of the said Rules, the award of Insurance Ombudsman shall be binding on the Insurers.


M. Vasantha Krishna Insurance Ombudsman


(Under Rule No: 16/17 of The Insurance Ombudsman Rules, 2017) Ombudsman : M. Vasantha Krishna

Case of:- Mr. Anandkumar R Tadvi V/S Future Generali India Life Ins. Co. Ltd Complaint Ref No. : AHD-L-017-1718-0265

Award No. : IO/AHD/A/LI/0002/2018-2019 1 Name of the Complainant & Address

of the complainant.

Mr. Anandkumar R Tadvi,

27, Niranjan Park, B/H Rangvatika, Nr Old

Bapod Jakat Naka, Waghodia Road, Baroda

2 Policy No:

Type of Policy

D.O.C

1309605

Future Generali Assured Money Back Plan

30-08-2016

3 Name of the L.A




4 Name of the insurer Future Generali India Life Ins. Co. Ltd.

5 Reason of repudiation Request for cancellation of policy

not within free look period


7 Nature of complaint Refusal of request for free-look cancellation

8 Amount of Claim Rs 100000/-

11 Amount of relief sought Rs 100000/- plus Rs 20000 for

mental harassment and interest

12 Date of receipt of Consent/SCN 05/07/2017 / SCN not received

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13 Complaint registered under Rule No. Rule13-1-b of IO Rules, 2017

14 Date of hearing/place 30/11/2018/Ahmedabad

15 Representation at the hearing:

For the Complainant

For the Insurer


Mr Nitesh Jain


17 Date of Award/Order 29/03/2019


The complainant was insured under the Future Generali Assured Money Back Plan Policy of the

respondent insurer. The policy was canvassed by the complainant’s father Mr. Ramanbhai Tadvi as he

was having agency with the insurer. The complainant returned the policy for cancellation to the local

office of the insurer within the free look period. The insurer did not consider his request within free look

period though he had produced the proof of dispatch of his request for cancellation by speed post. Thus

he was cheated by the insurance company by considering the application for cancellation as being

made after three months and not within the free look period. The complainant has therefore

approached the Forum seeking justice.

19. Arguments of the Complainant:

The complainant submitted that he was insured under the policy as mentioned above. The policy was

placed through the agency of his father. After receiving the policy, he was not satisfied with the terms

and the conditions mentioned therein. Hence he made a request to the insurer within the free look

period to cancel the policy. The request for cancellation was sent by speed post to the local branch

office of the insurance company which was not responded to by the company. Later he represented the

case to the Grievance Redressal Officer (GRO) of the insurer. The insurer considered the said

representation to be the application for cancellation and denied the request on the ground it was made

beyond the free look period. Aggrieved with the decision of the insurer, the complainant has

approached this Forum for justice.

20. Arguments of the Respondent:

The insurer’s representative submitted during the hearing that although the complainant had sent the

policy bond through speed post, it was not accepted as it was sent in the name of Manager, Future

Generali, Vadodara Branch and the Branch runs with multiple channels and with multiple Managers.

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21. Result of hearing (Observations & Conclusion):

5. The request for the cancellation was made within free look period. The complainant has produced the

evidence thereof by way of speed post receipt which shows that request for cancellation along with policy bond

was sent on 10.9.2016, within 15 days from date of coverage of 30.08.2016.

6. The respondent insurer admitted to the fact that the complainant sent the policy bond for cancellation by

speed post. However he argued that it was not properly addressed and since the local branch of the insurer

runs with multiple channels with multiple managers, the request of the complainant was not acted upon. This

argument of the insurer is unconvincing and untenable. The speed post receipt submitted by the complainant

reveals that his communication was properly addressed to the insurer’s Vadodara office and it was up to the

insurer to ensure that the communication was forwarded to the right channel/manager for necessary action.

They utterly failed to do so.

7. The Forum therefore concludes that the request for cancellation of policy was made by the complainant well

within the free look period. The insurer should therefore honour the request, cancel the policy and refund the

premium to the complainant. The Forum has no jurisdiction to award compensation for mental harassment as

claimed by the complainant.

8. The Forum regrets to note non-submission of SCN by the insurer and records its strong disapproval over the

same.

AWARD

Taking into account the documents submitted to the Forum and the submissions made

during the hearing the Forum, hereby, directs the Respondent Insurer to cancel the

policy and refund the premium Rs 100000/- to the Complainant along with interest as

provided under Rule 17(7) of the Insurance Ombudsman Rules, 2017.

23 The attention of the Complainant and the Insurer is hereby invited to Rules 17(6) and 17(8) of the Insurance Ombudsman Rules, 2017 as follows.

A) According to Rule 17(6) of Insurance Ombudsman Rules, 2017, the Insurer shall comply with the award within thirty days of the receipt of the award and intimate compliances of the same to the Ombudsman.

B) According to Rule 17(8) of the said Rules, the award of Insurance Ombudsman shall be binding on the Insurers.


M. Vasantha Krishna Insurance Ombudsman

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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF KARNATAKA

(UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN –NEERJA SHAH In the Matter of MR. PRAKASH.G.V. V/s EXIDE LIFE INSURANCE COMPANY LIMITED

Complaint No: BNG-L-025-1819 – 0252 Award No: IO/BNG/A/LI/0346/2018-2019

1. Name & Address of the Complainant

Mr.G.V. Prakash # 531/5, ‘Sumukh’ G.F. 14th ‘A’Cross, 12th ‘A’ Main ‘A’ Sector, Yelahanka New Town Bangalore – 560064 (M):9845189952 e-mail:[email protected]

2. Policy No: Type of Policy: Name of the Policy: Commencement of Policy/ Policy Period/PPT

03813439 Life Exide Life Guaranteed Income Insurance Plan 28.07.2018 15 Years/ 7 Years

3. Name of the Insured Name of the Policyholder

Mr G.V. Prakash

4. Name of the Respondent Insurer Exide Life Insurance Company Limited

5. Date of Repudiation/ Rejection 19.09.2018

6. Reason for repudiation/ Rejection Cancellation of policy not allowed beyond ‘cooling off period’

7. Date of receipt of Annexure VI-A 15.10.2018

8. Nature of complaint Mis-sale

9. Amount of claim ₹. 50,000/- + Interest

10. Date of Partial Settlement N A

11. Amount of relief sought ₹. 50,000/- + Interest

12. Complaint registered under Rule No

13(1) (c) & (d) of Insurance Ombudsman Rules, 2017

13. Date of hearing/place 18.03.2019 - Bengaluru

14. Representation at the hearing

a) For the Complainant Self

b) For the Respondent Insurer

Mr. Mukund Sharma – Manager Legal

15. Complaint how disposed Allowed

16. Date of Award/Order 21.03.2019

17. Brief Facts of the Case: The complaint emanated from the alleged mis-sale of the said policy by the agents/Brokers of the Respondent Insurer (RI). In spite of his representations to GRO, his request was denied. Being aggrieved, he has approached this forum.

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18. Cause of Complaint: - a. Complainant’s argument: The Complainant vide his letter dated 28.09.2018 that he was cheated by the representatives of the RI by promising health insurance package, for the entire family for the next 15 years and ₹. 8 lakhs on surrender after 15 years. When he represented the issue to the officials of the RI, they informed the complainant that he would be receiving the medical health insurance policy in the next 45 days. But even after the long wait nothing has happened and these agents/brokers/officials remained incommunicado. Realising fraud, he has approached this Forum for cancellation of the said policy and refund of premium paid. b. Respondent Insurer’s argument: The RI vide their SCN dated 17.12.2018 has admitted to the issuance of the said policy after receipt of all requirements from the Complainant in order. The said policy was issued and sent to the Complainant along with ‘Cooling Off Cancellation’ clause which stipulates that in the event of the Complainant not being satisfied with the terms and conditions of the policy, he could cancel the same within 15 days from the date of receipt of the policy bond. The features, benefits, terms and conditions of the policy were explained in detail to the Complainant and Complainant availed the said policy only after understanding the policy conditions, benefits, and its features of the policy. The Complainant has not alleged forgery and hence he is estopped from denying the contents of the proposal forms signed by him at the proposal stage. The Complainant has not reverted back to the Company during the cooling off period and lately has brought vague, ambiguous, and evasive plea that the said policy was mis-sold to him on the assurance of medical assurance and incorrect policy benefits. The RI denies such allegation as vague baseless and devoid of any merits. Further the Complainant has adequate financial capacity to pay the premium. As the Complainant has not submitted any proof of mis-selling, and he did not avail the opportunity of ‘Cooling Off Cancellation’ the Company rejected his request of delayed ’cooling off cancellation’. The RI has prayed the Forum that condonation of delay in approaching the RI would lead to mis-carriage of justice and has prayed the Forum to dismiss the said complaint. 19. Reason for Registration of complaint: - The complaint falls within the scope of Insurance Ombudsman Rules, 2017 under Sec 13(1)(d) and hence, it was registered. 20. The following documents were placed for perusal: -

a. Complaint along with enclosures,

b. Respondent Insurer’s SCN along with enclosures and

c. Consent of the Complainant in Annexure VIA &and Respondent Insurer in VII A.

21. Result of personal hearing with both the parties (Observations & Conclusions): The issue to be decided by the Forum is whether this is a case of mis-sale? During the personal hearing on 18.03.2019 the Complainant reiterated his earlier stand. From the records placed before the Forum it is observed that the Complainant wanted a medical health insurance package along with the above policy. But he was sold a traditional life insurance policy only which was totally at variance with the requirements. During the hearing the Complainant informed the Forum that he would like to continue this policy only if it included medical health policy to which the RI informed that they do not have mediclaim policy to offer. Hence, the Forum concludes that the medical

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health insurance package sought by the Complainant along with life insurance was not sold to him. Therefore the ‘Mis-Sale’ is established. The representatives of the RI strongly defended the case and informed the Forum that they had taken a decision to cancel the said policy under ‘cooling off cancellation’ by waiving the delay. Since the issue is of ‘Mis-Sale’ the RI should have cancelled the policy on the date of receipt of complaint i.e. 11.09.2018. Instead they have now come forward to return the premium amount after 6 months under ’Cooling Off Cancellation’. In view of Mis-Sale the RI is liable to refund the full premium amount with interest.

AWARD Taking into account, the facts & circumstances of the case, and the submissions made by both the parties during the course of Personal hearing, the RI is directed to refund total premiums received together with interest at 8.25%(6.25% bank rate +2% as per Regulation 14(2)(ii) of Policy Holders Protections Rules 2017) from the date of filing the complaint i.e. 11.09.2018 till the date of payment. Hence, the complaint is ‘Allowed’.

22) Compliance of Award:

The attention of the Complainant and the Respondent Insurer is hereby invited to the provisions of the Insurance Ombudsman Rules, 2017, whereby, the Complainant is directed to submit all the requirements/documents required for settlement of award within 15 days of receipt of the award to the Respondent Insurer. According to Rule 17 (6) of the said Rules, the Respondent Insurer shall comply with the Award within 30 days of the receipt of the Award and shall intimate compliance of the same to the Ombudsman. Dated at Bengaluru on 21th day of March 2019

(NEERJA SHAH) INSURANCE OMBUDSMAN

FOR THE STATE OF KARNATAKA

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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF

KARNATAKA (UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – NEERJA SHAH

Case of: Mrs. PREMILA MENON V/s PNB MET LIFE INDIA INSURANCE COMPANY LIMITED

Complaint No: BNG-L-033- 1819-0058 & 0059

Award No: IO/BNG/A/LI/350, & 0351/2018-2019

1. Name & Address of the

Complainant

Mrs. Premila Menon

Delphi-2 Flat No 404,

Prestige Acropolis, No 20, Hosur Road

Next to Forum Mall

Koramangala, Bangalore -560029

(M): 9845179037

E-mail: [email protected]

2. Policy No:

Type of Policy:

Name of the Policy:

Commencement of Policy:

Policy Period/ Premium Paying

Term:

Premium amount in Rupees

22098384 22218578

ULIP - Life ULIP -Life

Met Smart Platinum

New

Met Smart Platinum-

New

27.02.2017 13.06.2017

41 Years/10 Years 41 Years/10 Years

₹.4,00,000/- ₹.4,00,000/-

3. Name of the Insured

Name of the Policyholder

Mrs. Premila Menon

4. Name of the Respondent Insurer PNB MET Life Insurance Company Limited

5. Date of Repudiation/Rejection 11.04.2018

6. Reason for repudiation/Rejection Policy Cancellation Request received beyond

Cooling Off period


8. Nature of complaint Fraudulent mis-Sale of the above 2 policies

9. Amount of claim ₹. (1)4,33,333/- (2) ₹.4,00,000/-

10. Date of Partial Settlement Nil

11. Amount of relief sought ₹.8,33,333/-

12. Complaint registered under Rule

No:

13 (1) (c) of Insurance Ombudsman Rules, 2017

13. Date of hearing/place 18.03.2019/Bengaluru



b) For the Respondent

Insurer

Mr. Sagar -- ASM



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17. Brief Facts of the Case:

The complaint emanated from the alleged fraudulent mis-sale of the said 2 policies by the associates of

Respondent Insurer (RI). In spite of her representation to G.R.O. of the RI, seeking cancellation of the

policies, the G.R.O. declined her request as the same was received by them beyond the ‘Cooling Off

Period’. Hence the Complainant approached this Forum for cancellation of hers policies and refund the

premium thereon.

18. Cause of Complaint: -

a. Complainant’s argument: The Complainant had an old policy with RI wherein she had been paying the premium regularly for the

past 10 years. During the year January 2017, she went to the office of RI to close the old policy as she

had some urgent financial commitment. The sales representatives of the RI convinced the Complainant

that she could avail an insurance cover of over 10 times the single premium i.e. for ₹. 40,00,000/- by

paying a single premium of ₹. 4,00,000/-. The sales representatives also advised the Complainant to

redeem the old policy and in 2 instalments so that the Complainant could avoid some penalty. The first

policy was made in January 2017 and the second policy was made in June 2017. The premium for both

the policies were paid from the proceeds of the old policy. When she received the policy documents,

she was shocked to know that the both the policies were issued for an annual premium of ₹. 4,00,000/-

for a period of 10 years. Though the Complainant informed the sales representatives that she was a

senior citizen without any pensionary benefits, the Sales representatives insisted that she need not worry

and that they would look after the issue. Subsequently the Complainant started getting reminders and

calls from the office of RI to pay renewal premiums. When the Complainant confronted the associates of

the RI, they asked the Complainant to ignore the tele calls. In the month of March 2018, the associates

of the RI came to Complainants house and asked the Complainant to pay an additional amount of ₹.

35,000/- as the market had crashed and the value of the said policy was less than 1 annual premium. To

make good the deficit, the Complainant paid the said amount of ₹.35,000/-. Later on the Complainant

realized that the said amount of ₹.35,000/- was utilized to pay renewal premium on the 1st policy under

monthly mode. The RI sent reminders after reminders saying that the policy premiums had become

overdue and the risk cover had been suspended. Sensing trouble the Complainant went to office of RI

seeking cancellation of the said policy as she had lost confidence with the RI. But the RI declined her

request saying that the Complainant had approached the RI beyond ’Cooling-Off Period’. Being a

senior citizen, she could not sustain the magnitude of fraud being played on her. Hence, the

Complainant approached this Forum seeking cancellation of the said policies and refund of premiums

paid.

b. Respondent Insurer’s argument:

The RI vide their SCN dated 10.09.2018 has admitted to the issuance of said policies. The Complainant

applied for the said 2 policies by submitting all the necessary documents including benefit illustration

and the same being in order. The policy features were explained to the Complainant and she has

understood the same and only after she signed and submitted the same to the RI, the RI issued the said

policies and despatched the same to the Complainant on 03.03.2017 & 26.06.2017 respectively along

with necessary ‘Cooling Off cancellation’ and the Complainant has received the same.

It is implied that the Complainant being highly educated person, duly signed the proposal and

voluntarily applied for the said policies after understanding the product features. The Complainant

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submitted a request for changing his address and mode of payment of the premium on 08.02.2018 which

means the Complainant was satisfied with the terms and conditions of the policy. The Complainant

alleged the mis-sale for the first time on 28.03.2018 and as a customer centric organisation the RI sent

a regret letter on 11.04.2018 since the Complainant failed to approach the RI within ‘cooling off period’.

Also the RI mentioned that since the Complainant failed to pay further premiums, the policy is in lapsed

conditions with status ‘discontinued fund’.

Since the RI is not liable to entertain cancellation request which is beyond ‘Cooling Off Period’ as per

IRDA Regulations, the RI rejected the cancellation request of the Complainant. As the Complainant

failed to demonstrate any genuine grievance which is amenable, the present complaint is filed with mala

fide intentions by the Complainant to gain undue advantage of cancellation beyond ‘Cooling Off

Period’, the RI has prayed for dismissal of the same.

19. Reason for Registration of complaint: -

The complaint fell within the scope of the Insurance Ombudsman Rules, 2017 under Sec 13(1)(c) and

so, it was registered.

20. The following documents were placed for perusal: - d. Complaint along with enclosures,

e. Respondent Insurer’s SCN along with enclosures and

f. Consent of the Complainant in Annexure VIA &and Respondent Insurer in VII A

21. Result of personal hearing with both the parties (Observations & Conclusions):

The issue to be decided by the Forum is whether this is a case of fraudulent mis-sale and whether the

Complainant is eligible for refund of premium on such cancellation.

During the personal hearing on 18.03.2019 both the parties reiterated their respective stand.

The Forum after careful deliberations and examination of records notes that the Complainant went to RI

office to redeem their old policy. Instead of redeeming her old policy, the sales representatives of the RI

sold the said insurance policies on the assurance that they were ‘Single Premium Policies’, wherein the

premium is to be paid only once. But when she received the policy documents, she was shocked to note

that they were annual premium policies where an amount of ₹.4,00,000/- is to be paid every year.

The Forum further observes that RI erred in selling the said policies to the Complainants. Being senior

citizens, and of advanced age, instead of redeeming the old policy, they were sold ULIP policies. Further

the Complainants informed the Forum that they did not fill up the proposal forms. They only signed the

proposal in the last page of the proposal form. The RI informed the Forum that they changed the mode

of premium in the 1st policy to monthly mode, in order to enable the Complainants to pay further

premium

instead of single premium. In the process the RI collected ₹.4,00,000/ -+ ₹.4,00,000/- and thereafter

₹.33,333/- as renewal premium payable monthly. The Forum notes that the RI should not have

changed the mode without the consent of the Complainant. The Complainants informed the forum that

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the auto debit for the premiums on the said policies were effected by these sales representatives without

their consent.

Hence, considering the facts and circumstances of the case the Forum notes that this is a case of ‘Mis-

Sale’ as non-single premium policy were sold instead of single premium policy.

AWARD

Taking into account the facts & circumstances of the case and the submissions made by both

the parties during the course of the Personal Hearing, the RI is directed to refund the total

premiums received without any deduction and with interest at the rate of 8.25% (6.25%

bank rate +2% as per Policy Holders Protection Rules 2017) from the date of complaint with

the RI i.e. 28.03.2018 to till the date of payment.

Hence the complaint is ‘Allowed’.


The attention of the Complainant and the Respondent Insurer is hereby invited to the provisions of the

Insurance Ombudsman Rules, 2017, whereby, the Complainant is directed to submit all the

requirements/documents required for settlement of award within 15 days of receipt of the award.

According to Rule 17 (6) of the said Rules, the Respondent Insurer shall comply with the Award within

30 days of the receipt of the Award and shall intimate compliance of the same to the Ombudsman.

Dated at Bengaluru this 25th

Day of March 2019.

(NEERJA SHAH)

INSURANCE OMBUDSMAN


PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF

KARNATAKA (UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – NEERJA SHAH

Case of: MR. MOHAN MENON V/s PNB MET LIFE INDIA INSURANCE COMPANY LIMITED

Complaint No: BNG-L-033- 1819-0037 & 0038

Award No: IO/BNG/A/LI/0352, & 0353/2018-2019


Complainant

Mr. Mohan Menon

Delphi-2 Flat No 404,

Prestige Acropolis, No 20, Hosur Road

Next to Forum Mall

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Koramangala, Bangalore -560029

(M): 9972872327

E-mail: [email protected]

2. Policy No:

Type of Policy:

Name of the Policy:

Commencement of Policy:

Policy Period/ Premium Paying

Term:

22098439 22218732

ULIP - Life ULIP -Life

Met Smart Platinum Met Smart Platinum

31.01.2017 24.05.2017

33 Years/10 Years 33 Years/10 Years

3. Name of the Insured


Mr. Mohan Menon

4. Name of the Respondent Insurer PNB MET Life Insurance Company Limited


6. Reason for repudiation/Rejection Policy Cancellation Request received beyond

Cooling Off period


8. Nature of complaint Fraudulent mis-Sale of the above 2 policies

9. Amount of claim (1) ₹.3,00,000/- (2) ₹.3,00,000/-


11. Amount of relief sought ₹.6,25,000/-


No:

13 (1) (c) of Insurance Ombudsman Rules, 2017

13. Date of hearing/place 18.03.2019 /Bengaluru



b) For the Respondent

Insurer

Mr. Sagar -- ASM



17. Brief Facts of the Case:

The complaint emanated from the alleged fraudulent mis-sale of the said 2 policies by the associates of

Respondent Insurer (RI). In spite of his representation to G.R.O. of the RI, seeking cancellation of the

policies, the G.R.O. declined his request as the same was received by them beyond the ‘Cooling Off

Period’. Hence the Complainant approached this Forum for cancellation of his policies and refund the

premium thereon.

18. Cause of Complaint: -

a. Complainant’s argument: The Complainant had an old policy with RI wherein he had been paying the premium regularly for the

past 10 years. During the year January 2017, he went to the office of RI to close the old policy as he had

some urgent financial commitment. The sales representatives of the RI convinced the Complainant that

he could avail an insurance cover of ₹. 21,00,000/- by paying a single premium of ₹. 3,00,000/- i.e. he

could enjoy the risk cover 7 times the single premium. The sales representatives also advised the

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Complainant to redeem the said policy in 2 instalments (one in January & another in April) so that the

Complainant could avoid some penalty. The first policy was made in Jan 2017 and the 2nd

policy was

made in April 2017. The premium for both the policies were adjusted from the maturity sale proceeds

of the old policy. When he received the policy documents, he was shocked to know that the policy was

issued for an annual premium of ₹. 3,00,000/-for a period of 10 years. Though the Complainant

informed the sales representatives that he was a senior citizen without any pensionary benefits, the Sales

representatives insisted that he need not worry and that they would take care of Complainants policies.

Subsequently the Complainant started getting reminders and calls from the office of RI. When the

Complainant confronted the associates of the RI, they asked the Complainant to ignore the tele calls. In

the month of March 2018, the associates of the RI came to Complainants house and asked the

Complainant to pay an additional amount of₹. 25,000/- as the market had crashed and the value of the

said policy was less than 1 annual premium. To make good the deficit, the Complainant paid the said

amount of ₹.25,000/-. Later on the Complainant realized that the said amount of ₹.25,000/- was

utilized to pay renewal premium on the first policy. The RI sent reminders after reminders saying that

the policy premiums had become overdue and the risk cover had been suspended. Sensing trouble the

Complainant went to office of RI seeking cancellation of the said policy as he had lost confidence with

the RI. But the RI declined his request saying that the Complainant had approached the RI beyond

’Cooling-Off Period’. Being a senior citizen, he could not sustain the magnitude of fraud being played

on him. Hence, the Complainant approached this Forum seeking cancellation of the said policies and

refund of premiums paid.

b. Respondent Insurer’s argument:

The RI vide their SCN dated 27.08.2018 has admitted to the issuance of said policies. The Complainant

applied for the said 2 policies by submitting all the necessary documents including benefit illustration

and the same were in order. The policy features were explained to the Complainant and he has

understood the same and only after he signed and submitted the same to the RI, the RI issued the said

policies and despatched the same to the Complainant on 18.02.2017 & 12.06.2017 along with necessary

‘Cooling Off cancellation’ and the Complainant has received the same.

It is implied that the Complainant being highly educated person, duly signed the proposal and

voluntarily applied for the said policies after understanding the product features. The Complainant

submitted a request for changing his address and mode of payment of the premium on 08.02.2018 which

means the Complainant was satisfied with the terms and conditions of the policy. The Complainant

alleged the mis-sale for the first time on 28.03.2018 and as a customer centric organisation the RI sent

a regret letter on 11.04.2018 since the Complainant failed to approach the RI within ‘cooling off period’.

Also the RI mentioned that since the Complainant failed to pay further premiums, the policy is in lapsed

condition with status ‘discontinued fund’.

Since the RI is not liable to entertain cancellation request which is beyond ‘Cooling Off Period’ as per

IRDA Regulations, the RI rejected the cancellation request of the Complainant. As the Complainant

failed to demonstrate any genuine grievance which is amenable, the present complaint is filed with mala

fide intentions by the Complainant to gain undue advantage of cancellation beyond ‘Cooling Off

Period’, the RI has prayed for dismissal of the same.

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19. Reason for Registration of complaint: -

The complaint fell within the scope of the Insurance Ombudsman Rules, 2017 under Sec 13(1)(c) and

so, it was registered.

20. The following documents were placed for perusal: - g. Complaint along with enclosures,

h. Respondent Insurer’s SCN along with enclosures and

i. Consent of the Complainant in Annexure VIA &and Respondent Insurer in VII A

21. Result of personal hearing with both the parties (Observations & Conclusions):

The issue to be decided by the Forum is whether this is a case of fraudulent mis-sale and whether the

Complainant is eligible for refund of premium on such cancellation.

During the personal hearing on 18.03.2019 both the parties reiterated their respective stand.

The Forum after careful deliberations and examination of records, notes that the Complainant went to RI

office to redeem their old policy. Instead of redeeming his old policy, the sales representatives of the RI

sold the said insurance policies on the assurance that they were ‘Single Premium Policies’, wherein the

premium is to be paid only once. But when he received the policy documents, he was shocked to note

that they were annual premium policies where an amount of ₹.3,00,000/- is to be paid every year.

The Forum further observes that RI erred in selling the said policies to the Complainants. Being senior

citizens, and of advanced age, instead of redeeming the old policy they have sold ULIP policies. Further

the Complainants informed the Forum that they did not fill the proposal forms. They only signed the

proposal in the last page. The RI informed the Forum that they changed the mode of premium in the

policy to monthly mode in order to enable the Complainants to pay further premium instead of single

premium. In the process the RI collected ₹.3,00,000/ -+ ₹.3,00,000/- and thereafter ₹.25,000/- as

renewal premium payable monthly. The Forum notes that the RI should not have changed the mode

without the consent of the Complainant. The Complainants informed the forum that the auto debit for

the premiums on the said policies were effected by these sales representatives without the Complaint’s

consent.

Hence, considering the facts and circumstances of the case the Forum that this is a case of ‘Mis-Sale’ as

Non Single premium policies were sold instead of single premium policy.

AWARD

Taking into account the facts & circumstances of the case and the submissions made by both

the parties during the course of the Personal Hearing, the RI is directed to refund the total

premiums paid without any deduction with interest at the rate of 8.25%(6.25% bank rate +

2% extra as per Policy Holders Protection Rules 2017) from the date of filing the complaint

i.e. 28.03.2018 to till date of making the payment.

Hence the complaint is ‘Allowed’.

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The attention of the Complainant and the Respondent Insurer is hereby invited to the provisions of the

Insurance Ombudsman Rules, 2017, whereby, the Complainant is directed to submit all the

requirements/documents required for settlement of award within 15 days of receipt of the award.

According to Rule 17 (6) of the said Rules, the Respondent Insurer shall comply with the Award within

30 days of the receipt of the Award and shall intimate compliance of the same to the Ombudsman.

Dated at Bengaluru this 25th

Day of March 2019.

(NEERJA SHAH)

INSURANCE OMBUDSMAN


PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF M.P. & C.G.

(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)

Mr. Uday Kumar Jain……….. ………..…….………. Complainant

V/S

Bharti Axa Life Insurance Co.Ltd.………………..……Respondent

COMPLAINT NO: BHP-L-008-1819-0225 ORDER NO: IO/BHP/R/LI/ 0346/2018-2019

1.

Name & Address of the

Complainant

Mr. Uday Jain

146 Vineet Kunj Kolar Road,

Bhopal

2. Policy No:

Type of Policy

Duration of policy/DOC

501-3427686, 501-2580402, 501-3427678, 501-

2548318, 501-2928700

Secured income

10.08.2015, 18.11.2014, 10.08.2015, 28.10.2014,

19.03.2015

3. Name of the insured

Name of the policyholder

Mr. Uday Jain, Ms.Samidha,

Mr. Uday Singh

4. Name of the insurer Bharti Axa Life Insurance Co. Ltd.


6. Reason for repudiation/Rejection Lapse of free look period

7. Date of receipt of the Complaint 23.08.2018

8. Nature of complaint Mis-selling

9. Amount of Claim Rs.9,13,009/-

10. Date of Partial Settlement

11. Amount of relief sought Rs.9,13,009/-

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12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017

13. Date of hearing/place 30.01.2019 at Bhopal


a) For the Complainant Mr. Uday Kumar Jain

b) For the insurer Mr.Abhishek Kiro, Financial Advisor

15. Complaint how disposed Recommendation


17. Mr. Uday Kumar Jain (Complainant) has filed a complaint against Bharti Axa Life Insurance Co.

Ltd.(Respondent) alleging Mis-selling.

18. Brief facts of the Case - The complainant has stated that above policies were mis-sold to him by

the respondent by misguiding and on pretext of single premium and giving false assurance of

refund. When he came to know about factual position, he made request for cancellation of

policies before the respondent but his request was not considered. The complainant approached

this forum for payment of full amount.

The respondent in their SCN have stated that policies were issued on the basis of proposal form

and dispatched on 02.09.2015, 27.11.2014, 18.08.2015, 10.11.2014 and 27.03.2015 with option

of free look period of 15 days which were delivered to the complainant on 07.09.2015,

27.11.2014, 21.08.2015, 12.11.2014 and 30.03.2015. The complainant filed his complaint on

26.03.2018 which is after lapse of free look period i.e. after three years and five months.

19. The complainant has filed complaint letter, Annex. VI A and correspondence with respondent,

while respondent have filed SCN with enclosures.

20. Sincere efforts were made for mediation to resolve the subject matter of complaint. The

complainant and the representative of respondent company were heard. During course of

mediation, both the parties filed joint application (Mediation Agreement) duly signed by the

complainant and the representative of respondent mentioning therein about settlement of the

matter willingly and mutually and agreed to settle the subject matter of the complaint as follows:

The respondent Bharti Axa Life Insurance Co.Ltd. has agreed to cancel the existing policies

bearing no. 501-3427686, 501-2580402, 501-3427678, 501-2548318, 501-2928700 and issue a

single premium policy in the name of Ms. Samidha Jain, (Daughter of complainant) after

completing the required formalities by the complainant/ policy holder w.e.f. current date and

with no free look option without any penalty/ charges. The Complainant is also agreed for the

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same. Respondent is also agreed to make an enquiry with respect to amount of two DD as

mentioned in complaint and inform complainant accordingly.

21. As matter within parties has resolved mutually, hence the complaint is decided in terms of

mediation/mutual agreement between both the parties.

22. Let copies of this order be given to both parties.

Dated: March 05, 2019 (G.S.Shrivastava)

Place : Bhopal Insurance Ombudsman

Mr. Ramesh Magwane…………...…..…….………....………………. Complainant

V/S

Future Generali Life Insurance Co.Ltd.………………..……Respondent

COMPLAINT NO: BHP-L-017-1819-0306 ORDER NO: IO/BHP/R/LI/ 0350/2018-2019

1.


Complainant

Mr. Ramesh Magwane,

House no. 7778, N-1, A sector,

Govindpura, BHEL,

Bhopal

2. Policy No:

Type of Policy


01346305

Future Generali Assure Plus

30.04.2017



Miss Kirti Mangwane

Mr. Ramesh Mangwane

4. Name of the insurer Future Generali Life Insurance Co. Ltd.

5. Date of Repudiation/Rejection









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c) For the Complainant Mrs. Nirmla, wife of complainant

d) For the insurer Mr. Shashank Putambekar, Dy.Manager



Mr. Ramesh Magwane (Complainant) has filed a complaint against Future Generali Life

Insurance Co.Ltd. (Respondent) alleging Mis-selling.

Brief facts of the Case - The complainant has stated that above policy was mis-sold to him by

the respondent company on pretext of one time investment for one year. After the receipt of

policy bond on 12.05.2017, he came to know that it is a regular premium policy for 20 years

term. Thereafter he made request for cancellation of policy before the respondent company but

his request was not considered. The complainant approached this forum for refund of premium

amount.

The respondent in their SCN/reply have stated that policy was issued on the basis of proposal

form duly filled and signed by the complainant and dispatched with option of free look period of

15 days which was successfully delivered to the complainant’s address. The complainant had

approached to the company approximately after a span of one year which is beyond free look

period.

The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy

while respondent filed SCN and correspondence.

Sincere efforts were made for mediation to resolve the subject matter of complaint. The





The respondent Future Generali Life Insurance Co.Ltd. has agreed to cancel the existing

policy bearing no. 01346305 and issue a single premium policy with lock-in period of 5

years after completing the required formalities by the complainant/ policy holder w.e.f.

current date and with no free look option without any penalty/ charges. The Complainant

also agreed for the same.

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As matter within parties has resolved mutually, hence the complaint is decided in terms of


Let copies of this order be given to both parties.



Mr. Gyasuddin Khan..…...…..…….………....………………. Complainant

V/S

Shriram Life Insurance Co.Ltd.………………..………………Respondent

COMPLAINT NO: BHP-L-043-1819-0309 ORDER NO: IO/BHP/A/LI/0352/2018-2019

1.


Complainant

Mr. Gyasuddin Khan,

Ward No. 16,

Junardev Dist. Chhindwara

2. Policy No:

Type of Policy


NP011710102062, NP011709186622,

NP011711143835

Shriram New Shri Life Plan

25.10.2017, 28.09.2017, 27.11.2017



Mr.Gyasuddin Khan

-same-

4. Name of the insurer Shriram Life Insurance Co. Ltd.


6. Reason for repudiation/Rejection Reason of cancellation not acceptable



9. Amount of Claim Rs. 2,00,000/-


11. Amount of relief sought Rs. 2,00,000/-




e) For the Complainant Mr. Gyasuddin Khan

f) For the insurer Mr. Mridul Kushwah, Regional Operation

Manager

15. Complaint how disposed Dismissed


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Mr. Gyasuddin Khan (Complainant) has filed a complaint against Shriram Life Insurance

Co.Ltd. (Respondent) alleging Mis-selling.

Brief facts of the Case - The complainant has stated that Sh. Ahmad Husain, Branch Manager of

respondent company had taken Rs. 40,000/-, Rs. 60,000/- and Rs.1,00,000/- from him on

25.09.2017, 24.10.2017 and 26.11.2017 stating that policy would not be issued for these amount

and after some time the amount will be refunded to him. Thereafter three policies were issued for

amount of Rs.2,00,000/- yearly premium. It is further stated that he is not in position to pay the

premium every year. He made request for refund of his amount before the respondent company

but no reply was given to him. The complainant approached this forum for payment of refund of

his amount.

The respondent in their SCN/reply have stated that the complainant had applied and

recommended for insurance policies on his life by submitting proposal forms and by paying the

proposal deposit amount. Policies werre issued on 25.10.2017, 28.09.2017 and 27.11.2017 and

dispatched to the complainant with option of free look period of 15 days which were duly

received by the policy holder. Complainant failed to avail free look option. The complainant

made cancellation request on 15.09.2018 which was beyond free look period. It is further stated

that complainant being a sales officer of respondent had sourced the said policies on his own life

and also received commission from respondent.



Efforts for mediation failed. I have heard both the parties at length and perused paper filed on

behalf of the complainant as well as the Insurance Company.

Policies were issued on 25.10.2017, 28.09.2017 & 27.11.2017 and delivered to the complainant

in time. Delivery of policies in time is not disputed. Complainant has filed his complaint and

sought for cancellation of policies on 15.09.2018, which is after the lapse of free look period.

Respondent’s representative have argued that the complainant has filed complaint for

cancellation of policies after receiving of due commission as agent of respondent. The

complainant could not produce any evidence with respect to allegation of mis-selling. Mere

allegation is not sufficient to bring the sale of policy under purview of mis-selling. The

complainant is a retired head master and is a sales officer of respondent company. He is

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supposed to go through the policy documents after its receipt. A person who signs any document

is responsible for the contents mentioned in it.

In view of these facts and circumstances, I come to the conclusion that the insurance company

has made a reasonable offer to the complainant for cancellation within free look period which

was not availed by complainant. Hence, it is clear that the respondent has not erred in not

cancelling the policies of the complainant and complaint is liable to be dismissed.

The complaint filed by Mr. Gyasuddin Khan stands dismissed herewith.

Let copies of Award be given to both the parties.

Dated : March 07, 2019 (G.S.Shrivastava)


Mr. Ramesh Kumar Bele.…..…….………....………………. Complainant

V/S


COMPLAINT NO: BHP-L-043-1819-0310 ORDER NO: IO/BHP/A/LI/ 0351/2018-2019

1.


Complainant

Mr. Ramesh Kumar Bele

Ward No. 17, Datlawadi


2. Policy No:

Type of Policy


NN11712120215, NP011712246363

Assured income, New Shri Life Plan

22.12.2017, 28.12.2017



Ms.Gunjan Bele, Mr.Ramesh Bele

Mr. Ramesh Bele



6. Reason for repudiation/Rejection Reason of cancellation not acceptable








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g) For the Complainant Mr. Gyasuddin Khan, representative of complainant

h) For the insurer Mr. Mridul Kushwah, Regional Operation Manager



Mr. Ramesh Kumar Bele (Complainant) has filed a complaint against Shriram Life Insurance


Brief facts of the Case - The complainant has stated that he had given Rs.2,00,000/- to Sh.

Ahmad Husain, Branch Manager of respondent company for issuance of single premium policy

but he fraudulently issued a policy for premium paying term of 10 years. He is unable to pay

premium every year and made request for cancellation of policies and refund of amount before

the respondent company but no reply was given to him. The complainant approached this forum

for payment of refund of his amount.

The respondent in their SCN/reply have stated that the complainant had proposed for insurance

policy on his life by submitting proposal form and by paying the proposal deposit amount. Policy

was issued on 22.12.2017 & 28.12.2017 and dispatched to the complainant for option of free

look period of 15 days which were duly received by the policy holder. Complainant has failed to

avail free look option. The complainant made cancellation request on 15.09.2018 which was

beyond free look period.





Policies were issued on 22.12.2017 & 28.12.2017 and delivered to the complainant in time.

Delivery of policies in time is not disputed. Complainant has filed his complaint and sought for

cancellation of policies on 15.09.2018, which is after the lapse of free look period. The

complainant could not produce any evidence with respect to allegation of mis-selling. Mere

allegation is not sufficient to bring the sale of policy under purview of mis-selling. The

complainant is a post graduate. He is supposed to go through the policy documents after its

receipt. A person who signs any document is responsible for the contents mentioned in it.

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cancelling the policies of the complainant and complaint is liable to be dismissed.

The complaint filed by Mr. Ramesh Kumar Bele stands dismissed herewith.




Mrs. Najmunnisha Khan..…..…….………....………………. Complainant

V/S


COMPLAINT NO: BHP-L-043-1819-0311 ORDER NO: IO/BHP/A/LI/ 0353 /2018-2019

1.


Complainant

Mrs. Najmunnisha Khan,

Ward No. 16,


2. Policy No:

Type of Policy


NN011712171749

Shriram Life Assured income plus

27.12.2017



Mrs.Najmunnisha Khan

-same-



6. Reason for repudiation/Rejection Reason for cancellation not acceptable









i) For the Complainant Mr.Gyasuddin Khan, Complainant’s husband

j) For the insurer Mr. Mridul Kushwah, Regional Operation

Manager



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Mrs.Najmunnisha Khan (Complainant) has filed a complaint against Shriram Life Insurance


Brief facts of the Case - The complainant has stated that she had given Rs.1,50,000/- to Sh.

Ahmad Husain, Branch Manager of respondent company for issuance of single premium policy

but he issued a policy for premium paying term of 10 years. She is unable to pay premium every

year. She made request for cancellation of policy and refund of amount before the respondent

company but no reply was given to her. The complainant approached this forum for payment of

refund of her amount.

The respondent in their SCN/reply have stated that the complainant had proposed for insurance

policy on her life by submitting proposal form and by paying the proposal deposit amount.

Policy was issued on 27.12.2017 and dispatched to the complainant for option of free look period

of 15 days which were duly received by the policy holder. Complainant failed to avail free look

option. The complainant made cancellation request on 15.09.2018 which was beyond free look

period. It is further stated that complainant’s husband being a sales officer of respondent

company had sourced the said policy and also received commission.





Policy was issued on 27.12.2017 and delivered to the complainant in time. Delivery of policy in

time is not disputed. Complainant’s husband is also nominee in this policy. Complainant has

filed her complaint and sought for cancellation of policy on 15.09.2018, which is after the lapse

of free look period. Respondent’s representative have argued that the complainant has filed

complaint for cancellation of policy after receiving of due commission by her husband as agent

of respondent company. The complainant could not produce any evidence with respect to

allegation of mis-selling. Mere allegation is not sufficient to bring the sale of policy under

purview of mis-selling. The complainant is a government teacher and wife of the agent of

respondent company. She is supposed to go through the policy documents after its receipt. A

person who signs any document is responsible for the contents mentioned in it.

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cancelling the policy of the complainant and complaint is liable to be dismissed.

The complaint filed by Mrs. Najmunnisha Khan stands dismissed herewith.




Mr. Sunil Rathore..…...…..…….………....………………. Complainant

V/S

DHFL Pramerica Life Insurance Co.Ltd.………………..……Respondent


1.


Complainant

Mr. Sunil Rathore,

Ward No.11, Kathali Bazar Sironj,

Dist.Vidisha (MP)

2. Policy No:

Type of Policy


GC0000370056300, GC000370151800

DHFL Group Credit Life

20.12.2017, 26.12.2017



Mr. Sunil Rathore

4. Name of the insurer DHFL Pramerica Life Insurance Co. Ltd.


6. Reason for repudiation/Rejection


8. Nature of complaint Less payment of surrender value

9. Amount of Claim Rs. 40,235/-


11. Amount of relief sought Rs. 40,235/-




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k) For the Complainant Mr. Sunil Rathore

l) For the insurer Mr. Sprarsh Dwivedi, Sr.Training manager



Mr. Sunil Rathore (Complainant) has filed a complaint against DHFL Pramerica Life Insurance

Co.Ltd. (Respondent) alleging less payment of surrender value.

Brief facts of the Case - The complainant has stated that he had taken a home loan from Adhar

Housing Finance Ltd. At that time two insurance policies were issued from the respondent

company. The above policies were sold to him by officer of Housing Finance Ltd. stating that at

the time of refund only 10% amount will be deducted. In April 2018, he paid full loan amount

and submitted papers of insurance. Insurance company has deducted 50% amount and paid only

Rs.39063 and deducted Rs.40,235/-. The complainant has approached this forum for payment of

balance amount.

The respondent in their SCN/reply have stated that the above policies were issued on the basis

of information provided and declaration made in the application form by the complainant and

were dispatched to the complainant. Due to the request of the complainant for surrender of the

subject policies, the company had refunded the amount in accordance with the policy terms &

conditions.



I have heard both the parties at length and perused paper filed on behalf of the complainant as

well as the Insurance Company.

Policy no. GC0000370056300, GC000370151800 were issued on loan account of complainant.

As per SCN complainant has surrendered above policies and company had refunded amount of

Rs.26582.48 and Rs,12481.94 to the complainant. As per policy terms & conditions surrender

value shall be an amount 60% of single premium paid multiplied by (unexpired coverage term/

Total coverage term) multiplied by (coverage inforce/ coverage sum assured). Paid amount after

surrendering of policy is as per terms & conditions of policy.

In view of above facts and circumstances, I come to the conclusion that the insurance company

has acted in accordance with terms & condition of the policies and there is no reason to interfere

with the decision of respondent company. Hence complaint is liable to be dismissed.

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The complaint filed by Mr. Sunil Rathore stands dismissed herewith.




Mr.Kishori Sharan Chourasiya…..…………....………………. Complainant

V/S

Future Generali India Life Insurance Co.Ltd.……………..……Respondent


1.


Complainant

Mr. Kishori Sharan Chourasiya,

310 Vijay Puram Colony Behind Mahal,

Shivpuri

2. Policy No:

Type of Policy


01322553

Future Generali Pearls Guarantee

31.12.2016



Mr. Kishori Sharan Chourasiya

-same-

4. Name of the insurer Future Generali India Life Insurance Co. Ltd.

5. Date of Repudiation/Rejection 17.09.2018/

6. Reason for repudiation/Rejection Lapse of Free look period



9. Amount of Claim Rs. 49000/-+Rs.25111/- = Rs.74,111/-


11. Amount of relief sought Rs. 49000/-+Rs.25111/- = Rs.74,111/-




m) For the Complainant Mr. Kishori Sharan Chourasiya

n) For the insurer Mr. Shashank Putambekar, DM

15. Complaint how disposed REcommendation


Mr. Kishori Sharan Chourasiya (Complainant) has filed a complaint against Future Generali

India Life Insurance Co.Ltd. (Respondent) alleging Mis-selling.

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Brief facts of the Case - The complainant has stated that above policy was mis-sold to him

fraudulently by respondent company on allurement of return of money with 10% interest after

one year. When he came to know about factual position he made complaint for cancellation of

policy but his request was not considered. The complainant approached this forum for refund of

premium amount.


form duly filled and signed by the complainant and dispatched through Blue Dart Courier

no.40915569693 on 05.01.2017 with option of free look period of 15 days which was

successfully delivered on 10.01.2017 to the complainant’s address. The complainant had

approached to the company on 05.09.2018 which is beyond free look period.








The respondent Future Generali Life Insurance Co.Ltd. has agreed to cancel the existing policy

bearing no. 01322553 and issue a single premium policy for total premium amount paid by the

complainant with lock-in period of 5 years after completing the required formalities by the

complainant/ policy holder w.e.f. current date and with no free look option without any penalty/

charges. The Complainant also agreed for the same.






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Mr.Kishori Sharan Chourasiya…..…………....………………. Complainant

V/S

HDFC Standard Life Insurance Co.Ltd.……………..……Respondent

COMPLAINT NO: BHP-L-019-1819-0368 ORDER NO: IO/BHP/R/LI/ 0359 /2018-2019

1.


Complainant

Mr. Kishori Sharan Chourasiya,

310 Vijay Puram Colony Behind Mahal,

Shivpuri

2. Policy No:

Type of Policy


18793696 & 18870708

HDFC Classicassure Plus

09.11.2016, 23.12.2016



Mr. Kishori Sharan Chourasiya

-same-

4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.


6. Reason for repudiation/Rejection Lapse of Free look period



9. Amount of Claim Rs. 90000 + Rs.100000/-=1,90,000/-

(2-2 premiums in both policies)


11. Amount of relief sought Rs. 90000 + Rs.100000/-= 1,90,000/-




o) For the Complainant Mr. Kishori Sharan Chourasiya

p) For the insurer Mr. Kunal Kumar, DM-Ops



Mr. Kishori Sharan Chourasiya (Complainant) has filed a complaint against HDFC Standard Life

Insurance Co.Ltd. (Respondent) alleging Mis-selling.

Brief facts of the Case - The complainant has stated that above policies were mis-sold to him

fraudulently by respondent company on allurement of return of money with 10% interest after

one year. When he came to know about factual position he made complaint for cancellation of

policy but his request was not considered. The complainant approached this forum for refund of

premium amount.

The respondent in their SCN have stated that policies were issued on the basis of proposal form

signed and submitted by the complainant. Policy was dispatched through Blue Dart courier with

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option of free look period of 15 days which was delivered on 21.11.2016 & 05.01.2017. The

complainant made request for cancellation of policy on 13.09.2018 which is beyond free look

period.








The respondent HDFC Standard Life Insurance Co.Ltd. has agreed to cancel the existing policy

bearing no. 18793696 & 18870708 and issue a single premium policy for total premium amount

paid by the complainant with lock-in period of 5 years after completing the required formalities

by the complainant/ policy holder w.e.f. current date and with no free look option without any

penalty/ charges. The Complainant also agreed for the same.






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Mohd. Saeed..…...…..…….………....………………. Complainant

V/S

HDFC Standard Life Insurance Co.Ltd.………………Respondent

COMPLAINT NO: BHP-L-019-1819-0333 ORDER NO: IO/BHP/R/LI/0360 /2018-2019

1.


Complainant

Mohd. Saeed,

House No.B-799 Mulla Colony,

B-Sector, Housing Board,Karond,

BHOPAL

2. Policy No:

Type of Policy


20351004

HDFC Life Classicassure plus

26.04.2018



Mohd. Saeed

-


5. Date of Repudiation/Rejection -

6. Reason for repudiation/Rejection -



9. Amount of Claim Rs.51,000/-


11. Amount of relief sought Rs.51,000/-




q) For the Complainant Mr. Mohd. Saeed

r) For the insurer Mr. Kunal Kumar, DM-OPS



Mohd.Saeed (Complainant) has filed a complaint against HDFC Standard Life Insurance Co.Ltd.

(Respondent) alleging Mis-selling.


respondent company on pretext of one time deposit but regular premium policy was issued.

When he came to know about factual position, he made request for cancellation of policy and

refund of premium amount, but no action was taken by the respondent. The complainant

approached this forum for refund of premium amount.


form duly filled and signed by the complainant and dispatched via speed post with option of free

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look period of 15 days which was delivered on 09.05.2018 The complainant had approached to

the company on 08.10.2018 for cancellation of policies which is beyond free look period.








The respondent HDFC Standard Life Insurance Co.Ltd. has agreed to cancel the existing policy

bearing no. 20351004 and issue a single premium policy of Rs.50,000/- with lock-in period of 5

years after completing the required formalities by the complainant/ policy holder w.e.f. current

date and with no free look option without any penalty/ charges after depositing balance amount

by the complainant. The Complainant also agreed for the same.







V/S

PNB Met Life Insurance Co.Ltd.…………………..……..……Respondent


1.


Complainant

Mohd. Saeed,



BHOPAL

of 412

2. Policy No:

Type of Policy


22461913 & 22573060

PNB Met Life Endowment Saving Plan

16.02.2018, 30.05.2018



Mohd. Saeed

-

4. Name of the insurer PNB Met Life Insurance Co. Ltd.





9. Amount of Claim Rs. 20,600/- + Rs.35,000/-


11. Amount of relief sought Rs. 20,600/- + Rs.35,000/-




s) For the Complainant Mr. Mohd. Saeed

t) For the insurer Mr. Avinash Sharma, CSM



Mohd.Saeed (Complainant) has filed a complaint against PNB Met Life Insurance Co.Ltd.


Brief facts of the Case - The complainant has stated that above policies were mis-sold to him by

respondent company on pretext of one time deposit but regular premium policies were issued.

When he came to know about factual position, he made request for cancellation of policies and



The respondent in their SCN/reply have stated that policies were issued on the basis of proposal

form duly filled and signed by the complainant and dispatched through speed post on 19.02.2018

and 06.06.2018 with option of free look period of 15 days which was delivered to the

complainant’s address. The complainant had approached to the company on 12.10.2018 for

cancellation of policies which is beyond free look period.





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The respondent PNB Met Life Insurance Co.Ltd. has agreed to cancel the existing policy bearing

nos. 22461913 & 22573060 and issue a single premium policy for total premium amount paid by

the complainant with lock-in period of 5 years after completing the required formalities by the


charges after. The Complainant also agreed for the same.







V/S

Bharti Axa Life Insurance Co.Ltd.……………..……Respondent

COMPLAINT NO: BHP-L-008-1819-0330 ORDER NO: IO/BHP/R/LI/0363/2018-2019

1.


Complainant

Mohd. Saeed,



BHOPAL

2. Policy No:

Type of Policy


501-7025171

Elite advantage

27.03.2018



Mohd. Saeed

-





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9. Amount of Claim Rs. 99,998/-






u) For the Complainant Mr. Mohd. Saeed

v) For the insurer Mr. Abhishek Kiro



Mohd.Saeed (Complainant) has filed a complaint against Bharti Life Insurance Co.Ltd.








form duly filled and signed by the complainant and dispatched on 29.03.2018 with option of free

look period of 15 days which was delivered on 02.04.2018 The complainant had approached to

the company on 04.10.2018 for cancellation of policies which is beyond free look period.








The respondent Bharti Axa Life Insurance Co.Ltd. has agreed to cancel the existing policy

bearing no. 501-7025171 and issue a single premium policy of Rs.1,00,000/- with lock-in period

of 5 years after completing the required formalities by the complainant/ policy holder w.e.f.

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current date and with no free look option without any penalty/ charges after depositing balance

amount by the complainant. The Complainant also agreed for the same.







V/S

DHFL Pramerica Life Insurance Co.Ltd.…………………..……..……Respondent

COMPLAINT NO: BHP-L-013-1819-0331 ORDER NO: IO/BHP/A/LI/0364 /2018-2019

1.


Complainant

Mohd. Saeed,



BHOPAL

2. Policy No:

Type of Policy


00608539

DHFL Pramerica Roz Sanchay

30.06.2018



Mohd. Saeed

-

4. Name of the insurer DHFL Pramerica Life Insurance Co. Ltd.











w) For the Complainant Mr. Mohd. Saeed

x) For the insurer Mr. Sparsh Dwivedi, Sr.Training Manager



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Mohd.Saeed (Complainant) has filed a complaint against DHFL Pramerica Life Insurance









look period of 15 days. The complainant had approached to the company on 04.10.2018 for

cancellation of policies which is beyond free look period.





From perusal of record, it is clear that above Policy was issued on 30.06.2018, dispatched on

07.07.2018 through Speed post no. EH747678037IN and delivered to the complainant on

10.07.2018. Complainant has filed his complaint and sought for cancellation of policy on

04.10.2018 and had not applied within free look period. The complainant could not produce any

evidence with respect to allegation of mis-selling. Mere allegation is not sufficient to bring the

sale of policy under purview of mis-selling. The complainant is a business man and is supposed

to go through the policy documents after its receipt. A person who signs any document is

responsible for the contents mentioned in it.





The complaint filed by Mr. Mohd. Saeed stands dismissed herewith.




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Mohd. Saeed..…...…..…….………....……..……………. Complainant

V/S

Exide Life Insurance Co.Ltd.…………………..……..……Respondent


1.


Complainant

Mohd. Saeed,



BHOPAL

2. Policy No:

Type of Policy


03735354

Exide Life Secured Income Ins.

23.02.2018



Mohd. Saeed

-

4. Name of the insurer Exide Life Insurance Co. Ltd.





9. Amount of Claim Rs. 39,998.42


11. Amount of relief sought Rs. 39,998.42




y) For the Complainant Mr. Mohd. Saeed

z) For the insurer Mr. Saurav Sharma, SSM



Mohd.Saeed (Complainant) has filed a complaint against Exide Life Insurance Co.Ltd.







The respondent in the SCN/reply stated that the above policy was issued on the basis of proposal

form duly signed by the complainant and dispatched with option of free look period of 15 days.

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It is further stated that complainant has not written for cancellation of insurance policy and

request for cancellation of the policy through learned Insurance Ombudsman has been made after

expiry of the free look period.





From perusal of record, it is clear that above Policy was issued on 23.02.2018, dispatched on

01.03.2018 through registered post no. RD954974438IN and delivered to the complainant on

09.03.2018. Complainant has filed his complaint and sought for cancellation of policy on

04.10.2018 and had not applied within free look period. The complainant could not produce any

evidence with respect to allegation of mis-selling. Mere allegation is not sufficient to bring the

sale of policy under purview of mis-selling. The complainant is a transport business owner and is

supposed to go through the policy documents after its receipt. A person who signs any document

is responsible for the contents mentioned in it.





The complaint filed by Mr. Mohd. Saeed stands dismissed herewith.




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Mr. Nar Singh Patel.………………….…....………………. Complainant

V/S

Bharti Axa Life Insurance Co.Ltd.………………….………..……Respondent


1.


Complainant

Mr. Nar Singh Patel,

House No.132, Darogapara Tikrapara,

Darogamuda, Raigarh

2. Policy No:

Type of Policy


501-1998662, 501-2015649, 501-2167846, 501-

2168307, 501-2372933, 501-2373105, 501-

1938973, 501-1998563

31.03.2014, 16.05.2014, 23.06.2014, 23.06.2014,

15.09.2014, 15.09.2014, 31.03.2014, 25.04.2014,



Ms.Tukanti, Ms. Ekta , Nar singh Patel

Mr.Nar Singh Patel






9. Amount of Claim Deposited Amount


11. Amount of relief sought Deposited Amount


13. Date of hearing/place


aa) For the Complainant Mr. Nar Sing Patel

bb) For the insurer Mr. Abhishek Kiro, Financial Advisor



Mr. Nar Singh Patel (Complainant) has filed a complaint against Bharti Axa Life Insurance


Brief facts of the Case - The complainant has stated that the above policies were mis-sold to

him by the agent of respondent company on pretext of one time deposit. When he came to know

about factual position, he made request for cancellation of the policies but his request was not

considered by the respondent company. It is further stated that he is unable to pay premiums. The

complainant approached this forum for refund of premium amount.

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form duly filled and signed by the complainant and dispatched on with option of free look period

of 15 days which were delivered to the complainant in time. The complainant approached with

cancellation request on 08.08.2018 which is beyond free look period.


while respondent filed SCN with enclosures.







bearing nos. 501-1998662, 501-2015649, 501-2167846, 501-2168307, 501-2372933, 501-

2373105, 501-1938973, 501-1998563 and issue a single premium policy of Rs. 4,00,000/- in the

name of Ms.Ekta Patel, daughter of complainant with lock-in period of 5 years after completing

the required formalities by the complainant/ policy holder w.e.f. current date and with no free

look option without any penalty/ charges. Respondent has also agreed to refund the balance

amount to the complainant.The Complainant also agreed for the same.






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Mr. Rakesh Chouhan.…….………....………………. Complainant

V/S

Bharti Axa Life Insurance Co.Ltd.………………..……Respondent


1.


Complainant

Mr. Rakesh Chouhan,

2730-E Sudama nagar,

Near Hawa Banglow, Indore

2. Policy No:

Type of Policy


501-2343033

Bharti Axa Life Aajeevan Sampatti

22.08.2014



Mr. Rakesh Chouhan

-same-












cc) For the Complainant Mr. Rakesh Chouhan

dd) For the insurer Mr. Abhishek Kiro, Financial Advisor



Mr. Rakesh Chouhan (Complainant) has filed a complaint against Bharti Axa Life Insurance



giving wrong information about plan by the respondent company and it was stated that he from

6th

year he will get 75,000/- every year and after 10 years he will get full deposit amount. But he

found that plan was different from it. When he came to know about factual position he made

request for cancellation of policy before the respondent company but his request was not

considered. The complainant approached this forum for refund of premium amount.



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look period of 15 days which was delivered on 02.09.2014. The complainant had approached to

the company on 13.04.2018 for cancellation of policy which is beyond free look period.









bearing no. 501-2343033 and issue a single premium policy for total premium amount paid by

the complainant with lock-in period of 5 years after completing the required formalities by the


charges. The Complainant also agreed for the same.






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Mr. Manohar Patidar..…...…..…….....………………. Complainant

V/S

Life Insurance Corporation of India.……………..……Respondent


1.


Complainant

Mr. Manohar Patidar,

Gram Jharkheda,

Dist.Sehore

2. Policy No:

Type of Policy


362721555, 362700803, 362700800

Endowment & New Children Money Back Plan

24.03.2018, 24.03.2018, 24.03.2018



Manohar, Harshita & Dinesh Patidar

-same-

4. Name of the insurer Life Insurance Corporation of India





9. Amount of Claim


11. Amount of relief sought




ee) For the Complainant Absent

ff) For the insurer Mrs. Manisha Bhatnagar, Manager(CRM)

15. Complaint how disposed Dismissed as settled


Mr. Manohar Patidar (Complainant) has filed a complaint against Life Insurance Corporation of

India (Respondent) alleging Mis-selling.

Brief facts of the Case - The complainant has stated that above policies were mis-sold to him by

agent of respondent company on pretext of single premium but regular premium policy was

issued. When he came to about factual position, he made request for cancellation of policy and



Three separate SCNs are filed for above three policies. The respondent in their SCN/reply have

stated that policy holder has applied for cooling off of policy no. 362721555, 362700803 &

362700800 in 08/2018. They have further stated that cooling off action has been taken & amount

payable under cooling off has been made to policyholder through NEFT in above policies on

24.01.2019.

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Complainant remained absent during hearing. I have heard respondent’s representative and

perused papers filed on behalf of the complainant as well as the Insurance Company.

During course of hearing respondent’s representative has stated that cooling off action has been

taken and payment has been made through NEFT on 24.01.2019 to the complainant. None

appeared on behalf of complainant to press the complaint. As the amount of premium of above

policies had already been paid to the complainant, hence the complaint is liable for dismissal.

The complaint filed by Mr. Manohar Patidar stands dismissed as settled.




Mrs. Kavita Patidar..…...…..…….....………………. Complainant

V/S



1.


Complainant

Mrs. Kavita Patidar,

Gram Jharkheda,

Dist.Sehore

2. Policy No:

Type of Policy


362700801

LIC’s Jeevan Labh

24.03.2018



Mrs. Kavita Patidar

-same-






9. Amount of Claim






of 412

gg) For the Complainant Absent

hh) For the insurer Mrs. Manisha Bhatnagar, Manager (CRM)



Mrs. Kavita Patidar (Complainant) has filed a complaint against Life Insurance Corporation of


Brief facts of the Case - The complainant has stated that above policy was mis-sold to her by


issued. When she came to about factual position, she made request for cancellation of policy and



The respondent in their SCN/reply have stated that policy holder has applied for cooling off of

policy no. 362700801 in 08/2018. They have further stated that cooling off action has been taken

& amount payable under cooling off has been made to policyholder through NEFT on

24.01.2019.








policy had already been paid to the complainant, hence the complaint is liable for dismissal.

The complaint filed by Mrs. Kavita Patidar stands dismissed as settled.




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Mrs. Krishna Patidar..…...…..…….....………………. Complainant

V/S



1.


Complainant

Mrs. Krishna Patidar,

Gram Jharkheda,

Dist.Sehore

2. Policy No:

Type of Policy


362700802

LIC’s Jeevan Labh

24.03.2018



Mrs. Krishna Patidar

-same-






9. Amount of Claim






ii) For the Complainant Absent

jj) For the insurer Mrs. Manisha Bhatnagar



Mrs. Krishna Patidar (Complainant) has filed a complaint against Life Insurance Corporation of


Brief facts of the Case - The complainant has stated that above policy was mis-sold to her by


issued. When she came to about factual position, she made request for cancellation of policy and



The respondent in their SCN/reply have stated that policy holder has applied for cooling off of

policy no. 362700802 in 08/2018 . They have further stated that cooling off action has been

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taken & amount payable under cooling off has been made to policyholder through NEFT

24.01.2019.








policy had already been paid to the complainant, hence the complaint is liable for dismissal.

The complaint filed by Mrs. Krishna Patidar stands dismissed as settled.




Mr. Praveen Premchandani……....…………………..…. Complainant

V/S

HDFC Standard Life Insurance Co.Ltd.………………..……Respondent


1.


Complainant

Mr. Praveen Premchandani,

Regal 4, Hamilton Court,

Manuabhan Takri, Bhopal

2. Policy No:

Type of Policy


Master policy no.PP000092

HDFC Life Group Credit Protect Plus

Insurance Plan

12.04.2016 (commencement of membership)



Mr. Praveen Premchandani

HDFC Ltd.

of 412





8. Nature of complaint Non issuance of policy

9. Amount of Claim -

10. Date of Partial Settlement -

11. Amount of relief sought Issuance of policy and free look period




kk) For the Complainant Mr. Praveen Premchandani

ll) For the insurer Mr. Sudhir Kumar Singh, Asst.Legal Manager



Mr.Praveen Premchandani (Complainant) has filed a complaint against HDFC Standard Life

Insurance Co.Ltd. (Respondent) alleging non issuance of policy.

Brief facts of the Case - The complainant has stated that he had taken a home loan from HDFC

Housing Dev. finance Corp.Ltd. Bhopal. Thereafter the bank employee Mr. Praveen Gupta

insisted upon him for mandatory instruction of bank to insure home loan amount of Rs.40 lac

and it will be paid on monthly premium amount Rs.1710.00 which will be payable in 108

installments. Thereafter the agreed terms and conditions were ex-parte modified and under

misconception the entire premium amount was paid to the HDFC Life Insurance Co. which was

deducted again as a loan providing of Rs.1,82,709/- without his knowledge. He repeatedly sent

emails for issuance of insurance policy, terms & conditions/ inclusions and exclusions which was

not provided till date and suppressed opportunity and rights for free look period. The

complainant approached this forum for redressal of his grievance.

The respondent in their SCN have stated that above group insurance policy was issued after

receiving the MIF/ proposal form and funded premium amount to secured the loan amount

sanctioned by responded. Master policy holder also informed complainant about the premium

amount which will be deducted from the funded loan amount and after taking the consent on

premium calculator slip respondent had forwarded the application of issuance of policy. Policy

was issued in 2016 and complainant raised his complaint in 2018 after a lapse of period of 2

years. Respondent had funded the total loan amount of Rs.41,82,709/- which is inclusive of

premium amount payable to HDFC Life. Policy was sent to the master policy holder i.e. HDFC

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Ltd. and said master policy holder has delivered policy document to group member. Complainant

has himself admitted in his mail dated 07.08.2018 that he has received the policy document. It is

pertinent to mention here that said document received by the complainant is a complete

document and said as certificate of insurance. The allegations made in complaint are denied as

being false and incorrect.

The complainant has filed complaint letter, annex VI A, Policy Copy & correspondence copy


I have heard both the parties at length and perused paper filed on behalf of the complainant as

well as the Insurance Company.

The complainant has filed a complaint against the respondent with the prayer that kindly accept

his complaint against HDFC Life for non issuance of policy and help him, stating in brief that he

had taken a loan from HDFC Housing Development Finance Corporation Ltd. Bhopal alongwith

insurance of loan amount. In the complaint complainant has alleged for non issuance of policy by

the respondent. As per SCN of respondent group insurance policy was issued and sent to master

policy holder and master policy holder has handed over the certificate of insurance to group

member. The representative of the respondent has argued that complainant through his email

dated 06.08.2018 has admitted the receiving of the policy document. He further argued that

certificate of insurance was sent in three pages in which at page two, terms & conditions

including cancellation in free look period were mentioned. First page shows the details of

insured and third one as surrender value chart. At the time of hearing these three pages were

shown to the complainant and complainant has admitted of receiving of these three pages. In

email dated 06.08.2018 of complainant, the complainant has mentioned that policy documents

not sent/ provided physically, except front page of policy sent on email after lapse of long period.

The complainant with annexure VI A filed a copy of insurance certificate in two pages in which

at first page details of insurance and at page two terms & conditions are mentioned. Filing of

these two pages by complainant shows the receiving of certificate of insurance alongwith terms

& conditions. It is pertinent to mention here that in his email complainant had admitted the

receiving of front page only while at the time of hearing complainant has admitted receiving of

three pages of certificate of insurance. In his complaint complainant has not mentioned receiving

of front page. During hearing representative of respondent has stated that policy contains only

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three pages. Hence, it is clear that certificate of insurance in three pages were received by the

complainant and complaint with respect to non receiving of policy was made in 2018 after 2

years of issuance of policy.

In view of these facts and circumstances, I come to the conclusion that as the complainant had

already received the certificate of insurance, hence the complaint of non issuance of policy is

liable to be dismissed.

The complaint filed by Mr. Praveen Premchandani stands dismissed herewith.




Mr. Rakesh Jain..…...…..…….………....………………. Complainant

V/S

PNB Met Life Insurance Co.Ltd.…………………..……..……Respondent


1.


Complainant

Mr. Rakesh Jain

2017/1, New Kanchanpur Adhartal,

Jabalpur

2. Policy No:

Type of Policy


22321756

PNB Met life Endowment saving plan plus

22.09.2017



Mr. Rakesh Jain

-same-

4. Name of the insurer PNB Met Life Insurance Co. Ltd.









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mm) For the Complainant Mr. Rakesh Jain

nn) For the insurer Mr. Sandeep Motlani, Regional Manager



Mr. Rakesh Jain (Complainant) has filed a complaint against PNB Met Life Insurance Co.Ltd.



agent of respondent company by giving false information. It was stated by the agent that

premium would be deposited only one time and on deposit of 60,000/- insured amount shall be

6,00,000/- and after maturity he will get Rs.6,00,000/- and two gold coin. When he received the

policy, he came to know that insurance was issued only for Rs.2,50,000/-. He made request for

cancellation of policy and refund of premium amount, but his request was repudiated on

03.09.2018. The complainant approached this forum for refund of premium amount.


form duly filled and signed by the complainant and dispatched through speed post no.

EM867406693IN on 03.10.2017 with option of free look period of 15 days which was delivered

to the complainant’s address. The complainant had approached to the company on 20.08.2018

for cancellation of policy which is beyond free look period.








The respondent PNB Met Life Insurance Co.Ltd. has agreed to cancel the existing policy bearing

nos. 22321756 and issue a single premium policy for total premium amount paid by the

complainant with lock-in period of 5 years after completing the required formalities by the


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charges after in the name of Mr. Sagar Jain S/O Mr. Rakesh Jain (Complainant). The

Complainant also agreed for the same.






Ms. Pooja Chourasiya…..…………....…………………. Complainant

V/S

HDFC Standard Life Insurance Co.Ltd.……………..……Respondent


1.


Complainant

Ms. Pooja Chourasiya,

Makan no.130, Ward no.02,

Umariya Pan, Katni

2. Policy No:

Type of Policy


19879139, 20039996

HDFC SL Progrowth Flexi

31.10.2017,………….



Ms. Pooja Chourasiya

-same-





8. Nature of complaint Wrong deduction on cancellation of policy and

mis-selling

9. Amount of Claim






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oo) For the Complainant Mr. Anand Swaroop Chourasia, son of

complainant

pp) For the insurer Mr. Sudhir Kumar Singh, Asst.Legal Manager

15. Complaint how disposed Partially allowed


Ms. Pooja Chourasiya (Complainant) has filed a complaint against HDFC Standard Life

Insurance Co.Ltd. (Respondent) alleging wrong deduction on cancellation of policy and

misselling.

Brief facts of the Case - The complainant has stated that she had taken policy no. 19879139

after depositing Rs.3,00,000/-. Thereafter respondent has cancelled her policy within one month

and refunded Rs.2,67,306/- after deduction of Rs.32,694/-. She has made complaint for amount

deducted. The officers of respondent have assured her that amount will be refunded within 15

days. By giving assurance of refund they issued a new policy no. 20039996. After lapse of 9

months she did not get any refund. The complainant approached this forum for refund of

deducted amount Rs.32,694/- and cancelltion of policy no. 20039996.

The respondent in their SCN have stated that policy was issued on the basis of proposal form

signed and submitted by the complainant. Policy was dispatched via speed post with option of

free look period of 15 days which was delivered to the complainant on 06.01.2018. The above

mentioned policy was cancelled on the ground of non discloser of income, occupation and

education truly at the time of proposal stage. Respondent has transferred amount of

Rs.2,67,306.55 to the account of complainant. Details of amount paid is shown in SCN.

Respondent in their SCN filed on 29.03.2019 have stated that single premium policy no.

20039996 was issued after receipt of proposal form and policy was delivered on 10.02.2018

which was sent through speed post no. EA657175031IN. It is further stated that complainant in

her complaint has not mentioned any specific ground for cancellation of policy, hence allegations

are denied.





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Policy no. :- 19879139 - This policy was issued on the life of complainant with risk

commencement date as 15.12.2017. This policy was cancelled by the respondent on account of

non discloser of income, education and occupation truly in proposal form and as per SCN

cancelled value of policy on the date of cancellation was Rs.2,74,386.55 and surrender charges

of Rs.6,000/- and GST Rs.1,080/- was deducted and amount of Rs. 2,67,306.55 was paid to the

complainant. Policy was cancelled on the ground of non discloser of true facts. On the date of

issuance of policy it was the obligation of respondent to satisfy themselves with the details

provided in the proposal form. Respondent has deducted Rs.6000/- as surrender charges from the

amount of cancelled value. Definitely policy was not surrendered by the complainant, hence it is

not a case of surrendering of policy by the complainant and hence, surrender charges are not

payable to the respondent. As policy was Unit Linked policy, hence payable amount shall depend

upon unit price on the date of cancellation. Hence, respondent has wrongly deducted Rs. 6,000/-

as surrender charges. Complaint is partially allowed and Respondent is directed to refund a

sum of Rs.6,000/- deducted by them as surrender charges, to the complainant within 30

days of receipt of this order.

Policy No. 20039996 – In her complaint complainant has also prayed for the cancellation of this

policy. In her complaint complainant has mentioned that she is in fear of old policy deduction by

the respondent, hence she wants to cancel this policy. Policy was issued on 15.12.2017 which

was dispatched through speed post on 06.02.2018 and delivered on 10.02.2018. Complainant has

not made any complaint with the respondent for cancellation of this policy and directly prayed

this forum for cancellation. Besides this no specific cause for cancellation is shown and cause

shown in complaint is hypothetical and not justified. Hence, prayer with respect to

cancellation of this policy is not justified and complaint pertaining to this policy stands

dismissed herewith.




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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA (UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – SHRI B N MISHRA CASE OF (Smt Devabati Tripathy –V-Bharati Axa Life) COMPLAINT REF: NO: BHU-L-008-1718-0419 AWARD NO: IO/BHU/A/LI/ 0107/2017-2018


Smt. Devabati Tripathy, C/O- Rabindra Kumar tripathy, Plot No. 490/P, Sahidnagar, Bhubaneswar.

2. Policy No: Type of Policy Duration of policy/Policy period

501-3045397 Life 28.03.2015

3. Name of the insured Name of the policyholder

Devabati Tripathy. -do-

4. Name of the insurer Bharati Axa Life

5. Date of Repudiation NA

6. Reason for repudiation NA

7. Date of admission of the Complaint

13.11.2017

8. Nature of complaint Mis sale ( Regular premium policy in lieu of Single premium policy.


10. Date of Partial Settlement NA


12. Complaint registered under Rule no: of Insurance Ombudsman Rules

13(1)(a)

13. Date of hearing/place 25.03.2019 / Bhubaneswar

14.

Representation at the hearing

qq) For the Complainant Devabati Tripathy

rr) For the insurer Santosh Panigrahi

15 Complaint how disposed Under Insurance Ombudsman Rule 17.

16 Date of Award/Order 26.03.2019

17) Brief Facts of the Case:- The complainant took the aforesaid policy from present Insurer during March 2015. When the policy was taken through the agent it was told to be a single premium policy. But on receipt of policy bond it was seen to be a regular premium policy which she could not afford within the income. So she applied for cancellation of policy and refund of premium and the request letter was received by the Insurer on 22.05.2015. But no communication had yet been received from the Insurer. Finding no other alternative, she approached this Forum for Redressal. As per the Insurer the policy documents were dispatched on 25.04.2015 which was received by the policy holder on 30.04.2015. The request was beyond free look period hence, it was not entertained. 18) Cause of Complaint: a) Complainant’s argument:- Complainant’s argument was that, she was canvassed for a single premium policy. Being convinced, she paid Rs.200000/- to the agent but it was invested in a regular

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premium policy which she came to know when she received the policy document. Being unable to afford such a huge amount of premium, she requested the insurer to cancel the policy and refund of premium. But, the Insurer did not respond to her request. b) Insurers’ argument:- The Insurer on the other hand denied the allegation made by the claimant. As per the Insurer, they possess the PIVC recording obtained prior to the issue of the policy. The policy was issued to the party after obtaining the consent and signature in all the relevant papers. Policy documents were dispatched on 25.04.2015 which was received by the policy holder on 30.04.2015. In this case the company received the complaint on 22.05.2015 for cancellation. As the request was beyond free look period hence, it was not entertained. 19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. This is a complaint against non-settlement of claim by Insurer. 20) The following documents were placed for perusal. a) Photo copies of proposal/policy document. b) Photo copy of complaint letter and rejection letter by Insurer. 21) Result of hearing with both parties (Observations & Conclusion):- After going through the argument and presentations of both the parties, it was observed that the claimant was cheated by the concerned agent purposefully to earn more commission. The claimant received the policy bond on 30.04.2015 and applied for cancellation on 22.05.2015 i.e after 22 days of receipt of the same. As per rules free look period expires after 15 days only for which the request of the complainant was not honored. In the process, the ultimate loser appears to be the complainant. However, to strike a balance, a common man needs to be protected and simultaneously the interest of the insurer should not be overlooked. Having regard to the peculiar facts and circumstances of the case vis-à-vis the interest of the parties concerned, the Insurer is hereby directed to convert the aforesaid policy into a single premium plan policy with minimum term as currently available without any provision of free look period. At the time of actual conversion the interest of the complainant should be safe guarded as far as practicable. The complainant is to extend all sorts of cooperation in materializing the desired conversion. As a result, at the time of hearing both the parties (both insurer and insured) agreed to convert the policy to a single premium policy with immediate effect.

22) The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017:

AWARD

Taking into account the facts & circumstances of the case and the submissions made

by both the parties during the course of hearing, it is awarded that the policy is to be

converted to a single premium plan with immediate effect.

Hence, the complaint is treated as allowed accordingly.

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a. According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with the

Award within 30 days of the receipt of the award and shall intimate the compliance to the

Ombudsman.

b. As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as specified

in the regulations framed under the Insurance Regulatory and Development Authority of India Act

1999, from the date the claim ought to have been settled under the regulations, till the date of

payment of the amount awarded by the Ombudsman.

c. As per the rule 17(8), of the said rules the award of the Insurance Ombudsman shall be binding on

the Insurers.

Dated at Bhubaneswar on 26th March.2019

(I SURESH BABU) INSURANCE OMBUDSMAN FOR THE STATE OF ODISHA


OMBUDSMAN – Shri I Suresh Babu CASE OF (Sri Subodh Kumar Das – Bharati Axa Life Insurance) COMPLAINT REF: NO: BHU-L-008-1718-0612 AWARD NO: IO/BHU/A/LI/0104 /2017-2018


Sri Subodh Kumar Das, Qrs. No. M/104 Housing Board Colony, Bhimtangi Bhubaneswar- 751002 Bhubaneswar


5015039240, 20.12.2016


Sri Subodh Kumar Das -do-

4. Name of the insurer Bharati Axa Life Insurance Co. ltd




15.03.2018

8. Nature of complaint Mis Sale

9. Amount of Claim Rs.25000/-


11. Amount of relief sought Refund of Premium with Interest

12. Complaint registered under Rule no: of Insurance

13(1)(d)

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Ombudsman Rules


14.


ss) For the Complainant Subodh Kumar Das

tt) For the insurer Prasant Kumar Hati



17) Brief Facts of the Case-: The said policy was sold to the complainant with a promise that an interest free loan would be sanctioned against the policy. The agent had also committed that the amount will be invested in a single premium policy. However after completion of the same, the complainant came to know that instead of single premium, the amount was invested in a regular premium policy in which premium is payable for 12 years. On his enquiry, he was assured that loan will be sanctioned immediately against the policy. He had several communication with the concerned agent regarding his loan but in vain. Later on 3rd Feb. 2017 he appealed for cancellation of the policy and for refund of premium with immediate effect. But, his request was not entertained as it was beyond free look period. Being dissatisfied, the complainant approached this forum for redressal. 18) Cause of Complaint: a) Complainant’s argument:- Complainant argued that, he was canvassed for this policy by a broker named SMC Insurance Broker Pvt. Ltd over phone by creating an impression that he will be sanctioned an interest free loan against the said policy. He was a low paid employee in a private organization with a very little savings in his bank account. But after selling this policy no loan was sanctioned. He had several e-mail communication with the broker, but of no result. He was also assured that the amount would be invested in a single premium policy. But it was a regular premium policy. Hence, when he applied for cancellation of the policy and refund of premium, his request was not honored citing the cause that free look period was over. Hence, he felt that he is cheated and appealed to this forum. b) Insurers’ argument:- Insurer stated that after generation of lead by the broker, the Insurer collected the signed proposal along with premium. Policy bond was issued to the complainant after pre insurance verification call. But no PIVC recording could be produced by the Insurer. However, the request of the claimant to cancel the policy was not entertained as it was beyond free look period. 19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. This is a complaint against non-payment of claim by the Insurer. 20) The following documents were placed for perusal. a) Photo copies of policy documents. b) Photo copy of representation to Insurer and its reply. 21) Result of hearing with both parties (Observations & Conclusion):- After going through the documents in detail it is observed that there is a grave allegation of mis-sale of Insurance policy. The policy schedule prominently reflects the name of Insurance broker as “SMC Insurance Brokers Pvt. ltd” and it is a case of distance marketing. It is well known that in exercise of powers conferred u/s 14(1) IRDA Act, 1999, the guidelines on distance marketing have been devised to protect the interest of the policy holders and to regulate, promote and to ensure the orderly growth of the Insurance Industry. As per those guidelines, the Insurer shall preserve in an inalterable and easily retrievable form, a

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voice/electronic/physical records as applicable of the entire process beginning with lead generation/solicitation and concluding in sale of insurance. But in the present case the Insurer has no such record before the issue of the policy. The complainant has also submitted some email records received by him from the broker in support of the loan sanctioned in his favor. It proves that the insurer was aware of this large scale scam. Wittingly or unwittingly insurers were also a party to the scam. From all these records it is apparent that the complainant was trapped by the broker (SMC Insurance Brokers Pvt. ltd) and was mis-sold an Insurance policy with a hope to avail interest free loan. Hence, this forum is of the opinion that the Insurer should cancel the policy and refund the deposit amount to the complainant in entirety.

.

22) The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017: a) According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with the Award within 30 days of the receipt of the award and shall intimate the compliance to the Ombudsman. b) As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as specified in the regulations framed under the Insurance Regulatory and Development Authority of India Act 1999, from the date the claim ought to have been settled under the regulations, till the date of payment of the amount awarded by the Ombudsman. c) As per the rule 17(8), of the said rules the award of the Insurance Ombudsman shall be binding on the Insurers.


(I SURESH BABU)

INSURANCE OMBUDSMAN FOR THE STATE OF ODISHA

AWARDS

Taking into account the facts & circumstances of the case and the submissions made by both the parties during the course of hearing, a sum of Rs.25000 (Rupees Twenty five thousand only) along with interest as specified by IRDA from the date of rejection of the claim to the date of refund is hereby awarded to be paid by the Insurer to the Complainant, towards full and final settlement of the claim. Hence, the complaint is treated as allowed accordingly

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OMBUDSMAN – Shri I Suresh Babu CASE OF (Sri Vikash Jhajaria Vs- Bharati Axa Life Ins. Co) COMPLAINT REF: NO: BHU-L-008-1819-0585 AWARD NO: IO/BHU/A/LI/ 0102/2018-2019


Mr. Vikash Jhajaria, Marwari Para, Sambalpur, 768001.


5013190482 Life 24.04.2015


Sri Vikash Jhajaria. - do-

4. Name of the insurer Bharati Axa Life Ins. Company ltd.




06.03.2019


9. Amount of Claim Rs.200000/- with interest


11. Amount of relief sought Rs.200000/-+Interest @ 18%+Mental torture +Mental toture Rs.1,00,000/- +Policy cost Rs.50,000/-.


13(1)(a)

13. Date of hearing/place 25.03.2019/ Bhubaneswar

14.


uu) For the Complainant None

vv) For the insurer Prasant Kumar Hati



17) Brief Facts of the Case:- The aforesaid policy was taken by the complainant on 24.04.2015 from the present Insurer. In his petition to this Forum he mentioned that policy was mis-sold by fraud and misrepresentation with a promise of offering loan at 0 % interest for a long term. The matter came to light when loan was practically not disbursed. The moment free look cancellation of policy was lodged a call came to continue it since loan was ready for disbursement within 2-3 days time. The original policy bond was collected also. When loan was not received, the cancellation of policy & refund premium intimation was sent to Insurer but refund of premium was regretted. Finding no other alternative complainant moved to this Forum for Redressal.

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The Insurer submitted SCN/Counter pleading that the aforesaid policy was issued on receipt of signed proposal from complainant. Since serious complaint was lodged regarding booking of policy by the complainant against respondent company, the agents and intermediaries may be called for witness by the Honorable Ombudsman as per Rule 2/Rule 15 of the Ombudsman Rule 2017. The complaint applied for cancellation policy after 1 year who slept over his rights beyond rules. More over in this case, the complaint used the insurance investment machinery to first claim various tax exemption and then claim alleging mis-selling to get refund of premium. Since the complainant applied for cancellation of policy beyond free look period, the request was rejected by the company. 18) Cause of Complaint: a) Complainant’s argument:- Complainant’s argument:- In December 2014, the Insurance Broker solicited interest free loan for a long term at 0% rate of interest against sale of policy. Being convinced he invested Rs.200000/-- and received the policy. When he did not get the loan amount and came to know that he had been cheated, he wrote to the Insurer for cancellation and refund in November, 2015. But there was no response. b) Insurers’ argument:- After generation of lead by the broker, the Insurer collected the signed proposal along with premium. Policy bond was issued to the complainant after pre insurance verification call. PIVC recording was also submitted by the Insurer at the time of hearing which confirms that the policy holder was well aware of the terms and conditions of the policy sold to him. However, the request of the claimant to cancel the policy was not entertained as it was beyond free look period. 19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. This is a complaint against non-payment of claim by the Insurer. 20) The following documents were placed for perusal. a) Photo copies of policy documents. b) Photo copy of representation to Insurer and its reply. 21) Result of hearing with both parties (Observations & Conclusion):- After going through the documents in detail it is observed that there is a grave allegation of mis-sale of Insurance policy. The policy schedule prominently reflects the name of Insurance broker as “India Infoline” and it is a case of distance marketing. It is well known that in exercise of powers conferred u/s 14(1) IRDA Act, 1999, the guidelines on distance marketing have been devised to protect the interest of the policy holders and to regulate, promote and to ensure the orderly growth of the Insurance Industry. As per those guidelines, the Insurer shall preserve in an inalterable and easily retrievable form, a voice/electronic/physical records as applicable of the entire process beginning with lead generation/solicitation and concluding in sale of insurance. But in the present case the Insurer has no such record except the PIVC which was only recorded after lead generation and before the issue of the policy. It was also observed that the agent was always in constant touch with the local branch and the complainant was getting all information/direction from such agent which was very much in the knowledge of local branch. Moreover, it is observed that on request of cancellation of policy during free look period the complainant was lured instantly that the loan is already sanctioned and it is in the process of disbursement. The complainant has also submitted some email records received by him from the broker in support of the loan sanctioned in his favor. Some of the insurers cancelled their policies and returned their premiums on receipt of complaints from same insured who have also been promised interest free loans and the ready willingness of some of the insurers to cancel the policies and retain only one single policy, only proves that the insurers were aware of this large scale scam. Wittingly or unwittingly insurers were also a party to the scam.

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From all these records it is apparent that the complainant was trapped by the broker (India Infoline) and was mis-sold an Insurance policy with a hope to avail interest free loan. Hence, this forum is of the opinion that the Insurer should cancel the policy and refund the deposit amount to the complainant in entirety.

22) The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017: a) According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with the Award within 30 days of the receipt of the award and shall intimate the compliance to the Ombudsman. b)As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as specified in the regulations framed under the Insurance Regulatory and Development Authority of India Act 1999, from the date the claim ought to have been settled under the regulations, till the date of payment of the amount awarded by the Ombudsman c) According to the said rule, the award of the Insurance Ombudsman shall be binding on the Insurers.

Dated at Bhubaneswar on 26th March. 2019 (I SURESH BABU)



OMBUDSMAN – Shri I Suresh Babu CASE OF (Sri Subodh Kumar Das – Future Generali India Life Insurance) COMPLAINT REF: NO: BHU-L-017-1718-0611 AWARD NO: IO/BHU/A/LI/0127/2017-2018


Sri Subodh Kumar Das, Qrs. No. M/104 Housing Board Colony, Bhimtangi Bhubaneswar- 751002 Bhubaneswar


01316832 Life 04.11.2016

AWARD

Taking into account the facts & circumstances of the case and the submissions made by

both the parties during the course of hearing, a sum of Rs.200000/- (Rupees Two Lakh

only) along with interest as specified by IRDA from the date of repudiation of claim to

the date of refund is hereby awarded to be paid by the Insurer to the Complainant,

towards full and final settlement of the claim.


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Sri Subodh Kumar Das -do-

4. Name of the insurer Future Generali India Life Insurance




15.03.2018




11. Amount of relief sought Refund of Premium with Interest


13(1)(d)


14.


ww) For the Complainant

Subodh Kumar Das

xx) For the insurer Vimal Acharya



17) Brief Facts of the Case-: The said policy was sold to the complainant with a promise that an interest free loan would be sanctioned against the policy. The agent had also committed that the amount will be invested in a single premium policy. However after completion of the same, the complainant came to know that instead of single premium, the amount was invested in a regular premium policy in which premium is payable for 12 years. On his enquiry, he was assured that loan will be sanctioned immediately against the policy. He had several communication with the concerned agent regarding his loan but in vain. Later on 3rd Feb. 2017 he appealed for cancellation of the policy and for refund of premium with immediate effect. But, his request was not entertained as it was beyond free look period. Being dissatisfied, the complainant approached this forum for redressal. 18) Cause of Complaint: a) Complainant’s argument:- Complainant argued that, he was canvassed for this policy by a broker named SMC Insurance Broker Pvt. Ltd over phone by creating an impression that he will be sanctioned an interest free loan against the said policy. He was a low paid employee in a private organization with a very little savings in his bank account. But after selling this policy no loan was sanctioned. He had several e-mail communication with the broker, but of no result. He was also assured that the amount would be invested in a single premium policy. But it was a regular premium policy. Hence, when he applied for cancellation of the policy and refund of premium, his request was not honored citing the cause that free look period was over. Hence, he felt that he is cheated and appealed to this forum. b) Insurers’ argument:- Insurer stated that after generation of lead by the broker, the Insurer collected the signed proposal along with premium. Policy bond was issued to the complainant after pre insurance verification call. But no PIVC recording could be produced by the Insurer. However, the request of the claimant to cancel the policy was not entertained as it was beyond free look period.

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19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. Mis sale. 20) The following documents were placed for perusal. a) Photo copies of policy documents. b) Photo copy of representation to Insurer and its reply. 21) Result of hearing with both parties (Observations & Conclusion):- After going through the documents in detail it is observed that there is a grave allegation of mis-sale of Insurance policy. The policy schedule prominently reflects the name of Insurance broker as “SMC Insurance Brokers Pvt. ltd” and it is a case of distance marketing. It is well known that in exercise of powers conferred u/s 14(1) IRDA Act, 1999, the guidelines on distance marketing have been devised to protect the interest of the policy holders and to regulate, promote and to ensure the orderly growth of the Insurance Industry. As per those guidelines, the Insurer shall preserve in an inalterable and easily retrievable form, a voice/electronic/physical records as applicable of the entire process beginning with lead generation/solicitation and concluding in sale of insurance. But in the present case the Insurer has no such record before the issue of the policy. The complainant has also submitted some email records received by him from the broker in support of the loan sanctioned in his favor. It proves that the insurer was aware of this large scale scam. Wittingly or unwittingly insurers were also a party to the scam. Hence, the case is to be admitted as a mis sale. Further the claimant received the policy bond in time and applied for cancellation after free look period. As per rules free look period expires after 15 days only for which the request of the complainant was not honored. In the process, the ultimate loser appears to be the complainant. However, to strike a balance, a common man needs to be protected and simultaneously the interest of the insurer should not be overlooked. Having regard to the peculiar facts and circumstances of the case vis-à-vis the interest of the parties concerned, the Insurer is hereby directed to convert the aforesaid policy into a single premium plan policy with minimum term as currently available without any provision of free look period. At the time of actual conversion the interest of the complainant should be safe guarded as far as practicable. The complainant is to extend all sorts of cooperation in materializing the desired conversion. In this case the complaint had paid Rs.35000/- as a regular premium. But as per the insurer, the minimum single premium is Rs.50000/-. So, the claimant was asked to deposit balance of Rs.15000/- and the insurer would issue a single premium policy with a premium of Rs.50000/. Hence, at the time of hearing both the parties (both insurer and insured) agreed to convert the policy to a single premium policy with immediate effect.


AWARD

Taking into account the facts & circumstances of the case and the

submissions made by both the parties during the course of hearing, the

insurer is directed to convert the policy to a single premium plan after

receiving an additional amount of Rs.15000/ from the complainant.


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a) According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with

the Award within 30 days of the receipt of the award and shall intimate the compliance to the

Ombudsman.

b) As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as

specified in the regulations framed under the Insurance Regulatory and Development Authority

of India Act 1999, from the date the claim ought to have been settled under the regulations, till

the date of payment of the amount awarded by the Ombudsman.

c) As per the rule 17(8), of the said rules the award of the Insurance Ombudsman shall be binding

on the Insurers.

Dated at Bhubaneswar on 28th March 2019 (I SURESH BABU)



OMBUDSMAN – SHRI I SURESH BABU CASE OF (Mr. Rupesh Kumar Panda Vs. Reliance Nippon Life Ins.) COMPLAINT REF: NO: BHU-L-036-1819-0559 AWARD NO: IO/BHU/A/LI/ 0101 /2017-2018


Mr.Rupesh Kumar Panda. At- Modipara, Near Sparsh Nursing Home, Sambalpur-768002


52353309 Life 07.09.2015


Mr. Rupesh Kumar Panda ---do----

4. Name of the insurer Reliance Nippon Life Ins. Co.ltd.




03.02.2019




11. Amount of relief sought Rs.1,50,000/- with interest


13(1)(d)



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14.

a) For the Complainant None

b) For the insurer Kamrul Bharat



17) Brief Facts of the Case:- The aforesaid policy was taken by the complainant on 07.09.2015 from the present Insurer. In his petition to this Forum he mentioned that policy was mis-sold by fraud and misrepresentation with a promise of offering loan at 0 % interest for a long term. The matter came to light when loan was practically not disbursed. The moment free look cancellation of policy was lodged a call came to continue it since loan was ready for disbursement within 2-3 days time. The original policy bond was collected also. When loan was not received, the cancellation of policy & refund premium intimation was sent to Insurer but refund of premium was regretted. Finding no other alternative complainant moved to this Forum for Redressal. 18).Cause of Complaint: a) Complainant’s argument:- In December 2014, the Insurance Broker solicited interest free loan for a long term at 0% rate of interest against sale of policy. Being convinced he invested Rs.150000/-- and received the policy. When he did not get the loan amount and came to know that he had been cheated, he wrote to the Insurer for cancellation and refund in Feb.2016. But there was no response. b) Insurers’ argument:- After generation of lead by the broker, the Insurer collected the signed proposal along with premium. Policy bond was issued to the complainant after pre insurance verification call. PIVC recording was also submitted by the Insurer at the time of hearing which confirms that the policy holder was well aware of the terms and conditions of the policy sold to him. However, the request of the claimant to cancel the policy was not entertained as it was beyond free look period. But, the respondent company in it’s written submission stated that “without accepting any of the allegations mentioned in the complaint and as a goodwill gesture the company is agreeable to settle the present case by offering a Single Premium policy to the complainant by issuing a new Single Premium Policy with current RCD and without any free look-in period subject to the completion of the necessary formalities by the complainant 19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. This is a complaint against non-payment of claim by the Insurer. 20) The following documents were placed for perusal. a) Photo copies of policy documents. b) Photo copy of representation to Insurer and its reply. 21) Result of hearing with both parties (Observations & Conclusion):- After going through the documents in detail it is observed that there is a grave allegation of mis-sale of Insurance policy. The policy schedule prominently reflects the name of Insurance broker as “India Infoline” and it is a case of distance marketing. It is well known that in exercise of powers conferred u/s 14(1) IRDA Act, 1999, the guidelines on distance marketing have been devised to protect the interest of the policy holders and to regulate, promote and to ensure the orderly growth of the Insurance Industry. As per those guidelines, the Insurer shall preserve in an inalterable and easily retrievable form, a voice/electronic/physical records as applicable of the entire process beginning with lead generation/solicitation and concluding in sale of insurance. But in the present case the Insurer has no such record except the PIVC which was only recorded after lead generation and before the issue of the policy. It was also observed that the

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agent was always in constant touch with the local branch and the complainant was getting all information/direction from such agent which was very much in the knowledge of local branch. Moreover, it is observed that on request of cancellation of policy during free look period the complainant was lured instantly that the loan is already sanctioned and it is in the process of disbursement. The complainant has also submitted some email records received by him from the broker in support of the loan sanctioned in his favor. Further, some of the insurers cancelled their policies and returned their premiums on receipt of complaints from same insured who have also been promised interest free loans and the ready willingness of some of the insurers to cancel the policies and retain only one single policy, only proves that the insurers were aware of this large scale scam. Wittingly or unwittingly insurers were also a party to the scam. The Insurer’s offer to convert the policy to a single premium policy was also not accepted by the complainant as he has already suffered a big financial loss from such investment and there was an inordinate late in refund of the premium. From all these records it is apparent that the complainant was trapped by the broker (India Infoline) and was mis-sold an Insurance policy with a hope to avail interest free loan. Hence, this forum is of the opinion that the Insurer should cancel the policy and refund the deposit amount to the complainant in entirety.


a) According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with

the Award within 30 days of the receipt of the award and shall intimate the compliance to the

Ombudsman.


specified in the regulations framed under the Insurance Regulatory and Development Authority

of India Act 1999, from the date the claim ought to have been settled under the regulations, till

the date of payment of the amount awarded by the Ombudsman.

c) As per the rule 17(8), of the said rules the award of the Insurance Ombudsman shall be binding

on the Insurers.


(I SURESH BABU)



both the parties during the course of hearing, a sum of Rs.150000 (Rupees One Lakh Fifty

Thousand only) along with interest as specified by IRDA from the date of repudiation of

claim to the date of refund is hereby awarded to be paid by the Insurer to the

Complainant, towards full and final settlement of the claim.


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OMBUDSMAN – SHRI I SURESH BABU CASE OF (Mr. Subodh Kumar Das Vs. India First Life Insurance Co. ltd.) COMPLAINT REF: NO: BHU-L-024-1718-0610 AWARD NO: IO/BHU/A/LI/ 0109 /2017-2018


Subodh kumar Das, Qrs. No- M/104, Housing Board Colony, Bhimtangi, Bhubaneswar


10460841 Life 29.09.2016


Mr. Subodh Kumar Das -----do-----

4. Name of the insurer India First Life Insurance Co. ltd.




14.03.2018

8. Nature of complaint Mis-sale



11. Amount of relief sought Rs.30000/- with interest


13(1)(d)


14.


a) For the Complainant Subodh Kumar Das

b) For the insurer None



17) Brief Facts of the Case:- The said policy was purchased by the claimant from the present Insurer on 29.09.2016. The claimant was assured that he was investing in a single premium policy. But to his utter surprise, he came to know that, it was a regular premium policy. Then he wanted to cancel the policy on 03.02.2017. But his request was not honored with a plea that free look period was over. Being dissatisfied, he approached this forum for redressal. 18) Cause of Complaint: a) Complainant’s argument:-. The complainant stated that the above policy was mis-sold to him by the agent. He was asked to invest in a single premium policy. But when he got the policy bond he came to know that he was cheated and the amount was invested in a regular premium policy. So immediately he requested to cancel the policy. But his request was not honored with a plea that free look period was over. b) Insurers’ argument:- The Insurer on the other hand submitted SCN stating that “Without getting into merits of the case and without admission of any allegation as made in the captioned notice,

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Complainant policy bearing no. 10460841 has already been cancelled and the premium amount of Rs.30000/- has been refunded to bank account of the complainant” on 16.03.2018. Hence, the complaint may be closed. 19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. This is a complaint against non-settlement of claim by Insurer. 20) The following documents were placed for perusal. a) Photo copies of proposal/policy document. b) Photo copy of complaint letter and rejection letter by Insurer. 21) Result of hearing with both parties (Observations & Conclusion):- After going through the argument of both the parties in detail it is observed that, on the basis of the request of the complainant, the policy bearing no.10460841 has been cancelled and premium amount of Rs.30000/- has already been credited to the Bank account of the complainant on 16.03.2018 by the Insurer. The complainant also admitted of receiving the amount through NEFT. Hence, this forum is of the opinion that the case should be disposed off.


a) According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply

with the Award within 30 days of the receipt of the award and shall intimate the compliance

to the Ombudsman.


specified in the regulations framed under the Insurance Regulatory and Development

Authority of India Act 1999, from the date the claim ought to have been settled under the

regulations, till the date of payment of the amount awarded by the Ombudsman.

c) According to the said rule, the award of the Insurance Ombudsman shall be binding on the

Insurers.

Dated at Bhubaneswar on 27th March 2019 (I SURESH BABU)


AWARD

Taking into account the facts & circumstances of the case and the

submissions made by both the parties during the course of hearing, the

complaint is treated as disposed off.

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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH

(UNDER INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – Dr. D K Verma

Case of Shri Gurkirpal Singh Dhatt V/S HDFC Standard Life Insurance Co. Ltd.

COMPLAINT REF: NO: CHD-L-019-1718-0846


Complainant

Shri Gurkirpal Singh Dhatt

# 1030, Phase-4, Mohali

2. Policy No:

Type of Policy

Duration of policy/Policy period

16265062

Classic Assure Plus

10/7 years



Sh Sarvdeep Singh Dhatt






9. Amount of Claim NA


11. Amount of relief sought Rs. 1.7 lakhs

12. Complaint registered under

Rule no:

13.1(d)


For the Complainant Self

For the insurer Shri Arpit Higgins,

Manager(Legal&Comp)

Shri Gurpreet Singh, Dy Manager(Legal)


15 Date & Place of Hearing 06.02.2019/Chandigarh

16) Brief Facts of the Case:

On 30.08.2017, Shri Gurkirpal Singh Dhatt had filed a complaint in this office against HDFC

Standard Life Insurance Company about mis-selling of policy bearing number 16265062. He

was sold many policies during the same time in order to get benefits along with refund of new

policies. However, when he did not get any refund, he realized that he had been cheated. He

requested the Insurance Company to cancel the policy and refund the premium but could not get

any relief. Hence, feeling aggrieved, he has approached this forum to seek justice.

17) Cause of Complaint:

Complainant’s argument:

The complainant re-iterated the contents of his complaint and said that he was sold many policies

on the pretext of getting huge benefits along with refund under the new policies. He was sold 9

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policies out of which, he received refund under 8 policies of other insurance companies. In this

policy, another premium was also deducted through ECS.

Insurers’ argument:

The representative of the Company informed that the policy bearing number 16265062 was

issued on 26.08.2013 for a premium of Rs. 1.7 lakhs to be paid for 7 years. The policy was

delivered on 07.09.2013 and the first complaint was received on 09.08.2016 which was 3 years

late.

18) The following documents were placed for perusal :-

a) Complaint to the Company

b) Reply of the Insurance Company

19) Result of personal hearing with both parties (Observations & Conclusion)

I have examined the various documents available in the file including the copy of the complaint,

Annexure-VI and the contents of the SCN filed by the Insurance Company. It is evident from the

documents and submission of both the parties that the complainant was mis-informed about the

benefits he would get on purchasing new policies. The complainant and his family has been sold

many policies of different insurance companies within the same period without assessing their

insurance requirements and the financial capacity. However, the complainant has also approached

the Insurance Company after a delay of 3 years.

The attention of the complainant and the Insurer is hereby invited to the following provisions of

Insurance Ombudsman Rules, 2017:

a. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply

with the award within 30 days of the receipt of the award and intimate compliance of the same

to the Ombudsman.

Dated at Chandigarh on 7th

day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN

Taking into account facts and circumstances of the case and submissions made

by both the parties during the course of hearing, the Insurance Company is

directed to cancel the policy bearing number 16265062 since inception and

adjust the premiums collected there-in into a new single premium unit-linked

policy subject to underwriting and fulfillment of requirements and no freelook

clause.

Hence, the complaint is treated as closed.

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Case of Shri Purshotam Dass V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Purshotam Dass

293/2, Gulati Road, Samalkha

2. Policy No:

Type of Policy


10651126

Unit Linked Young Star

10 years



Sh Purshotam Dass








11. Amount of relief sought Rs. 3 lakhs + interest


Rule no:

13.1(d)




Manager(Legal&Comp)





On 16.10.2017, Shri Purshotam Dass had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 10651126. He purchased

the policy on 19.07.2006 and as per schedule, paid premiums for 10 years. On maturity, he was

offered only Rs. 19,029/= against Rs. 3 lakhs of premium paid. Feeling cheated, he complained

to the Company but could not get any relief. Hence, feeling aggrieved, he has approached this

forum to seek justice.

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The complainant said that he was sold a policy in 2006 wherein he paid all premiums in time,

even then he was given Rs. 19,029/= on maturity as against a premium payment of Rs. 3 lakhs.

He did not get any policy document or unit statement.



issued on 19.07.2006 for a quarterly premium of Rs. 25,000/= to be paid for 10 years. The

complainant paid premium for only 3 years amounting to Rs. 3 lakhs. The complainant

approached the Insurance Company on 30.06.2014 when he was informed that the policy was in

lapsed condition since 19.07.2009 due to non-payment of premium. Detailed unit statement

mentioning deduction of charges was also sent to him. Hence, at the time of maturity, a sum of

Rs. 19,029/= was lying unclaimed with the Insurance Company.



b) Reply of the Insurance Company was sent on 22.03.2019


I have examined the various documents available in the file including the copy of the complaint and

the contents of the SCN filed by the Insurance Company. The policy purchased by the complainant

is a unit-linked plan wherein premium is to be paid for 10 years. However, the complainant did not

pay any premium after 3 years. Units were added to his account for the premiums paid by him but

the charges under the policy were deducted as per schedule for the entire term of 10 years. In view of

this, the number of units kept decreasing over the years and at the time of maturity only 1154.46775

remained in his account, the value of which was paid to him. The complainant has alleged that he

was paid less than the amount he has invested, although benefits paid were as per those mentioned in

the policy document. The plea taken by the complainant during personal hearing that he has not

received the policy document seems to be an after-thought, there being not a single word about the

same in the complaint. On the other hand, the Insurance Company has paid a maturity amount of Rs.

19,029/=. However, this amount does not correspond to the unit statement sent by the Company. As

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per the statement, there were 929.7082 units remaining in the complainant’s account with unit price

of Rs. 129.1016 as on the date of maturity i.e. 19.06.2016 which makes payable value of Rs.

1,20,026.82. The Company vide an email dated 25.03.2019 has expressed its inability to clarify and

has agreed to process the calculated amount to the complainant.



a. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall

comply with the award within 30 days of the receipt of the award and intimate

compliance of the same to the Ombudsman.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Shri Ajay Kumar Khanijo & 7 others V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Ajay Kumar Khanijo

C/o Amba Rice Mill, Jind Road, Kaithal

2. Policy No:

Type of Policy


14813465, 14813690, 14829034, 14828819,

14833066, 14833626, 14833058, 14870154,

14870632, 14936394, 14958416

Classic Assure Plus, Crest



Sh Sanjeev Kumar, Shri Ajay Kumar, Shri

Sahil Khanijo, Shri Sahab Khanijo, Ms.

Anju Rani, Ms Isha Khanijo, Ms. Deepika

Khanijo, Ms. Anita Rani



directed to make a payment of Rs. 1,20,026.82 as maturity claim along with 6%

interest from the date of maturity till the date of actual payment.


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11. Amount of relief sought Rs. 7 lakhs


Rule no:

13.1(d)



For the insurer Shri Arpit Higgins, Manager(Legal&Comp)


14 Complaint how disposed Dismissed



On 14.08.2017, Shri Ajay Kumar Khanijo and 7 others had filed a complaint in this office against HDFC

Standard Life Insurance Company about mis-selling of 11 policies bearing numbers 14813465,

14813690, 14829034, 14828819, 14833066, 14833626, 14833058, 14870154, 14870632, 14936394 and

14958416. They were sold the policies as an FD which would yield 18% interest. None of the

complainants has signed the proposal form and none of the policy documents were received by them.

They complained to the Company against the cheating but could not get any relief. Hence, feeling

aggrieved, they has approached this forum to seek justice.



The complainant said that he and his family were sold nine policies in 2011-12. They had a Rice

Mill whose accounts were maintained in HDFC Bank. They were advised by the Bank Manager

to invest in an FD. However, when he received a call for renewal premium payment, he realized

that they had been sold insurance policies. All the premium was paid through the Company’s

account.


The representative of the Company informed the following

Policy No. Life Assured Premium Premium Term Issue Date Delivery

Date

14813465 Sanjeev Kumar 50,000 5 years 26.12.201

1

04.01.2012

14813690 Ajay Kumar 50,000 5 years 26.12.201

1

07.01.2012

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14829034 Ajay Kumar 50,000 7 years 03.01.201

2

12.01.2012

14828819 Sanjeev Kumar 50,000 7 years 03.01.201

2

12.01.2012

14833066 Sahil Khanijo 50,000 7 years 03.01.201

2

14.01.2012

14833626 Sahab Khanijo 50,000 7 years 03.01.201

2

14.01.2012

14833058 Anju Rani 50,000 7 years 03.01.201

2

14.01.2012

14870154 Isha Khanijo 99,999 7 years 19.01.201

2

30.01.2012

14870632 Deepika Khanijo 99,999 7 years 19.01.201

2

01.02.2012

14936394 Anita Rani 99,999 7 years 13.02.201

2

23.02.2012

14958416 Sahab Khanijo 50,000 7 years 21.02.201

2

01.03.2012

The first complaint was received on 12.01.2017 which was 5 years after the purchase of the

policies.






the contents of the SCN filed by the Insurance Company. All the policies were purchased within a

span of three months. Although the complainant claims that the premium was paid through Rice

Mill’s account but all the proposal forms mention DD s made through different individual accounts.

The complainants have mentioned in their complaint that they did not receive the policy document

but during personal hearing, the complainant said that they did receive some policies contradicting

his own statement. The first complaint regarding non-receipt of policy documents was made on

10.02.2013 but even after not receiving a fruitful response, no follow-up complaint was lodged till

2017 i.e. for 4 years.

Further, even if the complainants were sold the policies as FD, when they received some insurance

policies, they should have realized that they were not FDs and filed a complaint. Moreover, on

receipt of the call for payment of renewal premium, they should have complained immediately but

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they have taken five years from the purchase of policies to file a complaint for which they have not

been able to give any reasonable justification. Hence, the complaint seems to be an after-thought.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH


INSURANCE OMBUDSMAN-Dr. D.K. VERMA

Case of Ms. Radha Rani Vs SBI Life Insurance Co. Ltd.

CASE NO- CHD-L-041-1718-0532


Complainant

Ms. Radha Rani, House No. 43, Ward No. 21,

Chawla Colony, Rohtak, Haryana-124001

2. Policy No: DOC

Type of Policy


06030868003/ 27.01.2009

SBI Life-Sudarshan Plan A



Ms. Radha Rani

Ms. Radha Rani

4. Name of the insurer SBI Life Insurance Co. Ltd.




8. Nature of complaint Mis-Selling

9. Amount of Claim Refund of premium


11. Amount of relief sought Refund of premium


Rule no: Insurance Ombudsman

Rules, 2017

13 [1] [d

13. Date of hearing/place 27.12.2018 23.01.2019 & 22.02.2019 / Chandigarh


d) For the Complainant Absent


made by the Company during the course of hearing, there is no need for any

interference and the complaint is dismissed.


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e) For the insurer Mr. Raman Malhotra

15. Complaint how disposed Dismissed in default.


17. Brief Facts of the case:

On 22.06.2017, Ms. Radha Rani had filed a complaint of mis-selling against SBI Life Insurance Co.

Ltd. in respect of polices bearing no 06030868003.

18). Arguments of Insurer In personal hearing & in SCN the insurance company submitted that the company issued a policy

bearing no. 06030868003 with date of commencement 27.01.2009 for a sum assured of Rs. 1,00,000/-

and equivalent benefit under accidental death/ TPD rider. The terms of the policy was 20 years and

the mode of the premium payment was yearly. The complainant has paid all the premiums from

27.01.2009 to 27.01.2017 which means that she has accepted the terms and conditions of the policy.

The complainant has not raised any complaint till 03.06.2017 from the date of commencement of the

policy and suddenly she raised complaint of fraud and has demanded refund of premium. The

company further submitted that it is an afterthought of the complainant and the same is not

maintainable. The policyholder has availed the insurance cover for the premium paid by her and if any

unfortunate event had happened, the company would have paid the insurance claim. The representative

of the insurer also requested for dismissal of the case as the complainant has not presented herself on

various dates fixed for personal hearing.

19). Observations & Findings:-

The complainant was given opportunity of personal hearing on 28.12.2018, 23.01.2019 & 22.02.2019.

The complainant did not attend the hearing on either of dates fixed for personal hearing. Non

appearance in personal hearing indicates that she has nothing to say in this matter. However, the

insurance company was represented by Mr. Raman Malhotra who requested for dismissal of the

complaint since sufficient opportunities have been given to the complainant to present her case.

AWARD


made by insurance company during the course of personal hearing, the complaint

in respect of policy no. 06030868003. Is dismissed in default.


Dated at Chandigarh on 22.02.2019

Dr. D. K. Verma

INSURANCE OMBUDSMAN

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(UNDER INSURNCE OMBUDSMAN RULES, 2017)


Case of Shri Harparkash singh V/S Kotak Life Insurance Company Ltd.



Complainant

Shri Harparkash Singh

245A, Street No. 7

Sant Vihar, Vill Baloke, Ludi]hiana

2. Policy No:

Type of Policy


01904044, 01839703, 01839765, 01862656,

01890267, 01892665, 02292421

Super Advantage, endowment

20 years, 15 years



Ms. Lakhwinder Kaur, Ms. Simran Singh

4. Name of the insurer Kotak Life Insurance Company









Rule no:

13.1(d)



For the insurer Sh. Aditya Singh, Chief Manager Legal

Sh. Manish Mittal, Chief Manager




On 26.08.2016, Shri Harparkash Singh had filed a complaint in this office about mis-selling of seven

policies bearing numbers 01904044, 01839703, 01839765, 01862656, 01890267, 01892665 and

02292421 from 2009 to 2011 to his father in the name of his daughter and grand-daughter without

taking their signatures on any form. When he realized that he had been duped, he sought withdrawal

but was refused the refund by the Company. Hence, he has approached this office to seek justice.



The complainant re-iterated the contents of his complaint and said that his father was mis-sold

seven policies by forging signatures.

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The representative of the Company informed that the policies bearing numbers 1862656, 1890267,

1892605 and 2292421 were purchased on 22.01.2010, 13.02.2010, 16.02.2010 and 21.04.2011 for a

premium of Rs. 15,000/=, Rs. 49,999/-=, Rs. 50,000/= and Rs. 30,008/= to be paid for 20, 20, 20 and

15 years respectively. The policy documents were dispatched on 04.02.2010, 19.02.2010, 22.02.2010

and 27.04.2011 respectively. The first complaint alleging mis-sale was received by the Company on

28.06.2016. The status of the mentioned policies along with others was as under

a) 1862656 - Cancelled in the freelook period as the client alleged false commitment of bonus after

3 years.

b) 1890267 – foreclosure payout of Rs. 5000.90 was released via cheque no. 473094 which was

encashed on 23.03.2013

c) 1892605 – foreclosure payout of Rs. 5000/= was released

d) 1839765 – withdrawn at proposal stage in 2010, refund cheque encashed on 27.03.2016

e) 1870838 – withdrawn at proposal stage in 2010

f) 1870887 – withdrawn at proposal stage in 2010

g) 1874750 – withdrawn at proposal stage in 2010

h) 1874837 – withdrawn at proposal stage in 2010, refund cheque encashed on 06.04.2010

i) 1904044 – withdrawn at proposal stage in 2010

j) 1839703 – withdrawn at proposal stage in 2010, refund cheque encashed on 06.04.2010

The Company had requested the client to submit KYC documents for investigation of allegation

of signature mis-match which was not provided. Hence, the Company declined to cancel the

policies.



b) Annexure VI-A

c) Reply of the Insurance Company

19)Result of personal hearing with both parties (Observations & Conclusion)


Annexure-VI and the contents of the SCN filed by the Insurance Company and also considered

submissions made by both sides during personal hearing. As requested by the Insurance Company, a

month’s time was given to the Company to confirm encashment of cheques. The Company vide an

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email dated 22.03.2019, has produced encashment details of four cheques. Cheques have been

encashed at Kotak Mahindra Bank Ltd., 120 Feroze Gandhi Market, Ludhiana. The complainant has

made a complaint of 7 policies although he had proposed for more policies out of which some were

withdrawn at the proposal stage. This indicated that he was aware as well as conscious of the

policies he was purchasing. Moreover, had he been dis-satisfied with the policies, he could have also

got the same cancelled as he did for others. However, the complaint has approached the Company

with his grievance after 6 years for which he has not been able to give any suitable justification.

Dated at Chandigarh on 22nd

day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Mr. Jagdish Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1146


Complainant

Mr. Jagdish Singh S/o Shri Malkeet Singh,

H. No.- 29550, St. No.- 9, Janta Nagar, Bathinda,

Punjab- 8699290019

2. Policy No: DOC

Type of Policy


03428870 & 03414764 / 21-10-2016, 22-09-2016

Exide Life Guaranteed Income Insurance Plan

10/20 Yrs/Rs. 19275 & 07/15/Yrs Rs. 60717/-



Mr. Jagdish Singh

Mr. Jagdish Singh


5. Date of Repudiation NIL


7. Date of receipt of the Complaint 12-12-2017


ORDER



interference and the compliant is dismissed.


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9. Amount of Claim NIL

10. Date of Partial Settlement NIL

11. Amount of relief sought Refund of premiums under the above policies



Rules, 2017

13.1.(d)

13. Date of hearing/place 12.02.2019/Chandigarh



For the insurer Mr. Vignesh Ram- Assistant Manager- Legal

15. Complaint how disposed Award



On 12-12-2017, Mr. Jagdish Singh had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policies bearing no’s. 03428870 & 03414764. He has alleged that above policies have

been missold to him based on the assurance of refund from Mr.Gurpal Singh’s old policies and the

premiums under the said policies have been paid by Mr.Gurpal Singh. He has further stated that he has

not signed any proposal forms and when he complained to the company for cancellation of these

policies, his request was not responded by the company. Hence, feeling aggrieved, he approached this

office to seek justice.

The Insurer in their SCN dated 05.04.2018, has stated that the above policies were issued after

receipt of duly filled and signed proposal forms, from the complainants and the policy bonds

along with welcome letter were dispatched and duly delivered at complainant’s address. The

complainant has not disputed on receipt of the said policy bonds and later on filed a complaint on

18.10.2017 and sought cancellation of said policies which is after a lapse of almost 12 months from

the receipt of policy documents.



Mr. Jagdish Singh, the complainant attended the personal hearing on 12.02.2019, reiterated the contents

of the complaint and submitted that his friend Mr. Gurpal Singh had requested to purchase above

policies so that he could receive the refund under his old policies. He further submitted that Mr.Gurpal

Singh has also given him cash for depositing in his bank account so that he could issue cheques to the

above company. The complainant also provided his bank pass book showing the deposit of cash

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transaction in his account and also submitted that he has not signed the proposal forms under the said

policies and no agent of the above company had ever visited him for collecting any documents. He

further added that he had sent only signed cheques and KYC documents as was advised telephonically

by the agent of above company and he was also assured that premiums under the said policies will be

refunded to him later on.


The insurer’ representative reiterated the contents of SCN and informed that the complainant has

submitted his complaint almost after a lapse of almost 12 months from the receipt of policy

documents under the said policies. However he could not submit any proof of delivery of said

policies from which the date of receipt of policy documents could be established.

19) The following documents were placed for perusal:-

a) Photocopies of all the proposal forms. b) Complaint to the insurer. c) Reply of the company


On going through the various documents available in the file and also hearing both the complainant and

the representative of the Insurance Company, It is observed that it is a case of gross and composite mis-

selling by the agent of the Insurance Company who allured and assured Mr. Gurpal Singh

(acquaintance of the complainant) to purchase multiple policies on the lives of his family members, co

workers and acquaintances. Actually, insurance is a subject matter of solicitation and it appears that the

agent/ representative of the company sold the insurance in a fraudulent manner promising returns on

the earlier policies, without looking into actual insurance needs and premium paying capacity of the life

assured/ policy holder. The representative of the Insurance Company although submitted that the policy

bonds were delivered to the complainant in time, but he could not furnish any dispatch details or proof

of delivery of said policy bonds. The Insurance Company has not followed the norms related to

financial underwriting in a proper manner and now the company cannot take shelter of free look period.

Surprisingly the insurance company vide its letter dated 27.10.2017 has asked the complainant to

submit ITR copies of last two financial years i.e. for 2015-16 & 2016-17 which should have been called

for before issuance of above said policies.

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The attention of the Complainant and the Insurer is hereby invited to the following provisions of






day of February, 2019.

D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Jarnail Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1142


Complainant

Mr. Jarnail Singh S/o Shri Darbag Singh,

VPO- Manuke, Distt.- Moga, Punjab-0

Mobile No.- 9653941773

2. Policy No: DOC

Type of Policy


03467238 & 03467213 / 28-12-2016

Exide Life Income Advantage Plan, Exide Life

Guaranteed Income Insurance Plan

07/16yrs/Rs. 38550/- & 08/16/Rs.38550/-



Mr. Jarnail Singh

Mr. Jarnail Singh





AWARD


both the parties during the course of hearing, an award is passed with a direction to the

insurance company to cancel the policies bearing no’s 03428870 & 03414764, since

inception and refund all the premiums collected there-in without interest and without

deductions of any charges.


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Rules, 2017

13.1.(d)








On 06-12-2017, Mr. Jarnail Singh had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policies bearing no’s. 03467238 & 03467213. He has alleged that the above policies

have been missold to him based on the assurance of refund from Mr.Gurpal Singh’s old policies and the

premiums under the said policies have been paid by Mr. Gurpal Singh. He has further stated that he has







complainant has not disputed on receipt of the said policy bonds and later on filed a complaint

and sought cancellation of said policies which is after a lapse of almost 09 months from the receipt

of policy documents.



Mr. Jarnail Singh, the complainant attended the personal hearing on 12.02.2019, reiterated the contents




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financial underwriting in a proper manner and now the company cannot take shelter of free look period.



for before issuance of above said policies.

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AWARD









b. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of February, 2019

D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Gurmeet Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1143


Complainant

Mr. Gurmeet Singh

St. No.-11, Sucha Singh Nagar, Bathinda,

Punjab-0

Mobile No.- 9041940732

2. Policy No: DOC

Type of Policy


03431008 & 03431023 / 24-10-2016

Exide Life Income Advantage Plan, Exide Life


08/16yrs/Rs.47224/- &07/15yrs/Rs.48188/-



Mr. Gurmeet Singh

Mr. Gurmeet Singh






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Rules, 2017

13.1.(d)








On 12-12-2017, Mr. Gurmeet Singh had filed a complaint of mis-selling against Exide Life Insurance

Co. Ltd. in respect of policies bearing no’s. 03431008 & 03431023. He has alleged that above policies

have been missold to him based on the assurance of refund from Mr. Gurpal Singh’s old policies and the









and sought cancellation of said policies which is after a lapse of almost 12 months from the receipt

of policy documents.



Mr. Gurmeet Singh, the complainant attended the personal hearing on 12.02.2019, reiterated the

contents of the complaint and submitted that his friend Mr.Gurpal Singh had requested to purchase

above policies so that he could receive the refund under his old policies. He further submitted that

Mr.Gurpal Singh has also given him cash for depositing in his bank account so that he could issue

cheques to the above company. The complainant also provided his bank pass book showing the deposit

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of cash transaction in his account and also submitted that he has not signed the proposal forms under

the said policies and no agent of the above company had ever visited him for collecting any documents.

He further added that he had sent only signed cheques and KYC documents as was advised

telephonically by the agent of above company and he was also assured that premiums under the said

policies will be refunded to him later on.



















financial underwriting in a proper manner. Even no income proof/ income tax return has been taken

from the complainant before issuing him policies with yearly premiums of Rs. One Lakh payable for

08 yrs and 07 years under the respective policies and now the company cannot take shelter of free look

period. Surprisingly the insurance company vide its letter dated 27.10.2017 has asked the complainant

to submit ITR copies of last two financial years i.e. for 2015-16 & 2016-17 which should have been

called for before issuance of above said policies.

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AWARD









a) According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall





D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Malkeet Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1144


Complainant

Mr. Malkeet Singh S/o Mr. Bhola Singh,

VPO- Sivian, Bathinda, Punjab- 151001

Mobile No.- 8054167927

2. Policy No: DOC

Type of Policy


03448995, 03449012 / 22-11-2016

Exide Life Guaranteed Income Insurance Plan,

Exide Life Income Advantage Plan

16yrs/Rs.48183/- & 15yrs/Rs. 48183/-



Mr. Malkeet Singh

Mr. Malkeet Singh





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Rules, 2017

13.1.(d)








On 12-12-2017, Mr. Malkeet Singh had filed a complaint of mis-selling against Exide Life Insurance

Co. Ltd. in respect of policies bearing no’s. 03448995, 03449012. He has alleged that above policies

have been missold to him based on the assurance of refund from Mr.Gurpal Singh’s old policies and

the premiums under the said policies have been paid by Mr.Gurpal Singh. He has further stated that he

has not signed any proposal forms and when he complained to the company for cancellation of these











Mr. Malkeet Singh, the complainant attended the personal hearing on 12.02.2019, reiterated the


above policies so that he could receive the refund under his old policies. He further submitted that


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the said policies and no agent of the above company had ever visited him for collecting any documents.

He further added that he had sent only signed cheques and KYC documents as was advised

telephonically by the agent of above company and he was also assured that premiums under the said

policies will be refunded to him later on.





















07 yrs and 08 years under the respective policies and now the company cannot take shelter of free look


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AWARD



insurance company to cancel the policies bearing no’s 03448995, 03449012 , since inception

and refund all the premiums collected there-in without interest and without deductions of

any charges.









D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Kaur Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1148


Complainant

Mr. Kaur Singh

VPO- Sivian, Distt.- Bathinda, Punjab- 151002

Mobile No.- 7508923797

2. Policy No: DOC

Type of Policy

Duration of policy/Premium

03562003 & 03560307 / 25-05-2017, 24-05-2017

Exide Life Income Advantage & Exide Life


07/15/Rs. 48187/- & 08/16/Rs. 48187/-



Mr. Kaur Singh

Mr. Kaur Singh





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Rules, 2017

13.1.(d)








On 12-12-2017, Mr. Kaur Singh had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policies bearing no’s. 03562003, 03560307. He has alleged that above policies have














Mr. Kaur Singh, the complainant attended the personal hearing on 12.02.2019, reiterated the contents



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07yrs and 08 years under the respective policies and now the company cannot take shelter of free look


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AWARD










comply with the award within 30 days of the receipt of the award and intimate compliance

of the same to the Ombudsman.



D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Gurjit Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1141


Complainant

Mr. Gurjit Singh S/o Nazar Singh,

Village- Gill Patti, P.O.- Goniana Mandi,

Bathinda, Punjab-0

Mobile No.-9464482434

2. Policy No: DOC

Type of Policy


03448220 & 03448145 / 07-12-2016, 08-12-2016

Exide Life Income Insurance Advantage Plan,


08/16yrs/Rs.48185/- & 07/15yrs/Rs. 48185/-



Mr. Gurjit Singh

Mr. Gurjit Singh




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Rules, 2017

13.1.(d)








On 12-12-2017, Mr. Gurjit Singh had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policies bearing no’s . 03448220 & 03448145.He has alleged that above policies have










alleging misselling and sought cancellation of said policies which is after a lapse of almost 10

months from the receipt of policy documents.



Mr. Gurjit Singh, the complainant attended the personal hearing on 12.02.2019, reiterated the contents

of the complaint and submitted that his friend Mr.Gurpal Singh had requested to purchase above




of 412


























07 years and 08 years under the respective policies and now the company cannot take shelter of free

look period. Surprisingly the insurance company vide its letter dated 27.10.2017 has asked the

complainant to submit ITR copies of last two financial years i.e. for 2015-16 & 2016-17 which should

have been called for before issuance of above said policies.

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AWARD














D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Jagjit Singh Vs Max Life Insurance Co. Ltd.

CASE NO-CHD-L-032-1718-0985


Complainant

Mr. Jagjit Singh S/o Mr. Sukhdev Singh,

House No.- 212,V.P.O.- Sohian Kalan,

Near Pani Di Tanki, Tehsil- Majitha, Distt.- Amritsar,

Punjab- 143601

Mobile No.- 9876086911

2. Policy No: DOC

Type of Policy


130362486 / 29.11.2016



Mr. Jagjit Singh

4. Name of the insurer Max Life Insurance Co. Ltd.





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9. Amount of Claim Refund of deposited amount


11. Amount of relief sought NA



Rules, 2017

13 [1] [d]

13. Date of hearing/place 22-02-2019 / Chandigarh


f) For the Complainant Self

g) For the insurer Sh. Sanjeev

15. Complaint how disposed Award for refund of premium



On 16-10-2017, Mr. Jagjit Singh had filed a complaint of mis-selling against Max Life Insurance Co.

Ltd. in respect of policy bearing no. 130362486. The complainant has first time made complaint to

company on 28.09.2017 that the insurer has issued insurance policy instead of fixed deposit document

and requested for refund of the deposited amount.

18. Cause of Complaint

a) Complainant’s argument

In personal hearing, Mr. Jagjit Singh has reiterated the contents of complaint and submitted that

he has taken the policy in 2016 as suggested by his banker and left the country as he lives in

Melbourne. He also submitted that actually he thought the amount was for fixed deposit where as

it was insurance policy with 20 years annual premium paying period. He came back in India

[date shown in his passport] in 2017 and made complaint to insurer for refund of premium.

b) Insurer Arguments The insurance company during the personal hearing submitted that policy holder has approached

for refund after the expiry of free look period and regretted for not submitting SCN.

19. Result of Personal hearing with both parties (Observations & Conclusion):

On perusal of various documents available in the file and considering the submission of complainant and

representative of the insurance company, it has been observed that the complainant was sold insurance

policy in the name of fixed bank deposit without his knowledge with the help of bank manager.

Moreover company has not submitted SCN. Since it is clear case of mis-selling of policy and the

insurance company has not filed any SCN detailing their defense. The insurance company is directed to

refund the premium amount.

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ORDER

Taking into accounts the facts and circumstances of the case and the submissions made by

the both parties during the course of personal hearing, the insurance company is directed

to refund the premium collected under the policy without interest and without deduction

of any charges.



Dr. D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Sushant Gupta Vs SBI Life Insurance Co. Ltd.

CASE NO-CHD-L-041-1718-0874


Complainant

Mr. Sushant Gupta, House No. 161, Sector-21,

Faridabad, Haryana-121001,

Mobile No.: 9582826660

2. Policy No: DOC

Type of Policy


1K053016301/ 26.05.2016

SBI Life-Smart Wealth Builder Policy

10 years



Mr. Sushant Gupta

Mr. Sushant Gupta

4. Name of the insurer SBI Life Insurance Co. Ltd.

5. Date of Repudiation Na

6. Reason for repudiation Na




10. Date of Partial Settlement Na




Rules, 2017

13 [1] [d

13. Date of hearing/place 27.12.2018 23.01.2019 & 22.02.2019 /

Chandigarh


h) For the Complainant Absent

i) For the insurer Mr. Raman Malhotra

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15. Complaint how disposed Dismissed in default.



On 29.08.2017, Mr. Sushant Gupta had filed a complaint of mis-selling against SBI Life Insurance Co.

Ltd. in respect of policy bearing no. 1K053016301.

18. Insurers’ argument

In personal hearing & in SCN the insurance company submitted that the complainant, Mr. Sushant

Gupta has applied for SBI Life Smart Wealth Builder plan in his name through proposal no.

1KAN079067 dated 23.05.2016 with an initial proposal deposit of Rs. 99,900/- with regular yearly

mode of premium paying term of 5 years and the term of the policy was 10 years. Based on the details

furnished in the proposal form, SBI Life Smart Wealth Builder plan policy bearing no. 1K053016301

was issued with date of commencement of policy as 26.05.2016 for a term of 10 years and for basic sum

assured of Rs. 9,90,000/-. A copy of the proposal form was also sent along with the policy documents,

but the complainant did not raise any issue regarding the same within FLC period. The complainant had

also paid the first renewal premium under the policy which indicates his acceptance to the terms and

conditions of the policy. Further, the complainant has submitted request for fund switch under the policy

which shows that he has accepted the terms and conditions of the policy. The representative of the

insurer also requested for dismissal of the case as the complainant has not presented himself on any of

dates fixed for personal hearing.

19). Observations & Findings:-

The complainant was given opportunity of personal hearing on 28.12.2018, 23.01.2019 & 22.02.2019

the complainant did not attend the hearing on either of dates fixed for personal hearing. Non

appearance in personal hearing indicates that he has nothing to say in this matter. However, the

insurance company was represented by Mr. Raman Malhotra who requested for dismissal of the

complaint since sufficient opportunities have been given to the complainant to present his case.

AWARD



in respect of policy no. 1K053016301. Is dismissed in default.



Dr. D. K. Verma

INSURANCE OMBUDSMAN

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PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH


OMBUDSMAN – SH. D.K.VERMA

CASE OF Mr. Naresh Kumar Dhuria V/s ICICI Prudential Life Insurance Company

COMPLAINT REF. No. : CHD-L-021-1819-1152

1. On 17.01.2019, Mr. Naresh Kumar Dhuria had filed a complaint against ICICI Prudential

Life Insurance Company in respect of policy bearing number 07828174.

2. This office pursued the case with the insurance company to re-examine the complaint and

they agreed to reconsider the claim.

3. On 25.03.2019, the insurer has informed through mail that they are ready to settle the claim.

4. On 29.03.2019, Mr. Naresh Kumar Dhuria has also confirmed through mail that he has

accepted the offer of Insurance Company. Now, he is satisfied and requested for closure of

the complaint.

5. In view of the above, no further action is required to be taken by this office and the

complaint is disposed off accordingly.

Dated : 29.03.2019 D.K. VERMA

PLACE: CHANDIGARH INSURANCE OMBUDSMAN



OMBUDSMAN – Dr. D. K. Verma

CASE OF Mr. Prashant V/s Exide Life Insurance Co. Ltd.



Complainant

Mr. Prashant

VPO- Baldhan Kalan, Tehsil- Dahina,

Distt.- Rewari,

Haryana- 123401, Mobile No.- 8059277967 2. Policy No: DOC

Type of Policy

Term of policy /Premium

03069981


Name of the policy holder

Mr. Prashant

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On 27-05-2017, Mr. Prashant had lodged a complaint of misselling in this office against Exide Life

Insurance Co. Ltd. in respect of Policy bearing No. 03069981. He has alleged that he had received the

policy documents under the said policy on 15.12.2016 and submitted on the same day at Gurgaon branch

for cancellation but it was denied by the company, hence, feeling aggrieved, he approached this office to

seek justice.


a) Complainant’s argument:

Mr. Prashant, the complainant reiterated the contents of basic complaint and submitted that he had paid

about Rs. 148000/- under the said policy whereas the company has refunded him only Rs. 108418/- but

he could not provide any detail regarding remittances of premiums paid him. Earlier also he was asked

to submit the details but he could not provide any documentary evidence while attending the hearing on

12.02.2019.

b) Insurers’ argument:

The insurer’s representative submitted that they have already refunded Rs. 108418/- through NEFT to

the complainant on 29.09.2018 which was already conveyed by the company through their mail dated

27.11.2018.The company vide their mail dated 19.02.2019 has also sent details of amounts deposited

by the complainant which is as below

4. Name of the insurer Exide Life Insurance Co. Ltd. 5. Date of receipt of the Complaint 27-05-2017 6. Nature of complaint Mis-selling 7. Date of Repudiation NIL 8. Reason for repudiation NA 9. Amount of Claim NA

10. Date of Partial Settlement NIL 11. Amount of relief sought Refund of premiums 12. Complaint registered under


Rules, 2017.

13.1.(c.)

13. Date of hearing/place 11-12-2018 & 12.02.2019/ Chandigarh 14. Representation at the hearing

For the Complainant Self For the insurer Mr. Vignesh Ram- Assistant Manager- Legal)

15 Complaint how disposed Dismissed 16 Date of Award/Order 12.03.2019

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09/03/2015 Cheque 24999

21/07/2015 Cash 24815

31/03/2016 Cash 51440

31/03/2016 Cash 8535


a) Request letter to the insurer. b) Reply of the insurer.



the representative of the Insurance Company, It is observed that the complainant had opted for policy

mentioned in the complaint in the March 2015 but had approached the insurer in May 2017 alleging

mis-selling & non receipt of policy documents which is more than 02 years after issuance of said policy.

The complainant has alleged that he had paid Rs. 148000/- to the company and they have refunded Rs.

108418/- only whereas in his mail dated 11.05.2017 addressed to the company he has requested for

refund of Rs. one Lakh only. He was asked to submit details of amount deposited by him in the personal

hearing on 12.02.2019 whereas he could not submit a single document showing remittances to the

company but had submitted that he will shortly sent the same to this office. Even till date no

documentary evidence has been received and in the absence of any documentary evidence there is no

need to interfere with the decision of the insurer as the insurer has already refunded the premiums

deposited by the complainant.


day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

ORDER


both the parties during the course of hearing, there is no need to interfere with the decision

of the insurer. Hence, the complaint is dismissed.


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Case of Mr. Kamil Abbaas Nakvi Vs Canara HSBC Oriental Bank of Commerce

Life Insurance Co. Ltd.

CASE NO-CHD-L-010-1718-1163


Complainant

Mr. Kamil Abbaas Nakvi

House No.- 83, Jhampur, Distt.- Mohali, Punjab-0

Mobile No.- 8528609079

2. Policy No: DOC

Type of Policy


0013544617 / 31-03-2010

Canara HSBC Oriental Bank of Commerce Life Saral

Bima Plus

07yrs/15yrs/Rs.12000/-





4. Name of the insurer Canara HSBC Oriental Bank of Commerce Life

Ins.Co. Ltd.







11. Amount of relief sought Refund of premiums



Rules, 2017

13.1.(c)




For the insurer Mr. Lalit Kumar( Center Manager)



17. Brief Facts of the case: On 12-12-2017, Mr. Kamil Abbaas Nakvi had filed a complaint of mis-selling against Canara HSBC

Oriental Bank of Commerce Life Insurance Co. Ltd. in respect of policy bearing no. 0013544617

alleged to have been missold to him along with policies of other companies also and when he tried to

reach the insurer for cancellation of the aforesaid policy, they did not resolve the issue, Hence feeling

Aggrieved he approached this office to seek justice.

The insurer had informed vide their SCN dated 31.01.2018 that the policy mentioned in the complaint

was issued on 31.03.2010 for 15yrs with premium paying term for 07 years, on the basis of the proposal

forms submitted by the complainant and the policy Bond along with terms and conditions were

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delivered to him at the address mentioned in the proposal forms. The complainant had not raised any

objection at that time during free look period and after payment of initial premium next premium was

due on 09.03.2012 and the company has sent reminder notice to the complainant but he chose not to pay

the due premium. As per terms and conditions of the policy if the regular premiums are not paid during

the first 03 years from the commencement date, the policy would terminate, if the policyholder does not

exercise the revival or surrender options. The insurer has further stated that the complainant did not use

any of the options available and hence the said policy got terminated and the complainant was issued a

cheque of Rs.9318.49 dated 08.04.2014.



Mr. Kamil Abbaas Nakvi, the complainant attended the personal hearing on 20.02.2019 and reiterated

the contents of basic complaint.


The insurer’s representative reiterated the contents of SCN and submitted that the said policy was issued

on 31.03.2010 and the complainant had not raised any objection at that time during the free look period

but had complained to them after 07 years from issuance of said policy.






mentioned in the complaint in the March 2010. He had accepted during the hearing that he had received

the policy bond well in time but had not raised any concern during the free look period. It has been also

observed that after receiving the policy documents, the complainant had ample opportunity to go

through the terms and conditions of the policy but he did not utilize the free look option. The

complainant has mentioned in his complaint that he was assured that his money will be doubled after 05

years but he did not approach the insurer after 05 years but had approached them alleging mis-selling

after 07 years from the issuance of said policy. Hence, the complaint seems to be an after-thought.


day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

ORDER





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OMBUDSMAN – Dr. D.K.Verma

CASE NO-CHD-L-006-1617-1760

Case of Mr. Balbir Singh Dogra Vs Bajaj Allianz Life Insurance Co. Ltd.

1. On 27.02.2017, Mr.Balbir Singh Dogra had lodged a complaint in this office against Bajaj

Allianz Life Insurance Co. Ltd. in respect of Policy number 0095839895.



3. Now, the complainant has informed through letter dated 08.02.2019 that the insurer has

released the maturity payment through cheque and he has also requested for withdrawal of

the complaint.





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CASE OF Mrs. Meena Kumari V/s Tata AIA Life Insurance Co. Ltd.


1. On 21.12.2016, Mrs. Meena Kumari had lodged a complaint in this office against Tata AIA

Life Insurance Co. Ltd. in respect of Policy number U054845952.

2. The case was fixed for personal hearing on 22.11.2018 and the complainant was informed

to attend the hearing vide our letter dated 31.10.2018 but she did not attend the said hearing.

She was again informed vide our letter dated 01.02.2019 to attend the hearing on

20.02.2019.

3. Mr. Kulwant Rai, husband of the complainant attended the hearing on 20.02.2019 on behalf

of the complainant and submitted the letter sent by the complainant stating that she wants to

continue the aforesaid policy and had also requested for withdrawal of the complaint.





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CASE OF Mr. Het Ram Kalia V/S Future Generali India Life Ins. Co. Ltd.

COMPLAINT REF. No. CHD- L-017-1617-1600


On 02.01.2017 Mr. Het Ram Kalia had filed a complaint in this office against Future Generali India

Life Ins. Co. Ltd. alleging mis-selling of policy bearing no. 01170381.The complainant has alleged

that the representative of the insurer promised him that he would arrange refund of premium under his

existing policies and interest free loan from bank provided he purchases one policy of above insurance

company and was missold multiple policies on similar pretexts. He trusted the agent and the above

mentioned policy was issued. When he did not get any refund, he found that he was cheated and

approached the insurer with the complaint which was rejected by the insurer on 26.09.2016 because

the free look period had elapsed.

Annexure VI-A was received on 17.03.2017.

Insurer’s SCN was received on 23.04.2018.

1. Name & Address of the Complainant Mr. Het Ram Kalia,

Vill.-Panga P.O. Bijhari, Tehsil-Barsar Panga, Distt.-

Hamirpur, Hamirpur, H.P.-0

2. Policy No:

Type of Policy

Term of policy

01170381 DOC 11.12.2013

Endowment

15 years



Mrs. Neena Devi

Mrs. Neena Devi

4. Name of the insurer Future Generali India Life Ins. Co. Ltd.(Mumbai).


6. Reason for repudiation NIL


8. Nature of complaint Mis- selling



11. Amount of relief sought Rs. 95, 500/-


Ombudsman Rules ,2017

13.1. (c)

13. Date of hearing/place 20.09.2018, 20.11.2018 & 20.02.2019/ Chandigarh


For the Complainant Self on 20.02.2019

For the insurer Mr. Vishal Kumar



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The insurer had mentioned in the SCN that the policy was issued on the basis of proposal form duly

filled and signed by the proposer, Mrs. Neena Devi. The policy was dispatched on 13.12.2013 which

was delivered on 23.12.2013.The complainant had requested for cancellation of policy which was far

beyond the free look period and was rejected vide letter dated 26.09.2016.



Mr. Het Ram Kalia, the complainant attended the personal hearing on 20.02.2019 and reiterated the

contents of the complaint. He informed that the said policy was mis-sold to his wife who is a

housewife, through cheating and false commitments by the representative of the company.


The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had

requested for cancellation of policy which was far beyond the free look period and his request was

rejected by the Insurer.


a) Photocopy of Proposal Forms. b) Photocopies of Policy Schedules. c) Reply of the insurer.

20) Result of personal hearing with both parties (Observations & Conclusion) On going through the various documents available in the file and also hearing both the complainant

and the representative Insurance Company, It is observed that the said policy has been missold through

misrepresentation of facts as the complainant was misguided and allured to purchase multiple policies

including the policy mentioned in the complaint. On perusal of proposal forms it is observed that the

complainant has mentioned his previous policies with annual premium amounting to about Rs. 02

Lakhs payable for 12 years on the basis of annual income of Rs. 05 lakhs and still the above policy was

issued with an annual premium of about 01 Lakh without taking any income proof. Hence, it is

observed that financial underwriting was lacking and paying capacity of the proposer was also ignored

and now insurer can’t take shelter of free look period.

ORDER

Taking into account the facts & circumstances of the case and the submissions made by both the

parties during the course of hearing, the insurer is advised to cancel policy bearing no. 01170381

and issue a new single premium policy by adjusting all the premiums collected therein, with a

lock-in period of 5 years and without a free look clause subject to underwriting and fulfillment

of requirements.


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a) According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply

with the award within 30 days of the receipt of the award and intimate compliance of the

same to the Ombudsman.


day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN




CASE OF Mr. Dalbir Singh V/S Future Generali India Life Ins. Co. Ltd.



Complainant

Mr. Dalbir Singh S/o Sh. Suraj Bhan,

Near SFC Hospital

Vill.- Seenkh, Tehsil- Panipat, Distt. Panipat

Haryana-132107

2. Policy No:

DOC

Type of Policy

Term of policy

01215903 & 01216105

19.06.2014 29.06.2014

Participating Money Back Plan

18/12 yrs 18/12 yrs



Mr. Dalbir Mr. Rohit

Mr. Dalbir Mr. Dalbir

4. Name of the insurer Future Generali India Life Ins. Co. Ltd. (Mumbai).



7. Date of receipt of Complaint 11.05.2017




11. Amount of relief sought Refund of premium paid



13.1. (c)

13. Date of hearing/place 20.11.2018 & 20.02.2019/ Chandigarh



For the insurer Mr. Vishal Kumar SM

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On 11.05.2017, Mr. Dalbir Singh had filed a complaint in this office against Future Generali India Life

Ins. Co. Ltd. alleging mis-selling of policies bearing nos. 01215903 & 01216105 issued on 19.06.2014

and 29.06.2014 respectively. The complainant had alleged that the agent of the company called him on

mobile and told the complainant that the scheme would be giving 10% assured return and premium

would be payable one time. He never signed any paper and fake educational and occupational particulars

were filled in the proposal papers. The complainant had approached the insurer with the complaint on

19.12.2016 but the Insurer informed that request for cancellation of policies should be within 15 days of

receipt of policies and declined the request being out of free look period.


Insurer’s SCN received on 18.02.2019



Mr. Dalbir Singh, the complainant attended the personal hearings on 20.02.2019 and reiterated the

contents of the complaint. He submitted that he is doing private job and earning about Rs. 20000/- per

month only and his son was in 12th

standard at the time of issuance of said policies whereas his

educational qualification is mentioned as Graduate in the proposal forms. He further submitted that he

and his son have never signed any proposal forms and their fake educational, occupational and previous

insurance particulars were filled in the proposal papers.


The Insurer’s representative reiterated the contents of SCN and submitted that the said policies were

delivered in July 2014 and the complainant has requested for cancellation of policies on 19.12.2016

which is approximately 02 years from the date of delivery of the policies and is far beyond the free look

period.




On going through the various documents available in the file and also hearing both the complainant

and the representative of the Insurance Company, It is observed that the said policies have been missold

through misrepresentation of facts as the complainant was misguided to purchase said policies, alluring



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him of high returns against the said policies. It is a fact that the complainant has filed the complaint

after about 02 years from the issuance of said policies but it is also evident from the documents and the

submission of the complainant that the representative of the company have sold the policies in a

fraudulent manner promising high returns and without taking into consideration actual insurance needs

of the policyholder/life assured. Even no income proof/ income tax return has been taken from the

complainant before issuing him policies with yearly premiums of Rs. One Lakh and forty five thousand

payable for 12 years. Hence, it is observed that financial underwriting was lacking and paying capacity

of the complainant was also ignored and now insurer can’t take shelter of free look period. Moreover

the fact regarding the delivery of said policies could not be corroborated by any documentary proof like

POD by the insurer.

AWARD


both the parties during the course of personal hearing, an award is passed with a

direction to the insurance company to cancel all the policies bearing numbers 01215903

& 01216105, since inception and refund all the premiums collected there-in without

interest and without deduction of any charges.





with the award within 30 days of the receipt of the award and intimate compliance of the same to

the Ombudsman.


day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

of 412




CASE OF Mr. Narender kumar V/S Future Generali India Life Ins. Co. Ltd.



On 16.02.2017, Mr. Narender Kumar had filed a complaint in this office against Future Generali India

Life Ins. Co. Ltd. alleging mis-selling of policy bearing no. 00126581. The complainant has alleged

that the representative of the company approached him and told that the company had launched a new

ULIP plan where Rs. 11,000/- as onetime payment will get doubled after 5 years and accident benefit

of Rs. 5 lakhs will also be given. The complainant trusted him and provided him all the necessary

documents along with DD for Rs. 11,000/- and when he received the policy bond he kept it in safe

custody. The complainant has further stated that when he did not receive any information during the

period of next 5 years and after 5 years, when he approached the insurer for refund of double amount;

he was told that the policy has already been closed. The complainant had approached the insurer with


Complainant

Mr. Narender Kumar S/o Sh. Suraj Bhan,

Vill.- Kalupur, Ward No. 25, Near Opp. Shiv Mandir,

Distt. Sonepat-Haryana-131001

2. Policy No:

Type of Policy

Term of policy

00126581/ 25.04.2009

Future Guarantee ULIP

20 yrs



Mr. Narender Kumar

Mr. Narender Kumar

4. Name of the insurer Future Generali India Life Ins. Co. Ltd.(Mumbai).



7. Date of receipt of the

Complaint

16.02.2017







13.1. (c)

13. Date of hearing/place 20.09.2018,20.11.2018 & 20.02.2019/ Chandigarh

14. Representation at the

hearing


For the insurer Sh. Vishal Kumar SM



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the complaint on 04.10.2016 but the Insure did not reply. Hence feeling Aggrieved he approached this



Insurer’s SCN received on 20.09.2018



Mr. Narender Kumar, the complainant attended the personal hearing on 20.02.2019 and reiterated the

contents of basic complaint.



on 25.04.2009 and the complainant had not raised any objection at that time during the free look period

but had complained to them for the first time in 2016 which is after about 07 years from issuance of said

policy.









through the terms and conditions of the policy but he did not utilize the free look option. The

complainant has mentioned in his complaint that he was assured that his money will be doubled after 05

years but he did not approach the insurer after 05 years but had approached them alleging mis-selling

after 07 years from the issuance of said policy. Hence, the complaint seems to be an after-thought.

ORDER






day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

of 412




CASE OF Mr. Prem Paul Bajaj V/S Future Generali India Life Ins. Co. Ltd.



On 22.02.2017, Mr. Prem Paul Bajaj had filed a complaint in this office against Future Generali India

Life Ins. Co. Ltd. alleging mis-selling of policies bearing nos. 01249587, 01249508 & 01249603 issued

on 03.03.2015, 04.03.2015 and 05.03.2015 respectively. The complainant has alleged that the

representative of the insurer introduced himself as chief manager posted at IRDA Delhi and told him

that IRDA had full information about all LIC policies and he would be getting huge bonus of 50 lakhs

on his insurance policies. He was also told to pay service tax and the same would be refunded with

bonus. In this way, the said representative cheated him and arranged to issue the aforesaid policies along

with policies of other insurance companies also. But on receiving the policy bonds the complainant

realised that he was cheated. The complainant had approached the insurer with the complaint but no

response received. Hence feeling aggrieved the complainant has approached this office to seek justice.


Complainant

Mr. Pre Paul Bajaj

H. No. 312, Permeshwari Vihar Lal Dara Colony,

Yamunanagar Haryana-135001

2. Policy No:

Type of Policy

Term of policy

01249587 01249508 01249603

Money Back

18 years/ 12 years.



Kunal Bajaj Sonam Bajaj Hitesh Bajaj

Prem Paul Bajaj Sonam Bajaj Hitesh Bajaj

4. Name of the insurer Future Generali India Life Ins. Co. Ltd. (Mumbai).



7. Date of receipt of the Complaint 22.02.2017.

8. Nature of complaint Mis- selling and cheating






13.1. (c)

13. Date of hearing/place 20.09.2018, 20.11.2018 & 20.02.2019/ Chandigarh


For the Complainant Mr. Hitesh Bajaj (son of the complainant)

For the insurer Mr. Vishal Kumar



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The insurer had mentioned in the SCN that the policies were issued on the basis of proposal forms duly

filled and signed by the respective proposers. The complainant is neither policy holder nor life assured

under pol. nos. 01249508 and 01249603. Hence, he does not hold any locus to file the complaint. The

policy bonds under policies bearing nos. 01249587, 01249508 & 01249603 were delivered on

12.03.2015, 10.03.2015 & 12.03.2015 respectively. The complaint had been lodged on 16.02.2017 i.e.

approximately two years after the receipt of the policy bonds. The same was rejected being out of free

look period.



Mr. Hitesh Bajaj, son of the complainant attended the personal hearings on 20.11.2018 & 20.02.2019

and reiterated the contents of the complaint. He submitted that the said policies were mis-sold through

cheating and false commitments by the representative of the company. He also submitted that they have

not signed any proposal forms under the said policies and the premiums were paid by his father, Mr.

Prem Paul Bajaj under the said policies, hence he has complained to this office.


The Insurer’s representative reiterated the contents of SCN and submitted that the policyholders under

the above said policies had jointly requested for cancellation of policies on 16.02.2017 which was far

beyond the free look period and their request was rejected by the Insurer.




On going through the various documents available in the file and also hearing the complainant’s

representative and the representative of the Insurance Company, It is observed that the said policies

have been missold through misrepresentation of facts as the complainant was misguided and allured to

purchase multiple policies including the policies mentioned in the complaint, alluring him of high

returns against his earlier policies and without taking into consideration his paying capacity and

moreover without taking any income proof. It is a fact that the complainant has filed the complaint after

about 02 years from the issuance of said policies but it is also evident from the documents and the

submission of the complainant’s representative that the representative of the company have sold the

policies in a fraudulent manner promising high returns and without taking into consideration actual

need of insurance. Hence, it is observed that financial underwriting was lacking and paying capacity of

the complainant was also ignored and now insurer can’t take shelter of free look period. Moreover the

fact regarding the delivery of said policies could not be corroborated by any documentary proof like

POD by the insurer.

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to the Ombudsman.


day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN



OMBUDSMAN – DR. D.K. VERMA

CASE OF Mr. Mahesh Kumar Vs Aegon Religare Life Insurance Company

COMPLAINT REF. No. : CASE NO. CHD-L-001-1617-1111


Complainant

Shri Mahesh Kumar,

VPO- Kalyan Malka, Tehsil- Nathana, Distt.- Bathinda

2. Policy No: DOC

Type of Policy


160314631738 19.03.2016

Aegon Life Flexi Money Back Advantage Ins.Plan

Rs.22000/-



Shri Mahesh Kumar

Shri Mahesh Kumar

4. Name of the insurer Aegon Religare Life Insurance co ltd




8. Nature of complaint Misselling

AWARD


both the parties during the course of personal hearing, an award is passed with a

direction to the insurance company to cancel all the policies bearing numbers bearing

nos. 01249587, 01249508 & 01249603 since inception and refund all the premiums

collected there-in without interest and without deduction of any charges.


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11. Amount of relief sought Refund of premiums paid


Insurance Ombudsman Rules

2017

13.1 (d)

13. Date of hearing/place 12.07.2018,22.11.2018 & 20.02.2019/Chandigarh


For the Complainant Self (Present on 20.02.2019)

For the insurer Mr. Ashish K. Ovalekar (AVP Legal)

Present on 12.07.2018 & 22.11.2018

but Absent on 20.02.2019




On 29-8-2016 Shri Mahesh Kumar had lodged a complaint in this office against Aegon Religare Life

Insurance Co Ltd in respect of Policy bearing No. 160314631738 alleged to have been missold to him.

The complainant had stated that he was trapped through telecalling by the person impersonating as

IRDA official who promised him refund of premiums from the existing policy of Life Insurance

Corporation (LIC), if he purchases a policy from Aegon Life and was also assured refund of the

deposited money after 191 days. Accordingly he invested Rs. 22000 in the policy of Aegon Life Ins.

Company. The complainant has further stated that he is doing private job and cannot afford to pay Rs.

22000 every year for 10 years. He has further stated that when he realised that the said policy has been

issued fraudulently, he requested the insurance company vide his letter dated 25-7-2016 to cancel the

above policy and refund the premium of Rs. 22000/- which was declined by insurer vide their letter

dated 8-8-2016 because the request was received after free look period. Hence feeling aggrieved the

complainant has approached this office to seek justice.

As per SCN received from the Insurance Company on 12.12.2016, it is explained that they have issued

policy bearing no. 160314631738 on 19-3-2016 with Yearly premium of Rs. 22000/-, based on the

proposal form and documents submitted by the life assured and had dispatched the policy document vide

speed post on 22-3-2016 at the communicated address. The complainant had not raised any objection on

receipt of the policy documents and complaint for the first time was received on 25.07.2016 which is 03

months after the expiry of free look period and request for cancellation was denied by the insurer vide

their letters dated 08.08.2016.


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The case was fixed for personal hearing on 12.07.2018 and the complainant was informed to attend the

hearing but he did not attend the said hearing. He was again informed vide our letter dated 01.11.2018

to attend the hearing on 22.11.2018 but he has requested for another hearing as the said letter was

received late by him and the case was scheduled for further hearing on 20.02.2019. The complainant

attended the personal hearing on 20.02.2019 and reiterated the contents of the complaint.


The Insurer’s representative attended the personal hearing on 12.07.2018 and 22.11.2018 but nobody

appeared on 20.02.2019 and neither informed this office regarding their absence. The Insurer’s

representative who attended the personal hearing on 12.07.2018 and 22.11.2018, reiterated the contents

of SCN and submitted that the policy bond under the said policy was delivered well in time but the

request for cancellation of above policy was received 03 months after the free look period. However he

could not submit any proof of delivery of said policy from which the date of receipt of policy documents could be

established.


a) Copies of the proposal forms b) Complaint to the insurer.

c) Annexure Vl-A d) Reply of the company



the representative of the Insurance Company, It is observed that the above said policy has been mis-

sold through misrepresentation of facts. The complainant has approached the insurer within reasonable

time from issuance of above policy but the insurer has rejected the request of the complainant for

cancellation of said policy, taking the plea of expiry of free look period. Moreover the insurer has not

been able to produce any proof of delivery of the said policy and now can’t take shelter of free look

period.

AWARD


both the parties, an award is passed with a direction to the insurance company to cancel

the policy bearing number 160314631738 , since inception and refund all the premiums

collected there-in without interest and without deduction of any charges.


of 412







day of March, 2019.

D.K.Verma

INSURANCE OMBUDSMAN



OMBUDSMAN – DR. D.K. VERMA

CASE OF Mr. Santosh Kumar Vs Aegon Life Insurance Company


1. Name & Address of the Complainant Mr. Santosh Kumar, S/o Shri Amar Singh,

R/o House No. 637/12, Arya Nagar Kartarpur,

Distt.- Jalandhar, Punjab-0

Mobile No.: 9872474578

2. Policy No:

Type of Policy


140714155105, 141014227128 & 150214335512

Rs.25500/- , Rs.35049/- & Rs.20000/-



Mr. Santosh Kumar

4. Name of the insurer Aegon Life Insurance co ltd







11. Amount of relief sought Rs.80549/-


Insurance Ombudsman Rules 2017

13.1 (d)

13. Date of hearing/place 12.07.2018, 22.11.2018 & 20.02.2019/Chandigarh



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For the insurer Mr. Ashish K. Ovalekar (AVP Legal)

Present on 12.07.2018 & 22.11.2018

but Absent on 20.02.2019




On 05-10-2016 Mr. Santosh Kumar had lodged a complaint of misselling in this office against Aegon

Life Insurance co ltd., in respect of Policies bearing No’s 140714155105, 141014227128 &

150214335512. The complainant has stated that the agent of the above company missold him above

policies as fixed deposits and later on convinced him to invest in other insurance companies also. The

complainant has further alleged that when he complained to the insurer vide his letter dated 22.08.2016;

it was not replied by the insurer. Hence feeling aggrieved, he approached this office to seek justice

The insurer has intimated vide their mail dated 21.11.2018 that the said policies have already been

surrendered on 05.11.2015 and submitted the details as below:

Policy

Number

Surrender

Amount

Date Courier Details

150214335512 6399.05 05.11.2015 44076753851

140714155105 7870.7 05.11.2015 44076753851

141014227128 11699.16 05.11.2015 44076753851 18) Cause of Complaint:


Mr. Santosh Kumar, the complainant attended the personal hearing on 22.11.2018 and reiterated the

contents of basic complaint. However he denied receipt of any surrender payments under the said

policies and he was advised to verify the receipt of payment from his bank account statement. The

complainant attended the further hearing on 20.02.2019 and submitted that he has received the surrender

payment as per detail furnished by the insurer and requested for refund of premiums deposited by him as

surrender payments released by the company were quite low in comparison to the amounts deposited by

him under the said policies.


The Insurer’s representative attended the personal hearing on 12.07.2018 and 22.11.2018 but nobody

appeared on 20.02.2019 and neither informed this office regarding their absence. The Insurer’s

representative who attended the personal hearing on 12.07.2018 and 22.11.2018, reiterated the contents

of their mail dated 21.11.2018 and further submitted that the said policies have already been surrendered

on 05.11.2015 whereas the complainant has approached them on 22.08.2016 alleging misselling under

the said policies.



of 412



the representative of the Insurance Company, It is observed that the said policies have already been

surrendered on 05.11.2015 whereas the complainant has approached the insurer on 22.08.2016 alleging

misselling which is almost after 09 months from receipt of surrender payment under the said policies.

Moreover the complainant has not been able to justify the delay in approaching the insurance company

with his grievance. The complainant has also accepted receipt of surrender payment under the said

policies; hence there is no need to interfere with the decision of the insurer.

ORDER


both the parties, there is no need to interfere with the decision of the insurer. Hence, the

complaint is dismissed.



day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN




Case of Mr. Parveen Kumar Vs PNB Metlife India Insurance Co. Ltd.

CASE NO-CHD-L-033-1617-1715


Complainant

Mr. Parveen Kumar

SCO-684, Kesho Ram Complex,

Burail, Sector – 45 C, Chandigarh

Mobile No.- 9915584121

2. Policy No: DOC

Type of Policy


21757848 16.12.2015

Met Endowment Saving Plan

10 years/Rs. 50000/-



Mr. Parveen Kumar

Mr. Parveen Kumar

4. Name of the insurer PNB Metlife India Insurance Co. Ltd.


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17) Brief Facts of the case:

On 13.02.2017, Mr. Parveen Kumar had filed a complaint of mis-selling against PNB Metlife India

Insurance Co. Ltd. in respect of policy bearing no 21757848. He has alleged in his complaint that the

above policy has been missold to him on the pretext that after paying annual premium of Rs. 50000/- for

5 years, he will get Rs. 434625/- and he can also withdraw money at anytime alongwith bonus. The

complainant has also alleged that he was also promised 2 grams gold coin which he did not receive even

after visiting the company’s office several times and when he received the policy document he realised

that he has been deceived and complained to the company vide his letters dated 29.11.2016 and

19.12.2016 for cancellation of above policy and refund of premium, which was declined by the company

vide their letter dated 29.11.2016. Hence, feeling aggrieved, he approached this office to seek justice.

The Insurer in their SCN dated 27.04.2017 and received by us on 02.05.2017 has stated that the

complainant being a Graduate and as an educated person has duly filled up, signed and has voluntarily

applied for their product after completely understanding the features, investment risks,charges,benefits

,terms and conditions thereof and submitted his application (proposal form). The Insurer has further

stated that the policy bond under the said policy was dispatched to the complainant on 27.12.2015 and

25.01.2016 but he has not raised any concern during the free look period. The insurer has further stated

that complaint for the first time was received on 29.11.2016 for alleged misselling which is about 10

months from dispatch of above policy.

18. Observations & Findings:-

The complainant was given opportunity of personal hearing on 04.09.2018, 15.10.2018, 10.12.2018 &

20.02.2019, but neither the complainant nor his representative turned up. Non appearance in personal




9. Amount of Claim Rs. 50000/-


11. Amount of relief sought Rs. 50000/-



Rules, 2017

13.1.(c)

13. Date of hearing/place 04.09.2018,15.10.2018,10.12.2018 & 20.02.2019/

Chandigarh


For the Complainant Absent on all occasions

For the insurer Mr. Rajeev

Sharma(04.09.2018,15.10.2018,10.12.2018)

Mr.Kamal Sachdeva Asstt. Manager(20.02.2019)

15. Complaint how disposed Dismissed in default


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hearing indicates that he has nothing to say in this matter.However,the insurance company was

represented by their representative on all the occasions who requested for dismissal of the complaint,

since sufficient opportunities have been given to the complainant to present his case and the case cannot

be kept pending indefinitely. It appears that the complainant doesn’t wish to pursue the matter as there is

no verbal or written communication from him in spite of best efforts by this office. Under the

circumstances, there is no option but to close the complaint and the case is being dismissed in default.

AWARD


insurance company during the course of personal hearing, the complaint in respect of

policy bearing no 21757848, is dismissed in default.



day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN


(UNDER INSURANCE OMBUDSMAN RULES, 2017) OMBUDSMAN – Dr. D.K.Verma

CASE OF Mr. Neeraj V/s Shriram Life Insurance Co. Ltd.

COMPLAINT REF. No. :CHD-L-043-1718-0215


Complainant

Mr. Neeraj

House No. 16-L, Model Town, Sonipat.

Sonipat – 131001, Haryana. 2. Policy No:

Type of Policy

Term of policy

NN131702016705

Shriram Life Assured Income Plan

10 years 3. Name of the insured


Sh. Neeraj Malhotra

Sh. Neeraj Malhotra 4. Name of the insurer Shriram Life Insurance Co Ltd. 5. Date of Repudiation NA 6. Reason for repudiation NA 7. Dt of receipt of the Complaint 15.05.2017. 8. Nature of Complaint Mis-selling 9. Amount of Claim NIL

10. Date of Partial Settlement NIL 11. Amount of relief sought Rs. 2, 50, 000/-

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On 15.05.2017 Sh. Neeraj Malhotra had lodged a complaint in this office against Shriram Life Insurance

Co. Ltd. in respect of Policy bearing No. NN131702016705 alleged to have been mis-sold to him. The

complainant has stated that the insurer’s representative allured him that company would be installing

tower at his land and for that, as a security, he would have to purchase a policy. Accordingly he

invested Rs. 2, 50,000/- but neither received the policy bond nor the tower was installed. He wrote letter

on 18-03-2017 to the insurance company to cancel the said policy and refund of premium but the insurer

informed that policy would be cancelled only after receipt of the same. The complainant has further

stated that he received the policy documents on 15.07.2017 and had applied for free look cancellation on

27.07.2017 but the policy has not been cancelled by the insurer till date. Hence feeling Aggrieved he

approached this office to seek justice.



The insurer had stated in their SCN that the policy no. NN131702016705 commencing the risk from

28.02.2017 for 10 years premium paying term, was issued on the basis of information provided in proposal

form and documents submitted by the life to be assured. The policy document, first premium receipt,

policy schedule, terms and conditions along with covering letter containing option for free look

cancellation were dispatched at the communication address of the policy holder but the same was returned

undelivered. On receipt of the complaint, the company contacted the complainant and appraised him the

reason for non-delivery. The complainant being satisfied gave his written consent for continuing the policy

and the policy document was again dispatched on 14-07-2017 and the same was delivered on 15.07.2017.

On receipt of the said policy bond, the complainant had submitted the policy for Free Look Cancellation on

27.07.2017 in spite of giving written consent to continue the policy.



Mr. Yogesh Malhotra, brother of the complainant attended the personal hearing on 20.02.2019 and reiterated

the contents of the complaint. He also explained that how the above policy have been issued

fraudulently to his brother and even after submitting the policy documents within free look period the



Rules, 2017.

13.1.c.

13. Date of hearing/place 08.10.2018/17.12.2018 & 20.02.2019/Chandigarh 14. Representation at the hearing

For the Complainant Mr. Yogesh Malhotra (brother of the complainant) For the insurer Sh. Ravi Sharma, Sr. Executive- Legal

15 Complaint how disposed Award 16 Date of Award/Order 15.03.2019

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company has not cancelled the said policy. He also submitted that his brother has never given any

written consent to the company for continuing the said policy.



submitted the policy for Free Look Cancellation on 27.07.2017 in spite of giving written consent to

continue the policy; hence the said policy was not cancelled.






representative and the representative of the Insurance Company, It is observed that the said policy has

been mis-sold through misrepresentation of facts.The complainant has approached the insurer within

free look period and the complainant’s representative denied of giving any written consent by the

complainant.

AWARD


both the parties during the course of personal hearing, an award is passed with a direction

to the insurance company to cancel the policy bearing number NN131702016705 , since


deduction of any charges.




c. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019

D.K.Verma

INSURANCE OMBUDSMAN

of 412




Case of Mr. Ish Vichher Vs Shriram Life Insurance Co. Ltd.

CASE NO-CHD-L-043-1718-1231


Complainant

Mr. Ish Vichher

32 New Colony, Aman Nagar, Jalandhar-1,

Punjab- 144004

Mobile No.- 9417292236

2. Policy No: DOC

Type of Policy

Duration of policy/Policyperiod

NP131400032575, NN131400032593 / 28-03-2014

New Shri Life Plan, Shriram Life Cash back

10yrs/ Rs.37976/- & 10yrs/Rs.22023/-



Mr. Ish Vichher

Mr. Ish Vichher








11. Amount of relief sought Refund of premiums with interest



Rules, 2017

13.1.(d)




For the insurer Sh. Ravi Sharma, Sr. Executive- Legal




On 29-12-2017, Mr. Ish Vichher had filed a complaint of mis-selling against Shriram Life Insurance Co.

Ltd. in respect of policies bearing no’s. NP131400032575, NN131400032593 alleged to have been mis-

sold to him. He has alleged that he was issued above policies as FD and was also assured loan

disbursement of Rs. 06 Lakhs at 6.5% rate of interest. He has also alleged he has not signed the proposal

forms under the said policies, his contact no is mentioned wrong in the proposal forms and it is also

mentioned that his father is alive and in good health whereas his father has already expired before the

issuance of said policies. The Complainant had further stated that he tried to reach the insurer for

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cancellation of the aforesaid policies but they did not resolve the issue, Hence feeling Aggrieved he


The insurer had informed vide their SCN dated 24.01.2018 that both the policies mentioned in the

complaint were issued on 28.03.2014 on the basis of the proposal forms submitted by the proposer along

with initial deposits and the policy Bonds along with terms and conditions were dispatched at the

communication address. The complainant had not raised any objection at that time during free look

period but after more than 02 years of the policies being lapsed the complainant approached them vide

letter dated 01.10.2017 alleging misselling and signatures mismatch in the proposal forms which was

duly replied by their letter dated 02.11.2017 requesting the complainant to submit his PAN card copy

along with attestation of his signatures by a bank manager but till date the complainant failed to provide

the documents called for.



Mr. Ish Vichher, the complainant reiterated the contents of the complaint. He also submitted that the

above policies have been issued fraudulently to him and requested for refund of premiums under the

said policies.


The Insurer’s representative reiterated the contents of SCN and submitted that the policy bonds were

delivered well in time and the request for cancellation of above policies was received on 01.10.2017

which was beyond the free look period. However he could not submit any proof of delivery of said






On going through the various documents available in the file and also hearing both, the complainant

and the representative of the Insurance Company, It is observed that the said policies have been mis-

sold through misrepresentation of facts and mismatching of family history and contact number in the

proposal forms indicates that either the proposal forms were not filled by the complainant or these were

not filled in his presence. The complainant has also submitted that he has not filled and signed any

proposal forms under the said policies. Though there seems to be delay on the part of the complainant

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in approaching the insurer with the complaint of mis-selling, yet the representative of the insurer also

could not explain the discrepancies observed in the proposal forms and also could not corroborate the

dispatch particulars of the said policies by any documentary proof.

AWARD



insurance company to cancel both the policies bearing no’s NP131400032575 &

NN131400032593, since inception and refund all the premiums collected there-in without

interest and without deductions of any charges.








day of March, 2019

D.K.Verma

INSURANCE OMBUDSMAN




CASE OF Mrs. Lovepreet Kaur V/s Max Life Insurance Company


1. On 01.06.2017, Mrs. Lovepreet Kaur & Mr. Jatinder Singh had filed a complaint

against Max Life Insurance Company in respect of policy bearing numbers

876418773,877570374 & 403480346.



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3. Now, the insurer has informed through mail dated 13.02.2019 that they have already

refunded the premium amount Rs.99999/, Rs. 70960.41 & Rs.99999 to the complainant

under policy numbers 877570374, 403480346 & 876418773 and the same has been

confirmed by settlement agreement letters dated 22.05.2018.








Case of Ms. Neena Mehta Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1209


Complainant

Ms. Neena Mehta

House No.- 252, Sector- 18, Panchkula,

Haryana- 134109

Mobile No.- 9417034252

2. Policy No: DOC

Type of Policy


03367553 / 30-06-2016


20 Years



Ms. Neena Mehta

Ms. Neena Mehta











Rules, 2017

13.1.(c)

13. Date of hearing/place 05.03.2019/ Chandigarh


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For the Complainant Ms. Neena Mehta

For the insurer Mr. Mukund Sharma- Assistant Manager

Mr. Muthanna M K –Intern- Legal

15. Complaint how disposed Agreement



On 22-12-2017, Ms. Neena Mehta had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policy bearing number 03367553. She has stated that she had taken policy of Aegon

Life Company in 2014 and had stopped paying the premiums due to family circumstances. She has

alleged that in April/May 2016 she was trapped through telecalling by the person with wrong identity

and wrong information who forced her to send cheques and her ID proof through courier on one

pretext or other and started sending her policies of different companies including the above mentioned

policy whereas she had never asked for these policies and never filled any proposal forms. The

complainant has further stated that after realizing something fishy she approached the above company

several times and through complaint dated 24.06.2017 and 22.07.2017 for cancellation of above policy

but the company’s response was not satisfactory, hence, feeling aggrieved, he approached this office to

seek justice.

18. The representative of the company informed that the above policy was issued after receipt of

duly filled and signed proposal forms, from the complainant and the policy bond along

with welcome letter were dispatched and duly delivered at complainant’s address.

However, the company agreed to cancel the policy bearing number 03367553 and refund the

premium received therein without interest and without deduction of any charges.

19. Accordingly, an agreement was signed between the Company and the complainant on

05.03.2019.

20. The complaint is closed with a condition that the company shall comply with the

agreement and shall send a compliance report to this office within 30 the days of receipt

of this order for information and record.

To be communicated to the parties.


day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN

of 412




Case of Mr. Kuldip Kaushik Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-0881


Complainant

Mr. Kuldip Kaushik

House No.- 3930, Sector-9 A, Bahadurgarh,

Haryana- 124507

Mobile No.- 8130157766

2. Policy No: DOC

Type of Policy


03533733 / 29-03-2017




Mr. Kuldip Kaushik

Mr. Kuldip Kaushik








11. Amount of relief sought Refund of premium Rs. 30000/-



Rules, 2017

13.1.(d)



For the Complainant Mr. Kuldip Kaushik






On 07-09-2017, Mr. Kuldip Kaushik had filed a complaint of mis-selling against Exide Life

Insurance Co. Ltd. in respect of policy bearing number 03533733 alleged to have been missold on the

assurance of higher sum assured to the tune of three lakhs rupees, 40% agent bonus and health

insurance plan for three people. He has further stated that when he complained to the company for

of 412

cancellation of said policy, his request was declined by the company. Hence, feeling aggrieved, he





However, the company agreed to cancel the policy bearing number 03533733 and refund the

premium received therein without interest and without deduction of any charges.


05.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Basant Kumar Vs Exide Life Insurance Co. Ltd.

CASE NO- CHD-L-025-1718-1336


Complainant

Mr. Basant Kumar

Village- Bhagu Majra, Tehsil- Jagadhri,

Distt.- Yamuna Nagar, Haryana- 135133

Mobile No.- 9992999381

2. Policy No: DOC

Type of Policy


03110694, 03051715 & 03121828

18-05-2015, 09-02-2015, & 06-06-2015


12/24/Rs.29100/-,10/20/Rs.19400 &15/30/Rs33738/

of 412



Mr Dalwinder Kumar

Mr. Basant Kumar










Rule no: Insurance

Ombudsman Rules, 2017

13.1.(c)



For the Complainant Mr. Basant Kumar






On 10-02-2018, Mr. Basant Kumar had filed a complaint of mis-selling against Exide Life

Insurance Co. Ltd. in respect of policies bearing no’s. 03110694, 03051715 and 03121828. The

complainant had alleged that the broker called him on mobile and told that bonus on his existing

policies with LIC had accrued and for release of the same, he would have to Deposit security. As

advised by the broker, he deposited the amount. Time and again the agent called him and collected

the amount sometimes in cash and then through cheque on one or the other pretext. In this way, the

broker arranged to issue 18 policies of 6 different Life Insurance Companies. The insurer had issued

the above mentioned two policies fraudulently. The complainant had approached the insurer with

the complaint on 21.07.2017 but the Insurer informed that request for cancellation of policies should be

within 15 days of receipt of policies and declined the request being out of free look period. Hence,

feeling aggrieved, he approached this office to seek justice.

18. The representative of the company informed that the above policies were issued after receipt

of duly filled and signed proposal forms, from the complainant and the policy bonds along

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However, the company agreed to cancel the policies bearing 03110694, 03051715 and

03121828 and issue a new single premium ULIP policy for Rs. 50,000 in the name of Mr.

Dalwinder Singh S/o Mr Basant Kumar with a lock-in-period of 5 years against the same,

subject to underwriting & fulfillment of requirements. The free look period clause shall not

apply for this new single premium ULIP policy. Further, company agreed to refund the

balance amount to the complainant, Mr. Basant Kumar.


05.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Harbhant Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1394


Complainant

Mr. Harbhant Singh S/o Shri Sharvan Singh,

H. No.- 6, New Friends Colony, Sohian Road,

Sangrur, Punjab-0

2. Policy No: DOC

Type of Policy

02968034, 02980860 & 02996108

31-08-2014, 18-09-2014 & 18-10-2014


of 412





Mr. Harbhant Singh

Mr. Harbhant Singh











Rules, 2017

13.1.(c)



For the Complainant Mr. Amanpreet Singh (Son)






On 28-02-2018, Mr. Harbhant Singh had filed a complaint of mis-selling against Exide Life

Insurance Co. Ltd. in respect of policies bearing no’s. 02968034, 02980860, and 02996108 alleged to

have been missold to him. The complainant had alleged that he was sold multiple policies of

different insurance companies one after another with false assurances of refund of payment and tax

benefits. He has further alleged that when he did not receive the promised benefits, he complained to

the company on 09.11.2017 for cancellation of above policies but the company’s response was not

satisfactory, hence, feeling aggrieved, he approached this office to seek justice.


of duly filled and signed proposal forms, from the complainant and the policy bonds

along with welcome letter were dispatched and duly delivered at complainant’s

address. However, the company agreed to cancel the policies bearing numbers

of 412

02968034, 02980860, and 02996108 and issue a new single premium ULIP policy in the name of

Mr. Amanpreet Singh S/o Harbant Singh with a lock-in-period of 5 years against the same,

subject to underwriting & fulfillment of requirements. The free look period clause shall not apply

for this new single premium ULIP policy.

19. Accordingly, an agreement was signed between the Company and the complainant’s son

Mr. Amanpreet Singh, on 05.03.2019.


agreement and shall send a compliance report to this office within 30 the days of receipt of

this order for information and record.



day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Harbhant Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1394


Complainant

Mr. Harbhant Singh S/o Shri Sharvan Singh,

H. No.- 6, New Friends Colony, Sohian Road,

Sangrur, Punjab-0

2. Policy No: DOC

Type of Policy


02968034, 02980860 & 02996108

31-08-2014, 18-09-2014 & 18-10-2014



3. Name of the insured Mr. Harbhant Singh

of 412

Name of the policyholder Mr. Harbhant Singh











Rules, 2017

13.1.(c)



For the Complainant Mr. Amanpreet Singh (Son)






On 28-02-2018, Mr. Harbhant Singh had filed a complaint of mis-selling against Exide Life

Insurance Co. Ltd. in respect of policies bearing no’s. 02968034, 02980860, and 02996108 alleged to

have been missold to him. The complainant had alleged that he was sold multiple policies of

different insurance companies one after another with false assurances of refund of payment and tax

benefits. He has further alleged that when he did not receive the promised benefits, he complained to

the company on 09.11.2017 for cancellation of above policies but the company’s response was not

satisfactory, hence, feeling aggrieved, he approached this office to seek justice.


of duly filled and signed proposal forms, from the complainant and the policy bonds

along with welcome letter were dispatched and duly delivered at complainant’s

address. However, the company agreed to cancel the policies bearing numbers

02968034, 02980860, and 02996108 and issue a new single premium ULIP policy in the

name of Mr. Amanpreet Singh S/o Harbant Singh with a lock-in-period of 5 years against

of 412

the same, subject to underwriting & fulfillment of requirements. The free look period clause

shall not apply for this new single premium ULIP policy.

19. Accordingly, an agreement was signed between the Company and the complainant’s son

Mr. Amanpreet Singh, on 05.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Suresh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-0555


Complainant

Mr. Suresh

House No. 80, VPO- Makarauli Khurd, Rohtak,

Haryana- 124006,

Mobile No.- 9416357169

2. Policy No: DOC

Type of Policy

Duration of policy/

03133815& 03259909 / 13-07-2015,31-01-2016

Exide Life Guaranteed Income Ins. Plan



Mr. Suresh

Mr. Suresh





Complaint

03-07-2017


of 412



11. Amount of relief sought Refund of Premiums


Rule no: Insurance


13.1.(d)

13. Date of hearing/place 07-01-2019,12.02.2019 & 05.03.2019/ Chandigarh


For the Complainant Absent on all the occasions

For the insurer Mr. Vignesh Ram, Assistant Manager - Legal

(07.01.2019 & 12.02.2019)

Mr. Mukund Sharma- Assistant Manager &

Mr. Muthanna M K –Intern- Legal (05.03.2019)



17 ) Brief Facts of the case:

On 03-07-2017, Mr. Suresh had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policies bearing no’s 03133815 & 03259909 alleged to have

been missold on the pretext of loan payment of Rs. 20 Lakhs and was also assured that the amount

deposited will be refunded later on and when he did not receive the promised loan, he complained to the

company for cancellation of above policies and refund of premium but his request was not responded by

the company. Hence, feeling aggrieved, he approached this office to seek justice.


receipt of duly filled and signed proposal forms, from the complainant and the policy bonds along

with welcome letter under policies bearing no’s 03133815 & 03259909 were dispatched on

23.07.2015 and 05.02.2016 respectively. Further the complainant has submitted his first complaint

on 31.05.2017 which was after a lapse of almost 15 months from the issuance of first policy and 07

months after the issuance of subsequent policy.


The complainant was given opportunity of personal hearing on 07-01-2019, 12.02.2019 & 05.03.2019

but neither the complainant nor his representative turned up. Non appearance in personal hearing

indicates that he has nothing to say in this matter. However, the insurance company was represented by

their representative on all the occasions who requested for dismissal of the complaint, since sufficient

opportunities have been given to the complainant to present his case and the case cannot be kept pending

indefinitely. It appears that the complainant doesn’t wish to pursue the matter as there is no verbal or

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written communication from him in spite of best efforts by this office. Under the circumstances, there is

no option but to close the complaint and the case is being dismissed in default.

AWARD



policies bearing no’s 03133815 & 03259909, is dismissed in default.



day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Anoop Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-0851


Complainant

Mr. Anoop Singh

House No.- 203, Kalhlour Colony, College Road,

Pathankot, Punjab-145001, Mobile No.- 9888665857

2. Policy No: DOC

Type of Policy


02991323 / 08-10-2014

Exide Life Guaranteed Income



Mrs. Kusam Lata

Mr. Anoop Singh











Rules, 2017

13.1.(d)

13. Date of hearing/place 07-01-2019, 12.02.2019 & 05.03.2019 / Chandigarh



of 412


(07.01.2019 & 12.02.2019)

Mr. Mukund Sharma- Assistant Manager & Mr.

Muthanna M K –Intern- Legal (05.03.2019)




On 01-09-2017, Mr. Anoop Singh had filed a complaint of mis-selling against Exide Life Insurance

Co. Ltd. in respect of policy bearing no. 02991323.He has stated that he was sold 04 policies of Kotak

life ins. Company in 2012, which could not be continued and were lying lapsed. He has further stated

that he was trapped through telecalling in 2014 and the person introduced him as IGMS official and

assured him refund against all the above policies, provided he takes a new policy from above company

and believing him he took a policy with an annual premium of Rs. 22000/-.The complainant has further

stated that when he did not receive the promised amount, he complained to the company for cancellation

of said policy and refund of premium, it was declined by the company, Hence, feeling aggrieved, he


The Insurer in their SCN dated 05.03.2018, has stated that the above policy was issued after

receipt of duly filled and signed proposal forms, from the complainant and the policy bond along

with welcome letter were dispatched and duly delivered at complainant’s address. The

complainant has not disputed on receipt of the said policy bond and filed a complaint on

28.07.2017 for alleged misselling and sought cancellation of said policy which is after a lapse of

almost 02 years and 07 months from the expiry of free look period.










of 412

AWARD






day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Chandra Pal Sharma Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-0406


Complainant

Mr. Chandra Pal Sharma

House No.- 24, Gali No.- 6 A, Old Faridabad,

Haryana-121002 Mobile No.- 9810323144

2. Policy No: DOC

Type of Policy


03362885 & 03362882 / 12-07-2016 & 28-06-2016


10yrs/ Rs.28912/- & 12yrs/ Rs28912/-












11. Amount of relief sought Refund of premiums under both policies



Rules, 2017

13.1.(d)



For the Complainant Absent on all the occasions but requested to decide the

complaint on merit basis


of 412

(07.01.2019 & 12.02.2019)






On 07-06-2017, Mr. Chandra Pal Sharma had filed a complaint of mis-selling against Exide Life

Insurance Co. Ltd. in respect of policies bearing no’s. 03362885 & 03362882.He has alleged that he was

misguided and missold above policies. He has further stated that these policies were sold as single

premium and being senior citizen it was not possible for him to pay the premiums every year. When he

complained to the company for cancellation of these policies, his request was declined by the company,

Hence, feeling aggrieved, he approached this office to seek justice.


receipt of duly filled and signed proposal forms, from the complainant and the policy bonds along


complainant has not disputed on receipt of the said policy bonds and later on filed an initial

complaint via IRDA with no specific allegation to misselling and further filed a complaint on

17.04.2017 for alleged misselling and sought cancellation of said policies which is after a lapse of

almost 09 months from the date of receipt of policy documents and the same was replied by the

insurer vide their letter dated 26.04.2017.

18. Observations, Findings & Conclusion

The complainant was given opportunity of personal hearing on 07-01-2019 & 12.02.2019.The

complainant vide his letter dated 31.01.2019 and which was received by us on 05.02.2019, had

requested to decide the complaint on merits as he was not able to attend the hearing on 12.02.2019 due

to his ill health. However he was given another opportunity of personal hearing on 05.03.2019 but

neither the complainant nor his representative turned up but the insurance company was represented by

their representative on all the occasions, who also requested for disposal of the complaint as the case

cannot be kept pending indefinitely, hence the complaint is considered as per request of the complainant

received on 05.02.2019. On going through the various documents available in the file, hearing the

representative of the Insurance Company and considering the written request/consent of the

complainant, it is observed that the said policies were issued in July 2016 and the policy bonds were

received by the complainant well in time as he has not disputed about receipt of policy bond. It has been

also observed that after receiving the policy documents, the complainant had ample opportunity to go

through the terms and conditions of the policies but he did not utilize the free look option. The

complainant had complained to the IRDA with no specific allegation of misselling and after that to the

insurer alleging mis-selling which is after about 09 months from the issuance of said policies. Even in

his complaint submitted to the insurer on 19.04.2017 he has described him as senior citizen whereas on

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perusal of proposal forms it is observed that his date of birth is mentioned as 01.02.1965 which

contradicts his statement. Keeping in view the facts stated above and also that the complainant has not

been able to justify the delay in approaching the insurance company with his grievance; the complaint

seems to be an after-thought.

AWARD

Taking into account the facts & circumstances of the case and the written submissions

of both the parties, there is no need to interfere with the decision of the insurer and the

complaint is dismissed.

Hence, the complaint is treated as closed


day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Jogender Singh Vs Exide Life Insurance Co. Ltd.

CASE NO- CHD-L-025-1718-1317


Complainant

Mr. Jogender Singh S/o Shri Sube Singh,

399/20, Gali No.- 2, Narender Nagar, Sonipat,

Haryana- 131001

Mobile No.- 9992511891

2. Policy No: DOC

Type of Policy


03313509 / 22-03-2016


15/30 Years/Rs. 40890/-



Mr. Jogender Singh

Mr. Jogender Singh











Rules, 2017

13.1.(c)


of 412








On 05-02-2018, Mr. Jogender Singh had filed a complaint of mis-selling against Exide Life Insurance

Co. Ltd. in respect of policies bearing no. 03313509.He has alleged that he was trapped through

telecalling and was missold above policy on the pretext of tower installation at his land and was also

missold multiple policies of other insurance companies also. He has further alleged that when he did not

receive the promised benefits, he complained to the company on 07.06.2016 for cancellation of above

policy but the company’s response was not satisfactory, hence, feeling aggrieved, he approached this


The Insurer in their SCN dated 19.03.2018, has stated that the above policy was issued after receipt of duly filled and

signed proposal forms, from the complainant and the policy bond along with welcome letter were dispatched and

duly delivered at complainant’s address. The complainant has not disputed on receipt of the said policy bonds and

later on filed a complaint for alleged misselling and signatures forgery on 07.06.2016 and sought cancellation of said

policy which is after a lapse of almost 02 months from the date of receipt of policy documents and the same was

replied by the insurer vide their letter dated 14.06.2016.



Mr. Jogender Singh, the complainant attended the personal hearing on 05.03.2019 and reiterated the

contents of the complaint. He also submitted that he is a farmer having meagre income and he has not

signed any proposal forms under the said policy.


The Insurer’s representative reiterated the contents of SCN and submitted that the policy bond under

the said policy was delivered well in time and the request for cancellation of above policy was received

after a lapse of almost 02 months from the date of receipt of policy documents. However he could not submit any

proof of delivery of said policy from which the date of receipt of policy documents could be established.






the representative of the Insurance Company, It is observed that the said policy has been mis-sold

of 412

through misrepresentation of facts. The complainant has approached the insurer within reasonable time

but the insurer has also not been able to produce any proof of delivery of the said policy and now the

company cannot take shelter of free look period.







day of March, 2019.

D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Devender Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1284


Complainant

Mr. Devender

House No.- 108/13, Gosai Wali Gali, Sikka Colony,

Near Idea Office Sonipat, Haryana- 131001

Mobile No. 9812211221

2. Policy No: DOC

Type of Policy


02968971 / 17-09-2014


15/30 Years Rs. 29100/-



Mr. Devender

Mr. Devender


AWARD



to the insurance company to cancel the policy bearing number 03313509, since inception

and refund all the premiums collected there-in without interest and without deduction of

any charges.


of 412










Rules, 2017

13.1.(c)









On 25-01-2018, Mr. Devender had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policy bearing no. 02968971 alleged to have been missold to him. He has stated that he

is a taxi driver and was sold above policy on the pretext that he will get loan for taxi @ 9 % which

seemed to him quite low as compared to other banks. When he did not receive the promised loan, he

complained to the company on 09.12.2017 for cancellation of above policy but the company’s response

was not satisfactory, hence, feeling aggrieved, he approached this office to seek justice.





for alleged misselling on 09.12.2017 and sought cancellation of said policy which is after a lapse of

03 years and 02 months from the date of receipt of policy documents.



Mr. Devender, the complainant attended the personal hearing on 05.03.2019 and reiterated the contents

of basic complaint. He also submitted that he has received the policy bond well in time.

of 412



on 17-09-2014 and the complainant had not raised any objection at that time during the free look period

but had complained to them after a lapse of 03 years and 02 months from the date of receipt of policy

documents.






mentioned in the complaint in September, 2014. He had accepted during the hearing that he had received



through the terms and conditions of the policy but he did not utilize the free look option and had

approached the insurer alleging mis-selling after more than 03 years from the issuance of said policy.

There was undue delay on the part of the complainant in lodging the complaint for which he had no

justified reason.

ORDER






day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Mr. Sandeep Kumar Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1270


Complainant

Mr. Sandeep Kumar S/o Shri Satish Kumar,

VPO- Dinarpur, Teh.- Saha, Distt.- Ambala, Haryana-

133102

Mobile No.- 9463303407

2. Policy No: DOC

Type of Policy


03510642 / 11-03-2017


15 Years



Mr. Sandeep Kumar

Mr. Sandeep Kumar











Rules, 2017

13.1.(c)









On 08.12.2017, Mr. Sandeep Kumar s/o Sh. Satish Kumar had filed a complaint against Exide Life

Insurance Co. Ltd. in respect of policy bearing no. 03510642 alleged to have been missold on false

assurance of getting amount from his existing ICICI insurance policy. He has further alleged that on

similar pretext he and his family members were sold policies of other insurance companies also and

when he did not receive the promised benefits, he complained to the company on 21.09.2017 for

cancellation of above policy but the company’s response was not satisfactory, hence, feeling aggrieved,

he approached this office to seek justice.

of 412




complainant has not disputed on receipt of the said policy bond and later on filed a complaint for

alleged misselling vide his letter dated 25.09.2017 and sought cancellation of said policy which is

after a lapse of almost 07 months from the date of receipt of policy documents and the same was

replied by the insurer vide their mail dated 03.10.2017.



Mr. Sandeep Kumar, the complainant reiterated the contents of the complaint. He also submitted that he

is illiterate person and the above policy has been issued fraudulently to him along with multiple policies

issued by other companies also.


The Insurer’s representative reiterated the contents of SCN and submitted that the policy bond was

delivered well in time and the request for cancellation of above policy was received after a lapse of

almost 07 months from the date of receipt of policy documents. However he could not submit any

proof of delivery of said policy from which the date of receipt of policy documents could be

established.






the representative of the Insurance Company, It is observed that the said policy has been mis-sold

through misrepresentation of facts. The complainant has approached the insurer within reasonable time;

moreover the insurer has also not been able to produce any proof of delivery of the said policy and now

the company cannot take shelter of free look period.

AWARD



to the insurance company to cancel the policy bearing number 03510642, since inception


any charges.


of 412







day of March, 2019.

D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Amandeep Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1173


Complainant

Mr. Amandeep Singh

R/o H. No.- 165, Churhard Patti, Ward No.- 8, Cheema,

Distt.- Sangrur, Punjab- 148029

Mobile No.- 9465730593

2. Policy No: DOC

Type of Policy


03482374 / 19-01-2017


15 Years/Rs. 86739/-



Mr. Amandeep Singh

Mr. Amandeep Singh











Rules, 2017

13.1.(c)



For the Complainant Mr. Amandeep Singh

of 412






On 13-12-2017, Mr. Amandeep Singh had filed a complaint of mis-selling against Exide Life

Insurance Co. Ltd. in respect of policy bearing no. 03482374.He has alleged that he was trapped

through telecalling and was missold above policy on the pretext of tower installation at his land and

handsome return in lieu of that was assured. He has further alleged that when he did not receive the

promised benefits, he complained to the company on 13.09.2017 for cancellation of above policy but

the company’s response was not satisfactory, hence, feeling aggrieved, he approached this office to

seek justice.




complainant has not disputed on receipt of the said policy bond and later on filed a complaint

for alleged misselling on 13.09.2017 and sought cancellation of said policy which is after a lapse of

almost 08 months from the date of receipt of policy documents and the same was replied by the

insurer vide their mail dated 21.09.2017.



Mr. Amandeep Singh, the complainant reiterated the contents of the complaint and submitted that the

above policy has been issued to him fraudulently.


The insurer’s representatives attended the personal hearing on 05.03.2019 and reiterated the contents of

SCN. They submitted that the request for cancellation of said policy and refund of premium was

received after free look period and the same was rejected.



the representative of the Insurance Company, it is observed that the complainant was misguided and

sold the policy on the pretext of handsome return and other benefits, without looking into actual

insurance needs and premium paying capacity of the life assured/ policy holder. The fact regarding the

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delivery of the said policy could not be corroborated by any documentary proof like POD by the

insurer.

AWARD



insurance company to cancel the policy bearing no 03482374 , since inception and refund

all the premiums collected there-in without interest and without deduction of any charges.




b. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019.

D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Sikander Singh Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-1151


Complainant

Mr. Sikander Singh S/o Shri Jarnail Singh,

Village- Goniana Kalan, P.O.- Harrai Pur,

Distt.- Bathinda, Punjab- 151201

Mobile No.- 8146237614

2. Policy No: DOC

Type of Policy


03460221 / 19-12-2016


07/15yrs/ Rs. 38545/-



Mr. Sikander Singh

Mr. Sikander Singh

of 412











Rules, 2017

13.1.(d)

13. Date of hearing/place 12.02.2019 & 05.03.2019/Chandigarh








On 12-12-2017, Mr. Sikander Singh had filed a complaint of mis-selling against Exide Life Insurance

Co. Ltd. in respect of policy bearing no. 03460221. He has alleged that above policy have been missold

to him based on the assurance of refund from Mr.Gurpal Singh’s old policies and the premium under the

said policy has been paid by Mr.Gurpal Singh. He has further stated that he has not signed any proposal

forms and when he complained to the company for cancellation of this policy, his request was not

responded by the company. Hence, feeling aggrieved, he approached this office to seek justice.


receipt of duly filled and signed proposal forms, from the complainants and the policy bond along

with welcome letter was dispatched and duly delivered at complainant’s address. The

complainant has not disputed on receipt of the said policy bond and later on filed a complaint on

18.10.2017 and sought cancellation of said policy which is after a lapse of almost 10 months from




Mr. Sikander Singh, the complainant attended the personal hearing on 05.03.2019, reiterated the


of 412

above policy so that he could receive the refund under his old policies. He further submitted that




the said policy and no agent of the above company had ever visited him for collecting any documents.

He further added that he had sent only signed cheque and KYC documents as was advised

telephonically by the agent of above company and he was also assured that premium under the said

policy will be refunded to him later on.




documents under the said policy. However he could not submit any proof of delivery of said

policy from which the date of receipt of policy documents could be established.


a) Photocopies of the proposal forms. b) Complaint to the insurer. c) Reply of the company










bond was delivered to the complainant in time, but he could not furnish any dispatch details or proof of

delivery of said policy bond. The Insurance Company has not followed the norms related to financial

underwriting in a proper manner and now the company cannot take shelter of free look period.



for before issuance of above said policy.

of 412

AWARD



insurance company to cancel the policy bearing no 03460221, since inception and refund

all the premiums collected there-in without interest and without deductions of any charges.








day of March, 2019

D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Jai pal Vs Exide Life Insurance Co. Ltd.

CASE NO- CHD-L-025-1718-1423


Complainant

Mr. Jai pal S/o Shri Nar Singh,

R/o R.R.S. HAU, Tehsil- Bawal, Distt.- Rewari,

Haryana-0

2. Policy No: DOC

Type of Policy


03003064 / 12-11-2014


20 Years/ Rs. 70000/-



Mr. Jai pal

Mr. Jai pal









12. Complaint registered under 13.1.(d)

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Rules, 2017









On 09-03-2018, Mr. Jai pal had filed a complaint of mis-selling against Exide Life Insurance Co. Ltd. in

respect of policy bearing no. 03003064 alleged to have been missold to him. He has alleged that he was

trapped through tellecalling and was missold above policy under the assurance of bonus worth 10 Lakhs,

benefits and tower installation and was also missold policy of another insurance company on similar

pretext. When he did not receive the promised benefits, he complained to the company on 04.11.2017

for cancellation of above policy but the company’s response was not satisfactory. Hence, feeling

aggrieved, he approached this office to seek justice.





for alleged misselling vide his letter dated 10.11.2017 and sought cancellation of said policy which

is after a lapse of almost 03 years from the date of receipt of policy documents.



Mr. Jai pal, the complainant attended the personal hearing on 05.03.2019 and reiterated the contents of

basic complaint. He also submitted that he has received the policy bond well in time.




but had complained to them after a lapse of almost 03 years from the date of receipt of policy

documents.

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mentioned in the complaint in November, 2014. He had accepted during the hearing that he had received



through the terms and conditions of the policy but he did not utilize the free look option but had

approached the insurer alleging mis-selling after more than 03 years from the issuance of said policy.

There was inordinate delay on the part of the complainant in lodging the complaint, alleging mis-selling

which he could not justify.

ORDER






day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN




Case of Mr. Ramesh Chand Vs Exide Life Insurance Co. Ltd.

CASE NO- CHD-L-025-1718-1424


Complainant

Mr. Ramesh Chand S/o Late Shri Dumna Ram,

Village- Dadoura, Teh.- Balh, P. O.- Dhaban,

Nar Chowk, Mandi, Himachal Pradesh-0

Mobile No.- 9418665171

2. Policy No: DOC

Type of Policy


03008502 / 17-11-2014


20 years/Rs. 47531/-

of 412



Mr. Ramesh Chand

Mr. Ramesh Chand











Rules, 2017

13.1.(d)









On 09-03-2018, Mr. Ramesh Chand had filed a complaint of mis-selling against Exide Life Insurance

Co. Ltd. in respect of policies bearing no. 03008502 alleged to have been missold to him. He has alleged

that he was trapped through tellecalling and was missold above policy under the assurance of bonus and

was also missold policies of other insurance companies on similar pretext. When he did not receive the

promised benefits, he complained to the company on 23.10.2017 for cancellation of above policy but the

company’s response was not satisfactory, hence, feeling aggrieved, he approached this office to seek

justice.





for alleged misselling vide his letter dated 30.10.2017 and sought cancellation of said policy which

is after a lapse of almost 03 years from the date of receipt of policy documents.



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Mr. Ramesh Chand, the complainant attended the personal hearing on 05.03.2019 and reiterated the

contents of basic complaint. He also submitted that he has received the policy bond well in time under

the said policy.




but had complained to them after a lapse of almost 03 years from the date of receipt of policy

documents.






mentioned in the complaint in November, 2014. He had accepted during the hearing that he had received


observed that after receiving the policy documents, the complainant being an educated person had ample

opportunity to go through the terms and conditions of the policy but he did not utilize the free look

option but had approached the insurer alleging mis-selling after almost 03 years from the issuance of

said policy. There was inordinate delay on the part of the complainant in lodging the complaint, alleging

mis-selling which he could not justify.

ORDER






day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Mr. Rahul Singla Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-0753


Complainant

Mr. Rahul Singla

House No.- 3314, Sector- 27 D, Chandigarh,

Mobile No.- 9988385264

2. Policy No: DOC

Type of Policy


01916740 / 14-07-2010

Exide Life New Fulfilling Life

16/61/ Rs. 19796/- (paid for 06 yrs)



Mr. Rahul Singla

Mr. Rahul Singla







10. Date of Partial Settlement 25334/-

11. Amount of relief sought Refund of premiums with interest



Rules, 2017

13.1.(c)

13. Date of hearing/place 07-01-2019 & 05.03.2019 / Chandigarh



For the insurer Mr. Vignesh Ram Assistant Manager- Legal 07.01.19


Mr. Muthanna M K –Intern- Legal 05.03.2019

/Chandigarh




On 04-08-2017, Mr. Rahul Singla had filed a complaint of mis-selling against Exide Life Insurance Co.

Ltd. in respect of policy bearing no. 01916740.He has alleged that he was missold above policy on the

pretext that amount deposited by him will be refunded with interest after 03 years and when after 03

years he approached the company for money back, he was told that he will have to pay the premium for

one more year. He has further stated that after 04 year when he approached the company again for

money back he was told that the amount will be paid within 08 days but was not paid. Therefore he

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requested the company to cancel the said policy by refunding of all premiums with interest, but he

received partial amount of Rs. 25334/- on 06.04.2015, Hence, feeling aggrieved, he approached this




with welcome letter were dispatched at complainant’s address on 17.07.2010. Further the

complainant has submitted his first complaint on 07.04.2016 which was after a lapse of almost 05

years from the receipt of policy documents under the said policy.



Mr. Rahul Singla, the complainant attended the personal hearing on 07.01.2019 and reiterated the

contents of the complaint. He also submitted that he never received the original policy bond from the

insurer despite his regular follow up with the company and whenever he visited the company’s office

and asked for policy bond he was informed to submit the affidavit. He also alleged that without his

consent the company has deducted 5th

year renewal premium out of his money back payment which

was due to him after paying premiums for 04 years premiums.


The Insurer’s representative reiterated the contents of SCN.He also submitted that policy bond was

dispatched at complainant’s address on 17.07.2010 but he could not provide any dispatch details

and poof of delivery against the same.






the representative of the Insurance Company, It is observed that the complainant has not received the

original policy bond under the said policy and the insurer has also not been able to produce any proof

of delivery of the said policy to the complainant. Instead of issuing original policy bond to the

complainant, the insurer has asked the complainant to submit affidavit which shows deficiency of

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service on their part. It is also observed that the said policy was missold through misrepresentation of

facts on the pretext that money back will be released after paying premiums for three years. The

complainant had applied for cancellation of said policy when the company has deducted 5th

year’s

premium out of his money back payment and instead of resolving the complaint the company has

declined his request. Since original policy bond was never received by the complainant and renewal

premium was also deducted without the consent of the complainant, the fault lies with the company;

hence the company cannot take shelter of free look period.

AWARD

Taking into account the facts & circumstances of the case and the submissions made by both the

parties during the course of personal hearing, an award is passed with a direction to the

insurance company to cancel the policy bearing number 01916740, since inception and refund

all the premiums collected there-in without interest and without deduction of any charges

subject to deduction of Rs. 25334/- paid earlier to the complainant.




c. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN

of 412




Case of Mr. Shalender Markandey Vs Exide Life Insurance Co. Ltd.

CASE NO-CHD-L-025-1718-0417


Complainant

Mr. Shalender Markandey

House No.- 1698, Sector-22 B, Chandigarh-160022

Mobile No.- 9873105665

2. Policy No: DOC

Type of Policy


03545422 / 31-03-2017

Exide Life Secured Income Insurance Plus

07 yrs/ Rs. 24094/-












11. Amount of relief sought Refund of premiums under both policies



Rules, 2017

13.1.(d)





(07.01.2019 & 12.02.2019)






On 12-06-2017, Mr. Shalender Markandey had filed a complaint of non receipt of policy bond and mis-

selling against Exide Life Insurance Co. Ltd. in respect of policy bearing no. 03545422. He has alleged

that he was allured to purchase above policy and till date he has not received the policy documents

.When he complained to the company on 26.04.2017 followed by reminders on different dates for non

receipt of policy documents, every time it was replied by the company that the policy documents have

been dispatched on 13.04.2017 at his registered address and the same has not been received undelivered

by the company, Hence, feeling aggrieved, he approached this office to seek justice.

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with welcome letter were dispatched on 13.04.2017 and duly delivered at complainant’s address

on 17.04.2017. Further the complainant has submitted his first complaint on 31.05.2017 which was

after a lapse of more than a month from the receipt of policy documents.










AWARD






day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Rajender Kumar Vs Bharti AXA Life Insurance Co. Ltd.

CASE NO-CHD-L-008-1718-0892


Complainant

Mr. Rajender Kumar

V.P.O.- Bani, Distt.- Sirsa, Sirsa, Haryana- 125075

Mobile No.- 9416920755

2. Policy No: DOC

Type of Policy


501-2367859 / 31-08-2014

Secure Income Plan

Rs. one Lakh



Mr. Rajender Kumar

Mr. Rajender Kumar

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4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.









Rule no: Insurance


13.1.(c)



For the Complainant Mr. Rajender Kumar

For the insurer Mr. Puneet Chataley- TTM

Mr. Raj Kumar (Sales Manager)




On 13-09-2017, Mr. Rajender Kumar had filed a complaint of mis-selling against Bharti AXA

Life Insurance Company in respect of policy bearing number 501-2367859 alleged to have been missold

on the pretext of obtaining bonus from Kotak Life Insurance policy and thereafter sold policies of other

insurance companies also alluring him of installation of tower at his land. He has further alleged that

when he did not receive the promised benefits, he complained to the company for cancellation of above

policy, but it was not responded by the company. Hence, feeling aggrieved, he approached this office to

seek justice.

18) The representative of the company informed that the said policy was issued on the basis of duly

filled and signed application form under the said policy and policy documents were dispatched on

13.09.2014. However, the company agreed to cancel the policy bearing number 501-2367859 and issue

a new single premium ULIP policy with a lock-in-period of 5 years against the same, subject to

underwriting & fulfillment of requirements. The free look period clause shall not apply for this new

single premium ULIP policy.

19) Accordingly, an agreement was signed between the Company and the complainant on

05.03.2019.

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20) The complaint is closed with a condition that the company shall comply with the





day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Raj Karan Vs Bharti AXA Life Insurance Co. Ltd.

CASE NO-CHD-L-008-1718-0883


Complainant

Mr. Raj Karan S/o Sh. Ram Singh,

Tehsil- Thanesar, P.O.- Sanghour,

Distt.- Kurukshetra, Haryana- 136156

Mobile No.- 9467274980

2. Policy No: DOC

Type of Policy


501-4870926, 501-4869431, 501-4721749, 501-5299554,

501-5300725, 501-5298457

27-09-2016,26-09-2016,10-08-2016,28-01-2017,27-01-2017

Elite Advantage Plan,



Mr. Raj Karan, Mr. Rohit Duhan, Ms. Priyanka Devi

Mr. Raj Karan, Mr. Rohit Duhan, Ms. Priyanka Devi





Complaint

08-09-2017




11. Amount of relief sought Refund of premiums under all the above policies


Rule no: Insurance


13.1.(d)

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hearing

For the Complainant Mr. Raj Karan






On 08-09-2017, Mr. Raj Karan had filed a complaint of mis-selling against Bharti AXA Life

Insurance Co. Ltd in respect of policies bearing no’s. 501-4870926, 501-4869431, 501-4721749, 501-

5299554, 501-5300725, and 501-5298457. He has alleged that he was missold above policies on the

pretext of refund of Rs. 05 Lakhs from his earlier lapsed LIC policies and when he did not receive the

promised benefits he complained to the company for cancellation of all policies, but it was not

responded by the company, Hence, feeling aggrieved, he approached this office to seek justice.




However, the company agreed to cancel the policies bearing numbers 501-4870926, 501-

4869431, 501-4721749, 501-5299554, 501-5300725, and 501-5298457 and refund all the

premiums received therein without interest and without deduction of any charges.


05.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN

of 412


(UNDER INSURANCE OMBUDSMAN RULES, 2017) INSURANCE OMBUDSMAN-Dr. D.K. VERMA

Case of Ms. Satish Gorowara Vs Bharti Axa Life Insurance Co. Ltd.

CASE NO-CHD-L-008-1718-0112


Complainant

Ms. Satish Gorawara C/o Dr. Sushma Sood,

House No. 1153-B, GMCH Campus,

Sector 32, Chandigarh

Mobile No.: 9646121534

2. Policy No: DOC

Type of Policy

Duration of policy/Policy

period

Rs 100000/- Rs. 99000/- Rs. 49000/-



4. Name of the insurer Bharti Axa Life Insurance Co.Ltd.




Complaint

21.04.2017




11. Amount of relief sought Refund of above amount under which no policies

were issued


Rule no: Insurance


13.1.(h)

13. Date of hearing/place 27.08.2018, 14.11.2018, 08.01.2019 & 05.03.2019

/Chandigarh


hearing


For the insurer Mr Rahul Gandhi &Mr.Puneet Chataley(27.08.2018)

Mr.Ritin Purohit(14.11.2018) Mr.Puneet Chataley

(08.01.2019) & Mr.Puneet Chataley &

Mr. Raj Kumar (05.03.2019) at Chandigarh




On 21.04.2017, Ms. Satish Gorowara had filed a complaint against Bharti Axa Life Insurance Co. Ltd.

in respect of cheques issued by her in favour of above company but till date the company neither has

neither issued any policies against the same nor had not refunded the said amounts despite her regular

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follow up with the company. When she complained to the company on 11.11.2016 for refund of amount

deposited with the company, it was not responded by the company. Hence feeling aggrieved, she


The Insurer in their written submission received by this office on 21.02.2019 has stated that the payment

details mentioned in the complaint is not sufficient to evaluate the same from their records and nothing

can be found from the given details. Further the insurer has requested to share any bank statement which

elucidates the actual payment transfer and the details as the company is not in a position to verify the

averments made by the complainant.



Mrs. Satish Gorowara, the complainant attended all the personal hearings and reiterated the contents of

the complaint. She also submitted bank statement alongwith bank certificate certifying the issuance of

three cheques of Rs.one Lakh, Rs.ninty nine thousand and Rs. forty nine thousand drawn in favour of

the company and also requested for refund of amount with interest.


The insurer’s representatives reiterated the contents of written submission and requested to share any

bank statement from which the company is in a position to verify the averments made by the

complainant. It was also submitted by them that the said cheques were issued in Feb, 2016 and March,

2016 whereas the complainant has approached them in November 2016 which is after almost 09

months from issuance of said cheques.


a) Complaint to the insurer. b) Annexure Vl-A c) Reply of the company



the representatives of the Insurance Company, It is observed that the said cheques were issued by the

complainant in Feb, 2016 and March, 2016 but she did not bother to know about the realization of said

cheques until in November 2016 when she complained to the company for non issuance of policies

against the said cheques, along with the details regarding issuance of three cheques drawn in favour of

the company. The company had requested for submission of bank certificate as the bank statement

provided by the complainant showed some manual corrections and the complainant submitted the same

on 05.03.2019.It is a fact that the complainant has approached the company after almost 09 months

from the issuance of said cheques but despite sufficient time being given to the insurer for verification,

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they are still not able to explain as to why the policies were not issued against the said cheques and

neither has not been able to confirm the receipt of amounts against the respective cheques which

indicates deficiency of service on their part.

AWARD



insurance company to refund all the amounts received against the cheques bearing ref

no’s MC 021312031112, 021312031428 & 000000000078.




d. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019

D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Harinder Kumar Prajapati Vs Bharti AXA Life Insurance Co. Ltd.

CASE NO-CHD-L-008-1718-0904


Complainant

Mr. Harinder Kumar Prajapati

Plot No.- 68, New Nanak Nagar, Farkpur, Jagadhari

Workshop, Tehsil- Jagadhari, Distt.- Yamunanagar,

Haryana- 135002

Mobile No.- 9466763933

2. Policy No: DOC

Type of Policy


501-2697065 / 14-01-2015

Samriddhi

of 412














Rule no: Insurance


13.1.(c)









On 16-09-2017, Mr. Harinder Kumar Prajapati had filed a complaint of mis-selling against Bharti AXA

Life Insurance Co. Ltd in respect of policy bearing no. 501-2697065.He has alleged that the above

policy was missold to him on the pretext that he can withdraw the amount anytime after 01 year

alongwith interest @ 8% but later on he realised that it was regular premium payable policy. He has

further alleged that when he did not receive the promised benefits, he complained to the company for

cancellation of said policy, but it was declined by the company, Hence, feeling aggrieved, he


As per SCN received from the Insurance Company on 02.05.2018 it is explained that the said policy was

issued on the basis of duly filled and signed application form under the said policy and policy

documents were delivered on 06.02.2015.The complainant did not invoke the free look option and after

28 months from the issuance of said policy first complaint was received in May 2017 alleging misselling

which was denied by the company.



of 412

Mr. Harinder Kumar Prajapati, the complainant attended the personal hearing on 05.03.2019, reiterated

the contents of the complaint and admitted that the policy bond under the said policy was received well

in time.


The Insurer’s representative reiterated the contents of SCN and submitted that the complaint for the first

time for alleged misselling was received in May, 2017 which was after a lapse of almost 28 months from

the commencement of said policy.


a) Copies of the proposal forms b) Complaint to the insurer. c) Reply of the company



the representative of the Insurance Company, it is observed that the said policy was issued in Janauary,

2015 and the policy bond was received by the complainant well in time. The complainant himself

working in Insurance Sector is supposed to be well conversant with the policy terms & conditions and

also had ample opportunity to go through the policy terms & conditions, but had raised an objection for

alleged misselling after a lapse of almost 28 months from the issuance of said policy, which seems to be

an afterthought. Hence, there being no justifiable reason for abnormal delay in filling the complaint,

there is no reason to interfere with the decision of the insurer.

ORDER


both the parties during the course of hearing, there is no need to interfere with the

decision of the insurer and the complaint is dismissed.



day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

of 412




CASE OF Mrs. Uma Sharma V/s Bharti AXA Life Insurance Co. Ltd.



On 15-06-2017, Mrs. Uma Sharma had lodged a complaint in this office against Bharti AXA Life Insurance Co.

Ltd. in respect of Policies bearing No. 501-5234247 & 501-5234221 alleged to have been mis-sold to her family

members. The Complainant had stated that she was contacted on mobile by the agent of above company and was

told that refund of premium had become due under her previous policies with ICICI Prudential policies and heavy

administrative charges would be deducted. She was also told that if she wanted waiver of administrative charges,

she would have to take life insurance policies and the amount invested would be doubled by the end of


Complainant

Mrs. Uma Sharma

Shayam Bhawan, Near Mangroo Cottage,

Below RTO, Shimla, Himachal Pradesh- 171004

Mobile No.- 8628882291

2. Policy No:

Type of Policy


501-5234247 & 501-5234221,



Ms. Mohini Joshi

Ms. Mohini Joshi










Rule no: Insurance

Ombudsman Rules, 2017.

13.1.(c.)

13. Date of hearing/place 14.11.2018 ,08.01.2019 & 05.03.2019/ Chandigarh



For the insurer Mr.Ritn Purohit (14.11.2018)

Mr. Puneet Chataley, TTM(08.01.2019) &

Mr. Puneet Chataley &Mr. Raj Kumar 05.03.2019/

Chandigarh

15 Complaint how disposed Dismissed in default


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31.03.2016. Accordingly, she agreed for fresh insurance and completed all the formalities for insurance on the life

of her family members. When she did not get the amount under policies of ICICI Prudential Co., She filed a

complaint with insurer on 15.06.2017 to cancel the policies and refund the premiums which was rejected by the

insurer being out of free look period.

As per SCN received from the insurer on 29.10.2018 the company has stated that in case of policies

bearing no’s 501-5234247, 501-5234221, 501-4202005, 501-5234262, 501-5234288 & 501-5234304

the complainant is neither the policy holder nor the life assured and thus has no locus standi to file the

present complaint. The insurer has also stated that after understanding the key features of the policy, the

respective policy holders had signed and submitted the proposal forms for insurance. The policy

documents along with copies of supporting documents under the Policies bearing No’s. 501-5234247, 501-

5234221, 501-4202005, 501-5234262, 501-5234288 & 501-5234304 were delivered on 09.03.2017,

09.03.2017, 29.04.2016, 07.03.2017, 03.02.2017 &03.03.2017 respectively. The policy holders had

retained the policy documents and did not invoke the free look option. The Insurer has further stated that

in the instant case, after the expiry of free look period and around 14 months from the issuance of last

policy, the company received a complaint on 14.06.2017 alleging that the products were different from

what was promised and seeking refund under the said policies.

The company has already refunded the amount under polices bearing no’s 501-5234221, 501-5234247,

501-5234262, 501-5234304 in March 2017 under freelook option.


The complainant was given opportunity of personal hearing on 14.11.2018, 08.01.2019 & 05.03.2019 but

neither the complainant nor her representative turned up. Non appearance in personal hearing indicates

that she has nothing to say in this matter. However, the insurance company was represented by their

representative on all the occasions who requested for dismissal of the complaint, since sufficient

opportunities have been given to the complainant to present her case. Moreover the company has already

refunded the premiums under free look period to the life assured Ms. Mohini Joshi in respect of policies

mentioned in the complaint and bearing no’s 501-5234221, 501-5234247. It appears that the complainant

doesn’t wish to pursue the matter as there is no verbal or written communication from her in spite of

best efforts by this office. Under the circumstances, there is no option but to close the complaint and the

case is being dismissed in default.

AWARD



policies bearing no’s 501-5234247 & 501-5234221, is dismissed in default.



day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN

of 412




Case of Mr. Rameshwar Dass Vs Bharti AXA Life Insurance Co. Ltd.

CASE NO-CHD-L-008-1718-0903


Complainant

Mr. Rameshwar Dass

House No.- 1262, Dhiman Nagar, Garhi Munday,

Jagadhari, Distt.- Yamunanagar, Tehsil- Jagadhari,

Haryana- 135003

Mobile No.- 9416119948

2. Policy No: DOC

Type of Policy


501-5786642 & 501-5298853 / 16-05-2017, 16-05-2017

Elite Advantage

Rs.46499/ & Rs.46499/-



Mr. Vishal Dhiman

Mr. Rameshwar Dass










Rule no: Insurance


13.1.(c)



For the Complainant Mr. Rameshwar Dass






On 16-09-2017, Mr. Rameshwar Dass had filed a complaint of mis-selling against Bharti AXA

Life Insurance Co. Ltd in respect of policies bearing numbers 501-5786642, 501- 5298853. He has

alleged that he was missold above policies on the pretext of refund/bonus from his earlier Reliance

policy and was also assured flat in a city. When he did not receive the promised benefits he complained

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to the company for cancellation of above policies, but it was not responded by the company. Hence,

feeling aggrieved, he approached this office to seek justice.

18. The representative of the company informed that the said policies were issued on the basis of

duly filled and signed application form under the said policies and policy documents were

delivered on 07.02.2017 and 27.05.2017 under the respective policies. However, the company

agreed to cancel the policies bearing numbers 501-5786642 & 501-5298853 and refund all the

premiums received therein without interest and without deduction of any charges.


05.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Shivakumar Ramasamy Vs Bharti AXA Life Insurance Co. Ltd.

CASE NO-CHD-L-008-1819-0472


Complainant

Mr. Shivakumar Ramasamy

Second Floor Chabba House, By pass road, Kather,

Solan, Himachal Pradesh-0

Mobile No.- 9318972629

2. Policy No: DOC

Type of Policy


period

501-3984983 / 28-01-2016

Elite Advantage Plan

Rs. 02 Lakhs renewal prem of Rs. 02 lakhs also deducted





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Complaint

12-07-2018




11. Amount of relief sought Rs. 04 Lakhs (including renewal premium)


Rule no: Insurance


13.1.(c)



For the Complainant Mr. Shivakumar Ramasamy





On 12-07-2018, Mr. Shivakumar Ramasamy had filed a complaint of mis-selling against Bharti

AXA Life Insurance Co. Ltd in respect of policy bearing no. 501-3984983 and has stated that

earlier, his friend Mr. Yogesh Kumar Chabba had filed a complaint of mis-selling against Bharti

Axa Life Insurance Co. Ltd. in respect of policies bearing no’s 501-3800619, 501-3867592 &

501-3984983 who had a policy with HDFC which was closed in 2011 as he was not

satisfied with terms and conditions of said policy. He has further stated that in the year 2015 his

friend was contacted by someone who assured him for getting more compensation up to Rs. 5

Lakhs under the closed policy and he being a retired person and drawing pension of Rs. 19500/-

p.m. was lured by such lucrative offer and fell for the bait. The complainant has further

alleged that after that his friend was allured and forced to deposit more amounts on one pretext

or other and assured payment upto 18 lakhs provided he purchases fresh policies. The

complainant has further stated that he was also forced by his friend Mr. Yogesh Kumar Chabba

to take the policy on his behalf so that he would get attractive payments and his friend also

promised him that he will pay the premium also .When the complainant realised that he has been

cheated, he complained to the company along with his friend Mr. Yogesh Kumar Chabba

seeking cancellation of these policies, it was declined by the Insurer vide their mail 31.08.2016.

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Hence, feeling aggrieved, he approached this office to seek justice. The complainant has further

stated that although he was co complainant under complaint no CHD-L-008-1617-1390

registered under policies bearing numbers 501-3800619, 501-3867592 & 501-3984983 and since

he could not attend the hearing on 04.07.2018 the complaint under policies bearing numbers 501-

3800619, 501-3867592 only was decided on 04.07.2018 and he was asked to file his complaint

individually and afresh. The complainant has further stated that despite his request submitted

with the bank on 27.01.2017 the renewal premium was also deducted by the bank.




However, the company agreed to cancel the policy bearing number 501-3984983 and refund all

the premiums received therein without interest and without deduction of any charges.


05.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Shri Gurpal Singh V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Gurpal Singh

#15341A, Dhillon Nagar, Joga Nanad

Road

Bathinda

2. Policy No: 19454911, 19448111

of 412

Type of Policy


Super Income Plan

16/8 years



Shri Satbinder Singh (Father)








11. Amount of relief sought Rs. 94,000/=


Rule no:

13.1(d)




Manager(Legal&Comp)


14 Complaint how disposed Agreement



On 27.11.2017, Shri Gurpal Singh had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of two policies bearing numbers 19454911 and

19448111 in the name of his father Shri Satbinder Singh. He was contacted telephonically and

sold the policies. However, his father was not financially capable of continuing the policies.

Hence, he requested the Company to cancel the policies and refund the premium but could not

get any relief. Hence, feeling aggrieved, he has approached this forum to get justice.

17) At the outset, the Company offered to cancel the policies and refund the premiums paid by the

complainant.

18) The Company’s offer is accepted by the Complainant.


06.03.2019.

of 412

20) The complaint is closed with a condition that the company shall comply with the agreement

and shall send a compliance report to this office within 30 days of receipt of this order for

information and record.



day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Amandeep Singh V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Amandeep Singh

#165, Churhard Patti, W.No. 8,

Cheema, Distt. Sangrur

2. Policy No:

Type of Policy


18861984



Shri Amandeep Singh










Rule no:

13.1(a)




Manager(Legal&Comp)


of 412




On 13.12.2017, Shri Amandeep Singh had filed a complaint in this office against HDFC

Standard Life Insurance Company about mis-selling of a policy bearing number 18861984 on

20.12.2016 on the pretext of installation of a mobile tower on his land. However, when no tower

installation took place, he realized that he had been cheated and complained to the Insurance

Company but could not get any relief. Hence, feeling aggrieved, he has approached this forum to

get justice.

17) The Insurance Company has informed that the policy was issued on 20.12.2016 for an yearly

premium of Rs. 40,000/= to be paid for 10 years. The policy was delivered on 30.12.2016 and

the first complaint was received on 14.09.2017 which was after the freelook period. However,

the Company agreed to cancel the policy and adjust the premium collected there-in into a new

unit-linked single premium policy with a lock-in period of 5 years and no freelook clause.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Ms Surinder Kaur V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Ms Surinder Kaur

VPO Sandhu Chatha, Kapurthala

2. Policy No:

Type of Policy


14489922

Classic Pension

10/5 years



Ms Surinder Kaur










Rule no:

13.1(a)




Manager(Legal&Comp)





On 19.12.2017, Ms Surinder Kaur had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 14489922. A Branch

official of HDFC Bank convinced her to purchase the policy which was like an FD and the

amount could be withdrawn after 5 years. However, when she received a reminder for payment

of renewal premium, she contacted the officials who gave her an assurance that she would get

the return after 5 years. After 5 years, she learnt that it was a regular premium policy and she

complained to the Insurance Company but could not get any relief. Hence, feeling aggrieved, he

has approached this forum to get justice.

of 412

17) The complainant said that she was told to invest Rs 1 lakh once to get good returns. She paid the

amount and went abroad. On her return, she found a letter reminding her for premium payment.

She contacted the Company’s office and she was given a letter confirming that on non-payment

of premium, she would continue to get saving bank account interest on the paid amount and

payment can be withdrawn after 5 years.


premium of Rs. 99,500/= to be paid for 6 years. No complaint regarding mis-selling has been

received by the Insurance Company so far. However, in view of the letter produced by the

complainant, the Company agreed to cancel the policy and refund the premiums paid by the

complainant.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Mukesh Kumar V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Mukesh Kumar

Gupta Tent House, Main Road

Taraori, Karnal

2. Policy No: 19287419

of 412

Type of Policy




Shri Gian Chand








11. Amount of relief sought Rs.


Rule no:

13.1(a)


For the Complainant Shri Gian Chand, Father


Manager(Legal&Comp)





On 09.12.2017, Shri Mukesh Kumar had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 19287419. He did not

receive the policy document and complained regarding non-receipt of policy. After some days,

he received a duplicate policy bond and realized that the policy was regular premium policy

although he was told the term was 3 years. He requested the Insurance Company for cancellation

of policy which was declined by the Company. Hence, feeling aggrieved, he has approached this

forum to get justice.

17) At the outset, the Company offered to cancel the policy and refund the premiums paid by the

complainant.



06.03.2019.

of 412






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Pooran Ram V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Pooran Ram

Jalalabad Road, Pragdas Street, Muktsar

2. Policy No:

Type of Policy


18406654, 18433491, 18486578, 18530961,

18328333



Late Shri Nirmal Singh










Rule no:

13.1(a)




Manager(Legal&Comp)

of 412





On 18.12.2017, Shri Pooran Ram had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of policies bearing numbers 18406654, 18433491,

18486578, 18530961 and 18328333. He had purchased a policy in 2012 wherein he could not

pay regular premiums. In February – March, 2016, he was advised through phone calls to pay

due premiums under the policy along with advance premiums. He handed over five cheques for

Rs. 25,000/=; Rs. 20,000/=; Rs. 35,200/=; Rs. 30,000/= and Rs. 22,600/- for the same. On

17.03.2017, he visited the Company’s office as he needed money but to his surprise, he found

that 5 new policies had been issued instead of paying premium under the existing policy. All the

policies were issued without his signatures and with incorrect information like date of birth etc.

The policy documents did not bear any stamp of the branch officials. He did not receive any

verification call as the mobile number given in the policy was not his. He complained to the

Insurance Company but could not get any relief. Hence, feeling aggrieved, he has approached

this forum to get justice.


complainant.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Shri Sukhraj Singh V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Sukhraj Singh

#165, Churhard Patti, W.No. 8,

Cheema, Distt. Sangrur

2. Policy No:

Type of Policy


18976085



Shri Sukhraj Singh










Rule no:

13.1(a)




Manager(Legal&Comp)





On 13.12.2017, Shri Sukhraj Singh had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 18976085 on 16.01.2017

on the pretext of installation of a mobile tower on his land. However, when no tower installation

took place, he realized that he had been cheated and complained to the Insurance Company on

17.09.2017 but could not get any relief. Hence, feeling aggrieved, he has approached this forum

to get justice.

of 412


premium of Rs. 90,000/= to be paid for 10 years. The policy was delivered on 07.02.2017 and

the first complaint was received on 14.09.2017 which was after the freelook period. However,

the Company agreed to cancel the policy and adjust the premium collected there-in into a new

unit-linked single premium policy with a lock-in period of 5 years and no freelook clause.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Ram Charan Yadav V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Ram Charan Yadav

#1306/3, Sector 30, Chandigarh

2. Policy No:

Type of Policy


18858760

Classic Assure Plus

10/7 years



Shri Ram Charan Yadav




of 412







Rule no:

13.1(a)




Manager(Legal&Comp)





On 27.12.2017, Shri Ram Charan Yadav had filed a complaint in this office against HDFC

Standard Life Insurance Company about mis-selling of a policy bearing number 18858760. He

had opened an account in HDFC Bank where he was advised to transfer some funds to some

other account. He agreed to transfer Rs. 70,000/= into PPF account. However, he was issued an

insurance policy. When he visited the Bank, they told him that he will have to pay for 7 years.

He complained to the Insurance Company but could not get any relief. Hence, feeling aggrieved,

he has approached this forum to get justice.


complainant.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Shri G S Dhillon V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri G S Dhillon

735, Army Flats, Phase-2

SAS Nagar, Mohali

2. Policy No:

Type of Policy


19843184

Youngstar Udaan

15/7 years



Shri G S Dhillon








11. Amount of relief sought Rs. 95,000/= + interest


Rule no:

13.1(a)




Manager(Legal&Comp)





On 10.01.2018, Shri G S Dhillon had filed a complaint in this office against HDFC Standard Life

Insurance Company about mis-selling of a policy bearing number 19843184 on 08.12.2017 as a

pre-condition for getting loan of Rs. 30,95,000/= at 0% interest. He even received phone calls

confirming the loan amount. However, when he did not get any loan, he complained to the

Insurance Company on 08.01.2018 but could not get any relief. Hence, feeling aggrieved, he has

approached this forum to get justice.

of 412


complainant.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Sandeep Kumar V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Sandeep Kumar

Shiv Colony, Ward No. 15, Samalkha

Panipat

2. Policy No:

Type of Policy


17705224

Click 2 Protect Plus



Late Shri Satpal Sharma






of 412





Rule no:

13.1(a)

13. Date & Place of Hearing 06.03.2019/Chandigarh


On 27.11.2017, Shri Sandeep Kumar had filed a complaint in this office against HDFC Standard

Life Insurance Company about repudiation of death claim under policy bearing number

17705224. The policy was purchased on 12.06.2015 and his father committed suicide on

17.03.2017. The Company repudiated the death claim as the age declared in the proposal form

was incorrect. Actually, PAN was submitted as age proof and Aadhar as residence proof and date

of birth on PAN was correct. Hence, feeling aggrieved, he has approached this forum to get

justice.



The complainant re-iterated the contents of his complaint and said that his father had purchased

the policy in 2015. He had given PAN card as proof of date of birth and Aadhar as proof of

residence. He was aware that the date of birth on his aadhar card was incorrect which he got

rectified later on. The Company repudiated the claim because of incorrect date of birth on

aadhar. The complainant submitted a copy of ration card, election i-card and transfer certificate

from Government school, Panipat as an evidence for correct date of birth which is same as per

PAN.



purchased on 09.06.2015 for a premium of Rs. 27,761/= to be paid for 25 years. The Life

Assured died on 17.03.2017, 21 months after the commencement of the policy. On investigation,

it was found that the Life Assured had not disclosed his correct age in the proposal form. As per

Aadhar Card, his date of birth was 18.05.1953. Hence, in view of providing false and inaccurate

answers in the proposal form, the contract was declared void ab initio and the death claim was

rejected.






Annexure-VI and the contents of the SCN filed by the Insurance Company. As per the

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documents presented, the date of birth as per PAN was correct as substantiated by the school

transfer certificate and election i-card. Hence, correct age was declared in the proposal form.



b. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply


to the Ombudsman.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Ms Neena Mehta V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Ms Neena Mehta

#252, Sector 18, Panchkula

2. Policy No:

Type of Policy


18429589, 18468682, 18498547, 18496051,

18525830, 18605335

Classic Assure Plus, Sampoorn Samridhi



Ms Neena Mehta










directed to settle the death claim as per terms and conditions of the policy.


of 412



Rule no:

13.1(a)




Manager(Legal&Comp)





On 22.12.2017, Ms Neena Mehta had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of six policies bearing numbers 18429589, 18468682,

18498547, 18496051, 18525830 and 18605335. In April-May2016, she was contacted over

telephone regarding an existing policy of Aegon Life. The caller took many cheques on one

pretext of the other. She realized much later that she had been made a part of a major mis-selling

and complained to the Insurance Company but could not get any relief. Hence, feeling aggrieved,

she has approached this forum to get justice.


complainant.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Sh Surinder Kumar Joshi & Ms Seema Sharma V/S HDFC Standard Life Insurance Co.

Ltd.



Complainant

Sh Surinder Kumar Joshi & Ms Seema

Sharma

#12396, Street no. 16, Prabhat Nagar

Ludhiana

2. Policy No:

Type of Policy


15867932, 15869066, 15876731



Ms Seema Sharma








11. Amount of relief sought Rs. 1,20,096/=


Rule no:

13.1(a)




Manager(Legal&Comp)





On 27.12.2017, Shri Surinder Kumar Joshi & Ms Seema Sharma had filed a complaint in this

office against HDFC Standard Life Insurance Company about mis-selling of three policies

bearing numbers 15867932, 15869066 and 15876731 on an assurance that it would give him

regular monthly pension along with bonus. Shri Joshi was 75 years of age and hence, all the

policies were issued in his children or grand-children’s names. He was mis-sold many policies of

different insurance companies amounting to Rs. 11 lakhs. When he realized that he was being

of 412

duped, he complained to all the companies but could not get any relief. Hence, feeling aggrieved,

he has approached this forum to get justice.



The complainant re-iterated the contents of her complaint and said that the policies were sold to

her father who was 75 years of age and the premium was paid by him. The complainant was a

receptionist in a school and was not aware of the policies, hence got delayed in filing a

complaint.


The representative of the Company informed that the policies bearing numbers 15867932,

15869066 and 15876731 were issued on 26.02.2013, 26.02.2013 and 28.02.2013for an yearly

premium of Rs. 36,028/=; Rs. 36,028/= and Rs. 48,039/=respectively to be paid for 7 years each.

The policies were delivered on 08.03.2013, 08.03.2013 and 12.03.2013 and the first complaint

was received on 10.11.2017 which was after the freelook period.







documents and submission of both the parties that the policies were sold to Ms Seema Sharma as

Life Assured and her father Shri Surinder Kumar Joshi as the proposer. Since the premium was paid

by Shri Surinder Kumar Joshi, his annual income was to be considered but the Company could not

produce any income proof for the same. All the three policies were sold within 4 days, hence sum

under consideration was more than Rs. 1 lakh, and even then no income proof was taken. Further,

the annual income of the Life Assured has been shown as Rs 2 lakhs in the proposal forms even

then, policies worth premium of Rs. 1.2 lakhs were sold to her.

of 412



c. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply


to the Ombudsman.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Shri Budhu Ram Biswas V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Budhu Ram Biswas

#23, Arjun Nagar, Jalandhar

2. Policy No:

Type of Policy


19571896, 19625472

Classic Assure Plus

15/10 years



Shri Budhu Ram Biswas










directed to cancel the policies bearing numbers 15867932, 15869066 and 1587673

since inception and refund the premium collected there-under without interest

or deduction of any charges.


of 412

11. Amount of relief sought Rs. 86,000/= + compensation


Rule no:

13.1(a)




Manager(Legal&Comp)





On 09.01.2018, Shri Budhu Ram Biswas had filed a complaint in this office against HDFC

Standard Life Insurance Company about mis-selling of two policies bearing numbers 19571896

and 19625472 as a pre-condition for getting housing loan of Rs. 8 lakhs at 0% interest. The loan

was to be disbursed in 15 days. When he did not get any loan, he complained to the Insurance

Company but could not get any relief. Hence, feeling aggrieved, he has approached this forum to

get justice.



The complainant re-iterated the contents of his complaint and said that he was sold the policies

as security for housing loan to be granted at 0% interest. When he did not get any loan, he

complained to the Company and recorded his conversations with the representatives who sold

him the policies.


The representative of the Company informed that the policies bearing numbers 19571896 and

19625472 were issued on 25.08.2017 and 14.09.2017 for a premium of Rs. 30.000/= and Rs.

55,999/= respectively to be paid for 10 years each. The policy documents were delivered on

08.09.2017 and 27.09.2017 and the first complaint was received on 31.10.2017 which was after

the free-look period.







documents and submission of both the parties that the complainant was deliberately offered housing

loan at 0% interest to sell policies as security for the same. When the complainant did not get the

assured loan, he wrote to the Company for cancellation of policies within a reasonable time of one

month from the sale of the policies.

of 412



d. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply


to the Ombudsman.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Shri Ajmer Singh V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Ajmer Singh

#1439/21, Sec-29B, Chandigarh

2. Policy No:

Type of Policy


19294464



Shri Ajmer Singh










directed to cancel the policies bearing numbers 19571896 and 19625472 since

inception and refund the premium collected there-under without interest or



of 412



Rule no:

13.1(a)




Manager(Legal&Comp)





On 27.12.2017, Shri Ajmer Singh had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 19294464. Although, he

did not receive any policy document, even then he got a message that the policy had been

delivered on 01.07.2017 at his village address. He had given Chandigarh address in the policy

still it was sent to his village address. On 10.07.2017, he visited his village home but could not

get his policy even there. He, then complained to the Insurance Company but could not get any

relief. Hence, feeling aggrieved, he has approached this forum to get justice.


complainant.



06.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Shri Deebanshu Bharija V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Deepanshu Bharija

#259/28, Jyoti Park, Gali No. 6

Gurugram

2. Policy No:

Type of Policy


19630497

Super Income Plan



Sh Deepanshu Bharija










Rule no:

13.1(d)


For the Complainant None


Manager(Legal&Comp)


14 Complaint how disposed Resolved by the Company



On 09.11.2017, Shri Deepanshu Bharija had filed a complaint in this office against HDFC

Standard Life Insurance Company about mis-selling of a policy bearing number 19630497. 16th

year. Affter 16th

year, he would get Rs. 3,86,172/= as maturity amount. Further, if he purchased

it immediately, he would get a complimentary New Immediate Immunity Plan wherein he would

get Rs. 24,242/= as pension ferom 17th

year till lifetime. He received the PCVC wherein the

benefits were confirmed. However, when he received the policy document, none of these

benefits were mentioned. Feeling cheated, he complained to the Insurance Company but did not

get any relief. Hence, feeling aggrieved, he has approached this forum to get justice.

of 412

17) On 08.03.2019, the Insurance Company has intimated to this office through an email that an

amount of Rs. 30,000/= had been paid to the complainant vide NEFT on 23.11.2017.

18) The complainant vide email dated 11.03.2019 has confirmed resolution of his complaint.

19) In view of the above, no further action is required to be taken by this office and the complaint is

disposed off accordingly.



day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Shambhu Kumar V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Shambhu Kumar

258/3, Key Line, Near Alpha Power

House

Ambala

2. Policy No:

Type of Policy


18597707, 18170677

Classic Assure Plus

15/5 years, 20/10 years



Sh Shambhu Kumar








of 412



Rule no:

13.1(d)




Manager(Legal&Comp)





On 09.08.2017, Shri Shambhu Kumar had filed a complaint in this office against HDFC Standard Life

Insurance Company about mis-selling of two policies bearing numbers 18597707 and 18170677 as an

FD which would yield 15% interest after one year. However, when he received the policy documents, he

did not find any such information. So, he complained to the Broker but did not get any solution. Then,

he complained to the Insurance Company, however, he did not get any relief there also. Hence, feeling

aggrieved, he has approached this forum to seek justice.

17) The Company has informed that the policies bearing numbers 18597707 and 18170677 were

issued on 30.07.2016 and 15.01.2016 for a premium of Rs. 44,000/= and Rs. 30,480/= to be paid

for 5 years and 10 years respectively. The policy documents were delivered on 18.08.2016 and

05.02.2016 and the first complaint was received on 06.06.2017 which was more than one year

after the purchase of the policies.

18) Neither the complainant nor his representatives appeared for the personal hearing on 21.01.2019,

06.02.2019 and 06.03.2019. The case is thus, dismissed in default and closed.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN

of 412




Case of Shri Harisimran Singh Sandhu V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Harisimran Singh Sandhu

#220, Sector 9C, Chandigarh

2. Policy No:

Type of Policy


15671376, 15670541

Unit Linked Pension



Shri Harisimran Singh Sandhu










Rule no:

13.1(a)




Manager(Legal&Comp)


14 Complaint how disposed Dismissed & Closed



On 12.12.2017, Retd. Col. Harisimran Singh Sandhu had filed a complaint in this office against

HDFC Standard Life Insurance Company about mis-selling of two policies bearing numbers

15671376 and 15670541 on 28.12.2012 on an assurance that the entire amount would be repaid

with interest after 5 years. However, in 2017, he was told that he would get only one-third back

and the rest would be retained by the Bank for paying annual interest. Since he already received

pension from the Government of India, he was never interested in purchasing a pension policy

and he did so only on the assurance that he would get his money back after 5 years. He

of 412

complained to the Insurance Company but could not get any relief. Hence, feeling aggrieved, he

has approached this forum to get justice.

17) On 15.03.2019, the complainant has informed that he had approached Consumer Court under the

same matter, hence, his complaint may be closed.

18) Hence, in accordance with Rule 14.5 of Insurance Ombudsman Rules, 2017 which states that “

No complaint before the Insurance Ombudsman shall be maintainable on the same subject

matter on which proceedings are pending before or disposed of by any court or Consumer

Forum or arbitrator”, the complaint is closed.



day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Mrs. Jasmel Kaur Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-0604

1. On 10-07-2017, Mrs. Jasmel Kaur had filed a complaint of mis-selling against Birla

Sun Life Insurance Co. Ltd. in respect of policy bearing no. 006615682.



3. Now, the insurer has informed through letter dated 08.03.2019 that they have already

refunded amount of Rs.49999/- under policy no. 006615682and same has been confirmed by

discharge voucher duly singed by the complainant.

of 412








Case of Mr. Abbaas Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-1069

1. On 09-11-2017, Mr. Abbaas had filed a complaint of mis-selling against Birla Sun

Life Insurance Co. Ltd. in respect of policy bearing no. 005151900.

2. This office pursued the case with the insurance company to re-examine the complaint

and they agreed to reconsider the claim.

3. Now, the insurer has informed through letter dated 08.03.2019 that they have already

refunded amount of Rs.30000/- under policy no.005151900 and same has been also

confirmed by the complainant in personal hearing on 08.03.2019.





of 412




Case of Mr. Ramesh Chand Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1422


Complainant

Mr. Ramesh Chand S/o Late Shri Dumna,

Village- Dadoura, Teh.- Balh, P.O.- Dhaban,

Nar Chowk, Mandi, Himachal Pradesh- 0

Mobile No.- 9418665171

2. Policy No: DOC

Type of Policy


006578426, 006559290 / 10-09-2014, 30-07-2014

BSLI Income Assured, Vision Life Income Plan

Annual



Mr. Ramesh Chander, Mr. Shivam

Mr. Ramesh Chander

4. Name of the insurer Birla Sun Life Insurance Co. Ltd.





9. Amount of Claim




Rule no: Insurance


13 [1][d]



For the Complainant Mr. Ramesh Chand

For the insurer Mr. Kaveesh, Senior- Legal Manager




On 09-03-2018, Mr. Ramesh Chander filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of polices bearing numbers 006578426, 006559290 with Annual

premium amount Rs. 60000 and 40000. The policy owner / complainant was given detailed description

about features of the said policies and was also apprised with its terms and conditions before signing of

the said applications.

The policyholder / complainant for the very first time had approached vide complaint letter dated

30-12-2017 i.e. 4 years after issuance of the policy. In the complaint the policyholder has stated that he

of 412

was trapped in hoax call and purchased the policy of Aditya Birla Sun Life Insurance. The complainant /

policyholder has failed to raise his concerns within the free look period.

18. In personal hearing the company agreed to cancel the policies bearing numbers 006578426,

006559290 and refund all the premiums received therein without interest and without deduction of any

charges. Accordingly, an agreement was signed between the company and the complainant on

08.03.2019.

19. The complaint is closed with a condition that the company shall comply with the agreement and

shall send a compliance report to this office within 30 the days of receipt of this order for




day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Ms. Saroj Bhalla Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1383


Complainant

Ms. Saroj Bhalla

W/o Late Shri Ashok Kumar Bhalla,

R/o House No.-32- A, Maharaja Garden,

Basti Peerdad, Jalandhar, Punjab- 144021

Mobile No.- 9781993959

2. Policy No: DOC

Type of Policy


007221842 / 28-02-2017

ABSLI Vision Endowment Plus

Annually



Ms. Saroj Bhalla

Ms. Saroj Bhalla


5. Date of Repudiation

6. Reason for repudiation



9. Amount of Claim

of 412




Rule no: Insurance


13 [1][d]



For the Complainant Mr. Amit Bhalla (Son)





On 28-02-2018, Ms. Saroj Bhalla filed a complaint of mis-selling against Birla Sun Life Insurance

company in respect of polices bearing number 007221842 with annual premium amount Rs. 20293/=.

The policy owner / complainant was given detailed description about the features of the said Policies

and was also apprised with its terms and conditions before signing of the said application. The

complainant cannot stake a claim to refund of the amount on the basic of non receipt of policy bond. The

company has dispatched the policy bond on 04-03-2017 via and the same was duly received by her on

17-03-2017.

18. In personal hearing the company agreed to cancel the policy bearing number 007221842 and

refund the premium received therein without interest and without deduction of any charges.

Accordingly, an agreement was signed between the Company and the complainant on 08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN

of 412




Case of Mr. Chaman Lal Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1377


Complainant

Mr. Chaman Lal S/o Shri Suraj Ram,

Village- Gokal Chak, P.O.- Jakhbar,

Teh. & Distt.- Kathua,

Jammu and Kashmir- 184104

Mobile No.- 9419441193

2. Policy No: DOC

Type of Policy


006313797, 006169083, 006199006, 006199427,

006367380 / 10-12-2013, 10-07-2013, 13-08-2013,

13-08-2013, 31-01-2014

BSLI Vision Life Income Plan, Bachat Endowment

Plan

Annually



Mr. Chaman Lal, Ms. Anita Sharma

Mr. Chaman Lal, Ms. Anita Sharma


5. Date of Repudiation




9. Amount of Claim




Rule no: Insurance


13 [1][d]



For the Complainant Mr. Chaman Lal





On 26-02-2018, Mr. Chaman Lal filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of polices bearing numbers 006313797, 006169083,

006199006, 006199427, 006367380 with Annual premium amount Rs.75002.2500,

20000.2700, 40416, 30312 and 35001.2100.

of 412

18. In personal hearing the company agreed to cancel the policies bearing numbers 006313797

and 006169083 and refund all the premiums received therein without interest and without deduction of

any charges and also agreed to convert the remaining policies bearing numbers 006199006, 006199427

and 006367380 into single premium ULIP policy w.e.f. 01.12.2015 with a lock-in-period of 5 years

against the same, subject to underwriting &fulfillment of requirements. The free look period clause

shall not apply for this new single premium ULIP policy. Accordingly, an agreement was signed

between the Company and the complainant on 08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Mr. Jasbir Singh Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1402


Complainant

Mr. Jasbir Singh

House No.- 32, VPO- Mangli Uchi,

Tehsil & Distt.- Ludhiana, Punjab-0

Mobile- 9876636060

2. Policy No: DOC

Type of Policy


005806846 / 25-10-2012

BSLI Vision Plan

Annually



Mr. Jasbir Singh

Mr. Jasbir Singh


5. Date of Repudiation N.A

6. Reason for repudiation N.A


of 412


9. Amount of Claim

10. Date of Partial Settlement N.A



Rule no: Insurance


13 [1][d]



For the Complainant Mr. Jasbir Singh [self]





On 01-03-2018, Mr. Jasbir Singh filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of polices bearing no 005806846 with annual premium amount of

Rs. 100002/-


issue a new single premium ULIP policy w.e.f. 01.12.2015 with a lock-in-period of 5 years against the

same, subject to underwriting & fulfillment of requirements. The free look period clause shall not apply

for this new single premium ULIP policy. Accordingly, an agreement was signed between the company

and the complainant on 08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN

of 412




Case of Mr. Jia Lal Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1403


Complainant

Mr. Jia Lal S/o Shri Dhanna Ram,

R/o Maira, P.O.- Jourian, Teh.- Akhnoor,

Distt.- Jammu and Kashmir- 181202

Mobile No.- 9419213388

2. Policy No: DOC

Type of Policy


005585842 / 29-05-2012

BSLI Vision Plan

Semi- annually



Mr. Jia Lal

Mr. Jia Lal






9. Amount of Claim




Rule no: Insurance


13 [1][d]



For the Complainant Mr. Amar Kumar (Son of Complainant)





On 01-03-2018, Mr. Jia Lal filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of policy bearing number 005585842 with annual premium

amount of Rs. 78783/-


refund the premium received therein without interest and without deduction of any charges.

Accordingly, an agreement was signed between the company and the complainant on 08.03.2019.

of 412






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Mr. Amit Mehan Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1249

2. On 30-12-2017, Mr. Amit Mehan filed a complaint of mis-selling against Birla Sun Life

Insurance Co. Ltd. in respect of polices bearing no 005861276.

3. During the personal hearing on 08.03.2019 the complainant has informed that he has been paying

renewal premium under the policy and also got policy loan and repaid the loan amount

subsequently. The complaint agreed to continue the said policy as per terms & conditions;

however, he has raised some doubts about policy which has been clarified during the personal

hearing by the representative of the insurer.

3. In view of the above, no further action is required to be taken by this office and the complaint

is disposed off accordingly.


.



of 412




Case of Mr. Hawa Singh Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-0964


Complainant

Mr. Hawa Singh S/o Shri. Harphool Singh,

Village – Aleva, Distt.- Jind,

Haryana-0

2. Policy No: DOC

Type of Policy


006300704, 006317942, 006335440, 006348743,

006348742 / 13-11-2013, 03-12-2013, 19-12-2013,

31-12-2013, 15-01-2014

BSLI Empower Pension, Vision Life Income,

Guaranteed Wealth Plan,

Annual



Mr. Hawa Singh, Mr. Amarjit Singh

Mr. Hawa Singh, Mr. Amarjit Singh






9. Amount of Claim





Rules, 2017

13 [1][d]



For the Complainant Mr. Hawa Singh





On 09-10-2017, Mr. Hawa Singh had filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of policies bearing numbers 006300704, 006317942, 006335440,

006348743 and 006348742 with annual premium amount of Rs.20000, Rs.25003.80, Rs. 34338,

Rs. 49990 and Rs. 49990 respectively.

of 412

18. In personal hearing the company agreed to cancel the policies bearing numbers 006300704,

006317942 and refund all the premiums received therein without interest and without deduction of any

charges and also agreed to convert the remaining policies bearing numbers 006317942, 006335440

and 006348743 into a single premium ULIP policy in the name of Mr. Amarjit Singh S/o Mr. Hawa

Singh w.e.f. 01.12.2015 with a lock-in-period of 5 years against the same, subject to underwriting &

fulfillment of requirements. The free look period clause shall not apply for this new single premium

ULIP policy. Accordingly, an agreement was signed between the Company and the complainant on

08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Mr. Syed Ejaz Husain Rizvi Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1262


Complainant

Dr. Syed Ejaz Husain Rizvi

Professor & Head Divison of Statistics & CS

Faculty of Basic Sciences, SKUAST- J, Main

Campus, Chatha, Jammu,

Mobile No.- 9419138953

2. Policy No: DOC

Type of Policy


005797177, 005895020, 006225203 / 02-11-2012,

31-01-2013, 13-09-2013

BSLI Vision Plan

Annual



Mr. Syed Ejaz Husain Rizvi, Mr. Ehtesham Abbas

Rizvi

Mr. Syed Ejaz Husain Rizvi




of 412



9. Amount of Claim




Rule no: Insurance


13 [1][d]



For the Complainant Dr. Syed Ejaz Husain Rizvi [self]





On 21-12-2017, Dr. Syed Ejaz Husain Rizvi filed a complaint of mis-selling against Birla Sun

Life Insurance Company in respect of policies bearing numbers 005797177, 005895020 and 006225203

with annual premium amount of Rs. 55000, Rs. 50000 and Rs.70000 respectively.


refund the premium received therein without interest and without deduction of any charges. The

complainant has confirmed in the personal hearing that he has no issue with policy nos-005797177&

05895020. Accordingly, an agreement was signed between the company and the complainant on

08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN

of 412




Case of Mr. Balwinder Singh Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-0608


Complainant

Mr. Balwinder Singh

Kothi No.- 699, Phase- 6, Mohali, Punjab-0

Mobile No.- 9501594534

2. Policy No: DOC

Type of Policy


006163618 / 31-08-2013

BSLI Vision Plan

Annual



Mr. Balwinder Singh

Mr. Balwinder Singh






9. Amount of Claim





Rules, 2017

13 [1][d]



For the Complainant Mr. Balwinder Singh [self]





On 11-07-2017, Mr. Balwinder Singh had filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of policy bearing number 006163618 with annual premium amount of

Rs.130065. The complainant had alleged that in the name of switching of fund with 12 % return the

company had issued him new policy in lieu of the old policy number 004083916 with forged signature

and impersonal medical reports.


issue a new single premium ULIP policy w.e.f. 01.12.2015 with a lock-in-period of 5 years against the

same, subject to underwriting & fulfillment of requirements. The free look period clause shall not apply

of 412

for this new single premium ULIP policy. Accordingly, an agreement was signed between the company

and the complainant on 08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN

.




Case of Mr. Hardev Singh Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-0534


Complainant

Mr. Hardev Singh

House No.- 206/9, Aanand Nagar,

Ward No.- 10, Kharar, Mohali, Punjab-0

2. Policy No: DOC

Type of Policy


006021005, 006089902 / 18-03-2013, 30-04-2013

BSLI Vision Plan, BSLI Bachat Money Back Plan



Mr. Hardev Singh

Mr. Hardev Singh











Rules, 2017

13 [1] [d]

of 412





15. Complaint how disposed Order for refund of premium



On 21-06-2017, Mr. Hardev Singh had filed a complaint of mis-selling against Birla Sun Life

Insurance Co. Ltd. in respect of policies bearing nos. 006021005 &, 006089902 with annual premium

amount Rs. 48790 and 29998. The complaint had stated that he was trapped in a hoax call and

purchased the policies.

18. Cause of Complaint:

a]Complainant’s argument:

Mr. Hardev Singh, the complainant, attended the personal hearing and reiterated the contents of the

complaint. He submitted that brokers of the insurance company gave him lucrative offer to invest in

bank like F.Ds which would give him better returns. But, later on, he came to know that he was cheated

and insurer had issued long term insurance policy instead of F.D. He informed that he had made

numerous calls on the toll Free No. of the insurer but did not get any response. He also added that his

annual income & profession has been wrongly mentioned, further the company has not called ITRS and

bank statements from him. He requested for refund of total premium paid under the policy.

b] Insurers’ argument:

In personal hearing the insurer reiterated the contents of SCN and submitted that the policy owner /

complainant was given detailed description about the features of the said policies and was also apprised

with its terms and conditions before signing of the said applications. The policyholder has paid 2nd

annual premium for the policy baring no 006021005 and one premium against the policy 006089902.

After that the Policyholder did not pay any further premium and due to which the both the policies were

lapsed and were terminated. The policyholder / complainant for the very first time had approached vide

complaint letter dated 07-04-2017 i.e. 4 years after issuance of the policy. In the complaint the Ph has

stated that he was trapped in a hoax call and purchased the policy of Birla Sun Life Insurance. Before

the issuance of the policy, a Pre issuance Verification call was made to the policyholder. In the said call,

the policyholder accepted that he is well aware of all the Term & Conditions of the policy.

19. The following documents were placed for perusal:

a) Complaint to the Company. b) Proposal Form.

c) Insurer’s SCN

of 412

20. Result of personal hearing with both parties (Observations & Conclusion)


and the representative of Insurance Company, It is observed that the policies with annual premium

about Rs. 80000/- payable for 12 & 20 years have been issued on the basis of annual income of Rs. 2.5

lac without any documentary proof neither the insurer has taken copy of bank statement to know

recurring income of the complainant as income proof for issuing regular premium paying policies.

Hence, it is observed that financial underwriting was lacking and paying capacity of the proposer was

ignored. Hence, the insurer can’t take shelter of free look period.

AWARD



to the insurance company to cancel the policies bearing numbers 006021005 &, 006089902

since inception and refund all the premium collected there-in without interest and without





e. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall



Dated at Chandigarh on 08.03.2019.

D.K.Verma

INSURANCE OMBUDSMAN

of 412




Case of Mr. Mohit Agarwal Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-1229


Complainant

Mr. Mohit Agarwal


Haryana-0

Mobile No.- 9872098042

2. Policy No: DOC

Type of Policy


004374999 / 15-09-2010

BSLI Freedom 58 Base Coverage

Annual



Mr. Mohit Agarwal

Mr. Mohit Agarwal






9. Amount of Claim





Rules, 2017

13 [1][d]



For the Complainant Mr. Mohit Agarwal





On 29-12-2017, Mr. Mohit Agarwal had filed a complaint of mis-selling against Birla Sun Life

Insurance Company in respect of policy bearing number 004374999 with annual premium amount Rs.

of 412

425000. The policy owner/complainant was given detailed description about the features of the said

Policies and was also appraised with its terms and conditions before signing of the said application.


issue a new single premium ULIP policy w.e.f. 01.12.2015 with a lock- in-period of 5 years against

the same, subject to underwriting & fulfillment of requirements. The free look period clause shall not

apply for this new single premium ULIP policy. Accordingly, an agreement was signed between the

Company and the complainant on 08.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN

.




Case of Mr. K.K. Malhotra Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-0446

1 .On 14-06-2017, Mr. K.K. Malhotra had filed a complaint of surrender value less paid against

Birla Sun Life Insurance Co. Ltd. in respect of policy bearing no. 003226765 with Annual

Premium Amounting Rs. 25000 in the year 2009.

2. The complainant was given detailed description about the features of the said policy and was also

apprised with its terms and conditions before signing of the said application. The complainant for the

very first time had approached vide complaint letter dated March 2017 i.e. 5 years after the last

premium against the policy was deposited. The company has received the surrender request on 07-03-

2017 from the policyholder and the company has deposited the amount of Rs. 140854.11 on 10-03-

2017 in the account of the complainant.

of 412

3. The complainant vide letter dated 01.03.2019 submitted that he wishes to withdraw his

authorization given to ombudsman office for mediation.

4. In view of the above, no further action is required to be taken by this office and the complaint is


Dated : 08.03.2019 Dr. D. K. VERMA





Case of Mr. Agyajit Singh Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-1194


Complainant

Mr. Agyajit Singh

# 136, Civil Lines, Patiala, Punjab- 147004

Mobile No.- 9478169464

2. Policy No: DOC

Type of Policy


004502398 , 004526125, 004483362,004339079 /

16-11-2010, 26-11-2010, 31-10-2010, 29-08-2010

BSLI Bachat Endowment Plan

Annual



Mr. Aekamdeep Singh,

Mr. Agyajit Singh











Rules, 2017

13 [1] [D]




of 412


15. Complaint how disposed Award for Refund & Conversion of policies into

Single Premium Policy.



On 19-12-2017, Mr. Agyajit Singh had filed a complaint of mis-selling against Birla Sun Life

Insurance Co. Ltd. in respect of policy bearing no. 004502398, 004526125, 004483362 & 004339079

with Annual premium amount Rs. 30936. 303000, 31956 &.24744 respectively.

18 Cause of Complaint:

a] Complainant’s argument

Sh. Agyajit Singh, the complainant, attended the personal hearing and reiterated the contents of the


bank like F.Ds which would give better returns. But, later on, he came to know that he was cheated and

insurer had issued long term insurance policies instead of F.Ds He informed that he had made


signatures were also forged. He requested for refund of total premium under all the four policies.

b] Insurers’ argument

In personal hearing the insurer reiterated the contents of SCN and submitted that on receipt of the duly

filled application forms and relevant documents, ABSLI issued the policies bearing nos 004339079,

004483362, 004526125 & 114502398 and the policy documents along with the copies of the application

forms were dispatched by courier at the communication address of the complainant and the same were

duly delivered. The first complaint was received from the complainant on 20-09-2013 vide Email/ letter

alleging misselling of the policies. The same was duly replied by ABSLI vide Email sent on 23-10-2013,

denying cancellation of the policies as the complainant had approached far beyond the free look period.

The policies got lapsed due to nonpayment of renewal premiums.



c) Insurer’s SCN



and the representative Insurance Company, It is observed that four policies with annual premium of

more than one lac payable for 20 years have been issued on the basis of annual income of Rs. 3 lac

without any documentary proof, neither, the insurer has taken copy of bank statement to know recurring

income of the complainant as income proof for issuing regular premium policies. Moreover, the

complainant is senior citizen and source income is only pension. It is observed that financial

of 412

underwriting was lacking and paying capacity of the proposer was ignored. Hence, the insurer can’t take

shelter of free look period.

ORDER

I order the insurer to cancel policy nos. 004502398, 004526125 & 004339079 and

refund the total collected/deposited amount without interest and without deduction of

any charges. I also order the insurer to cancel the policy no. 004483362 and convert it

into single premium policy in the name of Sh. Aekam Deep Singh grandson of Sh.

Agyajit Singh w.e.f. 01.12.2015 with lock in period of 5 years subject to other

underwriting requirements.



(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Mr. Shisha Singh Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1462


Complainant

Mr. Shisha Singh

House No.- 106-C/1, Seona Road, Ranjit Nagar,

Patiala, Punjab- 147001

Mobile No.- 7589472527

2. Policy No: DOC

Type of Policy


004668326, 004763081/ 31-01-2011, 16-03-2011

BSLI Bachat Money Back Plan



Mr. Kanwaldeep Singh, Ms. Gagandeep Kaur

Mr. Shisha Singh










Rule no: Insurance


13 [1] [D]

of 412





15. Complaint how disposed Award for Conversion of policies into Single

Premium Policy.



On 15-03-2018, Mr. Shisha Singh filed a complaint of mis-selling against Birla Sun Life

Insurance Co. Ltd. in respect of polices bearing no 004668326, 004763081.

18 Cause of Complaint:

a] Complainant’s argument

Sh. Shisha Singh the complainant attended the personal hearing and reiterated the contents of the


bank like F.Ds which would give better returns. But, later on, he came to know that he was cheated and

insurer had issued long term insurance policies instead of F.Ds He informed that he had made


signatures were also forged. He requested for refund of total premium under all the four policies.


In personal hearing the insurer reiterated the contents of SCN and submitted that on receipt of the

duly filled application form and relevant documents, ABSLI issued the policies bearing no.

004668326, 004763081 and the policy document along with copy of the application forms were

dispatched. The first complaint was received from the complainant on 09-02-2018 alleging misselling

i.e. after 7 years of policy issuance. In the present case, the complainant failed to approach ABSLI

within the free look period of 15 days with regards to any discrepancy in the said policy. The policy

got lapsed due to nonpayment of renewal premium.



c) Insurer’s SCN

20. Result of personal hearing with both parties (Observations & Conclusion) On going through

the various documents available in the file and also hearing both the complainant and the representative

Insurance Company, It is observed that four policies with annual premium of more than 2 lac payable

for 20 years have been issued on the basis of annual income of Rs. 4 lac without any documentary proof

neither the insurer has taken copy of bank statement to know recurring income of the complainant as

income proof for issuing regular premium policies. Hence, it is observed that financial underwriting was

of 412

lacking and paying capacity of the proposer was ignored. Hence, the insurer can’t take shelter of free

look period.

ORDER

I order the insurer to cancel policy nos. 004668326 & 004763081 and convert it into

single premium policy in the name of Sh. Kanwaldeep Singh S/O Shisha Singh w.e.f.

01.12.2015 with lock in period of 5 years subject to other underwriting requirements.



(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Mr. Basant Kumar Vs Birla Sun Life Insurance Co. Ltd.

CASE NO-CHD-L-009-1718-1338


Complainant

Mr. Basant Kumar

Village- Bhagu Majra, Tehsil- Jagadhri,

Distt.- Yamuna Nagar, Haryana- 135133

Mobile No.- 9992999381

2. Policy No: DOC

Type of Policy


006285540, 006220205, 006251610 / 29-10-2013,

16-09-2013, 30-09-2013

Vision Life Income Plan, Bachat Endowment Plan

Annual



Mr. Basant Kumar

Mr. Basant Kumar









12. Complaint registered under 13 [1] [d]

of 412

Rule no: Insurance









On 10-02-2018, Mr. Basant Kumar filed a complaint of mis-selling against Birla Sun Life Insurance

Co. Ltd. in respect of policies bearing nos. 006285540, 006220205 & 006251610. The complainant has

alleged that the representative of company assured him of high returns of invested amounts and was

victim of the hoax call.


a]Complainant’s argument

Mr. Basant kumar, the complainant, attended the personal hearing and reiterated the contents of the


bank like F.Ds which would give him better returns. But, later on, he came to know that he was cheated

and insurer had issued long term insurance policy instead of F.D. He informed that he had made


annual income & profession has been wrongly mentioned, further the company has not called ITRS and

bank statements from him. He requested for refund of total premium paid under the policy.


In personal hearing the insurer reiterated the contents of SCN and submitted that on receipt of the duly

filled application form bearing no. A48817397, A48118439, A48126471 and relevant documents,

ABSLI issued the policy bearing no. 006285540, 006220205 & 006251610.The policy document along

with the copies of the application forms were dispatched on 30-10-2013, 20-09-2013, and 25-10-2013

via courier. The company has not received renewal premiums under the policies and all policies got

lapsed and subsequently terminated. Further as alleged by the policy holder that he has given renewal

premium amount by cash to the agent. In such cases company request the policyholders to produce any

acknowledgement in terms of receipt copy for further investigation of the complaint.



c) Insurer’s SCN

of 412



and the representative Insurance Company, It is observed that the policies with annual premium of

more than Rs. 70000/- payable for 15 years have been issued on the basis of annual income of Rs. 3 lac

without any documentary proof neither the insurer has taken copy of bank statement to know recurring

income of the complainant as income proof for issuing regular premium paying policies. Hence, it is

observed that financial underwriting was lacking and paying capacity of the proposer was ignored.

Hence, the insurer can’t take shelter of free look period.

AWARD



to the insurance company to cancel the policies bearing numbers 006285540, 006220205

and 006251610 since inception and refund all the premium collected there-in without









D. K. Verma

INSURANCE OMBUDSMAN



INSURANCE OMBUDSMAN- SH. AJESH KUMAR

CASE NO-CHD-L-009-1617-1045

In the matter of Sh. Rajinder Singh Vs Birla Sun Life Insurance Company


Complainant

Sh. Rajinder Singh

R/o H. No. 603-A, New Partap Nagar,

Near Tarmika Property Dealer, Amritsar,

Punjab-0

2. Policy No: 006101192

of 412

Type of Policy


BSLI Bachat Endowment

20 yrs./ 20 yrs.



Sh. Rajinder Singh

Sh. Rajinder Singh

4. Name of the insurer Birla Sun Life Insurance Company




8. Nature of complaint Mis-selling, forgery and cheating



11. Amount of relief sought Refund of Rs. 82,000/- with intt.


Rule no:- Insurance Ombudsman

Rules, 2017.

13.1(c)

13. Date of hearing/place 04.06.2018, 23.10.2018 & 08.03.2019/

Chandigarh


For the Complainant Absent




17. Brief Facts of the case:-

On 13-10-2016 Sh. Rajinder Singh had filed a complaint in this office against Birla Sun Life

Insurance Company alleging mis-selling of policy bearing no.006101192 which was issued on

07.05.2013 on the basis of proposal form with forged signatures of his son, Sh. Bikaram Jit

Singh who was residing in Canada at that time. The matter was brought to the knowledge of

insurer on 05.08.2016 and requested for cancelling the policy and refund of premium but insurer

did not even reply to the complainant.

18. Arguments of Insurer

In personal hearing the insurer reiterated the contents of SCN and submitted that the

complainant did not avail free look cancellation option and approached to the insurer very first

time vide complaint letter dated 05.08.2016 i.e. 3 years after issuance of policy when the policy

had already been finally terminated on 07.05.2016 due to nonpayment of renewal premiums. The

representative of the insurer also requested for dismissal of the case as the complainant has not

presented himself or his representative in three scheduled personal hearings.


The complainant was given opportunity of personal hearing on 04.06.2018, 23.10.2018 &

08.03.2019. The complainant, he or his representative did not attend the hearing on either of

of 412

dates fixed for personal hearing. Non appearance in personal hearing indicates that he has

nothing to say in this matter. However, the insurance company was represented by Mr.

Kaveesh who requested for dismissed of the complaint. Since sufficient opportunities have

been given to the complainant to present his case and the case cannot be kept pending

indefinitely, the case is being decided on the basis of available documents.

AWARD



in respect of policy no. 006101192 is dismissed. Hence, the complaint is treated as

closed.


Dr. D. K. Verma

INSURANCE OMBUDSMAN




Case of Mrs. Kamla Kumari Vs Birla Sun Life Insurance. Co. Ltd.

CASE NO-CHD-L-009-1718-0276


Complainant

Mrs. Kamla Kumari


Haryana- 134109

Mobile No.- 8054933511

2. Policy No: DOC

Type of Policy


005743392 / 07-09-2012

BSLI Vision Plan

Annual



Mrs. Kamla Kumari

Mrs. Kamla Kumari











Rules, 2017

13 [1] [2]

of 412








On 31-05-2017, Mrs. Kamla Kumari had filed a complaint of mis-selling against Birla Sun Life

Insurance Co. Ltd. in respect of policy bearing no. 005743392 with Annual Premium Amount of Rs.

99185 in the year 2012.


a]Complainant’s argument: Mrs. Kamla Kumari, the complainant, attended the personal hearing

and reiterated the contents of the complaint and submitted that the representative of the insurer

convinced her for 5 year plan but actual policy was issued for 20 years annual premium paying in the

name of her daughter and making her owner/ proposer of the policy. She added that she was 67 years

old at the time of issuing policy and submitted what would be the use of money for her after 20 years.

She submitted that policy was issued in the name of her daughter making her as proposer of the policy

whereas initially policy was convinced for her life. She further added that she is widow senior citizen

and no regular income to meet her day to day needs and unable to run the policy for so long period and

requested the chair for refund of deposited amount. She also added that her annual income &

profession has been wrongly mentioned as an agriculturist whereas her actual profession is housewife,

further the company has not called ITRS and bank statements from her.

b] Insurers’ argument :The insurance company in personal hearing & in SCN submitted that the policy

Owner / complainant was given detailed description about the features of the said policies and was also

appraised with its terms and conditions before signing of the said applications. In the said policy the

proposer is the complainant. The policy holder has paid 5 annual premiums against the said policy. The

policyholder / complainant for the very first time had approached vide complaint letter dated 31-10-2016

i.e. 4 years after the issuance of the policy. In the complaint the Ph has stated that policy was missold to

husband of the complainant stating that the policy can be refunded after 5 years. Mrs. Kamla Kumari

being prudent person after understanding the terms and conditions of the policy contract had invested in

said policy.



c) Insurer’s SCN

20. Result of personal hearing with both parties (Observations & Conclusion) On going through the various documents available in the file and also hearing both the complainant

and the representative Insurance Company, It is observed that the policy with annual premium of more

of 412

than Rs. 100000/- payable for 20 years have been issued on the basis of annual income of Rs. 3 lac

without any documentary proof neither the insurer has taken copy of bank statement to know recurring

income of the complainant as income proof for issuing regular premium paying policy to the person

who was 67 years old at time of issuing policy. It is observed that initially the policy was convinced

for the complainant’s own life but the insurer has issued policy in the name of her daughter

Ms.Vandana .Moreover, the profession of the life assured has wrongly mentioned as an agriculturist for

housewife. It is also observed that financial underwriting was lacking and paying capacity of the

proposer was ignored. The insurer has issued the policy ignoring the basic facts of income, profession

and also the trust of the complainant.







D. K. Verma

INSURANCE OMBUDSMAN




Case of Shri Gaurav Agarwal V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Gaurav Agarwal

#2172/3, 1st Floor, Rajiv Nagar,

Gurugram

2. Policy No: 18535791

AWARD



to the insurance company to cancel the policy bearing number 005743392 since inception

and refund all the premium collected there-in without interest and without deduction of

any charges.


of 412

Type of Policy


Sanchay

15 years



Sh Gaurav Agarwal










Rule no:

13.1(d)



For the insurer Shri Arpit Higgins, Manager Legal

Shri Gurpreet Singh, Dy. Manager Legal

14 Complaint how disposed Dismissed in Default

15 Date of hearing/place 15.03.2018/Chandigarh


On 06.10.2017, Shri Gaurav Agarwal had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 18535791 on the

assurance that

a. Health Insurance policy for Rs. 3 lakhs will be issued with medical bill reimbursement of

Rs. 12,000/=

b. Credit Card payment of Rs. 50,000/= will be converted to EMI

c. Credit card limit will not be blocked

d. Reimbursement of processing fee and interest

e. auto-debit from credit card, but they have done from bank account

None of the assurances was fulfilled and hence, he sought cancellation of policy which was

denied. Hence, feeling aggrieved, he has approached this forum to seek justice.

17) The Company has informed that the policy bearing number 18535791 was issued on 29.06.2016

for a premium of Rs. 85,000/= to be paid for 15 years. The policy was delivered on 23.07.2016

and the first complaint was received on 18.07.2017 which was one year after the purchase of the

policy. Further, one more premiums have also been paid under the policy.

of 412

18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,



day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Ms Tejashwini V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Ms Tejashwini

23, 1st Floor, Sukhdev Venue,

Near Rajpura Nagar, Ludhiana

2. Policy No:

Type of Policy


17846034

Pro Growth Plus

10 years



Ms Tejashwini










Rule no:

13.1(d)







of 412


On 01.10.2017, Ms Tejashwini had filed a complaint in this office against HDFC Standard Life

Insurance Company about mis-selling of a policy bearing number 17846034 as a mutual fund

where money could be withdrawn any time. However, when she required money for medical

urgency, she was told that it was an insurance policy and she was required to pay the premium

every year. Feeling cheated, she complained to the Insurance Company and sought cancellation

of policy which was denied. Hence, feeling aggrieved, she has approached this forum to seek

justice.



and the first complaint was received on 19.09.2017 which was two years after the purchase of the

policy. Further, one more premium has also been paid under the policy.




day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Shri Hritik Roshan V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Hritik roshan

#635, GF, Sector 51, Gurgaon

2. Policy No:

Type of Policy


19305936

Classic Assure Plus

10/7 years



Sh Hritik Roshan





of 412






Rule no:

13.1(d)








On 11.09.2017, Shri Hritik Roshan had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of policy bearing number 19305936. The original

policy document was taken away by the representative of broker only to be returned after the

freelook period due to which he could not request for cancellation within the freelook period.

Hence, feeling aggrieved, he has approached this forum to seek justice.



and the first complaint was received on 21.07.2017 which was 53 days after the purchase of the

policy.




day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Shri R K Sood V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri R K Sood

#425, Sector 29, Faridabad

of 412

2. Policy No:

Type of Policy


19379084

Classic Assure Plus

10/7 years



Sh R K Sood










Rule no:

13.1(d)








On 24.10.2017, Shri R K Sood had filed a complaint in this office against HDFC Standard Life

Insurance Company about mis-selling of a policy bearing number 19379084 on false assurance and

was told that Rs. 1.88 lakhs would be paid to him. When he complained to the Company, he was not

given the assured amount. Hence, feeling aggrieved, he has approached this forum to seek justice.

17) The Company has informed that the policy bearing number 19379084 was issued on 16.06.2017 for

a premium of Rs. 80,000/= to be paid for 7 years. The policy was delivered on 28.06.2017 and the

first complaint was received on 16.10.2017 which was after 4 months from the issuance of the

policy.




day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN

of 412




Case of Ms Swati Agarwal V/S HDFC Standard Life Insurance Co. Ltd.


1. Name & Address of the Complainant Ms Swati Agarwal

Gurugram, Haryana

2. Policy No:

Type of Policy


19330643

Sanchay

15/5 years



Ms Swati Agarwal










Rule no:

13.1(d)








On 02.09.2017, Ms Swati Agarwal had filed a complaint in this office against HDFC Standard

Life Insurance Company about mis-selling of a policy bearing number 19330643 on false

promises. When she realized it, she sought cancellation of policy but did not get any relief.

Hence, feeling aggrieved, she has approached this forum to seek justice.

17) The Company has informed that the policy was issued on 28.05.2017 for a half-yearly premium

of Rs. 20,000/= to be paid for 5 years.




day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN

of 412




Case of Shri Pardeep Dharra V/S HDFC Standard Life Insurance Co. Ltd.



Complainant

Shri Pardeep Dharra

#43/1, Sainik Coony, Hisar Road, Rohtak

2. Policy No:

Type of Policy


18938993

Youngstar Super Premium

10 years



Sh Pardeep Dharra










Rule no:

13.1(d)








On 28.08.2017, Shri Pardeep Dharra had filed a complaint in this office against HDFC Standard

Life Insurance Company about non-receipt of policy document of a policy bearing number

18938993. He purchased the policy in February, 2017 but did not get the policy document even

after lot of follow-up. Hence, he requested the Insurance Company to cancel the policy and

refund the premium with interest.

17) The Company has informed that the policy was issued on 31.12.2016 for a premium of Rs.

25,000/= to be paid for 10 years.

of 412




day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN



INSURANCE OMBUDSMAN- Dr. D K Verma Case of Sh. Danendra Kumar Jain V/S L.I.C. of India. COMPLAINT REF: NO: CHD-L-029-1718 –0889


Complainant

Sh. Danendra Kumar Jain,

C/o Sh Akash Kumar Jain,

A73, Galax Apartment, Sector 43, Gurgaon.

Gurugram-Haryana-0

2. Policy No

Type of Policy


period

283453384






Divisional office- Varansi




Complaint

21-08-2017.

8. Nature of complaint Pension being paid instead of lump sum maturity

amount.

9. Amount of Claim 2.12 lac app.


11. Amount of relief sought 2.12 lac with interest.


Rule no: - Insurance


13(1) (a)




For the insurer Ms Poornima Mishra, Manager(CRM)

of 412

Ms Shylaja Bodh, AO(CRM)


16) Brief Facts of the Case: -

On 21.08.2017, the above Policy holder filed a complaint in this office against Life Insurance

Corporation of India, Lucknow/ Varanasi alleging that he had purchased Policy no. 283453384

in 2004. The premiums under the policy were to be paid for 13 years. He had paid all the 13

year’s premiums regularly and before maturity, he applied for transfer of his policy in May, 2016

but the insurer had not transferred the policy and replied that he should have applied for transfer

of policy one year before the maturity. He had applied for full and final payment in the month of

March, 2017 but the insurer refused to pay the amount and informed that periodical payments

would be made.

17) The Insurance Company has informed that the policyholder was requested vide letters sent 9

months and 6 months in advance to exercise an option for annuity payment but he did not give

any option. As per policy conditions, surrender is available under only one of the options but the

policyholder has refused to give the option in the Branch Office.

18) Neither the complainant nor his representative appeared for the personal hearing on 26.11.2018,

15.02.2019 and 15.03.2019. However, an email dated 11.02.2019 has been received from the

complainant suggesting various measures for improvement of functioning of Insurance Company

but the complainant has chosen to neither comment on his own complaint nor attend the personal

hearing on the scheduled dates. The case is thus, dismissed in default and closed.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Ms Neha Sharma V/S Aviva Life Insurance Company India Ltd.



Complainant

Ms Neha Sharma

3rd

Floor, Infinity Tower C

DLF, Phase 2, Gurugram

2. Policy No:

Type of Policy


SCG2183584/01684835

Sachin Century Plan

5 years

3. Name of the insured Shri Desh Bandhu Sharma

of 412


4. Name of the insurer Aviva Life Insurance Company









Rule no:

13.1(d)


For the Complainant Shri Shikhar Sharma, Cousin

For the insurer Shri Naresh Sharma, Branch Manager


15 Date and Place of Hearing 15.03.2019/Chandigarh


On 19.09.2017, Ms Neha Sharma had filed a complaint in this office against Aviva Life

Insurance Company about mis-selling of a policy bearing number SCG2183584/01684835 issued

to her father in 2008 on an assurance that the money could be withdrawn at any time after the

lock-in period. However, when he sought withdrawal, it was denied due to non-payment of

renewal premiums. Hence, feeling aggrieved, she has approached this forum to seek justice.



The representative of the complainant said that Ms. Neha Sharma’s father was sold a policy on

an assurance that money could be withdrawn any time after the lock-in period which was not the

case. He did not even receive any policy document.


The representative of the Company informed that the policy bearing number

SCG2183584/01684835 was purchased on 29.09.2008 for a quarterly premium of Rs. 10,000/=

to be paid for 5 years. Two premiums were paid under the policy and the status was changed to

“Earlt Lapsed” on 29.04.2009, to “Lapse Surrender” on 30.03.2011 and finally to “Revival

Termination” due to non-payment of premium. The first complaint was made via phone call on

31.07.2017 which was after 9 years from the purchase of the policy. Further, the complainant

was neither the policyholder nor the nominee.




of 412



the contents of the SCN filed by the Insurance Company. The representative of the complainant

alleges that the policyholder did not receive the policy document, even though the policyholder has

paid renewal premium under the policy for which he has not been able to give any reasonable

justification. Further, the complaint has been made by his daughter who is neither the policyholder

nor a nominee under the policy and that too after a long span of 9 years. On the other hand, there is

no lapse on the part of the Insurance Company which has proceeded as per the terms and conditions

of the policy.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Shri Balbir Singh V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Balbir Singh

Vill Kait, PO Sabapur, Tehsil

Jagadhari,

Yamunanagar

2. Policy No:

Type of Policy


52229047, 52307002, 52307022

Fixed Savings, Guaranteed Money Back

15/10 years



Shri Anurag Kamboj, Shri Balbir Singh

Shri Balbir Singh

4. Name of the insurer Reliance Life Insurance Company








of 412






Rule no: of RPG rules

12.1(c)



For the insurer Shri Lalit Saini, Sr. Team Leader




On 23.03.2018, Shri Balbir Singh had filed a complaint against Reliance Life Insurance

Company about mis-selling of three policies bearing numbers 52229047, 5230700 and 52307022

on the pretext of getting an interest-free loan of Rs. 25 lakhs. When he did not get any loan and

the representative became incommunicado, he complained to the Insurance Company but could

not get any relief. Hence, feeling aggrieved, they have approached this office to seek justice.

17) The complainant said that he was sold the policies on pretext of getting loan which was never

disbursed.

18) The Insurance Company has informed that the policies bearing numbers 52229047, 5230700 and

52307022 were issued on 27.05.2015, 30.07.2015 and 13.08.2015 for a premium of Rs.

99,999/=; Rs. 90,000/= and Rs. 60,000/= respectively to be paid for 10 years each. The policies

were delivered on 08.06.2015, 09.08.2015 and 24.08.2015 respectively and the first complaint

was received on 16.01.2018 i.e. after more than 2 years from the purchase of the last policy.

Meanwhile, policy 52307002 and 52307022 were foreclosed on 30.07.2018 and 13.08.2018 and

cheques for amount Rs. 13,043.55 and Rs. 8,695.67 were encashed by the complainant on

01.09.2018 and 17.09.2018 respectively. However, the Company agreed to cancel the policies

and refund the premium collected there-under without any interest and deduction of foreclosure

amount already encashed.


15.03.2019.




of 412



day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Nalesh H Thaman V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Nalesh H Thaman

Nirmal Sadan, College Road,

Near MC Colony Chowk, Pathankot

2. Policy No:

Type of Policy


51231844, 51225460, 51225494,

51238052

Guaranteed Money Back

15/5 years



Ms. Mini N Thaman, Ms Kashika N

Thaman

Shri Nalesh H Thaman








11. Amount of relief sought Rs. 3,76,853/= + interest



12.1(c)


For the Complainant Ms Kashika Thaman, Daughter




of 412


On 12.03.2018, Shri Nalesh H Thaman had filed a complaint against Reliance Life Insurance

Company about mis-selling of four policies bearing numbers 51231844, 51225460, 51225494

and 51238052 on the pretext of getting a bonus of Rs. 14 lakhs. The policies were issued on the

basis of forged signatures of the life assured. When he realized that he had been cheated, he

complained to the company but could not get any relief. Hence, feeling aggrieved, he has


17) The representative of the complainant said that her father was sold four policies in the name of

his two daughters. Her father was under depression and hence, could not understand the mis-sale.

He also sold wife’s jewellery to purchase policies.

18) The Insurance Company has informed the following

Policy No. Premium Issue Date Premium Term Proposer/LA

51225460 76,853 29.09.2013 5 years Nalesh Thaman

Mini N Thaman

51225494 1,50,000 29.09.2013 5 years Nalesh Thaman

Mini N Thaman

51231844 50,000 29.09.2013 5 years Nalesh Thaman

Kashika N Thaman

51238052 1,00,000 29.09.2013 5 years Nalesh Thaman

Kashika N Thaman

The policies were purchased on the same date and the first complaint was received on

14.04.2014 i.e. after more than 6 months from the purchase of the policies. The complaint was

replied by the Company on17.04.2014 rejecting his request for cancellation of policies as it was

after freelook period. The complaint has again been made to Ombudsman office in March, 2018.

However, the Company agreed to cancel the policies and adjust the premium collected there-

under into a new single premium unit-linked policy with a lock-in period of 5 years and no

freelook clause subject to underwriting and fulfillment of requirements.


17.01.2019.

of 412






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Ramesh Chand V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Ramesh Chand

Vill Dadoura, Tesil Balh, PO Dhaban

Nar Chowk, Mandi

2. Policy No:

Type of Policy


51632324

Super Money Back

30/15 years



Shri Ramesh Chand











12.1(c)






of 412


On 09.03.2018, Shri Ramesh Chand had filed a complaint against Reliance Life Insurance

Company about mis-selling of a policy bearing number 51632324 on the pretext of getting bonus

under existing policies. In fact, he was sold many policies of different insurance companies.

When he realized that he had been cheated, he complained to the company but could not get any

relief. Hence, feeling aggrieved, he has approached this office to seek justice.

17) The Insurance Company has informed that the policy bearing number 51632324 was issued on

08.05.2014 for a premium of Rs. 30,200/= to be paid for 15 years. The policy was delivered on

10.06.2014 and the first complaint was received on 27.10.2017 i.e. after more than 3 years. The

policy was foreclosed on 08.05.2017 and a cheque no. 311831 for an amount of Rs. 4,559.9 was

sent to the complainant which has been encashed. However, the Company agreed to cancel the

policy and refund the premium collected there-under without any interest after deducting the

amount of Rs. 4,559.9 already received by the complainant.


15.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Het Ram V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Het Ram

Vill Dhandhal, Kotli, Mandi

2. Policy No:

Type of Policy


52031797, 52108644


15/7 years, 15/10 years

of 412



Shri Het Ram, Shri Mukesh Kumar

4. Name of the insurer Reliance Nippon Life Insurance Co. Ltd.









Rule no:

13.1(d)







On 26.02.0218, Shri Het Ram had filed a complaint in this office against Reliance Nippon Life

Insurance Company about mis-selling of two policy bearing number 52031797 and 52108644 on

the pretext of getting huge benefits. In fact, he was sold many policies of different insurance

companies. When he realized that he had been cheated, he complained to the Company but could

not get any relief. Hence, feeling aggrieved, he has approached this forum to seek justice.

17) The Company has informed that the policies bearing numbers 52031797 and 52108644 were

issued on 23.01.2015 and 12.03.2015 for a premium of Rs. 20,000/= and Rs. 40,000/= to be paid

for 7 years and 10 years respectively. The policies were delivered on 02.02.2015 and 24.03.2015

and the first complaint was received on 17.02.2017 which was 2 year after the purchase of the

policies. Policy 52031797 was foreclosed on 23/01/2018 and the cheque was dispatched on

05.06.2018 and policy 52108644 was foreclosed on 11/03/2018 and the cheque was dispatched

on 28.04.2018. However, the Company agreed to cancel the policy and refund the premium

collected there-under without any interest or deduction of any charges. Foreclosure amount , if

received by the complainant would be deducted from the payout.


15.03.2019.




of 412



day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Jai Pal V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Jai Pal

RRS HAU, Tehsil Bawal, Rewari

2. Policy No:

Type of Policy


51327706, 51329443, 51398070,

51422244, 51559947, 51598231,

51591768, 51398097, 51493558


15/5/ years



Shri Jai Pal, Ms Kamla











12.1(c)







On 09.03.2018, Shri Jai Pal had filed a complaint against Reliance Life Insurance Company

about mis-selling of nine policies bearing numbers 51327706, 51329443, 51398070, 51422244,

of 412

51559947, 51598231, 51591768, 51398097 and 51493558 on the pretext of getting very good

benefits. When he realized that he had been cheated, he complained to the company but could

not get any relief. Hence, feeling aggrieved, he has approached this office to seek justice.

17) The Insurance Company has informed the following

Policy No. Premium Issue Date Premium Term Proposer/LA

51327706 99,000/= 26.11.2013 5 years Jaipal

51329443 30,500/- 27.11.2013 5 years Jaipal

51398070 99,000/= 31.12.2013 5 years Jaipal

51422244 49,500/- 31.12.2013 5 years Kamla

51559947 99,000/- 26.03.2014 5 years Jaipal

51598231 99,000/= 31.03.2014 5 years Kamla

51591768 80,000/= 21.04.2014 5 years Jaipal

51398097 99,000/= 31.12.2013 5 years Jaipal

51493558 1,80,000/= 30.03.2014 5 years Jaipal

51566330 89,000/= 28.03.2014 5 years Kamla

The policies were purchased continuously from November, 2013 to April, 2014 and the first

complaint was received on 06.11.2017 i.e. after more than 2 years from the purchase of the last

policy. However, in view of sold policies not in consonance with his annual income, the

Company agreed to cancel his policies and refund the premium collected there-under without

any interest or deduction of any charges.


15.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Shri Rajinder Singh V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Rajinder Singh

Vill Risalwa, Teh Assandh, Distt. Karnal

2. Policy No:

Type of Policy


52999096


15/10 years



Shri Rajinder Singh











12.1(c)







On 06.03.2018, Shri Rajinder Singh had filed a complaint against Reliance Life Insurance

Company about mis-selling of a policy bearing number 52999096 on the pretext of getting an

interest-free loan of Rs. 15 lakhs. When he did not get any loan and the representative became

incommunicado, he complained to the Insurance Company but could not get any relief. Hence,

feeling aggrieved, he has approached this office to seek justice.

17) The Insurance Company has informed that the policy bearing number 52999096 was issued on

30.06.2017 for a premium of Rs. 21,000/= to be paid for 10 years. The policy was delivered on

13.07.2017. Even then, the Company has offered to cancel the policy and refund the premium

collected there-in without any interest or cost.


of 412


15.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Gurmukh Singh Dhaliwal V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Gurmukh Singh Dhaliwal

Ward No.6, Guru Nanak Dev Nagar

Sahnewal, Ludhiana

2. Policy No:

Type of Policy


52843722

Increasing Income

24/12 years



Shri Gurmukh Singh Dhaliwal










Rule no:

13.1(d )


of 412






On 03.01.2018, Shri Gurmukh Singh Dhaliwal had filed a complaint in this office against

Reliance Nippon Life Insurance Company about mis-selling under policy bearing number

52843722 on the pretext of recovering all the investment made on false assurance of an interest-

free loan. However, when he realized that he had been cheated, he complained to the Company

but could not get any relief. Hence, feeling aggrieved, he has approached this forum to seek

justice.

17) The Company has informed that the policy was issued on 16.01.2017 for a premium of Rs.

25,000/= to be paid for 12 years. The policy was delivered on 25.01.2017 and the first complaint

was received on 29.05.2017 i.e. 4 months from the issuance of the policies. Meanwhile the

complainant has paid two quarterly premiums of Rs. 6,250/= each. However, the Company

agreed to cancel the policy and refund the premium collected there-under without any interest or



15.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Shri Shobhit Saksena V/S Reliance Nippon Life Insurance Company Ltd.



Complainant

Shri Shobhit Saksena

203, Royal Retreat-2, Charmwood,

Surajkund, Faridabad

2. Policy No:

Type of Policy


53075871

Fixed Money Guaranteed

15/10 years



Shri Shobhit Saksena

4. Name of the insurer Reliance Nippon Life Insurance

Company









Rule no:

13.1(d)


For the Complainant Shri Shri Kant Saksena, Father





On 17.12.2017, Shri Shobhit Saksena had filed a complaint in this office about mis-selling of

policy bearing number 53075871 received on 09.11.2017. On perusal of the policy document, he

realized that he had been misguided about the terms and condition of the policy and sought

cancellation of policy on 05.12.2017. He got late by some days as he was travelling, however the

Company did not cancel the policy. Hence, he has approached this office to seek justice.


for a premium of Rs. 50,000/= to be paid for 10 years. The policy document was delivered on

09.11.2017 and the first complaint was received on 05.12.2017 i.e. after one month from the

purchase of the policy. Further, two premiums have been paid under the policy. However, in

of 412

view of only one month delay, the Company agreed to cancel the policy and refund the premium

collected there-under without any interest or deduction of any charges.

18) Accordingly, an agreement was signed between the Company and the representative of the

complainant on 15.03.2019.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN




Case of Shri Sanam Topchhen Negi V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Sanam Topchhen Negi

VPO Nesang, Tehsil Pooh

Distt. Kinnaur

2. Policy No:

Type of Policy


52025372


15/10 years



Ms Tanisha Negi

Shri Sanam Topchhen Negi









12. Complaint registered under 12.1(c)

of 412




Shri Tejinder Negi, Son

For the insurer Shri Lalit Saini, Team Leader




On 17.03.2018, Shri Sanam Topchhen Negi had filed a complaint against Reliance Life

Insurance Company about mis-selling of a policy bearing number 52025372. After his retirement

in 2014, he was sold an Easy Retirement Solution Plan which would cover his life and give

protection to his family. He was required to pay Rs. 10 laksh in 10 annual installments. However,

after paying 3 premiums, he learnt that the policy was in life of his 17 year old daughter. Being a

patient of chronic depression and unstable mental health, the agent took advantage and mis-sold

the policy. He complained to the Insurance Company but could not get any relief. Hence, feeling

aggrieved, he has approached this office to seek justice.


Complainant’s argument:The complainant said that he was sold the policy in his name with his

daughter as a nominee. However, later he learnt that the policy was issued in his daughter’s name.

He could not comprehend that he was required to pay the premium for 10 years. The subsequent

premium was paid by his wife, however, he was not ina position to continue the policy as he had

retired.

Insurers’ argument:The representative of the Company informed that the policy bearing number

52025372 was issued on 27.01.2015 for a premium of Rs. 1 lakh to be paid for 10 years. The policy

was dispatched on 22.01.2015. The first complaint was received on 08.01.2018 i.e. after paying 3

premiums. Further, the complainant has already surrendered his policy on 28.06.2018 and surrender

amount of Rs. 1,44,045/= was paid to him.




19) Result of personal hearing with both parties (Observations & Conclusion)I have examined the

various documents available in the file including the copy of the complaint and the contents of the SCN

filed by the Insurance Company. The complainant alleged that he was not aware that the policy was

issued in the daughter’s name even though he had received the policy document in time. Further, he has

shown his incapability to continue payment of premium as he had retired in 2014, however, he has paid

two subsequent premiums also which indicate that he has accepted the policy and its terms and

conditions. In case he was not satisfied with the policy, he could have complained to the Company on

of 412

receipt of the policy document, however, he approached the Insurance Company after an inordinate

delay of three years for which he has not been able to give any reasonable justification. Further, he has

opted for surrender of the policy in June, 2018 and accordingly, the Insurance Company has made full

and final payment of surrender to the policyholder.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Ms Seema Kumar V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Ms Seema Kumar

Rampur, HPS, Vayal Tehsil-Nirmad

Kullu

2. Policy No:

Type of Policy


52416460


15/5 years



Ms Seema Kumar











12.1(c)






of 412


On 09.03.2018, Ms Seema Kumar had filed a complaint against Reliance Life Insurance

Company about mis-selling of a policy bearing number 52416460 on the pretext of getting bonus

of Rs. 5.5 lakhs under existing policies of other insurance companies. Infact, she was cheated to

the tune of Rs. 18.66 lakhs by selling many policies of different insurance companies. When she

realized that she had been cheated, she complained to the company but could not get any relief.

Hence, feeling aggrieved, she has approached this office to seek justice.

17) The complainant said that she received a call from somebody who had all the details of her

existing policies. He said that she had earned bonus on the policies which was not being given to

her but was being taken by the agents. In order obtain that bonus, she was sold the policy.

However she neither got any bonus nor refund of the premium of new policy.

18) The representative of the Company informed that the policy bearing number 52416460 was

issued on 08.12.2015 for a premium of Rs. 1,50,181.16 to be paid for 5 years. The policy was

delivered on 18.12.2015 and the first complaint was received on 01.01.2018 i.e. 2 years.

Meanwhile, a cheque no. 820156 for an amount of Rs. 5048.13 as excess payment was sent to

her on 05.03.2016 which has been encashed on 15.03.2016. Further, the policy was foreclosed on

08.12.2018 and a payout cheque no. 540041 for Rs. 17,942.25 was sent to her on 19.12.2018.

However, the Company agreed to cancel the policy and adjust the premium collected there-under

into a new single premium unit-linked policy with a lock-in period of 5 years and no freelook

clause subject to underwriting and fulfillment of requirements.



15.03.2019. Foreclosure amount of Rs. 17,942.25 would be returned by the complainant if the

cheque has been encashed by her.






day of March, 2019.

Dr. D.K.VERMA

INSURANCE OMBUDSMAN

of 412




Case of Shri Gurpreet Singh Nijher V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Gurpreet Singh Nijher

#1964, St, No, 14, Dashmesh Nagar

Ludhiana

2. Policy No:

Type of Policy


19452635, 19529162, 19584515


15/5 years



Shri Gurpreet Singh Nijher, Ms.

Rupinder Kaur











12.1(c)







On 05.03.2018, Shri Gurpreet Singh Nijher had filed a complaint against Reliance Life Insurance

Company about mis-selling of three policies bearing numbers 19452635, 19529162 and 19584515

by forging ITRs and signatures. He was sold policies for total premium of Rs. 1.74 lakhs even

though his income at that time was Rs. 2,01,500/=. Three different ITRs showing different annual

income viz. Rs. 9.5 lakhs, Rs. 9.5 lakhs and Rs. 3.5 lakhs were used in the policies. When he realized

this fact, he complained to the Insurance Company on 09.04.2015 but could not get any relief.

Hence, feeling aggrieved, he has approached this office to seek justice.



The complainant said that he was sold three policies by showing incorrect income. He realized

this when he saw the policy documents. Then, he complained to the Insurance Company.

of 412


The representative of the Company informed that the policies bearing numbers 19452635,

19529616 and 19584515 were issued on 04.11.2011, 30.11.2011 and 31.12.2011 for a premium

of Rs. 35,000/=; Rs. 30,000/= and Rs. 98,750/= respectively to be paid for 5 years each. The

policies were dispatched on 07.11.2011, 02.12.2011 and 02.01.2012 and the first complaint was

received on 09.04.2015 i.e. 3-4 years after the purchase of the policies which was rejected vide

Company’s letter dated 10.04.2015 as it was beyond the freelook period.






the contents of the SCN filed by the Insurance Company. The complainant has stated that he

received the policy document in time and saw that his income has been incorrectly mentioned in the

proposal forms, even then he approached the Company after an inordinate delay of more than three

years for which he has not been able to give any reasonable justification. Further, he has not

mentioned that he was not interested in purchasing the policies and that they were mis-sold. His only

grievance is incorrect income mentioned in policies which he has pointed out much after the expiry

of the freelook period.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN





of 412




Case of Shri Sunil V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Shri Sunil

#274, Vill Sangahera, Rohtak

2. Policy No:

Type of Policy


51756372, 51791836


15/10 years



Shri Sunil








11. Amount of relief sought Rs. 1 lakh/=


Rule no:

13.1(d)







On 30.01.0218, Shri Sunil had filed a complaint in this office against Reliance Nippon Life

Insurance Company about mis-selling of two policies bearing numbers 51756372 and 51791836

by alluring him with very good benefits. When he realized that he had been cheated, he

complained to the Company on 23.12.2017 but did not get any relief. Hence, feeling aggrieved,

he has approached this forum to seek justice.



The complainant reiterated the contents of his complaint and said that he was offered a loan on

0% interest within 3 days of purchasing the policy but he did not get any loan.

of 412


The representative of the Company informed that the policies bearing numbers 51756372 and

51791836 were issued on 31.07.2014 and 28.08.2014 for a premium of Rs. 30,000/= and Rs.

40,000/= to be paid for 10 years. The policies were delivered on 13.08.2014 and 11.09.2014 and

the first complaint was received on 28.12.2017 which was more than three years after the

purchase of the policies. Policy 51756372 was foreclosed and a cheque for Rs. 4381.49 was

dispatched on 14.12.2017. Similarly policy 51791836 was foreclosed and an amount of Rs.

6052/= was transferred online on 27.09.2018.






the contents of the SCN filed by the Insurance Company. The complainant alleged that he was sold

the policies in order to obtain an interest-free loan. When he did not get the assured loan, he could

have complained to the Company on receipt of the policy documents, however, he approached the

Insurance Company after an inordinate delay of three years for which he has not been able to give

any reasonable justification. On the other hand, the Insurance Company has proceeded as per the

terms and conditions of the policies by foreclosing the policies when due and sending the foreclosure

amount to the policyholder.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN





of 412




Case of Ms Om Kalia V/S Reliance Nippon Life Insurance Co. Ltd.



Complainant

Ms Om Kalia

#1181, Sector 42B, Chandigarh

2. Policy No:

Type of Policy


19979057


15/5 years



Shri Puneet Kalia

Ms Om Kalia










Rule no:

13.1(d )







On 30.08.2017, Ms Om Kalia had filed a complaint in this office against Reliance Nippon Life

Insurance Company about mis-selling of a policy bearing number 19979057. She was told that

the money could be withdrawn after 2 years. However, when she sought withdrawal, she was

told that nothing was payable. Hence, feeling aggrieved, she has approached this forum to seek

justice.



The complainant said that she received a call from Delhi who misguided her and her husband

about the return under the policy. They were assured that the money would be returned in 2 years

but when no money was returned to them, they complained to the Insurance Company.


of 412


issued on 28.03.2012 for a premium of Rs. 22,150/= to be paid for 5 years. The policy document

was delivered on 30.03.2012 and the first complaint was received on 07.06.2017 i.e. after more

than 5 years from the purchase of the policy.






the contents of the SCN filed by the Insurance Company. The complainant has stated that she

received the policy document in time but she waited for two years as she was assured to get money

back in two years i.e. 2014. However, she approached the Insurance Company in 2017 after an

inordinate delay of five years for which she has not been able to give any reasonable justification.


day of March, 2019

Dr. D K Verma

INSURANCE OMBUDSMAN




Case of Mr. Harish Chander Vs Bajaj Allianz Life Insurance Co. Ltd.

CASE NO-CHD-L-006-1718-0710

1. On 26-07-2017, Mr. Harish Chander had lodged a complaint in this office against

PNB Metlife India Insurance Co.Ltd in respect of Policy bearing number 0041201627.





of 412

2. This office pursued the case with the insurance company to re-examine the complaint.

3. Now, the complainant has informed through his mail dated 14.03.2019 that he does not

wish to pursue this complaint any further as the same has been resolved.








Case of Mr. Vijay Bahadur Singh Vs Bajaj Allianz Life Insurance Co. Ltd.

CASE NO-CHD-L-006-1718-0686


Complainant

Mr. Vijay Bahadur Singh

House No. 217, Sector-4, Panchkula,

Haryana-0

2. Policy No: DOC

Type of Policy


period

0045518462





4. Name of the insurer Bajaj Allianz Life Insurance Co. Ltd.




Complaint

24-07-2017




11. Amount of relief sought Payment of Rs. 33490/-being difference of

maturity payment paid less


Rule no: Insurance


13.1.( f )

13. Date of hearing/place 08-01-2019, 20.02.2019 &18.03.2019 /

Chandigarh

of 412



For the insurer Mr. Yogesh Kumar, Zonal Head-Legal



17 Brief Facts of the case:

On 24-07-2017, Mr. Vijay Bahadur Singh had filed a complaint against Bajaj Allianz Life Insurance Co.

Ltd. in respect of policy bearing no. 0045518462.He has alleged that total no of units as on maturity date

were 14760.29 with NAV as 28.57 and accordingly maturity amount worked out as 421900 whereas he

has been paid Rs. 387931/- .When he requested the company to release balance amount of Rs. 33490,it

was declined by the company, hence, feeling aggrieved, he approached this office to seek justice.




indicates that he has nothing to say in this matter. However, the insurance company was represented Mr.

Yogesh Kumar ( Zonal Head-Legal) on all the occasions who requested for dismissal of the complaint,

since sufficient opportunities have been given to the complainant to present his case and the case cannot

be kept pending indefinitely. It appears that the complainant doesn’t wish to pursue the matter since

there is no verbal or written communication from him in spite of best efforts by this office. Under the

circumstances, there is no option but to close the complaint and the case is being dismissed in default.

ORDER






day of March, 2019.

Dr. D. K. Verma

INSURANCE OMBUDSMAN

of 412




Case of Mr. Summitter Singh Sond Vs Bajaj Allianz Life Insurance Co. Ltd.

CASE NO-CHD-L-006-1718-0999


Complainant

Mr. Summitter Singh Sond

H. No.- HE 61, Phase-5, Mohali, Punjab-0

Mobile No.- 9041695245

2. Policy No: DOC

Type of Policy


0329673730

Rs. 55000/-



Mr. Summitter Singh Sond






9. Amount of Claim Mis-Selling


11. Amount of relief sought NIL


Rule no: Insurance


Refund of premiums(including renewal prem.)

13. Date of hearing/place 13.1.(c)

14. Representation at the hearing 18-03-2019 / Chandigarh

For the Complainant Mr. Summitter Singh Sond





On 25-10-2017, Mr. Summitter Singh Sond had filed a complaint of mis-selling against Bajaj

Allianz Life Insurance Co. Ltd. in respect of policy bearing number 0329673730. He has alleged that

the above policy was sold to him as single premium policy but after one year when he received the

reminder for renewal premium he realised that it was a regular premium payable policy and renewal

premium was deducted by the bank on 29.08.2017 without his permission /consent. When he

complained to the company on 21.09.2017 and 03.10.2017 for refund of his money it was not replied by

the company, hence feeling aggrieved he approached this office to seek justice.

of 412




However, the company agreed to cancel the policy bearing number 0329673730 and refund all

the premiums received therein without interest and without deduction of any charges.


18.03.2019.


agreement and shall send a compliance report to this office within 30 the days of receipt of

this order for information and record.



day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Serve Mohit Dalla Vs Bajaj Allianz Life Insurance Co. Ltd.

CASE NO-CHD-L-006-1718-0812


Complainant

Mr. Serve Mohit Dalla S/o Surjit Krishan Dalla,

Nabha, Distt.- Patiala, Punjab-0

Mobile No.- 9781991111

2. Policy No: DOC

Type of Policy


0045189870 / 28-03-2007

Bajaj Allianz Capital Unit Gain

20yrs/Rs. one Lakh



Mr. Serve Mohit Dalla

Mr. Serve Mohit Dalla






of 412





Rule no: Insurance


13.1.(d)

13. Date of hearing/place 08-01-2019 & 18.03.2019 / Chandigarh







On 23-08-2017, Mr. Serve Mohit Dalla had filed a complaint of mis-selling against Bajaj Allianz Life

Insurance Co. Ltd. in respect of policy bearing no. 004589870.He has alleged that the above policy was

missold to him in year 2007 as single premium payment for Rs. 01 Lakh and was also assured that after

10 years he will get Rs. 4.5 Lakhs. He has further alleged that after 10 years when he approached the

company for assured payment, he was told that it was a regular premium payable policy and nothing is

payable under the policy , Hence feeling aggrieved; he approached this office to seek justice.

The Insurer in their SCN dated 24.12.2018 has stated that the above mentioned policy has been issued

solely based on the documents ,information, statements and disclosures made through proposal forms

duly filled and signed by the policy holder and the complainant had not disputed during the free look

period. The complainant had complained to them for alleged misselling on 21.07.2017 i.e. almost after

10 years from commencement of above policy.



Mr. Serve Mohit Dalla, the complainant attended the personal hearing on 18.03.2019 and reiterated

the contents of basic complaint. He submitted that long term policy was issued instead of single

premium. He admitted that he had received the policy documents well in time.



approached them 10 years after the issuance of said policy.





of 412






through the terms and conditions of the policy but he did not utilize the free look option and had

approached the Insurer alleging mis-selling after 10 years from the issuance of said policy. There was

undue delay on the part of the complainant in lodging the complaint which he could not justify.

ORDER


by both the parties during the course of hearing, there is no need to interfere with the

decision of the insurer. Hence, the complaint is dismissed.



day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN




Case of Mrs. Deepa Sood Vs Bajaj Allianz Life Insurance Co. Ltd.

CASE NO-CHD-L-006-1718-0938


Complainant

Mrs. Deepa Sood

65, 2nd

Floor, Block 3, Charmwood Village,

Surajkund Road, Faridabad, Haryana- 121009,

Mobile No.- 9811549972

2. Policy No: DOC

Type of Policy


0080434986 / 28-12-2007

Bajaj Allianz New Unit Gain Plus-SP

05/Rs. 25000/- DOM 28.12.2012



Mrs. Deepa Sood

Mrs. Deepa Sood








of 412



Rule no: Insurance


13.1.(a)

13. Date of hearing/place 08-01-2019 & 18.03.2019/ Chandigarh


For the Complainant Mr. Rohit Chugh(husband of the complainant)





On 26-09-2017, Mrs. Deepa Sood had filed a complaint of mis-selling against Bajaj Allianz Life

Insurance Co. Ltd. in respect of policy bearing no. 0080434986.She has stated that she had taken above

policy in 2007 for single premium of Rs.25000/- and it was a unit linked policy with open ended term as

mentioned in clause 3.2 of the policy terms & conditions. She has further stated that without any request

for payment/surrender/closure she received in Feb.2017 an amount of Rs. 17232/- for which when she

inquired from the company she did not receive satisfactory reply, hence, feeling aggrieved, she


The insurer in their SCN dated 24.12.2018 has stated that the above policy was issued on 28.12.2012

and the complaint was received on 06.03.2017 which was after the policy was matured and a response

letter was sent to the complainant on 07.04.2017.The insurer has further stated that they have released

payment of Rs. 17731/- on 20.07.2017 and Rs. 155/- on 21.12.2017.



Mr. Rohit Chugh, husband of the complainant attended the personal hearing on 18.03.2019 and

reiterated the contents of the complaint.



approached them after the expiry of free look period. However the contents of the SCN were not found

satisfactory and were contradictory which was clarified by the Insurer’s representative at the time of

hearing and later vide the mail received from the company.


a) Copies of the proposal forms b) Complaint to the insurer c) Reply of the company



representative and the representative of the Insurance Company, It is observed that the said policy was

of 412

issued on 28.12.2007 with 05 years term and had matured on 28.12.2012.The insurer in their SCN had

submitted that the policy had matured on 28.12.2017 but later on it was clarified during the hearing

and afterward through mail that the said policy had matured on 28.12.2012 but the payment was

released in 2017 taking the fund value as in 2017 which indicates deficiency of service on their part.

AWARD

Taking into account the facts & circumstances of the case and the submissions of both the

parties, an award is passed with a direction to the insurance company to release the

maturity payment due on 28.12.2012 with fund value as on date of maturity under policy

bearing number 0080434986 alongwith interest @ 7 % subject to deduction of payment if

any paid earlier to the complainant.




f. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019.

D.K.Verma

INSURANCE OMBUDSMAN




Case of Ms. Sukhleen Kaur Loomba Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1370


Complainant

Ms. Sukhleen Kaur Loomba

B- 9/ 29, Harman Colony,

Near Geeta Petrol Pumb, Patiala,

Punjab-147001

Mobile No.- 98724499339

2. Policy No: DOC

Type of Policy


C156453242 / 14-10-2016

Smart Income Plus

Rs.20000/-

3. Name of the insured Ms. Sukhleen Kaur Loomba

of 412

Name of the policyholder Ms. Sukhleen Kaur Loomba

4. Name of the insurer Tata AIA Life Insurance Co. Ltd.









Rule no: Insurance


13.1.(c)



For the Complainant Ms. Sukhleen Kaur Loomba

For the insurer Mr. Harsimran Singh, Manager-Legal




On 21-02-2018, Ms. Sukhleen Kaur Loomba had filed a complaint against Tata AIA Life

Insurance Company in respect of policy bearing number C156453242. She has alleged that she has not

received the policy bond under the said policy and had complained and followed up with the company

for non receipt of policy bond. She has further stated that on 01.09.2018 the Manager of above

company called her and asked her to collect the policy bond from their Patiala branch which she did so

and on the same day i.e. on 04.09.2018 submitted policy bond for cancellation of policy under free

look clause but the company has not cancelled it. Hence, feeling aggrieved she approached this office

to seek justice.

18. The representative of the company informed that the policy was issued on 14.10.2016 based on

the fully filled and signed proposal forms and policy holder had paid initial premium. However,

the company agreed to cancel the policy bearing number C156453242 and refund the premium

received therein without interest and without deduction of any charges.


18.03.2019.


agreement and shall send a compliance report to this office within 30 the days of

receipt of this order for information and record.

of 412



day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mrs. Beenu Bhandari Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1134


Complainant

Mrs. Beenu Bhandari


Haryana- 134113

Mobile No.- 7508145173

2. Policy No: DOC

Type of Policy


C202842176 / 09-09-2016

Fortune Guarantee

05/15yrs/Rs.51125/-



Ms. Rupali Bhandari

Mrs. Beenu Bhandari










Rule no: Insurance


13.1.(c)



For the Complainant Mrs. Beenu Bhandari




of 412


On 05-12-2017, Mrs. Beenu Bhandari had filed a complaint of mis-selling against Tata AIA Life

Insurance Company in respect of policy bearing number C202842176. She has alleged that she

was missold above policy on the pretext that she need to pay Rs.50000/- and after 01 year she

will get Rs. 50000/- along with interest @ 12%. She has further stated that after one year when

she approached the company for payment she learnt that premiums has to be paid for 05 years

and payment can be withdrawn after 05 years only. Being a widow and suffering from cancer she

is not able to continue the policy and feeling betrayed she approached this office to seek justice.


the fully filled and signed proposal forms.The policy documents were sent to the policy holder

and which were received by her. However, the company agreed to cancel the policy bearing

number C202842176 and refund the premium received therein without interest and without



18.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Som Nath Khurana Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1393


Complainant

Mr. Som Nath Khurana

House No. 202, GH- 67, Sector- 20, Panchkula,

Haryana-0

Mobile No.- 9915510440

of 412

2. Policy No: DOC

Type of Policy


C279517049 / 30-09-2017

Smart Income Plus



Mr. Raghav Khurana

Mr. Som Nath Khurana










Rule no: Insurance


13.1.(c)



For the Complainant Mr. Som Nath Khurana





On 28-02-2018, Mr. Som Nath Khurana had filed a complaint of mis-selling against Tata AIA

Life Insurance Company in respect of policy bearing no. C279517049. He has stated that he has

taken above policy on the life of his minor grandson and instead of sending policy bond to him it

was delivered at his grandson’s address and it was until 22.11.2017 when his son visited him and

handed over the policy to him. The complainant has alleged that since there were some

discrepancies observed in the policy bond and he himself being not satisfied with the terms and

conditions of the policy, had submitted the documents for cancellation at company’s office on

27.11.2017, but it was declined by the company. Hence, feeling aggrieved he approached this



the fully filled and signed proposal forms and the policy documents were sent to the policy

holder on 07.10.2017. However, the company agreed to cancel the policy bearing number

C279517049 and refund the premium received therein without interest and without deduction of

any charges.

of 412


18.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN




Case of Mr. Jagsir Singh Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1371

1 On 20.02.2017, Mr. Jagsir Singh had lodged a complaint in this office against Tata AIA

Life Insurance Co. Ltd. in respect of policy bearing no. C182196874.

2. On 01.03.2019, the company has intimated that the complainant had filed the case before

Hon’ble Disrict Consumer Disputes Redressal Forum Mansa (Punjab) against the same

complaint.

3. Hence, in accordance with Rule 14.5 of Insurance Ombudsman Rules, 2017 which states that “




To be communicated to the parties



of 412




Case of Mr. Jagat Singh Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1010


Complainant

Mr. Jagat Singh

R/o Kando Ghanduri, Sub Teh.- Nohradhar,

Sirmour, Himachal Pradesh- 173104

Mobile No.- 9805521666

2. Policy No: DOC

Type of Policy


U671396651 26.08.2010

Invest Assure Apex Plus

03/10yrs/ Rs. 50000/-



Mr. Jagat Singh

Mr. Jagat Singh










Rule no: Insurance


13.1.(d)








On 26-10-2017, Mr. Jagat Singh had filed a complaint against Tata AIA Life Insurance Co. Ltd. in

respect of policy bearing no. U671396651.He has stated in his complaint that he has taken above policy

in Aug 2010 and had paid premiums for three years. He has requested for refund of premiums as he is

not able to continue the said policy but did not receive any payment. Hence feeling aggrieved; he


of 412

The Insurer in their SCN dated 21.11.2017 has stated that the policy was issued on 26.08.2010 based on

the fully filled and signed proposal forms and the policy documents were sent to the policy holder and

which were received by him. Thereafter the policyholder never submitted request for cancellation within

free look period. The renewal premium was due on 26.08.2011 which was not paid hence the policy

lapsed and a lapse notice was sent on 26.09.2011.The insurer has further stated that the policyholder for

the very first time in the year 2017 had informed them that he had paid premiums in cash to the agent

which was not deposited with the company and a fake receipt was issued by the agent.



Mr. Jagat Singh, the complainant attended the personal hearing on 18.03.2019 and reiterated the

contents of basic complaint. He admitted that he had received the policy documents well in time. He

further submitted that he has paid premiums for 03 years under the policy. The first premium was

paid to the company and other 02 premiums were paid to the agent of the company who had issued

him fake receipts but he could not submit any documentary evidence/receipt.



approached them 07 years after the issuance of said policy.







mentioned in the complaint in August 2010. He had accepted during the hearing that he had received the

policy bond well in time but had not raised any concern during the free look period. The Insurer has

submitted that the complainant has paid only one premium and the policy is lying lapsed due to

nonpayment of premium due since August 2011 whereas the complainant has alleged that he has paid

further 02 years renewal premiums to the agent of the company but could not submit any documentary

evidence/receipt against the same. It has been also observed that the complainant has not alleged

misselling under the complaints addressed to the company as well as to this office and could not produce

any documentary evidence/receipt of having paid the premiums for 03 years under the said policy. There

was undue delay on the part of the complainant in lodging the complaint which he could not justify and

the complaint seems to be an afterthought.

of 412

ORDER


by both the parties during the course of hearing, there is no need to interfere with the

decision of the insurer. Hence, the complaint is dismissed.



day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN




Case of Mr. Jia Lal Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1397


Complainant

Mr. Jia Lal S/o Shri Dhanna Ram,

R/o Maira, P.O.- Jourian, Teh.- Akhnoor,

Distt.- Jammu, Jammu and Kashmir- 181202

Mobile No.- 9419213388

2. Policy No: DOC

Type of Policy


C244353733, C244353746 / 31-12-2011,

Maha Life Gold

15/92yrs/Rs. 30000/-& Rs. 30000/-



Ms. Mukta Mani, Amar Kumar

Mr. Jia Lal










Rule no: Insurance


13.1.(d)



For the Complainant Mr.Amar Kumar s/o Sh. Jia Lal



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On 01-03-2018, Mr. Jia Lal had filed a complaint of mis-selling against Tata AIA Life Insurance Co.

Ltd. in respect of policies bearing no’s. C244353733, C244353746 alleged to have been missold on the

pretext of payment of huge benefits.Infact he was sold 14 policies of different insurance companies and

amounting to Rs. 24 Lakhs approximately. When he realised that fraud has happened, he complained to

the above company, but did not get any relief, and feeling aggrieved he approached this office to seek

justice.


the fully filled and signed proposal forms and the policy documents were sent to the policy holder on

14.01.2012 and which were received by him. Thereafter the policyholder never submitted request for

cancellation within free look period. The insurer has further stated that the policyholder submitted

complaint for misselling on 03.01.2018 which is after about 06 years of receipt of policy documents.



Mr.Amar Kumar s/o Sh. Jia Lal reiterated the contents of the complaint. He also submitted that the

above policies have been issued fraudulently to him & his sister and requested for refund of premiums

under the said policies. He also submitted that his father’s signatures have been forged on some places

in the proposal forms.


The Insurer’s representative reiterated the contents of SCN and submitted that the policy bonds were

delivered well in time and the request for cancellation of above policies was received on 06 years after

the expiry of free look period.





On going through the various documents available in the file and also hearing both, the complainant’s

son and the representative of the Insurance Company, It is observed that the complainant was

misguided and missold multiple policies alluring him of high returns and other benefits payable without

looking into actual insurance needs and premium paying capacity of the life assured/ policy holder. It is

also observed that the personal information on both the proposal forms under the said policies has been

corrected in various places and the cuttings has been confirmed through signatures which indicates that

information on the proposal forms may have been corrected after the receipt of the complaint and the

complainant was not informed about these corrections. The complainant has also submitted in his

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complaint that his signatures mismatch in the proposal forms. He has also submitted that he was asked

to return the policy bonds under the said policies and has also enclosed the postal receipts vide which

he has returned the said policy bonds and till date he has not received them back. It is a fact that the

complainant has filed the complaint after about 06 years from the issuance of said policies but it is also

a fact that the Insurance Company has not taken enough care at the time of issuing the said policies and

misselling cannot be denied as the insurer’s representative could not justify the cuttings on the proposal

forms and also could not submit the proof of delivery of said policies for the first time and its

redispatch to the complainant after the said policies were returned by the complainant.

AWARD



to the insurance company to cancel the policies bearing numbers C244353733 &

C244353746, since inception and refund all the premiums collected there-in without









day of March, 2019.

D.K.Verma

INSURANCE OMBUDSMAN




Case of Ms. Ramneek Walia Vs Tata AIA Life Insurance Co. Ltd.

CASE NO-CHD-L-046-1718-1047


Complainant

Ms. Ramneek Walia

H. No.- 9/1, Guru Nanak Pura West,

Jalandhar, Punjab-0

Mobile No.- 9814930825

2. Policy No: DOC

Type of Policy

Duration of policy/Policyperiod

C234138793 / 31-03-2017

Tata AIA Smart Income Plus

12/25yrs/ Rs. 25563/-

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Ms. Ramneek Walia

Ms. Ramneek Walia





Complaint

01-11-2017






Rule no: Insurance


13.1.(c)



For the Complainant Absent but requested to consider the complaint

on merit basis





On 01-11-2017, Ms. Ramneek Walia had filed a complaint of mis-selling against Tata AIA Life

Insurance Co. Ltd. in respect of policy bearing no. C234138793 alleged to have been missold to her. She

has stated that she was employee of Indus Ind Bank for 03 months only and was missold above policy

through bank by the agent of above company on the pretext that premiums has to be paid for 03 years

only. But later on when she received the policy she realised that premiums has to be paid 12 years and

approached the company for cancellation of said policy but it was declined by the company. Hence

feeling aggrieved she approached this office to seek justice.


the fully filled and signed proposal forms and the policy documents were sent to the policy holder and

which were received by her 17.05.2017. Thereafter the policyholder submitted request for cancellation

of policy on 19.06.2017 which was beyond the 15 days free look period. Hence the same was rejected.



Ms. Ramneek Walia, the complainant did not attend the personal hearing on 18.03.2019 but requested

to consider/process the complaint vide her mail dated 15.03.2019 as presently she is not residing in

India.

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approached them after the expiry of free look period.


a) Copies of the proposal forms b) Complaint to the insurer c) Reply of the company


On going through the various documents available in the file and verbal pleadings of the representative

of the Insurance Company, It is observed that the said policy has been missold through

misrepresentation of facts and the complainant has approached the insurer within reasonable time.

Moreover the insurer has also not been able to produce any proof of delivery of the said policy and thus

can’t take shelter of free look period.

AWARD

Taking into account the facts & circumstances of the case and the submissions of both the

parties, an award is passed with a direction to the insurance company to cancel the policy

bearing number C234138793, since inception and refund all the premiums collected there-

in without interest and without deduction of any charges.




g. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019.

D. K. Verma

INSURANCE OMBUDSMAN

of 412




CASE OF Mr. Samir Tandon V/s Tata AIA Life Insurance Co. Ltd.



On 06-06-2017, Mr. Samir Tandon had lodged a complaint in this office against Tata AIA Life Insurance Co. Ltd.

in respect of Policy No. C681107018. The complainant has also alleged that the above policy was issued to him in

October 2013 and he has paid renewal premium due in October 2014 also The complainant has further alleged

that when he visited the office of the company, he found that the above policy has been missold by the agent

through false commitments and promised returns were manipulated. He has further stated that when he requested

for cancellation of above policy and refund of premiums his request was not responded by the company.

Hence, feeling aggrieved, he approached this office to seek justice.


the fully filled and signed proposal forms and the policy documents were dispatched to the policy

holder on 06.11.2013, which were never received back undelivered. Thereafter the policyholder


Complainant

Mr. Samir Tandon

Shri G.R. Tandon, 464/9, Main Bazar,

Gohana, Haryana- 131301

Mobile No.- 9810021959

2. Policy No:

Type of Policy


C681107018 DOC 31.10.2013

Tata AIA Life Maha Life Gold

Rs. 136000/- paid renewal prem. due oct 2014 also



Mr. Samir Tandon

Mr. Samir Tandon








11. Amount of relief sought Refund of premiums including renewal prem. also



Rules, 2017.

13.1.(d)

13. Date of hearing/place 22.11.2018 & 18.03.2019/Chandigarh






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submitted request for cancellation of said policy on 28.03.2016 which was denied being out of free look

period.



Mr. Samir Tandon, the complainant attended the personal hearing on 18.03.2019, reiterated the contents of

the complaint and submitted that the above policy has been issued to him fraudulently and his father’s

name and other information filled in the proposal forms mismatches which indicates that his signatures

have been forged and submitted certified copies of his signatures verified by the bank. He also

submitted that he had complained to the company on 30.03.2016 but despite his continuous follow up

he was replied by the company on 07.02.2017.



approached them after more than 02 years from the expiry of free look period.






the representative of the Insurance Company, It is observed that the complainant was misguided and

missold the above policy through misrepresentation of facts, without looking into actual insurance needs

and premium paying capacity of the life assured/ policy holder. It is a fact that the complainant has filed

the complaint after more than 02 years from the issuance of the said policy but it is also a fact that the

Insurance Company has not followed the norms related to financial underwriting in a proper manner.

Even no income proof/ income tax return has been taken from the complainant before issuing him

policy with an annual premium of Rs One Lakh and thirty six thousand payable for 15 years. Hence, it

is observed that financial underwriting was lacking and paying capacity of the complainant was also

ignored and now insurer can’t take shelter of free look period. Moreover the fact regarding the delivery

of said policy could not be corroborated by any documentary proof like POD by the insurer.

AWARD



to the insurance company to cancel the policy bearing number C681107018, since inception


any charges.


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h. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019

D.K.Verma

INSURANCE OMBUDSMAN




Case of Mr. Balkar Singh Vs PNB Metlife India Insurance Co. Ltd.

CASE NO-CHD-L-033-1718-1182


Complainant

Mr. Balkar Singh S/o Sh. Jagir Singh,

VPO- Haveli, Opposite- Gurudwara,

Tehsil- Sadhora, Distt.- Yamunanagar,

Haryana- 133204

Mobile No.- 9812620670

2. Policy No: DOC

Type of Policy

Duration of policy/Prem

00864290

Rs.20000/- x03



Mr. Balkar Singh

4. Name of the insurer PNB MetLife India Insurance Co. Ltd.







11. Amount of relief sought Refund of all premiums paid


Rule no: Insurance


13.1.(c)



For the Complainant Mr. Balkar Singh

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For the insurer Mr. Rajeev Sharma, Sr. Manager Legal




On 14-12-2017, Mr. Balkar Singh had filed a complaint against PNB MetLife India

Insurance Company in respect of policy bearing number 00864290. He has stated that he had

taken the above policy in 2010 and after paying premiums for 03 years had applied for surrender

payment but it was never paid to him. He has alleged that he has learnt from someone that the said

surrender payment has been used by the company to issue fresh policy on some other life. When he

complained to the company on 18.07.2017 and 25.09.2017 for refund of premiums with interest, it was

not replied by the company. Hence, feeling aggrieved he approached this office to seek justice.



with welcome letter was dispatched and duly delivered at complainant’s address. However,

the company agreed to cancel the policy bearing number 00864290 and refund all the premiums

received therein without interest and without deduction of any charges.


18.03.2019.






day of March, 2019

D.K. VERMA

INSURANCE OMBUDSMAN

of 412



OMBUDSMAN – Dr. D.K.Verma CASE OF Mr. Rahul & Suresh V/s PNB Metlife India Insurance Co. Ltd.



On 01.05.2017, Mr. Rahul & Mr. Suresh had lodged a complaint in this office against PNB Metlife India

Insurance Co Ltd in respect of Policies bearing No’s. 21463340 & 21462230 allegedly mis-sold to them. They

have alleged in their complaint that they had visited the bank for FD but were issued policies through cheating. It

has been further stated that when the again visited the bank after 11 months for withdrawal of FD amount they

came to know that the policies have been issued to them and when they requested for cancellation of above

policies and refund of premiums vide their letters dated 09.08.2016 and 30.01.2017, it was not

responded by the company. Hence, feeling aggrieved, they approached this office to seek justice.

The Insurer in their SCN dated 30.07.2017 and received by us on 09.08.2017, has stated that the

complainant being an educated person has duly filled up, signed and has voluntarily applied for their

product after completely understanding the features, investment risks,charges,benefits ,terms and

conditions thereof and submitted his application (proposal form). The Insurer has further stated that the


Complainant

Mr. Rahul & Suresh

Village- Naina Tatarpue,

Tehsil & Distt.- Sonipat, Haryana- 131024

Mobile No.- 9671053456

2. Policy No: DOC

Type of Policy


21463340 & 21462230 28/12/2014 & 27/12/2014

Met Smart Platinum

Rs. 10000/- (Mly) & Rs. 10000/-(Mly)



Mr. Rahul , Ms. Saroj

Mr. Rahul , Ms. Saroj








11. Amount of relief sought Refund of all premiums paid under both the policies


Rule no: Insurance


13.1.(c.)

13. Date of hearing/place 15.10.2018 ,10.12.2018 & 18.03.2019 / Chandigarh


For the Complainant Mr. Rahul s/o of Mr. Suresh

For the insurer Mr. Rajeev Sharma Sr. Manager- Legal



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policy bonds under the said policies bearing no’s. 21463340, 21462230 were dispatched to the

complainant on 31.12.2014 & 30.12.2014 respectively, but he has not raised any concern during the free

look period. The insurer has further stated that after a period of 2 years complaint for the first time was

received on 09.08.2016 for alleged misselling which was replied by the company.



Mr. Rahul s/o Mr. Suresh attended the personal hearing on 18.03.2019, reiterated the contents of the

complaint and submitted that the above policies have been issued to them fraudulently. He further

stated that in some places his and his mother’s signatures have been forged and requested for refund of

premiums under the said policies.



approached them about 02 years after the expiry of free look period.






the representative of the Insurance Company, It is observed that the complainants who are not educated

enough were misguided and missold the above policies, without looking into actual insurance needs and

premium paying capacity of the life assured/ policy holder. It is a fact that the complainants have filed

the complaint after about 19 months from the issuance of the said policies but it is also a fact that the

Insurance Company has not followed the norms related to financial underwriting in a proper manner.

Even no income proof/ income tax return has been taken from the complainants before issuing them

policies with an annual premium of Rs One Lakh and twenty thousand under each policy, payable for 10

years. Hence, it is observed that financial underwriting was lacking and paying capacity of the

complainant was also ignored and now insurer can’t take shelter of free look period. Moreover the fact

regarding the delivery of said policies could not be corroborated by any documentary proof like POD by

the insurer.

AWARD



to the insurance company to cancel the policies bearing numbers 21463340 & 21462230,

since inception and refund all the premiums collected there-in without interest and without



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i. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019

D. K. Verma

INSURANCE OMBUDSMAN




Case of Ms. Shakuntla Devi Vs PNB Metlife India Insurance Co. Ltd.

CASE NO-CHD-L-033-1718-1164


Complainant

Ms. Shakuntla Devi

H. No.- 205, Bank Street Nabha, Distt.- Patiala,

Punjab- 147201

Mobile No.- 9814636461

2. Policy No: DOC

Type of Policy


00736734 / 18-12-2008

Met Smart Plus

Rs. 50000/-



Ms. Shakuntla Devi

Ms. Shakuntla Devi










Rule no: Insurance


13.1.(c)



For the Complainant Mr. Raj Kumar (son of the complainant)

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On 08-12-2017, Ms. Shakuntla Devi had filed a complaint against PNB MetLife India Insurance Co.

Ltd. in respect of policy bearing no. 00736734.She has stated that she had taken the above policy in

2008 and had paid the premium for 03 years .When she inquired the fund value on 06.12.2017 she was

told that it is more than Rs. 92000/- and as per terms & conditions the surrender value payable is Rs.

73600/- which is more than annualized premium of Rs. 50000/-.Earlier also when she had asked for the

fund statement on 22.06.2017 it was not sent by the company. The complainant has requested to advise

the company to provide her fund statement from the commencement of the policy.

The insurer in their SCN dated 24.04.2018 has submitted that the said policy was issued on 18.12.2008

and the complainant failed to pay the premium since 18.12.2013 hence the policy was in premium

discontinuance status effective from 18.12.2013.Then the company received the complaint from the

complainant asking for fund statement which was duly provided by the company.Therafter another

complaint was received from the complainant on 12.12.2017 raising query regarding fund value which

was duly replied vide letter dated 13.12.2017 informing her that Rs.34268.318 as stated in her letter

dated 12.12.2017 is only specified to Protector fund and she has opted three funds Balancer, Multiplier

& protector.



Mr. Raj Kumar, son of the complainant attended the personal hearing on 18.03.2019 on behalf of the

complainant and reiterated the contents of basic complaint. He submitted that now the desired fund

statement has been provided by the insurer and the insurance company may be advised to send the same

as and when it is required by the complainant, Ms. Shakuntla Devi and she has also requested that she

may also be informed by the company to deposit the premium whenever the fund value is less than

annualized premium of Rs. 50000/-.


The insurer’s representative reiterated the contents of SCN and submitted that the desired statement has

been sent to the complainant and assured that the complainant will be informed to pay the premium

whenever the fund value is less than annualized premium of Rs. 50000/-.


a) Copies of the proposal form. b) Complaint to the insurer.


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On going through the various documents available in the file and also hearing the representative of the

complainant and the representative of the Insurance Company, It is observed that the complainant had

applied for the fund statement under the above said policy which was not provided in complete form

thus arising doubt about the fund value. As desired by the complainant the company is advised to send

the fund statement in proper and complete form whenever it is required by her and in future, the

company is also advised to intimate the complainant, to deposit the premium whenever the fund value is

less than annualized premium of Rs. 50000/-.under the said policy.

ORDER


both the parties during the course of hearing, it is observed that the desired fund

statement has already been provided by the company, there is no need to interfere further

and the complaint is dismissed.



day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN




CASE OF Mrs. Reena V/S PNB Met Life Insurance Co. Ltd.


1. On 12.11.2017, Mrs. Reena had lodged a complaint in this office against PNB Met Life

Insurance Co. Ltd.in respect of Policy number 22030185.

2. On 05.03.2019, the company has intimated that the complainant had filed the case before

Hon’ble State Consumer Disputes Redressal Commission, Panchkula against the same

complaint.

3. Hence, in accordance with Rule 14.5 of Insurance Ombudsman Rules, 2017 which states that “


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To be communicated to the parties






CASE OF Mr. Mohan Lal V/s PNB Metlife India Insurance Co. Ltd.


1. On 17.05.2017, Mr. Mohan Lal had lodged a complaint in this office against PNB

Metlife India Insurance Co. Ltd. in respect of Policy number 21932402.



3. Now, the insurer has informed that complainant is interested in withdrawal of the complaint

and the same has also been confirmed by the complainant through his letter dated

10.12.2018 that he is fully satisfied now and has also requested for withdrawal of the

complaint.





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CASE OF Mrs. Sushma Devi V/s PNB Metlife India Insurance Co. Ltd.



On 01.05.2017, Mrs. Sushma Devi had lodged a complaint in this office against PNB Metlife India Insurance Co

Ltd in respect of Policy No. 21880844 allegedly mis-sold to her. She has stated in her complaint that the said

policy has been missold to her on false pretexts and when she received the policy document she realized that the

benefits are not matching with what were explained to her. Then she returned the original policy bond to the agent

for cancellation of policy who promised her to issue new policy with promised benefits but till date it has not been

cancelled. She has also alleged that when she complained to the company vide his letters 21.02.2017 and

29.03.2017 for cancellation of above policy and refund of premium but her request was declined by the

company vide their letter dated 25.03.2017. Hence, feeling aggrieved, she approached this office to seek

justice.


Complainant

Mrs. Sushma Devi

Village- Kot, VPO- Kot Maira,

Tehsil- Garhshankar, Hoshiarpur,

Punjab- 144523

Mobile No.- 9876532732

2. Policy No:

Type of Policy

Term of policy

21880844 DOC 12/04/2016

Met Money Back



Mrs. Sushma Devi

Mrs. Sushma Devi








11. Amount of relief sought Rs. Two Lakhs



Rules, 2017.

13.1.d.

13. Date of hearing/place 15.10.2018, 10-12-2018 & 18.03.2019/ Chandigarh






of 412


complainant being an Graduate and as an educated person has duly filled up, signed and has voluntarily

applied for their product after completely understanding the features, investment risks,charges,benefits

,terms and conditions thereof and submitted her application (proposal form). The Insurer has further

stated that the policy bond under the said policy was dispatched to the complainant on 18.04.2016 but

she has not raised any concern during the free look period. The insurer has further stated that complaint

for the first time was received on 21.02.2017 for alleged misselling which was declined by the company.


The complainant was given opportunity of personal hearing on 15.10.2018, 10-12-2018 & 18.03.2019

but neither the complainant nor her representative turned up. Non appearance in personal hearing

indicates that she has nothing to say in this matter. However, the insurance company was represented by

Mr. Rajeev Sharma Sr. Manager- Legal on all the occasions who requested for dismissal of the

complaint, since sufficient opportunities have been given to the complainant to present her case and the

case cannot be kept pending indefinitely. It appears that the complainant doesn’t wish to pursue the

matter since there is no verbal or written communication from her in spite of best efforts by this office.

Under the circumstances, there is no option but to close the complaint and the case is being dismissed in

default.

AWARD






day of March, 2019.

Dr. D. K. Verma

INSURANCE OMBUDSMAN

of 412



OMBUDSMAN – Dr. D. K. Verma CASE OF Mr. Bakha Singh V/s PNB Metlife India Insurance Co. Ltd.



On 08.05.2017, Mr. Bakha Singh had lodged a complaint in this office against PNB Metlife India Insurance Co

Ltd in respect of Policy No. 20959379. The complainant has stated that due to his due to his financial condition he

is not able to run the policy and had written to the company on 04.04.2016 to cancel the policy and refund of

premium but his request was not replied by the insurer, hence, feeling aggrieved, he approached this office to

seek justice.

The Insurer in their SCN which was received by us on 09.08.2017, has stated that the complainant

being an educated person has duly filled up, signed and has voluntarily applied for their product after

completely understanding the features, investment risks,charges,benefits ,terms and conditions thereof

and submitted his application (proposal form). The Insurer has further stated that the policy bond under

the said policy was dispatched to the complainant on 08.12.2012, but he has not raised any concern


Complainant

Mr. Bakha Singh

S/o Shri Jageer Singh,

Village- Malikpur, Tehsil- Safidon,

Distt.- Jind, Haryana- 0

Mobile No.- 9416830492

2. Policy No:

Type of Policy

Term of policy

20959379 DOC 26/11/2012

Met Easy Plus

15 yrs/ Rs. 20000/-



Mr. Bakha Singh

Mr. Bakha Singh






9. Amount of Claim Rs.





Rules, 2017.

13.1. (d)

13. Date of hearing/place 15.10.2018, 10-12-2018 & 18.03.2019/ Chandigarh






of 412

during the free look period. The insurer has further stated that they had received a surrender request

from the complainant on 29.07.2016 and the same was declined as the surrender request is to be

submitted at the branch office of the company along with original ID proof, however as per terms and

conditions of the policy, the said policy can be surrendered after 05 years.


The complainant was given opportunity of personal hearing on 15.10.2018, 10-12-2018 & 18.03.2019



Mr. Rajeev Sharma Sr. Manager- Legal on all the occasions who requested for dismissal of the

complaint, since sufficient opportunities have been given to the complainant to present his case and the

case cannot be kept pending indefinitely. It appears that the complainant doesn’t wish to pursue the

matter since there is no verbal or written communication from him in spite of best efforts by this office.

Under the circumstances, there is no option but to close the complaint and the case is being dismissed in

default.

AWARD






day of March, 2019.

Dr. D. K. Verma

INSURANCE OMBUDSMAN




Case of Mrs. Kiranjit Kaur Vs PNB MetLife India Insurance Co. Ltd.

CASE NO-CHD-L-033-1718-1127


Complainant

Mrs. Kiranjit Kaur W/o Shri Gurdeep Singh,

VPO- Ghadani Khurd, Tehsil- Payal,

Distt.- Ludhiana, Punjab- 141416

Mobile No.- 8146000531

2. Policy No: DOC

Type of Policy


22144071 / 15-03-2017

Met Guaranteed Income Plan

Rs. 99955.86/-

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Mrs. Charanjit Kaur

Mrs. Charanjit Kaur


5. Date of Repudiation 08.11.2017

6. Reason for repudiation Concealment of material facts



9. Amount of Claim Rs. 650000/-


11. Amount of relief sought Rs. 650000/-


Rule no: Insurance


13.1.(b)





15. Complaint how disposed Dismissed with Refund of premium only



On 04-12-2017, Mrs. Kiranjit Kaur had filed a complaint against PNB MetLife India Insurance Co. Ltd.

in respect of policy bearing no. 22144071.She has stated that her mother in law was illiterate and above

policy was sold to her on 15.03.2017 by bank out of proceed of death benefits of his father in law and

they were not aware that any insurance policy has been sold by the bank. She has further stated that her

mother in law expired on 27.03.2017 due to sudden heart attack and was not under any treatment from

any hospital and was not suffering from any disease. When she lodged the claim with the company, it

was repudiated by the company on the grounds of non disclosure of material fact, hence feeling

aggrieved she approached this office to seek justice.


deceased life assured had applied for an insurance policy on her life and completely relying upon the

declarations, statements, documents, representations and information furnished by the life assured, the

company had issued the policy bearing no 22144071 and Life Assured died on 27.03.2017. The death

claim was lodged as per death benefit option and during the investigation it was revealed that the said

policy was obtained by misrepresenting the true and actual facts pertaining to deceased life assured’s

medical condition. The insurer has further stated that the deceased life assured has suppressed the

material fact that she was suffering from coronary artery disease and was taking treatment for the same

since 04.03.2017 as apprised by Dr. Gurjeet Singh by producing his medical certificate. The company

has also annexed cash memo dated 19.03.2017 from the medical store in the name of life assured which

establish that life assured was under treatment prior to taking above policy.

of 412



Mrs. Kiranjit Kaur, the complainant submitted that Death Claim on the life of her mother-in-law was

repudiated by the Insurer due to concealment of material facts at the time of taking insurance. She

further told that her mother was illiterate and the said policy was missold to her as FD and her mother in

law was not suffering from any disease at the time of taking above policy.

b)Insurer’s argument:

The representative of the Company informed that death claim of Mrs. Charanjit Kaur was repudiated on

08.11.2017 on the ground of non-disclosure of material information regarding her health at the time of

taking insurance. The deceased life assured was suffering from coronary artery disease and was advised

to have regular treatment. The fact is confirmed by medical certificate issued by Dr. Gurjeet Singh. This

fact was not disclosed by the DLA at the time of taking insurance. As such death claim was repudiated

due to concealment of material facts.

(19) Result of personal hearing with both parties (Observations & Conclusion)

The submission of the complainant holds no merit as it is evident from the record produced by Insurer

that the prior to taking above policy, the deceased life assured was taking consultation for coronary

artery disease from Dr. Gurjeet Singh as OPD patient; however this certificate is not supported by any

reports/tests related to this disease. It has been also observed that the deceased life assured was missold

above policy through misrepresentation of facts as being illiterate she may not be aware about the

contents of the proposal forms and material information filled in the proposal forms, as the insurer has

also not taken enough care while issuing above policy to the deceased life assured.

ORDER


by both the parties during the course of hearing, the insurer has rightfully repudiated

the death claim under policy bearing no 22144071 but has not refunded the deposited

premium. So the insurer is advised to refund the deposited premium without any

deduction and interest.

Hence, the complaint is closed.



j. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019

D. K. Verma

INSURANCE OMBUDSMAN

of 412




Case of Mr. Sandeep Chauhan Vs ICICI Prudential Life Insurance Co. Ltd.

CASE NO-CHD-L-021-1718-0877


Complainant

Mr. Sandeep Chauhan

House No. 291, Ward No. 2,

Near Durga Mandir, Tosham, Bhiwani,

Haryana- 127040

2. Policy No: DOC

Type of Policy


18926875 / 11-10-2014

ICICI Pru Wealth Builder II



Mr. Sandeep Chauhan

Mr. Sandeep Chauhan

4. Name of the insurer ICICI Prudential Life Insurance Co. Ltd.




8. Nature of complaint Lock in period 5years

9. Amount of Claim Refund of deposited amount


11. Amount of relief sought Refund of deposited amount


Rule no: Insurance


13 [1] [d]

13. Date of hearing/place 16.10.2018 & 08-02-2019& 20.03.2019 /

Chandigarh



For the insurer Sh. Sukhminder Singh




On 31-08-2017, Mr. Sandeep Chauhan had filed a complaint of deposited amount not returning before

completion of five years [lock in period] against ICICI Prudential Life Insurance Co. Ltd. in respect

of policy bearing no. 18926875.issued in 10/2014.

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In personal hearing the insurer reiterated the contents of SCN and submitted that the subject policy is

issued strictly as per the duly filled in and signed proposal form received by us with a monthly total

premium of Rs. 8,417/-. The complainant has signed the proposal form must have read and understood

the terms and conditions of the policy. The complainant has paid the renewal premiums for the subject

policy till 2016. The complainant never approached the company with any discrepancy in the subject

policy before April 19, 2017. The complainant approached the company after 3 years from the policy

issuance with a concern that the subject policy was sold with incorrect policy features and benefits.


The complainant was given opportunity of personal hearing on 16.10.2018, 08.02.2019 & 20.03.2019.

The complainant, he or his representative did not attend the hearing on either of dates fixed for personal

hearing. Non appearance in personal hearing indicates that he has nothing to say in this matter.

However, the insurance company was represented by Mr. Sukhminder Singh who requested for

dismissal of the complaint. Since sufficient opportunities have been given to the complainant to present

his case and the case cannot be kept pending indefinitely, the case is dismissed in default.

AWARD



in respect of policy no. 18926875 is dismissed in default. Hence, the complaint is

treated as closed.


Dr. D. K. Verma

INSURANCE OMBUDSMAN



OMBUDSMAN – Dr. D.K. Verma

CASE OF Mr. Tajit Kumar V/s Edelweiss Tokio Life Insurance Co. Ltd.

COMPLAINT REF. No. : CHD-L-014-1718- 0609


Complainant

Mr. Tajit Kumar S/o Sh. Jagdish Kaushik,

Village- Noorpur, P.O. Karawara Manakpur,

Distt. Rewari, Rewari- Haryana-0

2. Policy No:

Type of Policy

Term of policy

100020151E

DOC:- 31.03.2016

Edelweiss Tokio Life – GCAP

15 years/ 7 years

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On 11-07-2017, Mr. Tajit Kumar had submitted a complaint in this office against Edelweiss Tokio Life

Ins. Co. in respect of Policy No. 100020151E alleged to have been mis-sold on his life. The complainant

had informed that he was contacted on mobile by the agent of insurer and he allured him for monthly

pension of Rs. 29, 500/- and forced him to invest money in Edelweiss Life Insurance policy. He had

filed a complaint vide letter dated NIL and requested to cancel the policy and refund of premium which

was rejected by the insurer vide letter dated 05.04.2017 being out of free look period.


In personal hearing the insurer reiterated the contents of SCN and submitted that the Policy No.

100020151E was issued on the life of the complainant with 7 years term, annual premium of Rs. 2, 18, 000. and

date of commencement 31.03.2016 based on the information provided in the proposal form and documents

submitted by the proposer and policy bond was delivered on 09.04.2016. The Insurer further stated that the pre

issuance verification call and policy pack delivery confirmation call were made to the policy holder and he had

not raised any concern at that time. The complainant had alleged that the policy was mis-sold and requested for

cancellation of policy and refund of premium which was rejected vide letters dated 05.04.2017 since the same was

received after free look period.



.The complainant, or his representative did not attend the hearing on either of dates fixed for personal

hearing. Non appearance in personal hearing indicates that he has nothing to say in this matter.



Sh. Tajit Kumar

Sh Tajit Kumar

4. Name of the insurer Edelweiss Tokio Life Ins. Co. Ltd.,



7. Dt of receipt of the Complaint 11-07-2017



10. Date of Partial Settlement nil

11. Amount of relief sought Refund of premium Rs. 2, 18, 000/-



Rules, 2017.

13.1.c.

13. Date of hearing/place 17.12.2018 , 23.01.2019 & 20.03.2019/ Chandigarh



For the insurer Ms. Navdeep Kaur



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However, the insurance company was represented by Ms. Navdeep Kaur who requested for dismissal of

the complaint. Since sufficient opportunities have been given to the complainant to present his case and

the case cannot be kept pending indefinitely, the case is dismissed in default.


Dr. D. K. Verma

INSURANCE OMBUDSMAN




Case of Mr. Satish Kumar Vs Edelweiss Tokio Life Insurance Co. Ltd.

CASE NO-CHD-L-014-1819-0487


Complainant

Mr. Satish Kumar

Village & P.O.- Dadial, Hoshiarpur,

Punjab- 144223

Mobile No.- 8196916408

2. Policy No: DOC

Type of Policy


007048629E, 100021199E / 17-03-2016, 29-04-2016

Edelweiss Tokio Life – GCAP

15 Years



Mr. Satish Kumar

Mr. Satish Kumar

4. Name of the insurer Edelweiss Tokio Life Insurance Co. Ltd.





9. Amount of Claim




Rule no: Insurance


13 [1][d]



AWARD



in respect of policy no. 100020151E is dismissed in default.

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For the Complainant Mr. Satish Kumar

For the insurer Ms. Navdeep Kaur, Regional Operation Manager




On 13-08-2018, Mr. Satish Kumar had filed a complaint of mis-selling against Edelweiss

Tokio Life Insurance Company in respect of policy bearing numbers 007048629E, 100021199E.

18. In personal hearing the company agreed to cancel the policies bearing numbers 007048629E,

100021199E and refund all the premiums received therein without interest and without

deduction of any charges. Accordingly, an agreement was signed between the company and the

complainant on 20.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN




Case of Mrs. Kamla Patial Vs Edelweiss Tokio Life Insurance Co. Ltd.

CASE NO-CHD-L-014-1819-0138


Complainant

Mrs. Kamla Patial W/o Shri Surinder Patial,

Shop No.-1, Alley No.-5, Middle Bazar, Shimla,

Himachal Pradesh- 171001

2. Policy No: DOC

Type of Policy


006197191E

3. Name of the insured Ms. Bandana Kumari

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Name of the policyholder Mrs. Kamla Patial

4. Name of the insurer Edelweiss Tokio Life Insurance Co. Ltd.





9. Amount of Claim 99,000/-




Rule no: Insurance


13 [1][d]



For the Complainant Mrs. Kamla Patial

For the insurer Ms. Navdeep Kaur, Regional Operation Manager




On 17-05-2018, Mrs. Kamla Patial had filed a complaint of mis-selling against Edelweiss

Tokio Life Insurance Company in respect of policy bearing number 006197191E.

18. In personal hearing the company agreed to cancel the policy bearing number 006197191E

and issue a new single premium ULIP policy with a lock-in-period of 5 years against the same,

subject to underwriting & fulfillment of requirements. The free look period clause shall not apply for

this new single premium ULIP policy. Accordingly, an agreement was signed between the

company and the complainant on 20.03.2019.






day of March, 2019

(Dr. D.K. VERMA)

INSURANCE OMBUDSMAN

of 412




CASE OF Mr. Paramjit Singh V/s Max Life Insurance Company


1. On 11.04.2018, Mr. Paramjit Singh had filed a complaint against Max Life Insurance

Company in respect of policy bearing number 709404420.




refunded the premium amount Rs. 1,00,000/- through NEFT dated 26.02.2019 to the

complainant under policy number 709404420 and the same has been confirmed by Mr.

Paramjit Singh telephonically.








CASE OF Mr. Sandeep V/s Max Life Insurance Company


1. On 30.07.2018, Mr. Sandeep had filed a complaint against Max Life Insurance Company in

respect of policy bearing number 125350116.




refunded the premium amount Rs. 31,125/- through cheque to the complainant on

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16.02.2019 under policy number 125350116 and the same has been confirmed by Mr.

Sandeep telephonically on 28.03.2019.








CASE OF Mrs. Mukesh Rani V/s Max Life Insurance Company

COMPLAINT REF. No. : CHD-L-032-1819-0878 & CHD-L-032-1819-1156

1. On 15-11-2018, Mrs. Mukesh Rani had filed a complaint in this office against Max Life

Insurance Company in respect of policies bearing numbers 123474645, 124798950,

125203695 & 332044312.

2. On 27-03-2019, the insurance company informed that the complainant has made complaint

for claim amount of Rs. 2,10,84,025/ under four policies on same life. The claim amount

exceeds the financial limit of the Ombudsman.

3. As per insurance Ombudsman Rules 2017, the Ombudsman can entertain the

complaint up to the amount of Rs. 30,00,000/-. The said complaint amount exceeds the

financial limit of this office. The objection raised by the Insurance Company is in order.

Hence, the said complaint is closed and the complainant is advised to approach the

appropriate forum.





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CASE OF Mr. Sunil Kumar V/s Max Life Insurance Company


1. On 31.07.2018, Mr. Sunil Kumar had filed a complaint against Max Life Insurance

Company in respect of policies bearing numbers 132448721 & 129917969.




4. On 28.03.2019, Mr. Sunil Kumar has also confirmed telephonically that he has received

refund of premium i.e. Rs. 43,056.25/- & Rs. 8,165/- under policies mentioned in the

complaint. Now, he is satisfied and has requested for closure of the complaint.








CASE OF Mr. Jasmir Singh V/s Max Life Insurance Company


1. On 08.10.2018, Mr. Jasmir Singh had filed a complaint against Max Life Insurance


2. This office pursued the case with the insurance company to re-examine the

complaint and they agreed to reconsider the claim.

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3. Now, vide letter dated 05.12.2018, he wants to withdraw the complaint against the

company as he has received the money from company. Accordingly complaint may

be closed.








CASE OF Mrs. Manjit Kaur V/s Max Life Insurance Company


1. On 22.10.2018, Mrs. Manjit Kaur had filed a complaint against Max Life Insurance


2. This office pursued the case with the insurance company to re-examine the

complaint and they agreed to reconsider the claim.

3. Now, vide letter dated 01.03.2019, she wants to withdraw the complaint against the

company as she has received the money from company. Accordingly complaint may

be closed.





of 412




CASE OF Mr. Parmood Kumar V/s Max Life Insurance Company


1. On 12.11.2018, Mr. Parmood Kumar had filed a complaint against Max Life Insurance

Company in respect of policies bearing numbers 875183832 & 884499179.




refunded the premium amount Rs. 29,999.16 /- & Rs. 99,997.56 /- to the complainant under

policies mentioned in the complaint and the same has been confirmed by settlement

agreement letter dated 18.02.2019.








CASE OF Mr. Randip Singh V/s Max Life Insurance Company


1. On 10.05.2018, Mr. Randip Singh had filed a complaint against Max Life Insurance




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4. On 28.03.2019, Mr. Randip Singh has also confirmed telephonically that he has received

refund of premium i.e. Rs. 1,00,000/- under policy mentioned in the complaint. Now, he is

satisfied and has requested for closure of the complaint.








CASE OF Mr. Gurdev Singh V/s Max Life Insurance Company


1. On 07.06.2018, Mr. Gurdev Singh had filed a complaint against Max Life Insurance





refunded the premium amount Rs. 7,472/- vide cheque number 043613 to the complainant

under policy number 718476179 and the same has been confirmed by settlement agreement

letter dated 05.03.2019.





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CASE OF Mr. Kuldip SinghV/s Birla Sun Life Insurance Company


1. On 24-04-2018, Mr. Kuldip Singh had filed a complaint against Birla Sun Life Insurance


2. This office pursued the case with the insurance company to re-examine the complaint and they

agreed to reconsider the claim.

3. Now, the insurer has informed through mail dated 27.03.2019 that they have already refunded

the premium amount Rs. 59724.36/- to the complainant under policy number 005933719.

4. The complainant has also confirmed vide his letter dated 12.07.2018 that he has received refund

of premium under policy mentioned in the complaint. Now, he is satisfied and requested for

closure of the complaint.








CASE OF Mr. Jatinder Singh Grewal V/s Birla Sun Life Insurance Company


1. On 17-04-2018, Mr. Jatinder Singh Grewal had filed a complaint against Birla Sun Life

Insurance Company alleging mis-selling of policy number 007269379.

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2. This office pursued the case with the insurance company to re-examine the complaint and they

agreed to reconsider the claim.

3. Now, the insurer has informed through mail dated 27.03.2019 that they have already refunded

the premium amount Rs. 50,000 /- to the complainant under policy number 007269379.

4. On 29.03.2019, Mr. Jatinder Singh Grewal has also confirmed telephonically that he has

received refund of premium under policy mentioned in the complaint. Now, he is satisfied and

requested for closure of the complaint.








CASE OF Mr. Sekh Giasuddin Mandal V/s ICICI Prudential Life Insurance Company


1. On 14.02.2019, Mr. Sekh Giasuddin Mandal had filed a complaint against ICICI Prudential





4. On 27.03.2019, Mr. Sekh Giasuddin Mandal has also confirmed through mail that he has

accepted the offer of Insurance Company and the same has been confirmed by settlement


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CASE OF Ms. Sumanpreet Kaur V/s ICICI Prudential Life Insurance Company


1. On 02.08.2018, Ms. Sumanpreet Kaur had filed a complaint against ICICI Prudential Life

Insurance Company in respect of policy bearing number 21262062.




refunded the premium amount Rs. 1,01,000/- to the complainant under policy number

21262062 and the same has been confirmed by settlement agreement letter dated

28.08.2018.





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CASE OF Ms. Loveleen Kesar V/s ICICI Prudential Life Insurance Company


1. On 02.08.2018, Ms. Loveleen Kesar had filed a complaint against ICICI Prudential Life

Insurance Company in respect of policies bearing numbers 20928677 & 20798142.




refunded the premium amount Rs. 8,01,000/- to the complainant under policies numbers

20928677 & 20798142 and the same has been confirmed by settlement agreement letter

dated 29.08.2018.








CASE OF Mr. Karamjeet Singh V/s ICICI Prudential Life Insurance Company


1. On 18.10.2018, Mr. Karamjeet Singh had filed a complaint against ICICI Prudential Life

Insurance Company in respect of policies bearing numbers 21629447, 21472171 and

21575716.



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refunded the premium amount Rs. 7,00,000/- to the complainant under policies numbers

21629447, 21472171 and 21575716 and the same has been confirmed by settlement









CASE OF Mr. Rama Kant Sharma V/s ICICI Prudential Life Insurance Company


1. On 17.12.2018, Mr. Rama Kant Sharma had filed a complaint against ICICI Prudential Life





refunded the premium amount Rs. 6,00,000/- to the complainant under policy number


06.01.2019.





of 412




CASE OF Mr. Sudagar SinghV/s ICICI Prudential Life Insurance Company


1. On 29.01.2019, Mr. Sudagar Singh had filed a complaint against ICICI Prudential Life





refunded the premium amount Rs. 98,000/- to the complainant under policy number


11.03.2019.








CASE OF Mr. Naresh Kumar Dhuria V/s ICICI Prudential Life Insurance Company


1. On 17.01.2019, Mr. Naresh Kumar Dhuria had filed a complaint against ICICI Prudential




of 412


4. On 29.03.2019, Mr. Naresh Kumar Dhuria has also confirmed through mail that he has

accepted the offer of Insurance Company. Now, he is satisfied and requested for closure of

the complaint.








CASE OF Mr. Raghbir Singh V/s ICICI Prudential Life Insurance Company


1. On 05.02.2019, Mr. Raghbir Singh had filed a complaint against ICICI Prudential Life

Insurance Company in respect of policies bearing numbers 18288480, 18414027,

18302792, 18414076 and 18522259.




refunded the premium amount Rs. 3,59,000/- to the complainant under policies mentioned

in the complaint and the same has been confirmed by settlement agreement letter dated

11.03.2019.





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Case of Mr. Dalvinder Singh v/s DHFL Pramerica Life Insurance Company Ltd.


1. Name & Address of the Complainant Mr. Dalvinder Singh

Village- Banohar, Teh. & Distt. - Ludhiana

Ludhiana-punjab-141102

2. Policy No:

Pol. Issue date

Type of Policy

Premium Amount

Prem. Paying Term & Term of policy

000266877 & 000266876

25.09.2013

Future Idols Gold Assured Money

Rs.27, 000/- Rs.27, 000/-

15/15yrs 15/15 yrs.



Dalvinder Singh Baljit Kaur

Dalvinder Singh Baljit Kaur

4. Name of the insurer DHFL Pramerica Life Insurance Company Ltd.



7. Date of receipt of the Complaint 02.01.2017.


9. Amount of Claim N.A.

10. Date of Partial Settlement N.A.

11. Amount of relief sought Refund of premium.

12. Complaint registered under Rule no:

Insurance Ombudsman Rules 2017

13.1 (c)

13. Date of hearing/place 23.10.2018,17.12.2018,20.02.2018 &29.03.2019/ Chandigarh



For the insurer Mr. Parmal Singh( Manager Legal)



17.) Brief Facts of the Case:

On 02-01-2017, Sh. Dalvinder Singh had filed a complaint in this office against DHFL

Pramerica Life Insurance Company alleging mis-selling of above mentioned 02 policies which

were issued in 2013. He has alleged that at the time of insurance, he was told that the policies

would be single premium and the invested amount would be doubled after three years. After

three years when he approached the insurer for refund of promised amount, he was told that the

policies had lapsed with zero value. He was shocked and approached the insurer for cancellation

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of Policies and refund of deposited amount but his request was rejected with the reason that the

same was out of Free Look Period.

Annexure VI-A has not been received.


As per SCN, the complainant had applied for the above policies after understanding the terms

and conditions of the same and the policies were issued on the basis of signed documents

along with KYC documents submitted by the proposers. The policy bonds under the said

policies were dispatched on 27.09.2013. The complainant had failed to pay the renewal

premium and he was informed to deposit the same vide Renewal Billing Notices dated

26.08.2014 and 25.10.2014.The complaint alleging mis-selling was received on

04.10.2016 i.e. after a gap of 3 years from the date of issuance of policies. The same was

denied vide company’s letter dated 13.10.2016 being out of free look period.


The complainant was given opportunity of personal hearing on 23.10.2018, 17.12.2018, 20.02.2019

&29.03.2019 but neither the complainant nor his representative turned up. Non appearance in

personal hearing indicates that he has nothing to say in this matter. However, the insurance

company was represented Mr. Parmal Singh( Manager Legal) on all the occasions who

requested for dismissal of the complaint, since sufficient opportunities have been given to the

complainant to present his case and the case cannot be kept pending indefinitely. It appears that

the complainant doesn’t wish to pursue the matter since there is no verbal or written

communication from him in spite of best efforts by this office. Under the circumstances, there is


ORDER



policies bearing no’s 000266877 & 000266876, is dismissed in default.



day of March, 2019.

Dr. D. K. Verma

INSURANCE OMBUDSMAN

of 412



INSURANCE OMBUDSMAN-DR. D.K. VERMA

CASE NO-CHD-L-001-1617-1435

Case of Mr. Madan Gopal Jindal Vs Aegon Religare Life Insurance Co.Ltd. (Mumbai)


Complainant

Mr. Madan Gopal Jindal

House No.- 552, Ward No. 10, Iqbal Ganj

Tehsil & Distt.-Ludhiana, Punjab-141001

Mobile No: 9216548996

2. Policy No: DOC

Type of Policy


120713569975 27.07.2012

Rs. 10000/- (Hly)





4. Name of the insurer Aegon Religare Life Insurance Co.Ltd.










Rules, 2017

13.1.(d)

13. Date of hearing/place 12.07.2018,22.11.2018,20.02.2019 &

18.03.2019 /Chandigarh


For the Complainant Absent on 12.07.2018,22.11.2018,20.02.2019

Present on 29.03.2019

For the insurer Mr.Ashish. K.Ovelakar( AVP Legal)

present on 12.07.2018,22.11.2018

Absent on 20.02.2019 & 29.03.2019




On 12.08.2016 Mr. Madan Gopal Jindal had lodged a complaint of misselling in this office against

Aegon Life Insurance co ltd., in respect of Policy bearing No. 120713569975. He has alleged in his

complaint that he has applied for debit card, but was issued above policy and was promised payment of

bonus and other rebates at that time of issuance of said policy. When he complained to the company for

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cancellation of said policy and refund of premium it was rejected by the insurer. Hence feeling

aggrieved, he approached this office to seek justice

As per SCN received from the Insurance Company on 20.01.2017 it is explained that the complainant

was issued three policies bearing no’s 120713569975,120513533649 & 120113407864 out of which he

had complained for the policy no 120713569975 only. The insurer has also submitted SCN on

12.09.2017 in which it is stated that complaint for the first time was received on 05.11.2012 which was 5

months after the issuance of above policy and request for cancellation was denied by the insurer vide

their letter dated 12.11.2012.The second call complaint was made on 22.06.2013.which is after almost

08 months of his first complaint and thereafter the complainant has approached the Hon’ble forum after

almost three years from the final decline by the company.



Mr. Madan Gopal Jindal, the complainant attended the personal hearing on 29.03.2019 and reiterated

the contents of basic complaint. He admitted that he had received the policy documents well in time.


The Insurer’s representative attended the personal hearings on 12.07.2018 and 22.11.2018 but nobody

appeared on 20.02.2019 & 29.03.2019 and neither informed this office regarding their absence.





On going through the various documents available in the file and also hearing the complainant and the

submissions of the Insurance Company, It is observed that the complainant had opted for policy

mentioned in the complaint in July 2012 and it is also submitted by the company that he had taken 03

policies but had complained against only policy bearing no 120713569975. It has been also observed

that after receiving the policy documents, the complainant had ample opportunity to go through the

terms and conditions of the policy but he did not utilize the free look option and had approached the

Insurer alleging mis-selling after 05 months from the issuance of said policy. He complained again on

22.06.2013 i.e. after 08 months from the first complaint but could not get a solution. The complainant

could not give a plausible reason for a waiting period of more than 03 years before filing a subsequent

complaint to this office in August 2016. Hence, the complaint seems to be an after-thought.

of 412

ORDER


by both the parties, there is no need to interfere with the decision of the insurer,

hence, the complaint is dismissed.



day of March, 2019.

D.K.VERMA

INSURANCE OMBUDSMAN

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH (UNDER INSURANCE OMBUDSMAN RULES 2017)

OMBUDSMAN – Dr.D.K.Verma

CASE OF Mr. Shamsher Singh V/s Aegon Religare Life Insurance Co.Ltd. (Mumbai) COMPLAINT

REF. No. : CHD- L-001-1617-1790


Complainant Mr. Shamsher Singh

s/o Sh. Bur Singh, Vill. Kotla Sorian

Distt Ludhiana

Mobile No.- 9814829978

2. Policy No: DOC Type of Policy

Term of policy/ Prem

150414390969, 150714441505 & 150614425022

17.04.2015, 28.08.2015 & 09.07.2015

Aegon Life Flexi Money Back Advantage Ins

Rs. 103699/- Rs. 44267/- Rs. 44000/-

3. Name of the insured Name of the policy holder

Mr. Shamsher Singh

Mr. Shamsher Singh

4. Name of the insurer Aegon Religare Life Insurance Co.Ltd.








12. Complaint registered under Ombudsman Rules

13.1. (d).

13. Date of hearing/place 04.10.2018 & 22.11.2018, 20.02.2019 &

29.03.2019/Chandigarh


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On 02.03.2017 Mr. Shamsher Singh has filed a complaint of mis-selling against Aegon Religare Life

Insurance Co Ltd. in respect of policies bearing no’s 150414390969, 150714441505 & 150614425022.

He has alleged that the above policies were missold to him as single premium policies, but later on when

he found that it was a regular long term plan. He has also alleged that he was assured bonus also which

had accumulated in his earlier policies and to claim that he was asked to take policies with other

companies also and was also promised refund of his invested amount. When he did not receive the

promised benefits, he complained to the Insurer for cancellation of above policies vide his letter dated

02.01.2017 but it was not responded by the insurer. Hence feeling aggrieved, he approached this office

to seek justice.

As per SCN received from the Insurance Company on 31.03.2017 the Insurer has stated that they have

issued the said policies bearing no’s 150414390969, 150714441505 & 150614425022 on the

information in the proposal form and documents submitted by the life assured and the policyholder had

signed the said proposal forms on his own will and consent. The policy documents were sent to the

complainant on 17.04.2015, 29.07.2015 & 09.07.2015 respectively and the customer has complained to

the company on 07.02.2017 which is after a period of one year and 10 months from issuance of first

policy and one year and 06 months from issuance of last policy. The Insurer has also stated that the

policy bearing no 150414390969 is already surrendered and payment of Rs. 25103.99 has been paid

through cheque.



Mr. Shamsher Singh attended the personal hearing on 20.02.2019 & 29.03.2019, reiterated the contents

of the complaint and submitted that he is a farmer, having meagre income and the above policies have

been issued to them fraudulently. He further submitted that he had never applied for surrender payment

under policy bearing no 150414390969 and neither signed and submitted any policy documents for

surrender.


The Insurer’s representative attended the personal hearings on 04.10.2018 and 22.11.2018 but nobody

appeared on 20.02.2019 & 29.03.2019 and neither informed this office regarding their absence.

For the Complainant Absent on 04.10.2018 & 22.11.2018,

Present on 20.02.2019 & 29.03.2019

For the insurer Mr.Ashish. K.Ovelakar( AVP Legal)

Present on 04.10.2018 & 22.11.2018

Absent on 20.02.2019 & 29.03.2019



of 412





On going through the various documents available in the file and also hearing the complainant and the

submissions of the Insurance Company, It is observed that the complainant who is not educated enough

was misguided and missold the above policies, without looking into actual insurance needs and premium

paying capacity of the life assured/ policy holder. It is a fact that the complainant has filed the complaint

after about 18 months from the issuance of the last policy but it is also a fact that the Insurance

Company has not followed the norms related to financial underwriting in a proper manner. Even no

income proof/ income tax return has been taken from the complainant before issuing him policies with

an annual premium of about Rs 02 Lakhs , payable for 10 years. Hence, it is observed that financial

underwriting was lacking and paying capacity of the complainant was also ignored and now insurer

can’t take shelter of free look period. Moreover the fact regarding the delivery of said policies could not

be corroborated by any documentary proof like POD by the insurer. It is also observed that the Insurer

has also released the surrender payment under policy bearing no 150414390969 without obtaining the

consent/policy documents from the complainant.

AWARD


both the parties, an award is passed with a direction to the insurance company to cancel

the policies bearing numbers 150714441505 & 150614425022, since inception and refund

all the premiums collected there-in without interest and without deduction of any charges.

Under policy bearing no 150414390969, the company is advised to refund the premium

received under the policy subject to deduction of the surrender amount already paid by the

company.




k. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall




day of March, 2019

D. K. Verma

INSURANCE OMBUDSMAN

of 412

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF TAMILNADU & PUDUCHERRY

(Under Rule No.17(1) of the Insurance Ombudsman Rules, 2017) COMPLAINT REF: NO: CHN-L-043-1819-0497

Smt.V.Visalatchi Vs Shriram Life Insurance Co. Ltd. AWARD NO: IO/CHN/A/L/0147/2018-19


Complainant

Smt.V.Visalatchi, w/o Shri Vinayagam, No.135-B, Sundara Chozhavaram, Thiruverkadu, Ayapakkam, Thiruvallur-600 077.

2. Policy No/SA /DOC / Pol. Term/Premium Paying Term Premium/Mode Type of Policy

011710065974/Rs .300000/20.10.2017 10 years/10 years Rs.30,000/- (excluding Service Tax)/Yly mode Shriram Assured Income Plan

3. Name of the insured Name of the Policy holder

Smt. V.Visalatchi Smt. V.Visalatchi

Name of the insurer Shriram Life Insurance Company Ltd.

5. Date of Rejection 15.05.2018 and 24.10.2018

6. Ground of Grievance False promise of loan of Rs 3 lacs


Complaint

31.10.2018.


9. Amount of Claim Rs.30,000/- (refund of premium)

10. Date of Partial Settlement Not applicable

11. Amount of relief sought Rs. 30,000/-

12. Complaint registered under Rule 13(1) (d) of the Insurance


13. Date of calling SCN Date of receipt of SCN

05.11.2018 22.11.2018

14. Date of hearing/place 03.01.2019/Chennai


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a) For the Complainant Smt.V.Visalatchi-complainant

b) For the insurer Smt. V.S.Mahalakshmi

16. How the case disposed off Award

17. Date of Award 18.03.2019

18. Brief Facts of the Complaint:- The complainant and the proposer Smt. V.Visalatchi submitted

that she is running a women’s self employed group. She had availed loan from HDFC Bank on three

occasions and she had repaid all the three loans and the loan accounts were closed.

Subsequently HDFC Bank staff Sakthi and Kumaresan advised her to avail bank loan of Rs.3,00,000/-,

for which she has to pay monthly instalment of Rs. 9500/- for three years. She was further informed that

she had to remit Rs.32,000/- in advance towards a deposit , which will be utilised for any default in

repayment of the loan in future. The complainant accordingly paid Rs.32,000/- to Shri Kumaresan,

HDFC Bank staff on 20.10.2017. Sakthi and Kumaresan, the HDFC staff assured the complainant, that

she will receive Rs.300000/- towards loan after 28 days. They also informed her that a she will get a

call from the Bank about her loan. But after 4 days the complainant received only the policy bond from

the respondent insurer. After waiting for 2 months, she went to the Mylapore Branch Office and asked

about her loan. The Mylapore Branch officials informed her that she will not get any loan but only what

she has paid to the insurance company. The complainant realised that she was cheated by the HDFC

officials and has approached this Forum requesting the Ombudsman to direct the insurer to refund the

amount she paid .

Insurer’s Version:

The insurer submitted In their Self Contained Note (SCN) dated 16.11.2018 that the

complainant had taken the policy after knowing all the product features and conditions without any

undue pressure by others, and that she remitted the first premium by cash.

The Insurer further stated that the complainant confirmed all the policy details and did not raise the

issue of assurance of loan at the time Pre Issuance Verification Call (PIVC). She confirmed during the

PIVC that she is taking this policy for her future life and not for the sake of any loan or any other

allurement. After getting her confirmation about her interest in the proposal, the insurer prepared the

policy document bearing No. 011710065974 for a sum assured (SA) of Rs. 3,00,000/- commencing the

risk from 20.10.2017 and issued the same. The complainant did not utilise the Free Look Option which

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was given to her for cancellation of the policy, in case she was not satisfied with the policy terms and

conditions.

Since the complainant applied for cancellation only after the expiry of the Free Look Period, the insurer

declined the request for refund of premium. Moreover the insurer had provided insurance cover and

undertaken the risk on the life of the complainant. Hence the insurer requested the Forum to dismiss

the complaint by taking above facts and circumstances in to account.

19) Reason for Registration of Complaint: This is a case of alleged mis-selling of policies by

giving false promise of future loan and comes within the scope of Rule 13(1) (d) of the

Insurance Ombudsman Rules, 2017.

20) The following documents were submitted to the Forum for perusal.

a) Complainant’s letter dated 08.07.2018 to this Forum.

b) Copy of the proposal form and policy schedule.

c) Complainant’s letter dated 13.04.2018 to the Grievance Redressal Officer (GRO) of the

insurer.

d) Complainant’s letter to insurer sent on 03.10.2018

e) Rejection of request for policy cancellation by the insurer dated 24.10.2018.

f) Insurer’s Self Contained Note(SCN) dated 22.11.2018.

g) Pre-issuance Verification call Recording

h) Annexure VI A submitted by the complainant

i) Insurer’s mail dated 22.01.2019 to the Forum (post-hearing)

21) Result of hearing with both parties (Observations & Conclusion): Based on the

submissions of both the parties made during the hearing and documents submitted, it is

observed as under:

1. Employees of HDFC Bank allegedly influenced the complainant to buy an insurance policy

by making a false promise of a loan of Rs.3 lakh after 2 months and collected Rs. 31,500/-

from her towards premium, making her believe that the payment was a security against any

default in repayment of loan. However as per complainant’s representation dated 13.04.2018

to the insurer, the mis-selling was by the representatives of HDB Financial Services and not

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of HDFC Bank. During the hearing, the representative of the insurer denied any business

relationship between them and HDB Financial Services.

2. The Complainant signed the proposal of respondent insurer and paid Rs.32,000/- by cash.

3. The respondent insurer issued policy No.011710065974 on the life of the complainant for SA

of 3,00,000/- with a yearly mode premium of Rs. 31,350 (including the tax). The Policy was

issued with risk commencing from 20.10.2017 for a term of 10 years and premium paying

term also of 10 years.

4. The complainant approached the insurer for the promised loan and was informed that there

was no such provision to grant loan. The complainant thereafter sought cancellation of the

policy issued and refund of premium.

5. The Insurer took the stand that when the Pre-issuance Verification call was made the

complainant did not disclose the inducements by way of loan offer made to her. Also, the

complainant did not seek to cancel the policy, before the Free-Look period expired.

Therefore, the request for cancellation of the policy and refund of premium was rejected.

6. During the hearing, the insurer’s representative highlighted the fact that the insured

had agreed to take the life insurance policy without any promise of loan payment as

established in the PIVC . But the complainant submitted to the Forum that she was

asked to reply suitably when she receives a call from the insurer so as to get the

promised loan. She admitted her mistake in agreeing to act as per the advice of the

intermediary.

7. As per Proposal form dated 10.10.2017, the policy was procured through an

intermediary with code No. 81258648. The possibility of the policy having been mis-

sold to the complainant cannot be ruled out. The allegation of mis-selling by the

complainant has not been investigated by the insurer with required seriousness.

There was no attempt made by the insurer to contact the various persons named in

the complaint, verify their antecedents and ascertain whether they had a role in the

alleged mis-selling.

8. In response to the query made by the Forum during the hearing as to what action

was taken against the agent named in the policy, the insurer responded post hearing

by their e mail dated 22.01.2019 that the agent concerned had denied mis-selling the

policy. Nevertheless he was warned by them and advised to inform the prospects

correctly about the policy plan and its benefits.

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9. It is evident from the narration of the complainant that she was never informed that

she was being sold an insurance policy. She was promised a loan and the premium

amount was collected in the guise of security against the same. This is prima facie,

evidence of mis-selling.

AWARD

Taking into account the facts and circumstances of the case as also the

written submissions made by both the parties during the course of hearing,

the Forum directs the insurer to cancel the policy No. NN011710065974 and

refund the amount of Rs. 30,000/- to the complainant and in addition pay

interest as per Rule 17(7) of the Insurance Ombudsman Rules, 2017.

The Complaint is, therefore, Allowed.

23) The attention of the Complainant and the Insurer is hereby invited to the following

provisions of the Insurance Ombudsman Rules, 2017:

a. As per Rule 17(6) of the Insurance Ombudsman Rules, 2017 the Insurer shall

comply with the Award within 30 days of the receipt of the award and intimate the


b. As per Rule 17(7) of the said rules the complainant shall be entitled to such

interest at the rate per annum as specified in the regulations, framed under the

Insurance Regulatory and Development Authority of India Act, 1999, from the date

the claim ought to have been settled under the regulations, till the date of

payment of the amount awarded by the Ombudsman.

c. As per Rule 17(8) of the said rules, the award of Insurance Ombudsman shall be

binding on the insurers.

Dated at Chennai on this 18th day of March, 2019.

(M.VASANTHA KRISHNA) INSURANCE OMBUDSMAN STATE OF TAMIL NADU & PUDUCHERY

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PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, STATE OF TAMILNADU & PUDUCHERRY (UNDER RULE NO: 17 (1) of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – SHRI M.VASANTHA KRISHNA

CASE OF: K.SRINIVASA RAO Vs BHARTI AXA LIFE INSURANCE COMPANY LTD.

COMPLAINT NO.: CHN-L-008-1819-0167

AWARD NO: IO/CHN/A/LI/0144/2018-19 1. Name & Address of the Complainant Shri K.Srnivasa Rao

No. 90/1, Second Main Road,

Gandhi Nagar,

Adyar,

Chennai-600 020

2. Policy No.

Sum Assured

Instalment Premium

DOC

Type of Policy

Policy Term

Premium Paying term

Mode of payment

First Unpaid Premium

Status of the Policy


501-3088652

Rs. 2,61,899

Rs. 49,412.89

28/03/15

Bharti Axa Life Samriddhi

10 years

5 years

Annual

28/03/17

Paid-up

K. SRINIVASA RAO

501-3036594

Rs. 15,71,397

Rs. 2,99,999.13

28/03/15

Bharti Axa Life Samriddhi

10 years

5years

Annual

20/04/17

Paid-up

K. SRINIVASA RAO

3. Name of the Life Assured

SRINIVASA ARAVIND SRINIVASA ARAVIND

4. Name of the insurer Bharti Axa Life Insurance Company Ltd.

5. Date of Repudiation Not a case of repudiation. The complainant alleges Mis-selling,

Forgery & mis-representation of the terms and conditions of

the policy.


Not a case of repudiation and hence, not applicable

7. Date of registration of the Complaint 08/06/18

8. Date of receipt of Annexure VI-A 19/06/18

9. Nature of complaint Mis-selling, Forgery & Mis-representation of the terms and

conditions of the policy.

10. Amount of Claim Refund of premiums paid, viz. Rs. 6,98,824.04


12. Amount of relief sought Refund of premiums paid, viz. Rs. 6,98,824.04

13. Complaint registered under Rule No. 13(1) (d) of the Insurance Ombudsman Rules, 2017

14. Date of hearing &

Place of hearing

23/11/2018 &

CHENNAI

15.


a) For the Complainant Shri K.Srinivasa Rao (Complainant)

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b) For the insurer Shri T.Palaniappan, Senior Business Manager,

Bharti AXA Life Insurance Company Ltd., Chennai

16. Complaint how disposed By Award

17. Date of Award/Order 11/03/2019


During the year 2015, the complainant took 2 policies (Nos. 501-3088652 & 501-3036594) on

the life of his son, Shri K.Srinivasa Aravind from Bharti-Axa Life Insurance Company Limited.

The term of the policies was 10 years whilst premium paying term was 5 years. In October

2016, the next instalment of premium under both the policies was also paid. Subsequent

thereto, on 14/03/18, Shri Srinivasa Aravind, herein the Life Assured (LA), sent a mail to the

insurer stating that the two policies were issued without his authorization or signature after his

aged father was cheated by an agent of the insurer. The LA further stated that he never signed

the application forms and didn’t consent for issuance of the policies and hence, requested for

termination of the policies & also, refund of moneys with interest. The insurer, vide its mail

dated 16/03/18, replied (to the LA) that no discrepancies were found at the time of issuance of

the policies and moreso, no communication was received from the LA seeking cancellation of

the policies within the Free Look period. This being so, the insurer conveyed to the LA that his

request cannot be acceded to. Aggrieved, the LA’s father who is the policyholder under both

the policies has filed this complaint.

19) Cause of Complaint: a) Complainant’s argument: The complainant alleged that he was cheated by the insurer’s agent (Ms P.Reshmi) in taking

two policies in the name of his son by mis-representing the terms and conditions of the

policies. The complainant’s contention is that he was told that only two annual premiums are to

be paid under the policies. The complainant’s further contention is that his signature and that

of his son were forged in the proposal forms. The complainant further stated that he was not

finding time to look into the finer issues regarding the terms and conditions of the policies and

also, about forgery of signatures in the proposal forms, during the Free-Look period since his

wife was taking treatment for ESR (End Stage Renal) failure at Apollo Hospitals since August

2014. The complainant requested for cancellation of the policies and refund of the premiums

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paid under both the policies. During hearing, the complainant informed that his son who was

abroad, had only recently pointed out to him the forgery of signatures in the proposal forms.


As the complainant was issued with the policies as per his own requirement and based on the

documents executed by him, he is estopped from seeking cancellation of the policies. Further,

the complainant didn’t raise any issues or objection in PIVC (Pre-Issuance Verification Call).

Moreover, the complainant was given Free-Look period of 15 days to approach the company in

case he is not satisfied with the terms and conditions of the policies. The complainant,

however, retained the policy documents and didn’t raise any concern within the Free-Look

period and instead, raised his grievance for the first time only after around three years from the

issuance of the policies. The matter was duly investigated and the allegations regarding mis-

selling turned out to be bereft of merits. The insurer while denying the allegations concluded

that the issues raised by the complainant are a mere ruse to seek refund of entire amount paid

under the policies to which he is not entitled to. The insurer, therefore, requested for dismissal

of the complaint. During hearing, the insurer’s representative stated that all KYC documents

were submitted by the complainant and policy benefit illustration was also signed by the

policyholder, herein the complainant.

20) Reason for Registration of Complaint: Since the complainant alleges mis-selling, etc.

the complaint is registered under the scope of Rule 13 (1) (d) of the Insurance Ombudsman

Rules, 2017.

21) The following documents were submitted to the Forum for perusal.

a) Proposal forms dated 30/03/15 b) Policy Schedule dated 28/03/15 & 13/04/15 c) First premium Receipts (2 Nos.) d) Terms & conditions of the policy e) Welcome letters f) Mail dated 14/03/18 of the Life Assured for cancellation of the policies g) Reply mail dated 16/03/18 of the insurer h) Investigation report dated 15/03/18 i) Complaint dated 22/05/18 to the Forum j) Annexure VI-A dated nil k) Self Contained Note (SCN) dated 28/09/18 of the insurer

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22) Result of hearing with both parties (Observations & Conclusion): Based on the

submissions of both the parties made during the hearing and documents submitted, it is

observed that:

a) As per the proposal forms and also, policy documents, no broker was involved in the

solicitation of the business. Both the proposals were secured by Ms P.Reshmi, Advisor of the

insurer with code no. 148795.

b) According to the insurer, policy document bearing no. 501-3036594 was delivered on

30/04/15 whilst the date of delivery was 28/04/15 under policy no. 501-3088652. However, the

first request dated 14/03/18 for cancellation of the policies was received after expiry of the

Free Look period (of 15 days from the date of receipt of the policy document). During hearing,

the complainant admitted receipt of the policy documents, as averred by the insurer.

c) The insurer produced copies of the proposal forms, illustration benefit forms and key feature

document forms in respect of both the policies. Post hearing, the insurer submitted the full set

of policy documents. The insurer, in its SCN, mentioned that the policy documents etc. were

sent to the complainant under cover of Welcome letter quoting provisions regarding Free Look

period. Perusal of such Welcome letters reveals that the LA’s attention was brought to the

“Free Look period” provision which is about exercising option to withdraw the policies in case

he does not agree with the terms and conditions thereof.

d) In his complaint, the complainant stated that he was cheated by the Life Advisor of the

insurer by mis-representing the terms and conditions of the policies. His stand is that he was

informed that only two payments (instalments of premiums) are required to be paid for the

policies. His further contention is that his signature and that of his son who is the LA were

forged in the proposal forms. Regarding the delay in approaching the insurer (outside the Free

Look period) for cancellation of the policies, the complainant cited the ill health of his spouse.

During hearing, the complainant reiterated his allegation regarding “forgery of the signatures”

and added that his son who lives abroad only brought the same to his notice.

e) The insurer stated that it is unable to consider the request of the complainant as the

investigation caused by it revealed that no mis-selling had taken place and more so, no

concern was raised during PIVC. Post hearing, the insurer submitted the investigation report

dated 15th March 18 wherein the insurer concluded that the act of the complainant in

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remitting the second instalment of premium under both the policies disproves his contention

that the policies were mis-sold to him. The insurer’s contention is that had the policies been

mis-sold, then the complainant would not have remitted the second instalment of premium.

During hearing, the insurer’s representative informed that late fee (interest) towards delayed

payment of second instalment of premium was waived at the request of the complainant and in

proof thereto, submitted relevant correspondences.

f) In the SCN, the insurer denied the complainant’s allegation regarding mis-representation in

the context that no material was submitted by him to that effect. The insurer’s contention is that

the representations made at the time of solicitation were in line with the product features of the

policies, as confirmed by the PIVC call recordings wherein the complainant didn’t raise any

issues or objections. The insurer’s further contention is that the request made by the LA for

cancellation of the policies was made outside the Free Look period.

g) Based on the documents submitted and the submissions made by both the parties, this

Forum is of the view that no material has been placed before this Forum to prove that the

terms and conditions of the policies were mis-represented to him and also, he was cheated by

the Life Advisor of the insurer. In fact, in his mail dated 14/03/18, the LA who is the

complainant’s son, didn’t say anything regarding mis-representation of the terms and

conditions of the policy. All that he said was his signature and also, that of his father was

forged in the policies. Furthermore, the allegation of “Forgery”, does not come under the

purview of Insurance Ombudsman and this Forum has no jurisdiction to deal with the same.

Apart from this, as contended by the insurer, the first request made on 14/03/18 for

cancellation of the policies was clearly done outside the timelines of the Free Look period.

h) According to the insurer, two annual premiums (due under the policies in the years 2015 &

2016) were paid and hence, in view of the provisions contained in clause 2B of the policies, the

policies acquired Paid-up status. The insurer quoted clause 2B (Paid-up policy) in the SCN

which, “inter alia”, states that once the policy becomes paid-up, the benefits will be reduced to

a Paid-up value which will be payable either on death or on maturity or on surrender. The

policyholder has the option to surrender a Paid-up policy.

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23)

Dated at CHENNAI on this day of 11th March 2019.

(M.VASANTHA KRISHNA) INSURANCE OMBUDSMAN

STATE OF TAMIL NADU & PUDICHERY

PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW


Mr. Athar Parvez .…..…………....…………………………Complainant

COMPLAINT NO: LCK-L-001-1718-0168 Order No. IO/LCK/A/LI/0073/2018-19

Mrs. Nazma Nazeer .…..…………....…………………………Complainant



Mrs. Adila Athar parvez .…..…………....…………………Complainant


V/S

Aegon Life Insurance Co. Ltd....…………………………………… Respondent

1.

Name & Address of the Complainant Mr. Athar Parvez , Mrs. Nazma Nazeer &

Mrs. Adila Athar Parvez

93/103 B, Boocharkahan

Rajbi Road, Kanpur , U.P.

2. Policy No:

Type of Policy


150414392353; (150514408838 & 150414392363)

& 150814471239 respectively

---

---

AWARD

Taking into account the facts and circumstances of the case & the submissions

made by both the parties during the course of the hearing, this Forum is of the

opinion that Insurer’s decision not to cancel the policies (No. 501-3036594 &

501-3088652) is justified and does not warrant interference.

The Complaint is, therefore, not allowed.

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---

---

4. Name of the insurer Aegon Life Ins. Co. Ltd.

5. Date of Repudiation/Rejection ---

6. Reason for repudiation/Rejection Beyond free look period



9. Amount of Claim 42500/- , (39220/- & 55721/-) & 99990/-

10. Date of Partial Settlement ---

11. Amount of relief sought ---

12. Complaint registered under Rule Rule No. 13(1)(C) of Ins. Ombudsman Rule 2017

13. Date of hearing/place On 11.03.2019 at 11.00 am at Lucknow


b) For the Complainant Absent

c) For the insurer Absent



17. Above complaints has been filed against Aegon Life Insurance Co.Ltd. (Respondent) alleging

Mis-selling.

COMPLAINT NO: LCK-L-001-1718-0168,0169,0170&0171 Order No. IO/LCK/A/LI/ /2018-19

18. Brief Facts Of The Case: Above complaints has filed dated 26.05.2017 before this forum alleging

that they have opted for a single premium paying policy but a regular premium paying policy was issued

to them. The Policy was sold to them fraudulently by Aegon Life insurance Co. Ltd. A complaint was

also mailed to the GRO by the complainant regarding the same. Now the complainants approached this

forum for the redressal of their grievance.

Respondent has filed a cumulative SCN with respect to policy nos. 151414392353 ; 150514408838 ;

150414392363 & 150814471239 which is annexed in this complaint. In their combined SCN /reply

stated that above policies were issued on acceptance of proposal of the complainant and policy

document along with detailed terms and condition which were dispatched to their address given in

proposal forms and was duly delivered. Further they have stated that the complainants have not raised

any objections during Free Look period.

19-The complainant has filed complaint latter, annex VIA, Correspondence with respondent and policy

copy while correspondent filed SCN with enclosures.

20. On the last fixed date i.e. 08.02.2019 respondent had sent an e-mail stating that they are ready to

settle the matter by refunding the entire premium amount received by the company with respect to above

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policies. E-mail dated 08.03.2019 of respondent shows that refund of premiums of all four policies has

been made to the policyholders. Email dated 11.03.2019 and 07.03.2019 is also on record in which it is

mentioned that Adila Ather, Ather Parvez & Nazma Parvez has received Rs. 99990, Rs. 42500/- & (Rs.

39220/- & Rs. 55721/-) respectively. As premium amounts of above policies had already refunded by

respondent, hence let above complaints be dismissed as settled.

21. Let copy of award be sent to the complainant & respondent and also keep with complaint no. LCK-

L-001-1718-0169, LCK-L-001-1718-0170 & LCK-L-001-1718-0171.

Dated : March 11, 2019 (G.S. Shrivastava)

Place : Lucknow Insurance Ombudsman



Mr. Dev Narayan Tiwari …..…………....………………. ……………Complainant

V/s

Bharti Axa Life Insurance Co. Ltd...…………………………………Respondent


1. Name & Address of the Complainant Mr. Dev Narayan Tiwari

A/27 Ambedkarnagar,Vijaynagar

Dt- Kanpur (UP)

Pin-208005

2. Policy No:

Type of Policy


501-4141815


29.02.2016



Mrs. Chameli Devi

Mr. Dev Narayan

4. Name of the insurer Bharti Axa Life Insurance Co. Ltd




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9. Amount of Claim ---






d) For the Complainant Absent

e) For the insurer Mohd. Imran Siddiqui



17. Mr. Dev Narayan Tiwari (Complainant) has filed a complaint against Bharti Axa Life Insurance

Company Limited. (Respondent) alleging Mis-selling.

18. Brief Facts Of the Case:- Complainant has stated that the above policy was sold to him fraudulently

stating that a branch is opening at Varanasi in which after one investment pension can


be taken up to 15 years. He has made complaint for cancellation which was rejected. Being aggrieved, the

complainant approached this forum for the redressal of his grievance.

Respondent has filed a cumulative SCN which is annexed in the above complaint.

In their SCN/reply respondent have stated that the above policy was issued on the basis of proposal form

duly signed by the complainant and dispatched through speed post on 18.03.2016 vide SP No

EA778686651IN and delivered on 26.03.2016 with option of free look period but complainant has

approached to the respondent company on 18.01.2017 i.e. after the expiry 10 months of the issuance of the

last policy for cancellation of policy which is after the expiry of free look period.

19-The complainant has filed complaint letter, annex VIA, Correspondence with respondent and policy


20- During hearing complainant remained absent I have heard representative of the respondent and perused

papers filed by complainant and respondent.

21. Policy no. 501-4141815 was issued on 29.02.2016, dispatched on 18.03.2016 through Speed Post no.

EA778686651IN and delivered on 26.03.2016 . A copy of complaint dated 18.01.2017 addressed to branch

manager Bhari Axa Life , Kanpur Nagar written by complainant is on record in which he had requested for

refund of deposited amount. Hence, the complainant had filed his complaint for cancellation after the lapse

of 9 months and complainant had not applied within free look period. The complainant could not produce

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any evidence with respect to allegation of Mis-Selling. Mere allegation is not sufficient to bring the sale of

the policy under purview of Mis-Selling. Complainant is supposed to go through the policy document after

its receipt.

22. In view of the above facts and circumstances, I come to the conclusion that the insurance company has

made a reasonable offer to the complainant for cancellation within free look period which was not availed by

the complainant. Hence, it is clear that the respondent has not erred in not cancelling the policy of the

complainant and complaint is liable to be dismissed.

23. The complaint filed by Mr. Dev Narayan Tiwari stands dismissed herewith.

24. Let copies of Award be given to both the parties.





Mr. Dev Narayan Tiwari …..…………....………………………….. Complainant

V/s

Bharti Axa Life Insurance Co. Ltd...…………………………………Respondent


1.

Name & Address of the Complainant Mr. Dev Narayan Tiwari


Dt- Kanpur (UP)

Pin-208005

2. Policy No:

Type of Policy


501-5081705


20.11.2016



Dev Narayan

Dev Narayan

4. Name of the insurer Bharti Axa Life Insurance Co. Ltd



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f) For the Complainant Absent

g) For the insurer Mohd. Imran Siddiqui



17. Mr. Dev Narayan Tiwari (Complainant) has filed a complaint against the decision of Bharti Axa Life

Insurance Company Limited (Respondent) alleging Mis-selling.

18. Brief Facts Of the Case:- Complainant has stated that the above policy was sold to him fraudulently

stating that a branch is opening at Varanasi in which after one investment pension can be


taken up to 15 years. He has made complaint for cancellation which was rejected. Being aggrieved, the

complainant approached this forum for the redressal of his grievance.

Respondent has filed a cumulative SCN which is annexed in the complaint no. LCK-L-008-1718-0331. In

their SCN/reply respondent have stated that the above policy was issued on the basis of proposal form duly

signed by the complainant and dispatched through speed post on 07.12.2016 vide SP No EA701344559IN

and delivered on 13.12.2016 with option of free look period but complainant has approached to the

respondent company on 18.01.2017 i.e. after the expiry free look period.

19-The complainant has filed complaint letter, annex VIA, Correspondence with respondent and policy copy

while correspondent filed SCN with enclosures.

20. During hearing complainant remained absent I have heard representative of the respondent and perused

papers filed by complainant and respondent.

21. Policy no. 501-5081705 was issued on 20.11.2016, dispatched on 07.12.2016 through Speed Post no.

EA701344559IN and delivered on 13.12.2016. A copy of complaint dated 18.01.2017 addressed to branch

manager Bhari Axa Life , Kanpur Nagar written by complainant is on record in which he had requested for

refund of deposited amount. Hence, the complainant had filed his complaint for cancellation after the lapse of

free look period. The complainant could not produce any evidence with respect to allegation of Mis-Selling.

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Mere allegation is not sufficient to bring the sale of the policy under purview of Mis-Selling. Complainant is

supposed to go through the policy document after its receipt.


made a reasonable offer to the complainant for cancellation within free look period which was not availed by

the complainant. Hence, it is clear that the respondent has not erred in not cancelling the policy of the


23. The complaint filed by Mr. Dev Narayan Tiwari stands dismissed herewith.






Mr.Lalman………………..……....………………. Complainant

V/S

Bharti Axa Life Insurance Co. Ltd...…………………………Respondent

COMPLAINT NO:LCK-L-008-1718-0339 Order No. IO/LCK/A/LI/0089/2018-19

1.

Name & Address of the Complainant Mr. Lalman

Daudpur

Jalaun

2. Policy No:

Type of Policy


501-3958839

Elite Advantage- 12/12

29.01.2016



Mrs. Surya Prabha

Mr. Lalman

4. Name of the insurer Bharti Axa Life Ins. Co. Ltd





9. Amount of Claim 98999/-

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11. Amount of relief sought 98999/-




h) For the Complainant Mr. Lalman

i) For the insurer Mohd. Imran Siddiqui



17. Mr. Lalman (Complainant) has filed a complaint against Bharti Axa Life Insurance Company

Limited (Respondent) alleging Mis-selling.

18. Brief Facts Of the Case:- Complainant has stated that the above policy was sold by the respondent.

He further stated that he was deceived by Mr. Ashok Sharma by making fake promises on phone. He

was also trapped by him by making false promises to refund his money


within some month. He was further told not to inform about this and he forced him to send his document

by which this policy was issued to him.


duly signed by the complainant and policy document was dispatched on 01.03.2016 through Speed Post

No. EA582908685IN and delivered on 08.03.2016 with an option of free look period but complainant

has approached to the respondent company on 07.06.2017 i.e. after 16 months from DOC of the policy

for cancellation of policy which is after the expiry of free look period.

19. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent and

copy of policy document while respondent filed SCN with enclosures.

20. Sincere efforts were made for mediation to resolve the subject matter of complaint. The complainant

and the representative of the respondent company were heard. During course of the mediation, both the

parties filed joint application (Mediation Agreement) duly signed by the complainant and the

representative of the respondent mentioning therein about settlement of the matter willingly and

mutually and agreed to settle the subject matter of the complaint as follows

The respondent Bharti Axa Insurance Co. Ltd. has agreed to cancel the existing policy bearing no.

501-3958839 and issue one single premium policy of Rs. 1,00,000/- with minimum risk coverage in

the name of Ms. Surya Prabha with lock-in period of 5 years after completing the required

formalities by the complainant/ policy holder w.e.f. current date and with no free look option

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without any penalty/ charges after depositing balance amount by the complainant. The

Complainant also agreed for the same.

21. As matter within parties has resolved mutually, hence the complaint is decided in terms

of mediation/mutual agreement between both the parties.

22. Let copies of this award be given to both the parties.





Mr. Dev Narayan Tiwari …..…………....………………………Complainant

V/s

HDFC Life Insurance Co. Ltd...…………………………………Respondent


1.


Complainant

Mr. Dev Narayan Tiwari


Dt- Kanpur (UP)

Pin-208005

2. Policy No:

Type of Policy


18411111

HDFC Life Super Income Plan

20.04.2016





4. Name of the insurer HDFC Standard Life Insurance Co. Ltd








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j) For the Complainant Absent

k) For the insurer Mr. Sudhir Kumar Singh

15. Complaint how disposed Dismissed as Settled


17. Mr Dev Narayan Tiwari (Complainant) has filed a complaint against HDFC Standard Life Insurance

Company Limited. (Respondent) alleging Mis-selling. 18. Brief Facts Of the Case:- Complainant has stated that the above policy was sold to him fraudulently

stating that a branch is opening at Varanasi in which after one investment pension COMPLAINT NO: LCK-L-019-1718-0329 Order No. IO/LCK/A/LI/0085/2018-19

can be taken up to 15 years. He has made complaint for cancellation which was rejected. Being

aggrieved, the complainant approached this forum for the redressal of his grievance.


duly singed by the complainant and dispatched through Blue dart courier service on 30.07.2016 vide No

AWB44271753934 with option of free look period but complainant has approached the respondent

company on 13.01.2017 which was beyond free look period.

19-The complainant has filed complaint letter, annex VIA, Correspondence with respondent and policy


20- During hearing complainant remained absent I have heard representative of the respondent and

perused papers filed by complainant and respondent.

21. Policy no. 18411111 was issued to the complainant on 20.04.2016. During hearing representative of

respondent has filed a letter stating that the company has settled the matter and cheque was sent to the

complainant through speed post. Photocopy of the cheque is also on record.

22. As the company had settled the matter and refunded the premium amount hence, complaint is liable

to be dismissed as settled.

23. Complaint of Mr. Dev Narayan Tiwari stands dismissed as settled.



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Mr. Lalman………………..……....………………. Complainant

V/S

IDBI Federal Life Insurance Co. Ltd...…………………………Respondent


1.


Daudpur

Jalaun

2. Policy No:

Type of Policy


4000227146

IAE&MB Plan

31.08.2010



Mrs. Surya Prabha

Mr. Lalman

4. Name of the insurer IDBI Federal Life Ins. Co. Ltd





9. Amount of Claim 2,75,000/-


11. Amount of relief sought 2,75,000/-




l) For the Complainant Mr. Lalman

m) For the insurer Mr. Sachin Agnihotri



17. Mr. Lalman (Complainant) has filed a complaint against IDBI Federal Life Insurance Company Limited


18. Brief Facts Of the Case:- Complainant has stated that the above policy was sold by the respondent. He

further stated that representative of company had told him that he would get money

liquidated after one year. He had paid 27 month premium but received no return. When he contacted

main branch of luck now they told him that policy is lapsed and money is not to be paid. He is

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deceived by the representative. He is in financial problem. Now he approached this forum for redressal

of his grievance.

In their SCN/reply respondent have stated that the above policy was issued on 31.08.2010 on the basis of

proposal form duly signed by the complainant and policy document was dispatched on 06.09.2010 through

DTDC courier pod no.-M55971137 and delivered on 11.09.2010 with an option of free look period but

complainant has approached to the respondent company on 28.09.2016 (through IRDA site) for cancellation

of policy which is after the expiry of free look period. Company had also sent a renewal notice to the

complainant and complainant had failed to pay amount of renewal premium hence, policy got lapsed on

15.11.2012.Later on policy got terminated on 03.11.2014. Complainant in year 2016 approached the

company with grievance of mis-selling and demanded refund of premium.

19. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent and copy

of policy document while respondent filed SCN with enclosures.

20. I have heard both the parties at length and perused paper filed on behalf of the complainant as well as

the Insurance Company.

21. Policy no. 4000227146 was issued on 31.08.2010 and dispatched on 06.09.2010 through DTDC courier

pod no.-M55971137. The complainant had registered a complaint on IRDA on 28.09.2016 stating that due

to financial condition , he could not pay premium and requested for cancellation of policy & refund of

amount. A copy of e-mail dated 03.06.2017 addressed to Grievance by complainant is on record in which he

had requested to provide some solution. Complainant has filed his complaint after the lapse of free look

period and after depositing the last monthly premium up to 30.09.2012. Complainant had not applied for

refund of money within free look period. The complainant could not produce any evidence with respect to

allegation of Mis-Selling. Mere allegation is not sufficient to bring the sale of the policy under purview of

Mis-Selling. Complainant was in government job and retired. He is supposed to go through the policy

document after its receipt. It is pertinent to mention here that after depositing the monthly premium up to

30.09.2012, complainant had failed to deposit further premiums hence, policy was lapsed on 15.11.2012 and

thereafter policy was terminated on 30.11.2014.


acted in accordance with terms and conditions of the policy and has not erred. Hence, complaint is liable to

be dismissed.

23. The complaint filed by Mr. Lalman stands dismissed herewith.




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PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP


Mr.Lalman………………..……....………………. Complainant

V/S

Exide Life Insurance Co. Ltd...…………………………Respondent


1.


Daudpur

Jalaun

2. Policy No:

Type of Policy


03312943

Guauanteed Income Insurance Plan

29.03.2016



Mrs. Surya Prabha

Mr. Lalman

4. Name of the insurer Exide Life Ins. Co. Ltd


6. Reason for repudiation/Rejection Beyond freelook period





11. Amount of relief sought 49000/-




n) For the Complainant Mr. Lalman

o) For the insurer Mr. Sanjay Chaudhary



17. Mr. Lalman (Complainant) has filed a complaint against Exide Life Insurance Company Limited


18. Brief Facts Of the Case:- Complainant has stated that the above policy was sold by the respondent. He

further stated that he was deceived by broker making fake promises on phone. He was also trapped by

broker by making false promises to refund his money within a year. He can not

continue this policy due to financial trouble.

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duly signed by the complainant and policy document was dispatched on 04.01.2016 through Registered Post

No-RK487277334IN with an option of free look period but complainant has approached to the respondent

company on 12.06.2017 for cancellation of policy which is after the expiry of free look period.

19. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent and copy

of policy document while respondent filed SCN with enclosures.



21. Policy no. 03312943 was issued on 29.03.2016 and dispatched on 01.04.2016 through Registered Post

no. RK487277334IN. A copy of e-mail dated 12.06.2017 addressed to complaints cell of Exide Life written

by complainant’s daughter is on record in which she had requested for possible solution for this policy.

Hence, the complainant had filed his complaint for cancellation after the lapse free look period and

complainant had not applied within free look period. The complainant could not produce any evidence with

respect to allegation of Mis-Selling. Mere allegation is not sufficient to bring the sale of the policy under

purview of Mis-Selling. Representative of the respondent have argued that in this policy as per

complainant’s request amount of premium was reduced to Rs. 25000/- after obtaining fresh proposal form.

Complainant was in government job and retired. He is supposed to go through the policy document after its

receipt.


made a reasonable offer to the complainant for cancellation within free look period which was not availed

by the complainant. Hence, it is clear that the respondent has not erred in not cancelling the policy of the


23. The complaint filed by Mr. Lalman stands dismissed herewith.




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Mr. Dilip Kumar Gupta .…..…………....………………. Complainant

V/S

PNB MET Life Insurance Company Limited...……………………..Respondent


1.

Name & Address of the Complainant Mr. Dilip Kumar Gupta

S/O Sri Tej Prakash Gupta

H.No-166/6,Shastri Nagar

Dt-Kanpur Nagar (UP),208005

2. Policy No:

Type of Policy


20753215

Met Suvidha Participating

16.02.2012



Dilip Kumar Gupta

Dilip Kumar Gupta

4. Name of the insurer PNB Met Life Ins Co. Ltd.


6. Reason for repudiation/Rejection Beyond Look Up Period



9. Amount of Claim --

10. Date of Partial Settlement --

11. Amount of relief sought --




p) For the Complainant Mr. Dilip Kumar Gupta

q) For the insurer Mr. Nitin Yadav , Sr. Executive Operation



17. Mr. Dilip Kumar Gupta (Complainant) has filed a complaint against PNB Met life Insurance

Company Limited (Respondent) alleging Mis-selling.

18. Brief Facts Of The Case: Complainant has stated that he has taken above policy from respondent in

which agent had told that amount deposited in five years shall become double and will be paid. He has

deposited one premium in 2012 and second premium in 2013. Later on he could not deposit further

premium due to bad financial status. He contacted the agent who told him that whole amount shall be

paid after five years. Thereafter he went to the office of respondent where he was told that policy is for

fifteen years. He had applied for return of money but RIC refused to make payment.

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Respondent in their SCN /reply have stated that the policy was issued on acceptance of proposal of the

complainant and policy document along with detailed terms and condition was dispatched to his address

through speed post EK320874187IN on 10.04.2012.After three years they have received an e- mail from

and unregistered e-mail id about reinstatement and surrender formalities. After exchange of some letters

they have explained surrender clause to the complainant. Complainant then alleged misspelling of policy

on 20.02.2017. Further they have stated that the complainant has not raised any objections during Free

Look period.



20. I have heard both the parties at length and perused paper filed on behalf of the complainant as well

as the Insurance Company.

21. Policy no. 20753215 was issued on 16.02.2012 and dispatched on 10.04.2012 through Speed Post no.

EK 320874187IN. A copy of complaint dated 20.02.2017 addressed to CEO PNB Metlife written by

complainant is on record in which he had requested for refund of deposited amount. Hence, the complainant

had filed his complaint for cancellation after the lapse 4.5 years and complainant had not applied within free

look period. The complainant could not produce any evidence with respect to allegation of Mis-Selling.

Mere allegation is not sufficient to bring the sale of the policy under purview of Mis-Selling. Representative

of the respondent have argued that after 3 years correspondence were made by the complainant with respect

to reinstatement and surrender of policy which was accordingly informed to the complainant and after that,

complaint for refund of money alleging mis-selling was received. Complainant is a graduate and business

man. He is supposed to go through the policy document after its receipt.





23. The complaint filed by Mr. Dilip Kumar Gupta stands dismissed herewith.




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Mr. Arun Kumar Niranjan .…..…………....………………. Complainant

V/s

PNB Met Life Insurance Com. Ltd....……………………………………Respondent


1.

Name & Address of the Complainant Dr. Arun Kumar Niranjan

H.No-568KH/49,Geetapalli

Alambagh

Dt- Lucknow

2. Policy No:

Type of Policy


21735229

Met Money Back

24.11.2015



Arun Kumar Niranjan

Arun Kumar Niranjan

4. Name of the insurer PNB Met Life Ins Co. Ltd.


6. Reason for repudiation/Rejection Beyond Free Look Period



9. Amount of Claim --

10. Date of Partial Settlement --

11. Amount of relief sought --




r) For the Complainant Dr. Arun Kumar Niranjan

s) For the insurer Mr. Nitin Yadav , Sr. Executive Operation



17. Mr. Arun Kumar Niranjan (Complainant) has filed a complaint against the PNB Met life Insurance

Company Limited (Respondent) alleging Mis-selling.

18. Brief Facts Of The Case: Complainant has stated that the above policy was sold by the agent of the

respondent by giving wrong information that I have to pay 5 yearly premiums and after 5 years I will get

basic Sum Assured. It was also told that if money is kept for 10 years then I will get money with interest.

Now he is not in a condition to continue the policy, so he requested to cancel the policy and return the

money deposited by him or convert his policy from annual to a single one time policy.

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Respondent in their SCN /reply stated that the policy was issued on acceptance of proposal of the

complainant and policy document along with detailed terms and condition which was dispatched to his

address through Blue Dart courier service on 29.11.2015. Further they have stated that the complainant had

not raised any objections during Free Look period.





21. Policy no. 21735229 was issued on 24.11.2015 and dispatched on 29.11.2015 through Blue Dart courier

no. 40711856323. A copy of complaint dated 18.05.2017 addressed to branch manager PNB Metlife luck

now written by complainant is on record in which he had requested for cancellation. Hence, the

complainant had filed his complaint for cancellation after the lapse 17.5 months and complainant had not

applied within free look period. The complainant could not produce any evidence with respect to allegation

of Mis-Selling. Mere allegation is not sufficient to bring the sale of the policy under purview of Mis-Selling.

Complainant is a doctor and he is supposed to go through the policy document and welcome letter after its

receipt.





23. The complaint filed by Dr. Arun Kumar Niranjan stands dismissed herewith.




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PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND

UNDER INSURANCE OMBUDSMAN RULES 2017

OMBUDSMAN – SMT. SANDHYA BALIGA

CASE OF MR. ANKIT K. MISHRA V/S HDFC STANDARD LIFE INSURANCE COMPANY LTD.

COMPLAINT REF: NO: NOI-L-019-1819-0202

AWARD NO:


Mr. Ankit Kumar Mishra, Flat-T, Dev Heights, Friends Enclave, Shahberi, Crossing Republic Road, Greater Noida, UP-201301.


2028507 HDFC Life Classic Assure Plus Policy Term Insurance of 15 years


Ankit Kumar Mishra Ankit Kumar Mishra



6. Reason for repudiation Beyond Free Look Period.




10. Date of Partial Settlement no


12. Complaint registered under IOB rules

13 (1) (d)

13. Date of hearing/place 15.03.2019

14. Representation at the hearing Noida

c) For the Complainant Mr. Ankit Kumar Mishra, Self

d) For the insurer Mr. Ankush Saini, DM Legal

15 Complaint how disposed Award in favour of complainant


17) Brief Facts of the Case: This complaint is filed by Shri Ankit Kumar Mishra against HDFC

Standard Life Insurance Co. Ltd. relating to mis-selling of Policy No. 20282507.

18) Cause of Complaint: Cancellation of Policy and refund of premium

Complainant’s argument: The complainant, Mr. Ankit Kumar Mishra, had stated in his complainant that the insurance company had sold him life insurance policy no. 20282507 on 30.3.2018 with fraudulent details. They allured him of providing loan over policy bond. Their agents kept him involved over phone calls so he could not cancel the policy within free-look period. When he approached the insurance company for cancellation of policy and return of premium amount of Rs.30,000/- via email

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dated 29.5.2018, he got reply via email dated 1.6.2018 that his request was not received within free look period so they are unable to process the refund of policy. Insurers’ argument: The insurance company in their SCN dated 8.3.2019 has stated that the complainant had taken life insurance policy no. 20282507 on 30.3.2018 in his name by signing the proposal form/CCD. The complainant was given 15 days freelook period to raise any concern for terms and conditions of the policy but the complainant did not raise any issue it means that he was fully satisfied and agreed to the terms and conditions of the policy. The complainant suddenly, on 29.5.2018, raised concern and discrepancy into solicitation and features of the policy and alleged that the policy was sold to him by misrepresentation and giving lure of loan. The policy was issued on the basis of first premium amount and documents received by the insurance company. The insurance company also did Insta Verification successfully before the insurance and the policy was issued after receiving consent from the complainant. During the Insta Verification, the features of the policy were explained and it was also explained that no bonus, gold coin, loan etc. is allied with the policy and if any commitment has been made by the broker, the Company will not be responsible. The above policy was sourced through Netambit Insurance Broker on behalf of HDFC and the allegation that a call was made by the employee/agent of the company for providing loan is incorrect. As per the Law of Estoppel, complainant is estopped from denying the fact of taking the policy as per terms agreed and finalized, thus the company denies the allegations being false and incorrect. 19) Reason for Registration of Complaint: Non refund of premium amount on account of mis-selling

20) The following documents were placed for perusal.

a) Complaint letter b) Proposal Form c) Policy Document d) SCN

21) Result of hearing with both parties (Observations & Conclusion): Both parties appeared for

personal hearing and reiterated their submissions. The complainant stated that an agent of the

insurance company sold him insurance policy by giving him false promise of providing loan against

the insurance policy. He played voice recording of the said agent who kept assuring him that his

loan amount was ready to be disbursed shortly. Later on, when he approached the insurance

company to get his policy cancelled and to initiate refund thereof, his request was denied being

beyond free look period. The complainant had given the reason for delay as he was busy in own

marriage and hence could not apply within the time frame. He approached the insurance company

for refund after two months of the date of issuance of policy. On going through the documents

placed and oral submissions during the hearing and voice call recording, it was observed that it was

a case of mis-selling. Hence, the insurer is directed to cancel the insurance policy and refund the

premium.

AWARD

Taking into account the facts , documents on record and submissions made by both the

parties during the course of hearing, an award is passed with the direction to insurance

company to cancel Policy No. 2028507 and refund the premium.

Hence, the complaint is treated as disposed off accordingly.

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22) The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017: t) According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant shall furnish to the

insurer within a period of 15 days from the date of receipt of this Award, a letter of acceptance that

the Award is in full and final settlement of his claim.

u) As per Rule 16(3) of the said rules the Insurer shall comply with the Award within 15 days of the

receipt of the acceptance letter of the Complainant and shall intimate the compliance to the

Ombudsman.

Place: NOIDA SANDHYA BALIGA Dated: 26.03.2019 INSURANCE OMBUDSMAN (WESTERN U.P AND UTTARAKHAND)

PROCEEDINGS BEFORE




CASE OF MR. HARISH KUMAR V/S HDFC STANDARD LIFE INSURANCE COMPANY LTD.


AWARD NO:


Mr. Harish Kumar, Street No. 01, Adarsh Colony, Vijay Nagar, Ghaziabad, UP - 201009


19779425, 19690833 & 19457032 HDFC Life Classic Assure Plus Policy Term Insurance of 15 years


Harish Kumar Harish Kumar



6. Reason for repudiation Beyond Free Look Period







13 (1) (d)


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v) For the Complainant Mr. Harish Kumar, Self

w) For the insurer Mr. Ankush Saini, D.M. Legal



17. Brief Facts of the Case: This complaint is filed by Shri Harish Kumar against HDFC Standard Life Insurance Co. Ltd. relating to mis-selling under Policy Nos. 19779425, 19690833 and19457032 18. Cause of Complaint: Cancellation of Policies and refund of premium Complainant’s argument: The complainant, Mr. Harish Kumar, had received phone call on behalf of Citi Bank, Delhi on 10.7.17 that he was eligible for 0% interest loan for Rs.4.0 lacs against his life insurance policy from HDFC Life Insurance, towards insurance premium of Rs. 40,000/- p.a. for 10 years. Accordingly, he made payment of Rs. 20,000/- for half yearly premium to HDFC and received Policy No. 19457032. Later on, he was informed that the loan amount had been enhanced to Rs. 50 lacs and he was offered an HDFC insurance policy of Rs. 3 lacs @ 30,000/- p.a. Again he was offered to convert the HDFC policy of Rs. 4 lacs to Rs.2 lacs thereby making policies of Rs. 5 lacs ( 2 lacs + 3 lacs) and premium of Rs. 50,000/- (20,000/- + 30,000/-). The complainant again purchased Policy No. 19690833 dated 11.10.2017. The complainant was informed that his loan is ready for Rs. 2.5 lacs and to avail this he had to deposit TDS of the loan amount @10%. He again took a policy of Rs. 50,000/- against Policy No. 19779425 on 17.11.2017 and deposited the TDS to avail loan. In the meanwhile, he was informed that the TDS would be refunded after loan disbursal and the policy would be surrended. The complainant had paid premium of Rs. 20,000/- + 30,000/-+ and 50,000/- total amounting to Rs. 1 lacs. But, loan was not given to the complainant then he requested the insurance company to refund the premium and TDS amount of Rs. 1 lac paid by him for three insurance policies. The insurance company is refusing to refund the premium amount. Insurers’ argument: The insurance company had stated in their SCN that the policies were issued after explaining the features of the plan to the complainant and accordingly he had signed the proposal forms. The policy documents along with letters were dispatched wherein it was mentioned that in case of non-agreement to any provisions of the policy or the details are wrong in the policy document, the policy can be returned stating the reasons within 15 days from the date of receipt of the policy documents. Three proposals forms were submitted by the complainant in the name of Harish Kumar, on various dates viz. 17.7.2017, 06.10.2017 and 13.11.2017 and policy nos. 19457032, 19690833 and 19779425 were issued respectively. The complainant had understood all the terms and conditions and investment risk involved in the plan and after verifying the details of the policies, he signed the illustration which shows the working and benefits along with all the applicable charges of the plan. A copy of the same was provided to the complainant. He had not approached the company for any of his grievances pertaining to the policies. The policies are in force and cancellation cannot be done. The complainant has not approached the insurance company within the Free Look-in Period and rather approached the Company after more than three months of the expiry of the specified period of 15 days. The complainant had neither alleged any signature forgery nor any mis-communication by the company. 19) Reason for Registration of Complaint: Non refund of premium amount on account of mis-selling 20) The following documents were placed for perusal.

a) Complaint letter b) Proposal Form

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c) Policy Document d) SCN

21) Result of hearing with both parties (Observations & Conclusion): Both parties appeared for personal hearing and reiterated their submissions. The complainant stated that an agent from Citi Bank gave him false assurance, over telephone, of providing him loan @ 0% rate of interest; hence he purchased three policies one by one to enhance his loan limit. The complainant presented recorded voice call of the said agent of Citi Bank wherein he was being informed that the demand draft of the loan amount was ready in the bank and the same would be disbursed to him shortly. The complainant was asked the reason for delay in filing complaint to the insurance company. He informed that he was kept on waiting by Citi bank agent till the month of February 2018 who assured him of disbursement of loan very soon, so he did not make any complaint. After a period of seven months when he did not receive the loan, he approached the insurance company for cancellation of his policies. The complainant is an educated person and an accountant by profession, he should be well aware of the terms and conditions of the policy. The insurance company presented recording of Pre Issuance Verification Call (PIVC) wherein the tele-caller of the insurance company besides being verified all the basic information of the complainant, asked questions whether he was given any false promises of loan or other monetary benefits for purchasing the policy by any agent. PIVC confirmed that the complainant had denied this fact and he also admitted the same at the time of hearing. Hence, the insurance company rejected the request of cancellation of policies being beyond free look period. Ongoing through documents placed during the hearing, it was observed that refund of premium cannot be justified being beyond free look period. The insurer is directed to convert all the three policies into Single Premium Policy with 5 years lock-in period without benefit of free look option.

22. The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017:

a) According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant shall furnish to

the insurer within a period of 15 days from the date of receipt of this Award, a letter of acceptance

that the Award is in full and final settlement of his claim.

b) As per Rule 16(3) of the said rules the Insurer shall comply with the Award within 15 days of the


Ombudsman

PLACE – NOIDA SANDHYA BALIGA DATE- 26.03.2019 INSURANCE OMBUDSMAN

WESTERN U.P. &UTTARAKHAND

AWARD

Taking into account the facts , documents on record and submissions made by both the parties

during the course of hearing, an award is passed with the direction to insurance company to

cancel Policy Nos. 19779425, 19690833 & 19457032 and issue a fresh single premium policy of

Rs. 1,00,000/- which will have 5 years lock-in period without benefit of free look option.


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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND

UNDER INSURANCE OMBUDSMAN RULES 2017 OMBUDSMAN – SMT. SANDHYA BALIGA

CASE OF MAHIPAL SINGH SAINI V/S FUTURE GENERALI LIFE INSURANCE COMPANY LTD. COMPLAINT REF: NO: NOI-L-017-1819-0262

AWARD NO:


Mr. Mahipal Singh Saini, S/o Anup Singh, VPO- Khatauli Jyoti Clinic, Bhoor, Muzaffarnagar, UP-251201.


1294770 20

1311732 12

1313840 18

1281389 12

1314701 18

1318224 20

1283332 20


Mahinder Pal Saini Mahipal Singh Saini

Mahinder Pal Saini Mahipal Singh Saini

Mahinder Pal Saini Rashi Saini

Dimple Saini Dimple Saini

Mahinder Pal Saini Vidhi Saini



4. Name of the insurer Future Generali Life Insurance Co. Ltd.


6. Reason for repudiation Beyond Free-Look Period


8. Nature of complaint Mis Selling


10. Date of Partial Settlement n.a.



13 (1) (d)

13. Date of hearing/place 15.03.2019/Noida


e) For the Complainant Mr. Mahipal Singh Saini, Self

f) For the insurer Mr. Mukesh Nagar, State Head



17) Brief Facts of the Case: This complaint is filed by Shri Mahipal Singh Saini against M/s Future Generali Life Insurance Co. Ltd. relating to mis-selling of life insurance policies in the name of his wife and himself.

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18)Cause of Complaint:

Complainant’s argument: The complainant, Shri Mahipal Singh Saini, had stated that he was misguided by some of the agents of Future Generali Life Insurance Company. They sold him 7 nos. of life insurance policies in the name of his wife and himself bearing policy nos. 1294770, 1311732, 1313840, 1281389, 1314701, 1318224 and 1283332 by influencing him that he would get refund of his old policies. Also he was told that he will get money in the form of pension under women power act. The complainant has requested that he is not able to pay premium of all these policies owing to his economic condition, hence requested to cancel these policies and get the refund. Insurers’ argument: The insurance company in their SCN dated 10.1.2019 has stated that the complainant has taken life insurance policy nos. 1294770 1311732 1313840 1281389 1314701 1318224 & 1283332 in the name of his wife Dimple Saini and himself Mahipal Singh Saini, assuring life of himself, his wife and his daughters. The insurance company has cleared that all the policies are new and not linked with each other, hence, the allegation of the complainant is denied. Further, in respect of policy no. 01318224, the complainant had not approached the GRO of insurance co. and had never raised any concern to the insurance co, hence they are not able to resolve any grievance with regard to the above mentioned policy. They have produced Annexure A, acknowledgement from insurer; vide which the complainant was warned to be aware of any false assurance of loan, gold coin or any other offers. The complainant had signed application forms and benefit illustrations that is evident as Annexure B. The complainant had paid premium for four years for policy no. 01294770 and for two years for policy no. 012833332, hence, it is not possible that he could not recognize the mis-selling of policies. The income of the complainant evident by Annexure C, i.e ITRs, clearly indicates that he has the monetary capacity to pay insurance premiums. Vide Annexure D; it is evident that the complainant had agreed to by all the terms and conditions of policies. This shows the negligence of the complainant. Further, the complainant has approached the insurance company after almost two years of issuance of policies. Also, the complainant had approached the insurance company for cancellation of three policies within free look period, the request was considered and accordingly the premium was refunded for three policies. Hence, the complainant is well aware of the terms and conditions of policies. The complainant had not approached the insurance company for cancellation of his policies within free-look period of 15 days and failed to produce any evidence to prove his contention.

19) Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules, 2017.


a) Complaint Letter b) Rejection Letter c) Policy Document d) SCN

21. Result of hearing with both parties (Observations & Conclusion): Both the parties appeared for personal hearing and reiterated their submissions. The complainant stated that some agents sold him policy nos. 1294770 1311732 1313840 1281389 1314701 1318224 & 1283332 who committed him that they would provide loan against the insurance policies. The complainant also confirmed that proposal forms were not signed by him as his personal details are incorrect. The information in proposal forms vary from each other as in some forms his income is written as 6 lacs per annum and qualification as ‘MBBS’ whereas, the actual qualification of complainant is ‘Diploma in Ayurvedic Medicine’ and his income is Rs.3.20 lacs per annum. Places of signing proposal forms are also manipulated. The total premium of all the 7 policies is Rs.2,95,906/- which is disproportionate to his income. The insurance

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company had stated that they have clarified all the terms and conditions of the policies before issuing. The complainant produced letters issued by Ministry of Finance, NPCI, etc. wherein he had been confirmed about the disbursal of loan which turned out to be fake subsequently. Incorrect personal details and income details in various proposal forms prove that these policies were mis-sold to the complainant. The insurance company agreed to cancel the policies and initiate refund thereof.


c) According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant shall furnish to

the insurer within a period of 15 days from the date of receipt of this Award, a letter of acceptance

that the Award is in full and final settlement of his claim.

d) As per Rule 16(3) of the said rules the Insurer shall comply with the Award within 15 days of the


Ombudsman

PLACE – NOIDA SANDHYA BALIGA DATE- 26.03.2019 INSURANCE OMBUDSMAN WESTERN U.P. & UTTARAKHAND

PROCEEDINGS BEFORE




CASE OF MR. BHARAT BHUSHAN JAIN V/S BHARTI AXA LIFE INSURANCE COMPANY LTD.


AWARD NO:


Mr. Bharat Bhushan Jain, 3, Mahavir Enclave Majra, Dehradun, Uttrakhand-248171.

2. Policy No: Type of Policy

501-6178880 Bharti AXA Life Elite Advantage Plan

AWARD

Taking into account the facts and circumstances of the case and the submissions made by

both the parties during the course of hearing, the insurance company is directed to cancel

policy nos..294770 1311732 1313840 1281389 1314701 1318224 & 1283332 and refund the

premium amount to the complainant.

The complaint is treated as closed accordingly.

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Duration of policy/Policy period Term Insurance of 12 years


Bharat Bhushan Jain Pranjal Jain






9. Amount of Claim 60,179/-

10. Date of Partial Settlement no



13 (1) (d)



g) For the Complainant Mr. Bharat Bhushan Jain, Self

h) For the insurer Mr. Sanjay Mundhra, Cluster Head



20) Brief Facts of the Case: This complaint is filed by Shri Bharat Bhushan Jain against Bharti AXA

Standard Life Insurance Co. Ltd. relating to mis-selling of Policy No. 501-6178880.

21) Cause of Complaint: Cancellation of Policy and refund of premium

Complainant’s argument: The complainant, Mr. Bharat Bhushan Jain, had stated in his complainant dated 17.9.2018 that one of the agent named Anjesh Kamboj visited him for the insurance policy for which he was not paying premium for the last five years. He assured him that he will get the premium refunded from the insurance company. The agent further talked about the five years insurance plan of Bharti AXA Life and pressurizing him to purchase the policy and assured the complainant that later on he will cancel the policy within free look period with full refund. After receiving he policy bond issued the complainant noticed that it was for twelve years whereas he had applied for five years plan. He requested Bharti Axa to cancel the policy and refund the premium amount as he was not able to pay premium for 12 years. Later on, the insurance company has denied his request of cancellation of policy as it is beyond free-look period.

Insurers’ argument: The insurance company in their SCN dated 12.3.2019 has stated that Policy No. 501-6178880 had been issued in the name of Mr. Bharat Bhushan Jain for the life of Pranjal Jain after receiving duly filled in and signed proposal form dated 8.9.2017. The proposal form was signed by the complainant after understanding the key features of the policy. The insurance company thereafter affected Pre Issuance Verification Call (PIVC) on the registered mobile no. of the complainant and he did not raise any concern or issue and he was in complete agreement with the terms and conditions of the policy. The policy documents and all supporting documents were dispatched to the complainant. In the covering letter it was clearly mentioned that if he is not satisfied with the policy, he can withdraw the policy stating reason/s within a period of 15 days from the date of receipt of the policy but the complainant did not revert within 15 days, it means he was agreed with the terms and conditions of the policy. After three months from the issuance of the policy, the complainant alleged that he was misguided and mis-represented that he would have to pay the premium only for five years, whereas he

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was aware that he had to pay premium for 12 years. The allegation of the complainant that the payment term was incorrectly explained to him so he did not want to continue the policy and demanded the refund of premium on 11.1.2018. The insurance company had evaluated the complaint and verified the records alongwith PIVC and sent denial letter dated 20.1.2018. The complainant had sent another letter dated 30.1.2018 and the same was also replied by letter dated 14.2.2018 stating that the company stood by its earlier decision dated 20.1.2018. The complainant had paid renewal premium also. Hence, the allegation of mis-selling is baseless. 19) Reason for Registration of Complaint: Non refund of premium amount on account of mis-selling


a) Complaint letter b) Proposal Form c) Policy Document d) SCN

21) Result of hearing with both parties (Observations & Conclusion): Both parties appeared for personal hearing and reiterated their submissions. The complainant stated that an agent of insurance company sold him term insurance policy as five years terms on 8.9.2017. After receiving documents on 11.1.2018, he came to know that the term of policy is for 12 years. Being a senior citizen, having not enough income to pay the premium for 12 years, he requested the insurance company to cancel the policy and initiate refund on 16.1.2018. His request was refused being beyond free-look period. The insurance company stated that as per their record, the policy was received by the complainant on 5.10.2017 and request for cancellation was received by them on 16.1.2018 i.e. after three month. The complainant stated that he had given the policy documents to the agent for cancellation, who kept the documents with him and returned to him in January, 2018. The insurance company offered to convert the policy it into single premium policy with five years term. On going through the documents placed and oral submissions during the hearing, it was observed that the complainant was sold a policy for 12 years at the age of 61 years. The complainant is an elder person, having annual income of apprs Rs.6 lacs and he cannot pay annual premium of Rs.60,179/- for 12 years. This was the case of mis-selling. The insurer is directed to cancel the insurance policy and refund the premium along with second premium being received by the insurance company via auto-debit payment system..



the insurer within a period of 15 days from the date of receipt of this Award, a letter of

acceptance that the Award is in full and final settlement of his claim.

AWARD

Taking into account the facts , documents on record and submissions made by both the

parties during the course of hearing, an award is passed with the direction to insurance

company to cancel Policy No. 501-6178880 and refund the premium alongwith renewal

premium.


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Ombudsman

PLACE – NOIDA SANDHYA BALIGA DATE- 29.03.2019 INSURANCE OMBUDSMAN WESTERN U.P. &UTTARAKHAND

PROCEEDINGS BEFORE




CASE OF MAHIPAL SINGH SAINI V/S BHARTI AXA LIFE INS. CO. LTD.


AWARD NO:


Mr. Mahipal Singh Saini, S/o Anup Singh, VPO- Khatauli Jyoti Clinic, Bhoor, Muzaffarnagar, UP-251201.


501-5273351 Bharti AXA Life Elite Advantage Plan Term Insurance of 12 years


Mahipal Singh Mahipal Singh

4. Name of the insurer M/s Bharti AXA Life Insurance Co. Ltd.


6. Reason for repudiation Beyond Free-Look Period


8. Nature of complaint Mis Selling

9. Amount of Claim 42,249.00

10. Date of Partial Settlement n.a.



13 (1) (d)



x) For the Complainant Mr. Mahipal Singh Saini, Self

y) For the insurer Mr. Harpal Singh, F.A.



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17) Brief Facts of the Case: This complaint is filed by Shri Mahipal Singh Saini against M/s Bharti AXA Life Insurance Co. Ltd. relating to mis-selling of life insurance policy No. 501-5273351.


Complainant’s argument: The complainant, Shri Mahipal Singh Saini, has stated that he had been misguided by some of the agents of Bharti Axa Life Insurance Company. They sold him life insurance policy No. 501-5273351 for the term of 12 years by tempting him in the way that he would get refund of his all previous policies. Deceived by their words, the complainant had paid a premium amount of Rs. 42,249/- for the aforesaid policy on 28 January, 2017. In the month of August, 2018, he had requested the insurance company for refund of premium but the company is denying to refund the premium Insurers’ argument: The insurance company in their SCN dated 11.3.2019 has stated that Policy No. 501-5273351 had been issued in the name of Mr. Mahipal Singh Saini for the life of himself after receiving duly filled in proposal form dated 17.1.2017 and the same was signed by the complainant after understanding the key features of the policy. The insurance company thereafter affected Pre Issuance Verification Call (PIVC) on the registered mobile no. of the complainant and he did not raise any concern or issue and he was in complete agreement with the terms and conditions of the policy. The policy documents and all supporting documents were dispatched to the complainant on 8.12.2017. In the covering letter it was clearly mentioned that if he is not satisfied with the policy, he can withdraw the policy stating reason/s within a period of 15 days from the date of receipt of the policy but the complainant did not revert within 15 days, it means he was agreed with the terms and conditions of the policy. After a period of around one year and six months from the issuance of the policy, the complainant filed a complaint dated 1.8.2018 alleging that the complainant was told that he would get pension from his earlier policies on taking of new policy from the Bharti Axa Insurance Company. After evaluating the complaint and verifying its records the company informed the complainant vide letter dated 6.8.2018 that his request could not be acceded to as it is beyond free look period. Further the complainant had not paid the renewal premium that was due on 28.1.2018 till date; the policy would acquire lapsed status. The insurance company would provide an option to him to revive the policy within 2 years from the date of last unpaid premium by making payments of all the outstanding premiums and any other procedure to be followed by the company’s underwriting policy. Even if after the revival period of 2 years, the complainant fails to pay the outstanding renewal premiums, the policy would acquire terminated status as on 28.2.2020.

19) Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules, 2017.

20) The following documents were placed for perusal : a) Complaint Letter b) Rejection Letter c) Policy Document d) SCN

20) Result of hearing with both parties(Observations & Conclusion) : Both the parties

appeared for personal hearing and reiterated their submissions. The complainant stated that he had purchased policy no. 501-5273351 from the agents of Bharti Axa Life Insurance Company. They committed him that they would provide loan against the insurance policy. He also confirmed that proposal form is not signed by him. The information in proposal form that his income as Rs. 6 lacs per annum and qualification as ‘MBBS’ is incorrect, whereas, the actual qualification of complainant is ‘Diploma in Ayurvedic Medicine’ and his income is Rs.3.20 lacs

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per annum. The premium of the policy is Rs.42,249/-. The insurance company had stated that they had done PIVC to confirm the details of insurance policy but the complainant did not raise any objection at that time. The complainant produced letters issued by Ministry of Finance wherein he had been informed about the disbursal of loan which turned out to be fake subsequently. So he had not objected at the time of PIVC. The insurance company agreed to cancel the policy and initiate refund thereof.


c) According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant shall furnish to





Ombudsman

PLACE – NOIDA SANDHYA BALIGA DATE- 26.03.2019 INSURANCE OMBUDSMAN WESTERN U.P. &UTTARAKHAND

PROCEEDINGS BEFORE




CASE OF SURESH NAGAR V/S PNB MET LIFE INSURANCE COMPANY LIMITED


AWARD NO:


Sh Suresh Nagar 74, Rza Yakubpur -1, Gautam Budh Nagar, Uttar Pradesh -201009

2. Policy No: Type of Policy

21620240 Life Plan

AWARD

Taking into account the facts and circumstances of the case and the submissions made by

both the parties during the course of hearing, the insurance company is directed to cancel

policy no. 501-5273351 and refund the premium amount to the complainant.


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Duration of policy/Policy period 12 years


Sh. Suresh Nagar Sh. Suresh Nagar

4. Name of the insurer PNB MET Life Insurance Company

5. Date of Repudiation 04-06-2018





10. Date of Partial Settlement None



13 (1) (d)

13. Date of hearing/place Noid / 15.03.2019


z) For the Complainant Sh.Suresh Nagar

aa) For the insurer Sh. Deepak Bakshi

15 Complaint how disposed Award in favour of Insurance company


17) Brief Facts of the Case:- This complaint is filed by Sh. Suresh Nagar against PNB Met Life Insurance Company Limited relating to mis-seling under policy bearing no. 21620240. 18) Cause of Complaint:- Cancellation of policy and refund of premium. Complainants argument :- The complaint stated that a policy bearing no. 21620240 had been mis-sold to him by the agent of insurer on 09-07-2015 and the complainant was told that he has to pay premium for 3 years only. After payment of 3 years premium the complainant can withdraw whole amount under the policy. The complainant visited the office of insurance after making payment of premium for 3 years, there he was told that policy term is 12 years and he has to make payment for the remaining term of policy. Then the complainant requested the insurer for cancellation of policy and refund of premium amount paid but his request had been denied by the insurer. Insurers’ argument:- The insurer stated that a policy named Met College Plan bearing no. 21620240 had been issued on the life of Sh. Suresh Nagar on 14-07-2015 for policy term of 12years after receipt of duly executed proposal form and accordingly policy had been dispatched at the mailing address of the complainant. The complainant had not raised any complaint / objection during the Free – look period , which shows that he was in complete agreement with the terms & conditions of policy. Hence the insurer was unable to accede request for cancellation of policy. 19) Reason for Registration of Complaint: - Mis-selling 20) The following documents were placed for perusal.

a) Complaint letter b) Proposal Form c) Policy document d) SCN

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21) Result of hearing ( Observations and Conclusions ) :- Both parties appeared for personal

hearing and reiterated their submissions. The complainant stated that he had paid premium for

three years . He further stated that he was told that whole amount paid can be withdrawn after 3

years but insurer had denied his request for cancellation of policy and refund of premium. The

insurance company stated that the policy had acquired paid up value.Hence policy could not be

cancelled. However the complainant could apply for surrender of policy . The other option was to

keep the policy in the paid up status and on maturity date he would get paid up value along with

bonus as maturity amount. Finally the complainant agreed for continuation of policy till the date of

maturity.







Ombudsman.

Place: Noida. SANDHYA BALIGA Dated: 26.03.2019 INSURANCE OMBUDSMAN

(WESTERN U.P. & UTTARAKHAND)

PROCEEDINGS BEFORE




CASE OF SH. RAVINDER NAGAR V/S PNB MET LIFE INSURANCE CO. LIMITED


AWARD NO:

1. Name & Address of the Complainant Sh. Ravinder Nagar Vill. Roja Yakubpur, Gautam Budh Nagar Uttar Pradesh- 201009

2. Policy No: 21272013

AWARD

Taking into account the facts and circumstances of the case and the submissions

made by both the parties during the course of hearing, I see no reason to

interfere with the decision of insurance company.


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Type of Policy Duration of policy/Policy period

Life Plan 10 years


Ravinder Nagar Ravinder Nagar

4. Name of the insurer PNB Met Life Insurance Co. Limited


6. Reason for repudiation Beyond Free look period







13 (1) (d)

13. Date of hearing/place Noida


c) For the Complainant Sh. Ravinder Nagar

d) For the insurer Sh. Deepak Bakshi

15 Complaint how disposed Award in favour of Insurance company


17) Brief Facts of the Case:- This complaint is filed by Sh. Ravinder Nagar against PNB Met Life Insurance Company Limited relating to mis-selling under policy no.21272013 18) Cause of Complaint:- Mis-selling Complainants argument :- The complainant stated that he was mis-sold a policy bearing no.21272013 on 28-02-2014 by the agent of the insurer. The agent told him that he had to pay premium for 3 years. Afer payment of 3 years premium complaint requested for refund of premium but he was informed that tne complainant has to pay premium for 10 years. Then the complainant registered complaint for this but his complaint had been cancelled. Insurers’ argument:- The insurer stated that a policy named Met Endowment Saving Plan had been issued on 28-02-2014 for policy term of 10 years on receipt of duly executed proposal form. According the insurer had dispatched the policy document at the mailing address of the complainant vide speed post no. EK431709436IN ON 01-03-2014. The complainant had not raised any objection or complaint during Free Look period which shows that he was in agreement with terms and conditions of policy. The insurer received complaint first time on 09-05-2018 alleging mis-selling by the agent on the pretext of policy for 3 yers only.On receipt of complaint the insurer had verified the complete details of the complainant and it was found that customer is educated enough to understand the basic details and policy features. And based upon the findings the insurer had declined the request as the same was not received during free look period as per terms & conditions of policy. 19) Reason for Registration of Complaint: - Mis-selling 20) The following documents were placed for perusal.

a) Complaint Letter b) Rejection Letter c) Proposal Form d) SCN

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21) Result of hearing ( Observations and Conclusions ) :- Both parties appeared for personal

hearing and reiterated their submissions. The complainant stated that he had paid premium for

three years . He further stated that he was told that whole amount paid can be withdrawn after 3

years but insurer had denied his request for cancellation of policy and refund of premium. The

insurance company stated that the policy had acquired paid up value.Hence policy could not be

cancelled. However the complainant could apply for surrender of policy . The other option was to

keep the policy in the paid up status and on maturity date he would get paid up value along with

bonus as maturity amount. Finally the complainant agreed for continuation of policy till the date of

maturity.







Ombudsman.



PROCEEDINGS BEFORE




CASE OF DINESH KUMAR JAIN V/S PNB MET LIFE INSURANCE COMPANY LTD.


AWARD NO:

1. Name & Address of the Complainant Sh. Dinesh Kumar Jain 103, Uttari Bazar,Main Bazar,Ami Nagar Sarai Baghpat Uttar Pradesh, Pin 250606

2. Policy No: 22179031

AWARD


made by both the parties during the course of hearing, I see no reason to

interfere with the decision of insurance company.


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Type of Policy Duration of policy/Policy period

Life Plan 10 years


Sh. Dinesh Kumar Jain Sh. Dinesh Kumar Jain

4. Name of the insurer PNB Met Life insurance company


6. Reason for repudiation Beyond Free –Look Period







13 (10 (d)



i) For the Complainant Sh. Dinesh Kumar Jain

j) For the insurer Sh. Deepak Bakshi

15 Complaint how disposed Award in favour of Insured.


17) Brief Facts of the Case:-This complaint is filed by Sh. Dinesh Kumar Jain against PNB Met Life Insurance company limited relating to mis-selling in respect of policy no. 22179031. 22) Cause of Complaint:- Mis-selling

Complainants argument :- The Complainant stated that he was mis-sold a policy by the agent of PNB Met life insurance company on 31-3-2017. He stated that the agent told him that on payment of premium of Rs.50,000/-, the sum assured of the policy will be 5 lakh. On receipt of policy document he found that sum assured on the policy bond was Rs.4,05,870/-which was in odd figure. Secondly the agent informed that appreciation in the policy will be 12 to 15% but this was not correct. Therefore the complainant did not deposit the renewal premium and requested on 17-3-2018 for cancellation of policy and refund of premium. The insurer had denied the request vide letter dated 12-9-2018. Insurers’ argument:- The insurer stated that a policy named “PNB Met Life Endowment Savings Plus” policy had been issued on the life Sh.Dinesh Kumar Jain on the basis of duly executed proposal form on 31-3-2017 for policy term of 10 years on annual mode of payment of premium of Rs.50,000/- and sum assured of Rs.405870/-.Accordingly the policy document was dispatched at the mailing address of the complainant on 17-4-2017 through speed post no.EA 175484702 IN that was duly received by the complainant. On receipt of policy document , the complainant for the first time lodged the complaint on 02-6-2018 i.e. after 15 months of receipt of policy document alleging that sum assured under the policy is Rs.405870/- while agent had assured sum of Rs.5 lakh and return of 12to 15%.The complainant never approached for cancellation of policy within the free look period of 15 days and kept quiet for 15 months and remained insured for one year. Thereafter, with the intent to get the premium back alleged mis-selling citing less sum assured. It is to be noted that sum assured was mentioned on the schedule of the policy itself but complainant failed to note it. Keeping in view the above facts the insurer was unable to accede to the request of complainant. 19) Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules 2017.

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a) Complaint Letter b) Policy Document c) Rejection Letter d) SCN

21) Result of hearing with both parties (observation & conclusion)- Both parties appeared and reiterated their submissions. The Complainant stated that he was mis-sold the said policy on promise of appreciation at the rate of 12-15% of the premium amount and was also received policy of odd sum assured amt of Rs. 405870/- whereas he was promised for full sum assured of 5 lakhs. He informed that being an uneducated person can not under stand the policy free look period details. He, however, with the help of his friend read the terms and conditions of the policy and understood that he had been cheated by the agent. He contacted the agent who kept on assuring him. In the mean time however, he met with an accident with a truck on 06.8.2017 in which he was seriously injured and finally recovered in month of Feb 2018. During the hearings, the Insurance Company agreed to cancel the said policy and refund the premium to the complainant. Hence the Insurer is directed to cancel the policy and refund the premium amount of Rs. 50000/- to the complainant. 22. The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017: c) According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant shall furnish to the

insurer within a period of 15 days from the date of receipt of this Award, a letter of acceptance that

the Award is in full and final settlement of his claim.



Ombudsman.

Place: Noida. (SANDHYA BALIGA) Dated: 29.03.2019 INSURANCE OMBUDSMAN


AWARD

Taking into account the facts and circumstances of the case and the submissions made

by both the parties during the course of hearing, the Insurance Company is directed to

cancel the policy and refund the premium. Accordingly, the complaint is disposed off.

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PROCEEDINGS BEFORE




CASE OF SH. ASHOK KUMAR V/S SBI LIFE INSURANCE COMPANY LTD.


AWARD NO:


Sh. Ashok Kumar H.No.124, Gali No. 1, New Defence Colony Muradnagar, Ghaziabad Pin-201206


1 H 304241110 Life Plan Term 10 years and PPT 5 years


Sh. Ashok Kumar Sh. Ashok Kumar

4. Name of the insurer SBI Life Insurance Company


6. Reason for repudiation Beyond Free-look Period







13 (1) (d)

13. Date of hearing/place Noida / 15.03.2015


e) For the Complainant Sh. Ashok Kumar

f) For the insurer MS Anjali Chahar



17) Brief Facts of the Case:- This complaint is filed by Sh. Ashok Kumar against SBI Life Insurance Company relating to Mis-selling under Policy number 1H 304241110 . 18)Cause of Complaint:- Mis-selling. Complainants argument :- The complainant stated that a policy bearing no. 1H30421110 had been mis-sold to him by the Ex –Manager of Muradnagar Branch of the SBI Life insurance company on 1-6-2017.He stated that a part of farming land was sold to the Government and against that the complainant got his account credited with a sum of amount. Then the complainant went to the branch for entry in the passbook and transfer of some amount to his elder brother account. Then the Ex-Manager Ms. Ruchi Tiwari and Sarfarz Saifi approached the complainant and told him that this is a single pay plan and after investing in this plan he will get a minimum of 10-12% of return and some other benefits. The complainant was convinced and agreed to pay a single premium of Rs.5 lakh and further it was facilitated by Priyanka Bansal. He further stated that on receipt of document he found that

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it was 5 year premium payment plan and term was policy was 10 years. Hence the complainant requested the insurer to cancel the policy and refund the premium amount to him. Insurers’ argument:- The insurer stated that a Plan named “SBI LIFE-RETIRE SMART “ bearing policy no. 1H 304241110 had been issued on the life of Sh. Ashok Kumar on annual mode of payment of premium of Rs.5 lakh for term of 5 years and policy term of 10 years with date of commencement as 1-6-2017 on the basis of duly executed proposal form . In case of dissatisfaction with the policy terms and conditions, there was an option to cancel the policy under free-look option of 15 days from the receipt of policy document. However no such representation was received by the insurer. Beside this Pre Issuance Welcome Calls after issuance of the policy was made at registered mobile no. of the complainant and based on his confirmation regarding the basic details of the policy during the call, the policy was issued. Under these circumstances , the insurer was unable to accede to the request for cancellation of policy and refund of premium. 19) Reason for Registration of Complaint: Scope of the Insurance Ombudsman Rules 2017 20) The following documents were placed for perusal.

a) Complaint Letter b) Policy Document c) Rejection letter d) SCN

21) Result of hearing with both parties(Observations & Conclusion):- Both parties appeared for

physical hearing and reiterated their submission. The complainant stated that he had retired from

ordinance factory. He further stated that he was told that it was single pay plan but on receipt of

policy document he found that the premium payment term was 5 years and policy term was 10

years. The insurance company stated that the complainant is retired but is a pensioner and also

agreed that the complainant was over insured. The complainant submitted that he was retired and

receiving pension of Rs.2.5 lakh per year and was unable to pay annual premium of Rs. 5 lakh. The

underwriting flaws are evident. This is a clear case of mis-selling.


a)According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant shall furnish

to the insurer within a period of 15 days from the date of receipt of this Award, a letter of


AWARD


made by both the parties during the course of hearing, the insurance company is

directed to cancel the policy and refund premium amount to the complainant.


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b) As per Rule 16(3) of the said rules the Insurer shall comply with the Award within 15 days of

the receipt of the acceptance letter of the Complainant and shall intimate the compliance to the

Ombudsman.



PROCEEDINGS BEFORE




CASE OF SH. VIJAY KUMAR PATHAK V/S SBI LIFE INSURANCE COMPANY LTD.


AWARD NO:


Sh. Vijay Kumar Pathak B-66 D, Rajat Vihar, Sector -62 Noida, Uttar Pradesh-201301


350108556210 Life Plan 5 years


Sh. Vijay Kumar Pathak Sh. Vijay Kumar Pathak

4. Name of the insurer SBI Life Insurance Company Limited


6. Reason for repudiation Beyond free look period



9. Amount of Claim RS.1,00,000/-


11. Amount of relief sought Rs. ,00,000/-


13 (1) (d)

13. Date of hearing/place Noida/ 15.03.2019


22) For the Complainant Sh. Vijay Kumar Pathak

23) For the insurer Ms. Anjali Chahar



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17) Brief Facts of the Case:- This complaint is filed by Sh. Vijay Kumar Pathak against SBI Life Insurance Company Limited relating to mis-selling in respect of policy bearing number 350108556210. 18) Cause of Complaint : Mis-selling Complainants argument :- The complainant stated that he had purchased a policy bearing no. 3501086210 on 7-6-2011 on annual mode of payment of premium of Rs.49866/- for term of 5 years. The complainant went to deposit third installment of premium in the branch office at Greater Noida, he was told by the Branch Manager Mr. Kumar Gaurav that this policy is not good and told him to take other policy. Mr. Kumar Gaurav further told the complainant to deposit 3 installments of premium in the new policy and the rest 2 installments will be adjusted from old policy and a new policy bearing no. 4057943309 was issued to him on 27-8-2013 for premium of Rs.50,000/-.The complainant continued to deposit premium in new policy but the premium deposited in the old policy was not adjusted in new policy as the old policy was lying in lapse condition. So the complainant requested the insurer to cancel the policy and refund premium. But the insurer rejected the request vide letter dated 27-6-2017 on the ground of beyond free look period. Insurers’ argument:- The insurer stated that on the basis of duly executed proposal form on 29-5-2011with initial deposit of Rs.50,000/- a policy named “ SBI Life Shubh Nivesh-Whole life plan bearing no. 35010856210 had been issued on the life of Sh. Vijay kumar Pathak on annual mode of payment of premium and the term of the policy as 5 years with date of commencement 7-6-2011.The company had received only two premiums under the policy and the policy lapsed due to non - payment of premium since the due date 7-6-2013 and onwards. Further the date of maturity under the policy was 7-6-2016 and as the policy was in lapsed status and only two renewal premiums were paid under the policy, the policy did not acquire any paid up value and policy was not in force on the date of maturity and hence nothing was payable on maturity. Further, the complainant had already availed the insurance cover for the period he had paid the premium, the request of complainant to refund of premium paid under the policy was not maintainable. 19)Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules 2017. 20) The following documents were placed for perusal.

a) Complaint Letter b) Rejection Letter c) Copy of Policy Document d) SCN

21) Result of hearing with both parties(Observations & Conclusion):- Both parties appeared for personal hearing and reiterated their submissions. The complainant stated that that he had taken a policy bearing no. 350108556210 in June-2011 and had deposited 2 installments of premium of Rs.50,000/- each. When the complainant went to deposit third installment of premium in the Greater Noida , SBI Branch, the Branch Manager persuaded not to deposit third premium in the policy and misguided him to take new policy and assured to get the two premiums adjusted in new policy. The complainant also showed the letter issued by the then Branch Manager to this effect which was not admitted by the insurer during hearing. The insurer stated that the company had received only two premiums under the policy and the policy was in lapsed status. The policy did not acquire any paid up value. Hence nothing was payable. During hearing the complainant also made a call to MR. Dubey, Branch Manager of Alpha Commercial Complex, Greater Noida on mobile no.9760320511, who told that Previous Branch Manager Mr. Gaurav used to misguide people to close previous policy and take the new policy as previous policy was not good and did not have much benefits. This is a clear case of mis-selling.

of 412

21. The attention of the Complainant and the Insurer is hereby invited to the following

provisions of Insurance Ombudsman Rules, 2017: a) According to Rule 16(2) of Insurance Ombudsman Rules, 2017, the complainant

shall furnish to the insurer within a period of 15 days from the date of receipt of this Award, a letter of acceptance that the Award is in full and final settlement of his claim.

b) As per Rule 16(3) of the said rules the Insurer shall comply with the Award within 15 days of the receipt of the acceptance letter of the Complainant and shall intimate the compliance to the Ombudsman.



PROCEEDINGS BEFORE




CASE OF MAHIPAL SINGH SAINI V/S SHRI RAM LIFE INSURANCE COMPANY LTD.


AWARD NO:


Sh. Mahipal Singh Saini S/O Anoop Singh, VPO- Khatauli, Jyoti Clinic, Bhoor, Muzaffarnagar, U.P. 251201


NH 131701008654 NH 131701016501 NH 131702012324 NH 131702012335 Life Plan Life Plan All policies for 10 years


Mahipal Singh, Rashi Saini, Vidhi Saini ------------Mahipal Singh----------------------

4. Name of the insurer Shri Ram Life Insurance Company



Beyond Free-Look Period


AWARD

Taking into account the facts and. circumstances of the case and the submissions

made by both the parties during the course of hearing, the insurance company is

directed to cancel policy no. 350108556210 and refund the premium amount paid.


of 412


9. Amount of Claim 49800+49800+49180+47042Total Rs.1,95,822/-




13 (1) (d)

13. Date of hearing/place Noida / 15.03.2019


C) For the Complainant Sh. Mahipal Singh Saini

D) For the insurer Sh. Abhinav k. Tripathi, Sr. Legal Executive



17) Brief Facts of the Case:- This complaint is filed by Sh. Mahipal Singh against Shri Ram Life insurance Company Limited relating to mis-selling in respect of policy no’s NN131702012324 , NN 131702012335 and NN 131701008654 & NN 131701016501. 18) Cause of Complaint:- Mis-selling. Complainants argument :-The complainant stated that he had been sold 2 policies bearing no’s NN 131701008654 and NN 131701016501 on 24-1-2017 & 28-1-2017 by the agent of the insurer on annual mode of payment of premium of Rs. 49800/- each. After some time two more policies were mis-sold in the name of my daughter Rashi Saini and Vidhi Saini without taking signatures on proposal form . The agent misguided the complainant and told the complainant that this time he will get refund of his previous policies. The complainant further stated that he has recording of the agent and requested to take action against agent. The complainant had also requested for cancellation of policy and refund of premium, but his request had been rejected by the insurer on the ground of beyond free look period vide their letter dated dated 14-8-2018. Insurers’ argument:- The insurer stated that in the year 2017 , the complainant had proposed insurance policies for himself and on the life of his daughters Ms. Rashi Saini & Ms. Vidhi Saini by submitting the proposal forms and had deposited proposal deposit amount. Accordingly policy documents were issued and same were dispatched at the mailing address of the complainant along with First Premium Receipt. The complainant had the option for cancellation of the policies within Free Look period of 15 days, which was not availed by the complainant , which shows that he was in agreement with terms and conditions of policy. The insurer further stated that they had covered risk on the life of complainant under all the policies. In view of above insurer was unable to accede to request of the complainant. 19) Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules 2017 20) The following documents were placed for perusal.

a) Complaint Letter b) Rejection Letter c) Policy document d) SCN

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21) Result of hearing with both parties(Observations & Conclusion):- Both the parties appeared for personal hearing and reiterated their submissions. The complainant stated that he had purchased 4 policies from Shri Ram Life insurance company . Two policies were on his own life whereas other two were on the life of his daughters Vidhi and Rashi. He further stated that his personal details were wrongly mentioned in proposal form. Income mentioned in 2 proposal was Rs. 4.42 lakh per annum where as in other two proposal income mentioned was Rs.6 lakh. The complainant is shown as Graduate and Doctor where as he is Diploma in Aurvedic Medicine and his income is Rs.3.20lakh per annum. This clearly shows mis-selling. The insurance company agreed to cancel all the policies and refund the premium amount to the complainant.







Ombudsman.

Place: NOIDA SANDHYA BALIGA Dated: 29.03.2019 INSURANCE OMBUDSMAN (WESTERN U.P AND UTTARAKHAND)

AWARD

Taking into account the facts and circumstances of the case and the submissions made

by both the parties during the course of hearing, the insurance company is directed to

cancel policies bearing no’s NH131701008654, NH 131701016501, NH 131702012335

and NH 1317020123324 and refund the premium amount to the complainant.


of 412

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE

OF ASSAM,ARUNACHAL,MIZORAM, MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA

(UNDER RULE NO:16(1)/17 OF THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN- SHRI K B SAHA

CASE OF Abbas Ali V/S HDFC Standard Life Insurance Co. Ltd.

COMPLAINT REF:NO: GUW-L-019-1819-0266

AWARD NO.

1. Name & Address Of The

Complainant

Abbas Ali

S/o. Hasen Ali P.O. Pokalagi, Pt-II

2.

Policy No.

Type Of Policy

Policy term/Policy Period

19393229,DOC- 22/06/2017 PPT- 7 Yrs.

Mode- Annual, Premium- 48149.00

Life

3. Name of the insured Abbas Ali

4. Name of insurer HDFC Standard Life Insurance Co. Ltd.

5. Date Occurrence of Loss/claim 22/06/2017

6. Details of Loss:

7. Reason For Grievance According to Rule 17(6) of the Insurance


8. Date of receipt of the Complaint 05-Feb-2019

9. Amount of Claim 48149/- & cancellation of policy.


11. Amount of Partial Settlement 0.00

12. Amount of relief sought 0


no: of RPG rules

Rule 13(1)(d)- Misrepresentation of policy terms

and conditions at any time in the policy

document or policy contract.

14. Date of hearing

Place of hearing

06-Mar-2019

Guwahati


a)For the Complainant Mr. Abbas Ali

b)For the Insurer Ms. Juri Hazarika

of 412

16. Complaint how disposed Through Hearing


18. Brief Facts of the Case

The complainant, as mentioned in his

application, received calls from Tapan Das and

Sudip Saha whose mobile no 8230860152 and

8697021170. Both assured him for a loan in lieu

of a policy. Trusting their words he has taken a

policy from HDFC Life on 22/06/2017. After few

days when he called in their said mobile

numbers , both the numbers were switched off.

He has informed all the happenings to the HDFC

Life Bongaigaon Branch and Grievance

Redressal Officer of the insurer on 14.11.2018

but the reply is still awaited. From then the

complainant has felt that he was cheated by

them.

19. Cause Of Complaint 13(1)(d), Mis represenatation

Complainant's Argument:

The policy was sold to him assuring for a loan

which he never received. Without his signature

the policy was issued. So he wants to cancel his

policy and return back the deposited amount.

Insurer's Argument:

The insurer has mentioned in their SCN that the

complaint has no merit as he said in his

application that the policy was issued without

his Signature and without his knowledge. The

PCVC call was successfully done and he made a

complaint after a year of receipt of the policy

document. After receiving the complaint for the

first time on 04/12/2018 alleging that the policy

was mis-sold with a promise of loan by forging

his signatures. In this regard the insurer sent a

reply dated 07/12/2018 requesting the

complainant to submit specimen signature

format and clear copies of signature proofs for

their investigation with regard to forgery

allegation. However they have not received the

requisite documents from him till 25/02/2019.

20. The following documents were

placed for perusal.

1) Application

2) SCN

3) Annexure – A ( Copy of Proposal form)

4) Annexure –B ( Copy of Policy document)

5) Annexure –C ( Copy of letter to the complainant

dated 07/12/2018)

21. Result of hearing with both

parties(Observations & Conclusion)

I have gone through all the documents on record. I have

also carefully heard both the parties. The complainant

of 412

has stated during hearing that he is a school teacher in

MV school in his village. Since he has not got any loan

against his policies so he is not able to continue the

policies. There is no documentary evidence of that

proposed loan. Although there is no evidence of any

forgery or misguidance, considering the limited income

of the complainant, it would be fair to cancel one policy

and another the complainant will continue. During

hearing the complainant has stated that he will be able to

continue the policy no 19393229

AWARD

Taking into account facts & circumstances of the case and the submissions made by both the

parties during the course of hearing this it is clear that the complainant has a small income and it

would be a heavy burden for him to continue both the policies. So this forum directs the insurer to

cancel the Pol no- 19299237. The deposited amount under this policy account will be adjusted

with the 2nd yly

premium of the pol no; - 19393229 and the balance amount, if any will be

refunded to the LA. With this award the forum closes the case.

The attention of the Complainant and the Insurer is hereby invited to the following

provisions of Insurance Ombudsman Rules, 2017:


comply with the award within thirty days of the receipt of the award and intimate


Dated at Guwahati on 6th

day of March” 2019

.............................

INSURANCE OMBUDSMAN

FOR THE STATE OF ASSAM,ARUNACHAL,MIZORAM,

MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA





CASE OF Abbas Ali V/S HDFC Standard Life Insurance Co. Ltd.


AWARD NO.

of 412


Complainant

Abbas Ali

S/o Hasen Ali P.O. Pokalagi, Pt-II

2.

Policy No.

Type Of Policy


19299237, DOC- 15.05.2017, Premium-

53006/= PPT- 7yrs, Term-10 yrs

Life

3. Name of the insured Abbas Ali



6. Details of Loss:




9. Amount of Claim Refund of Rs.53006 & Cancellation of Policy.





no: of RPG rules




14. Date of hearing

Place of hearing

06-Mar-2019

Guwahati


a)For the Complainant Mr. Abbas Ali












numbers but both the numbers were switched

off. He has informed all the happenings to the

of 412

HDFC Life Bongaigaon Branch and Grievance




them.







Insurer's Argument:















allegation.However they have not received the



placed for perusal.

6) Application

7) SCN



Annexure –C ( Copy of letter to the complainant dated

07/12/2018






MV school in his village. Since he has not got any loan

against his policies so he is not able to continue the

policies. There is no documentary evidence of that

proposed loan. Although there is no evidence of any

forgery or misguidance, considering the limited income

of the complainant, it would be fair to cancel one policy

and one whereupon the complainant will continue.

During hearing the complainant has stated that he will be

able to continue the policy no 19393229

of 412

AWARD


parties during the course of hearing it is cleared that since the complainant has a small income

and it would be a heavy burden for him to continue both the policies. So this forum directs the

insurer to cancel the Pol no- 19299237. The deposited amount under this policy account will be

adjusted with the 2nd

yly premium of the pol no; - 19393229 and the balance amount, if any will

be refunded to the LA. With this award the forum closes the case.








.............................

INSURANCE OMBUDSMAN







CASE OF Abdus Sabur Miah V/S HDFC Standard Life Insurance Co. Ltd.


AWARD NO.


Complainant

Abdus Sabur Miah

S/o Abdul Jubbar Vill & p.o.: Bidyar dabri, PT-II,

2.

Policy No.

Type Of Policy


19313884, DOC-22.05.2017,PPT-7yrs,

Premium- 28912/=, Mode- Yly

Life

3. Name of the insured Abdus Sabur Miah


5. Date Occurrence of Loss/claim 22.05.2017

6. Details of Loss:

of 412




9. Amount of Claim Refund of premium Rs.28912/- and cancellation

of policy





no: of RPG rules




14. Date of hearing

Place of hearing

06-Mar-2019

Guwahati


a)For the Complainant Mr.Abdus Sabur Miah


16. Complaint how disposed Through hearing



The complainant as mentioned in his







numbers but both the numbers were switched

off. He has informed all the happenings to the

HDFC Life Bongaigaon Branch and Grievance




them.







Insurer's Argument:



of 412













allegation.However they have not received the



placed for perusal.

10) Application

11) SCN




07/12/2018)






MV school in his village and DOB is 10/02/1961. Since he

has not got any loan against his policies so he is not able

to continue the policies. There is no documentary

evidence of that promised loan. Although there is no

evidence of any forgery or misguidance, considering the

limited income and age of the complainant, it would be

fair to cancel the policy.

AWARD


parties during the course of hearing it is clear that the complainant has a small income and he is

on the verge of retirement, so it would be a heavy burden and meaningless for him to continue

the policy. So this forum directs the insurer to cancel the Pol No 19313884 and refund the deposited

amount.







day of February 2019

.............................

INSURANCE OMBUDSMAN



of 412





CASE OF Hirendra Kr. Bhattacharjee V/S Birla Sun Life Insurance Co. Ltd.


AWARD NO.


Complainant

Hirendra Kr. Bhattacharjee

Kamakhya Colony Pandu,

2.

Policy No.

Type Of Policy


001486054

Life

3. Name of the insured Hirendra Kr. Bhattacharjee

4. Name of insurer Birla Sun Life Insurance Co. Ltd.


6. Details of Loss:

7. Reason For Grievance According to Rule 17(6) of the Insurance Ombudsman

Rules, 2017


9. Amount of Claim 0.00



12. Amount of relief sought 4,00,000.00


no: of RPG rules

Rule 13(1)(b) – any partial or total repudiation of claims by

an insurer

14. Date of hearing

Place of hearing

26-Mar-2019

Guwahati


a)For the Complainant Mr. Hirendra Kr. Bhattacharjee

b)For the Insurer Mr. Dipankar Das

of 412




The complainant mentioned in his complaint letter, he

invested Rs.100000/= in different dates for a period of three

years commencing from 28.02.2018 in Birla Sun Life

Insurance. But the complainant has not received any

communication like premium receipt, policy document etc

till 2018. On 08/05/2018 he obtained a premium paid

certificate dated 08/05/2018 and through this he has come to

know that his policy has been terminated on 28/05/2014.

Since then he has made several correspondences with the

insurer.

19. Cause Of Complaint 13(1)(f)

Complainant's Argument: As mentioned in para 18

Insurer's Argument: Dipankar Das

20. The following documents were placed for

perusal.

1)Complaint letter

2)Premium Paid Certificate

3)SCN





stated during hearing that he accepted the policy at his

higher age too since the sales person of the insurer Mr.

Sunman Majumder narrated him about the policy as it

was an investment cum insurance policy and you would

have to pay only three annual premium Rs.80000/- ,

Rs.10000/= and Rs.10000/- consecutively from 2008 to

2010 and after 8yars he would get Rs.4,00,000/=.

Accordingly he paid on 28th

Feb2008 Rs.80000/-, on 28th

Feb2009 Rs.10000/= and on 19th

Jan2010 Rs.10000/-

Total Rs.100000/- Premium paid certificate, which was

issued on 08/05/2018 by the insurer is also submitted. Till

date he has not received any policy document. The

insurer representative stated that the policy was sent to

the branch as per then practice. So he is not able to

produce any documentary evident of delivery of policy to

the LA.

AWARD

Taking into account facts & circumstances of the case and the submissions made by both the parties during the

course of hearing the forum opines that it is a clear case of mis-selling. Hence the forum directs to the insurer to

refund the deposited amount Rs.10000, 00/- along with interest @2% above bank rate from the date of deposit to the

date of actual payment. With this the forum closes the complaint

of 412

The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance

Ombudsman Rules, 2017:

a. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply with the award within

thirty days of the receipt of the award and intimate compliance of the same to the Ombudsman.


day of March 2019

.............................

INSURANCE OMBUDSMAN







CASE OF Naba Kumar Borah V/S SBI Life Insurance Co. Ltd.


AWARD NO.


Complainant

Naba Kumar Borah

C/o State Bank of India Local Head Office 5th

floor,"B" Block G.S. Road, Dispur

2.

Policy No.

Type Of Policy


04001805709,DOC- 09/09/2003, P-T= SBI LIFE

SCHOLAR, 19YRS TERM, MODE= YLY,

PREMIUM= 13820/

Life

3. Name of the insured Naba Kumar Borah

4. Name of insurer SBI Life Insurance Co. Ltd.


6. Details of Loss:




9. Amount of Claim 50000/=

of 412





no: of RPG rules

Rule 13(1) (c) – any dispute in regard to

premium paid or payable in terms of the policy.

14. Date of hearing

Place of hearing

06-Mar-2019

Guwahati


a)For the Complainant Mr. Naba Kumar Borah

b)For the Insurer Ms Moumita Das




As per policy document, issued to the LA the

first survival benefit was due on 09/09/2018.

The policy is known as SBI Life Scholar policy

where beneficiary is his child Sri Bhabarnab

Kachyap. The DOB of the beneficiary is

07.09.2000. As per the policy condition the 1st

SB due on the date of attaining 18yrs of the

beneficiary. Hence, the 1st SB shall fall due on

the policy anniversary following the date of

maturity.

19. Cause Of Complaint 13(1)(b)


The due SB on 09/09/2018 has not been

received by him till the date of complaint, even

after several correspondences made by him with

the insurer. But no satisfactory reply has been

received by him.

Insurer's Argument:

Through SCN the insurer has informed that it is

a printing mistake only and the insurer has sent

an endorsement to the complainant stating the

correct due date of last premium as on

09/09/2020 and due date of first Survival

Benefit as on 09/09/2019 vide letter dated

09/10/2018. Enclosed Annexure - D


placed for perusal.

1)Application

2)Copy of Policy Document

3)SCN

4) Copy of Endorsement

of 412

21. Result of hearing with both parties(Observations &

Conclusion)

The forum has gone through all the documents on

record and also has carefully heard both the

parties.

As per the policy condition the Survival Benefit is

due “On the Life assured surviving to the date on

which the Named Child attains the age of 18 years.

(The Date of Maturity).” The DOC is 09/09/2003.

The child has attained 18 years on 07/09/2018.

Hence, the next policy anniversary i.e on

09/09/2018 the survival benefit is due. The

endorsement, in view of this , becomes ultra virus

and it set aside.

AWARD

Taking into account facts & circumstances of the case and the submissions made by

both the parties the forum decides that the 1st SB is due on 09/09/2018. Hence, the

forum directs the insurer to make payment of 1st SB due on 09/09/2018 and confirmed

the subsequent SB will be due accordingly.







day of February 2019.

.............................

INSURANCE OMBUDSMAN






OMBUDSMAN- SHRI K B Saha

CASE OF Sahedul Haque V/S HDFC Standard Life Insurance Co. Ltd.


AWARD NO.

of 412


Complainant

Sahedul Haque

S/o Ukil Ali Vill:Pokalagi,Pt-II P.S. Golakganj

2.

Policy No.

Type Of Policy


19353366, DOC- 06.06.2017,PPT-7yrs, Term-

10Yrs, Premium- 28912/- Mode- Yly

Life

3. Name of the insured Sahedul Haque



6. Details of Loss:




9. Amount of Claim Refund of Rs.28912/ & cancellation of policies.





no: of RPG rules




14. Date of hearing

Place of hearing

06-Mar-2019

Guwahati


a)For the Complainant Mr. Sahedul Haque











days, when he called in their said mobile

numbers both the numbers were switched off.

He has informed all the happenings to the HDFC

of 412





them.

19. Cause Of Complaint

Rule 13(1)d)- Misrepresentation of policy terms








Insurer's Argument:







document. The insurer received the complaint

for the first time on 30/11/2018 alleging that

the policy was mis-sold with a promise of loan

by forging his signatures. The insurer sent a








placed for perusal.

14) Application

15) SCN








during hearing stated that he has a small business but

from that income he is not able to run his family

properly. As assured by the sales person he has not

received any loan against these policies, so he is not able




limited income of the complainant, it would be fair to

cancel his policies.

of 412

AWARD


parties during the course of hearing it is clear that the complainant has a small income and it

would be a heavy burden for him to continue both these policies. So this forum directs the insurer

to cancel both the Policies ( Pol No 19353366 & 19483203 ) and refund the deposited amount.






Dated at Guwahati on 6th day

of February 2019

.............................

INSURANCE OMBUDSMAN

FOR THE STATE OF,ARUNACHAL,MIZORAM, MANIPUR

,NAGALAND,TRIPURA, MEGHALAYA


OF ,ARUNACHAL,MIZORAM, MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA



CASE OF Sahedul Haque V/S HDFC Standard Life Insurance Co. Ltd.


AWARD NO.


Complainant

Sahedul Haque

S/o Ukil Ali Vill: Pokalagi,P-II P.S. Golakanj

2.

Policy No.

Type Of Policy


19483203, DOC-26/07/2017,PPT-7yrs,

Term- 10yrs, Premium- Rs.34,105/= Mode- Yly

Life

3. Name of the insured Sahedul Haque



6. Details of Loss:


of 412



9. Amount of Claim Refund of Rs.34105/= & Cancellation of Policy





no: of RPG rules

Rule 13(1)(d)- Misrepresentation of policy

terms and conditions at any time in the policy


14. Date of hearing

Place of hearing

06-Mar-2019

Guwahati


a)For the Complainant Mr. Sahedul Haque





The complainant as mentioned in his

application he received calls from Tapan Das

and Sudip Saha whose mobile no 8230860152

and 8697021170. Both assured him for a loan

in lieu of a policy. Trusting their words he has

taken a policy from HDFC Life on 22/06/2017.

After few days while called in their said mobile

numbers but both the numbers switch off. He

has informed all the happenings to the HDFC





them

19. Cause Of Complaint

Rule 13(1)d)- Misrepresentation of policy terms


document or policy contract






Insurer's Argument: The insurer has mentioned in their SCN that the

of 412






document. The insurer received the complaint

for the first time on 30/11/2018 alleging that

the policy was mis-sold with a promise of loan

by forging his signatures. The insurer sent a








placed for perusal.

18) Application

19) SCN








during hearing stated that he has a small business but

from that income he is not able to run his family

properly. As assured by the sales person he has not

received any loan against these policies, so he is not able




limited income of the complainant, it would be fair to

cancel his policies.

AWARD


parties during the course of hearing it is clear that the complainant has a small income and it

would be a heavy burden for him to continue both these policies. So this forum directs the insurer

to cancel both the Policies ( Pol No 19353366 & 19483203 ) and refund the deposited amount.






Dated at Guwahati on 6th day

of February 2019

.............................

INSURANCE OMBUDSMAN

FOR THE STATE OF,ARUNACHAL,MIZORAM, MANIPUR

,NAGALAND,TRIPURA, MEGHALAYA

of 412

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