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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
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. 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
Name of the Proposer
Mr. Anandkumar R Tadvi
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
6 Date of receipt of complaint 19/01/2017
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. Anandkumar R Tadvi
Mr Nitesh Jain
16 Complaint how disposed Award
17 Date of Award/Order 29/03/2019
18. Brief facts of the case:
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.
Dated at Ahmedabad on 29th March, 2019.
M. Vasantha Krishna Insurance Ombudsman
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. 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
Name of the Proposer
Mr. Anandkumar R Tadvi
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
not within free look period
6 Date of receipt of complaint 19/01/2017
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. Anandkumar R Tadvi
Mr Nitesh Jain
16 Complaint how disposed Award
17 Date of Award/Order 29/03/2019
18. Brief facts of the case:
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.
Dated at Ahmedabad on 29th March, 2019.
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
7. Date of receipt of Annexure VI-A 28.05.2018
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
14. Representation at the hearing
a) For the Complainant Self
b) For the Respondent
Insurer
Mr. Sagar -- ASM
15. Complaint how disposed Allowed
16. Date of Award/Order 25.03.2019
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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
Page 15 of 412
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
Page 16 of 412
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’.
23) 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.
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
FOR THE STATE OF KARNATAKA
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
1. Name & Address of the
Complainant
Mr. Mohan Menon
Delphi-2 Flat No 404,
Prestige Acropolis, No 20, Hosur Road
Next to Forum Mall
Page 17 of 412
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
Name of the Policyholder
Mr. Mohan Menon
4. Name of the Respondent Insurer PNB MET Life Insurance Company Limited
5. Date of Repudiation/Rejection 06.04.2018
6. Reason for repudiation/Rejection Policy Cancellation Request received beyond
Cooling Off period
7. Date of receipt of Annexure VI-A 09.05.2018
8. Nature of complaint Fraudulent mis-Sale of the above 2 policies
9. Amount of claim (1) ₹.3,00,000/- (2) ₹.3,00,000/-
10. Date of Partial Settlement Nil
11. Amount of relief sought ₹.6,25,000/-
12. Complaint registered under Rule
No:
13 (1) (c) 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. Sagar -- ASM
15. Complaint how disposed Allowed
16. Date of Award/Order 25.03.2019
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
Page 18 of 412
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.
Page 19 of 412
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’.
Page 20 of 412
24) 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.
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
FOR THE STATE OF KARNATAKA
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.
5. Date of Repudiation/Rejection 27.03.2018
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/-
Page 21 of 412
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
14. Representation at the hearing
a) For the Complainant Mr. Uday Kumar Jain
b) For the insurer Mr.Abhishek Kiro, Financial Advisor
15. Complaint how disposed Recommendation
16. Date of Award/Order 05.03.2019
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
Page 22 of 412
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.
Name & Address of the
Complainant
Mr. Ramesh Magwane,
House no. 7778, N-1, A sector,
Govindpura, BHEL,
Bhopal
2. Policy No:
Type of Policy
Duration of policy/DOC
01346305
Future Generali Assure Plus
30.04.2017
3. Name of the insured
Name of the policyholder
Miss Kirti Mangwane
Mr. Ramesh Mangwane
4. Name of the insurer Future Generali Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection Lapse of free look period
7. Date of receipt of the Complaint 11.10.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.1,00,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs.1,00,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 00.03.2019 at Bhopal
Page 23 of 412
14. Representation at the hearing
c) For the Complainant Mrs. Nirmla, wife of complainant
d) For the insurer Mr. Shashank Putambekar, Dy.Manager
15. Complaint how disposed Recommendation
16. Date of Award/Order 06.03.2019
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
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 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.
Page 24 of 412
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 06, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
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.
Name & Address of the
Complainant
Mr. Gyasuddin Khan,
Ward No. 16,
Junardev Dist. Chhindwara
2. Policy No:
Type of Policy
Duration of policy/DOC
NP011710102062, NP011709186622,
NP011711143835
Shriram New Shri Life Plan
25.10.2017, 28.09.2017, 27.11.2017
3. Name of the insured
Name of the policyholder
Mr.Gyasuddin Khan
-same-
4. Name of the insurer Shriram Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 17.10.2018
6. Reason for repudiation/Rejection Reason of cancellation not acceptable
7. Date of receipt of the Complaint 03.10.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 2,00,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs. 2,00,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 00.03.2019 at Bhopal
14. Representation at the hearing
e) For the Complainant Mr. Gyasuddin Khan
f) For the insurer Mr. Mridul Kushwah, Regional Operation
Manager
15. Complaint how disposed Dismissed
16. Date of Award/Order 07.03.2019
Page 25 of 412
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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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
Page 26 of 412
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)
Place : Bhopal Insurance Ombudsman
Mr. Ramesh Kumar Bele.…..…….………....………………. Complainant
V/S
Shriram Life Insurance Co.Ltd.………………..………………Respondent
COMPLAINT NO: BHP-L-043-1819-0310 ORDER NO: IO/BHP/A/LI/ 0351/2018-2019
1.
Name & Address of the
Complainant
Mr. Ramesh Kumar Bele
Ward No. 17, Datlawadi
Junardev Dist. Chhindwara
2. Policy No:
Type of Policy
Duration of policy/DOC
NN11712120215, NP011712246363
Assured income, New Shri Life Plan
22.12.2017, 28.12.2017
3. Name of the insured
Name of the policyholder
Ms.Gunjan Bele, Mr.Ramesh Bele
Mr. Ramesh Bele
4. Name of the insurer Shriram Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 17.10.2018
6. Reason for repudiation/Rejection Reason of cancellation not acceptable
7. Date of receipt of the Complaint 03.10.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 2,00,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs. 2,00,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 00.03.2019 at Bhopal
Page 27 of 412
14. Representation at the hearing
g) For the Complainant Mr. Gyasuddin Khan, representative of complainant
h) For the insurer Mr. Mridul Kushwah, Regional Operation Manager
15. Complaint how disposed Dismissed
16. Date of Award/Order 07.03.2019
Mr. Ramesh Kumar Bele (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 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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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 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.
Page 28 of 412
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. Ramesh Kumar Bele stands dismissed herewith.
Let copies of Award be given to both the parties.
Dated : March 07, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mrs. Najmunnisha Khan..…..…….………....………………. Complainant
V/S
Shriram Life Insurance Co.Ltd.………………..………………Respondent
COMPLAINT NO: BHP-L-043-1819-0311 ORDER NO: IO/BHP/A/LI/ 0353 /2018-2019
1.
Name & Address of the
Complainant
Mrs. Najmunnisha Khan,
Ward No. 16,
Junardev Dist. Chhindwara
2. Policy No:
Type of Policy
Duration of policy/DOC
NN011712171749
Shriram Life Assured income plus
27.12.2017
3. Name of the insured
Name of the policyholder
Mrs.Najmunnisha Khan
-same-
4. Name of the insurer Shriram Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 17.10.2018
6. Reason for repudiation/Rejection Reason for cancellation not acceptable
7. Date of receipt of the Complaint 03.10.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 1,50,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs. 1,50,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 00.03.2019 at Bhopal
14. Representation at the hearing
i) For the Complainant Mr.Gyasuddin Khan, Complainant’s husband
j) For the insurer Mr. Mridul Kushwah, Regional Operation
Manager
15. Complaint how disposed Dismissed
16. Date of Award/Order 07.03.2019
Page 29 of 412
Mrs.Najmunnisha 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 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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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.
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.
Page 30 of 412
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 policy of the complainant and complaint is liable to be dismissed.
The complaint filed by Mrs. Najmunnisha Khan stands dismissed herewith.
Let copies of Award be given to both the parties.
Dated : March 07, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mr. Sunil Rathore..…...…..…….………....………………. Complainant
V/S
DHFL Pramerica Life Insurance Co.Ltd.………………..……Respondent
COMPLAINT NO: BHP-L-013-1819-0314 ORDER NO: IO/BHP/A/LI/ 0355 /2018-2019
1.
Name & Address of the
Complainant
Mr. Sunil Rathore,
Ward No.11, Kathali Bazar Sironj,
Dist.Vidisha (MP)
2. Policy No:
Type of Policy
Duration of policy/DOC
GC0000370056300, GC000370151800
DHFL Group Credit Life
20.12.2017, 26.12.2017
3. Name of the insured
Name of the policyholder
Mr. Sunil Rathore
4. Name of the insurer DHFL Pramerica Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 22.10.2018
8. Nature of complaint Less payment of surrender value
9. Amount of Claim Rs. 40,235/-
10. Date of Partial Settlement
11. Amount of relief sought Rs. 40,235/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 18.03.2019 at Bhopal
14. Representation at the hearing
Page 31 of 412
k) For the Complainant Mr. Sunil Rathore
l) For the insurer Mr. Sprarsh Dwivedi, Sr.Training manager
15. Complaint how disposed Dismissed
16. Date of Award/Order 18.03.2019
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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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.
Page 32 of 412
The complaint filed by Mr. Sunil Rathore stands dismissed herewith.
Let copies of Award be given to both the parties.
Dated : March 18, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mr.Kishori Sharan Chourasiya…..…………....………………. Complainant
V/S
Future Generali India Life Insurance Co.Ltd.……………..……Respondent
COMPLAINT NO: BHP-L-017-1819-0369 ORDER NO: IO/BHP/A/LI/ 0358 /2018-2019
1.
Name & Address of the
Complainant
Mr. Kishori Sharan Chourasiya,
310 Vijay Puram Colony Behind Mahal,
Shivpuri
2. Policy No:
Type of Policy
Duration of policy/DOC
01322553
Future Generali Pearls Guarantee
31.12.2016
3. Name of the insured
Name of the policyholder
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
7. Date of receipt of the Complaint 19.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 49000/-+Rs.25111/- = Rs.74,111/-
10. Date of Partial Settlement
11. Amount of relief sought Rs. 49000/-+Rs.25111/- = Rs.74,111/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 20.03.2019 at Bhopal
14. Representation at the hearing
m) For the Complainant Mr. Kishori Sharan Chourasiya
n) For the insurer Mr. Shashank Putambekar, DM
15. Complaint how disposed REcommendation
16. Date of Award/Order 20.03.2019
Mr. Kishori Sharan Chourasiya (Complainant) has filed a complaint against Future Generali
India Life Insurance Co.Ltd. (Respondent) alleging Mis-selling.
Page 33 of 412
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.
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 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 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
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 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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 20, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 34 of 412
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.
Name & Address of the
Complainant
Mr. Kishori Sharan Chourasiya,
310 Vijay Puram Colony Behind Mahal,
Shivpuri
2. Policy No:
Type of Policy
Duration of policy/DOC
18793696 & 18870708
HDFC Classicassure Plus
09.11.2016, 23.12.2016
3. Name of the insured
Name of the policyholder
Mr. Kishori Sharan Chourasiya
-same-
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 17.09.2018
6. Reason for repudiation/Rejection Lapse of Free look period
7. Date of receipt of the Complaint 19.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 90000 + Rs.100000/-=1,90,000/-
(2-2 premiums in both policies)
10. Date of Partial Settlement
11. Amount of relief sought Rs. 90000 + Rs.100000/-= 1,90,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 20.03.2019 at Bhopal
14. Representation at the hearing
o) For the Complainant Mr. Kishori Sharan Chourasiya
p) For the insurer Mr. Kunal Kumar, DM-Ops
15. Complaint how disposed Recommendation
16. Date of Award/Order 20.03.2019
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
Page 35 of 412
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 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
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 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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 20, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 36 of 412
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.
Name & Address of the
Complainant
Mohd. Saeed,
House No.B-799 Mulla Colony,
B-Sector, Housing Board,Karond,
BHOPAL
2. Policy No:
Type of Policy
Duration of policy/DOC
20351004
HDFC Life Classicassure plus
26.04.2018
3. Name of the insured
Name of the policyholder
Mohd. Saeed
-
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 02.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.51,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs.51,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 26.03.2019 at Bhopal
14. Representation at the hearing
q) For the Complainant Mr. Mohd. Saeed
r) For the insurer Mr. Kunal Kumar, DM-OPS
15. Complaint how disposed Recommendation
16. Date of Award/Order 26.03.2019
Mohd.Saeed (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 policy was mis-sold to him by
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.
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 via speed post with option of free
Page 37 of 412
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 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
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 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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 26, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mohd. Saeed..…...…..…….………....………………. Complainant
V/S
PNB Met Life Insurance Co.Ltd.…………………..……..……Respondent
COMPLAINT NO: BHP-L-033-1819-0328 ORDER NO: IO/BHP/R/LI/ 0361 /2018-2019
1.
Name & Address of the
Complainant
Mohd. Saeed,
House No.B-799 Mulla Colony,
B-Sector, Housing Board,Karond,
BHOPAL
Page 38 of 412
2. Policy No:
Type of Policy
Duration of policy/DOC
22461913 & 22573060
PNB Met Life Endowment Saving Plan
16.02.2018, 30.05.2018
3. Name of the insured
Name of the policyholder
Mohd. Saeed
-
4. Name of the insurer PNB Met Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 02.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 20,600/- + Rs.35,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs. 20,600/- + Rs.35,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 26.03.2019 at Bhopal
14. Representation at the hearing
s) For the Complainant Mr. Mohd. Saeed
t) For the insurer Mr. Avinash Sharma, CSM
15. Complaint how disposed Recommendation
16. Date of Award/Order 26.03.2019
Mohd.Saeed (Complainant) has filed a complaint against PNB Met 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 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
refund of premium amount, but no action was taken by the respondent. The complainant
approached this forum for refund of premium amount.
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.
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
complainant and the representative of respondent company were heard. During course of
Page 39 of 412
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 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
complainant/ policy holder w.e.f. current date and with no free look option without any penalty/
charges after. The Complainant also agreed for the same.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 26, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mohd. Saeed..…...…..…….………....………………. Complainant
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.
Name & Address of the
Complainant
Mohd. Saeed,
House No.B-799 Mulla Colony,
B-Sector, Housing Board,Karond,
BHOPAL
2. Policy No:
Type of Policy
Duration of policy/DOC
501-7025171
Elite advantage
27.03.2018
3. Name of the insured
Name of the policyholder
Mohd. Saeed
-
4. Name of the insurer Bharti Axa Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 16.10.2018
6. Reason for repudiation/Rejection Lapse of free look period
7. Date of receipt of the Complaint 02.11.2018
Page 40 of 412
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 99,998/-
10. Date of Partial Settlement
11. Amount of relief sought Rs.99,998/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 26.03.2019 at Bhopal
14. Representation at the hearing
u) For the Complainant Mr. Mohd. Saeed
v) For the insurer Mr. Abhishek Kiro
15. Complaint how disposed Recommendation
16. Date of Award/Order 26.03.2019
Mohd.Saeed (Complainant) has filed a complaint against Bharti 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
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.
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 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 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
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 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.
Page 41 of 412
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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 26, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mohd. Saeed..…...…..…….………....………………. Complainant
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.
Name & Address of the
Complainant
Mohd. Saeed,
House No.B-799 Mulla Colony,
B-Sector, Housing Board,Karond,
BHOPAL
2. Policy No:
Type of Policy
Duration of policy/DOC
00608539
DHFL Pramerica Roz Sanchay
30.06.2018
3. Name of the insured
Name of the policyholder
Mohd. Saeed
-
4. Name of the insurer DHFL Pramerica Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 02.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.35,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs.35,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 26.03.2019 at Bhopal
14. Representation at the hearing
w) For the Complainant Mr. Mohd. Saeed
x) For the insurer Mr. Sparsh Dwivedi, Sr.Training Manager
15. Complaint how disposed Dismissed
16. Date of Award/Order 26.03.2019
Page 42 of 412
Mohd.Saeed (Complainant) has filed a complaint against DHFL Pramerica 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
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.
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 on 10.07.2018 with option of free
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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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.
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.
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 policy of the complainant and complaint is liable to be dismissed.
The complaint filed by Mr. Mohd. Saeed stands dismissed herewith.
Let copies of Award be given to both the parties.
Dated : March 26, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 43 of 412
Mohd. Saeed..…...…..…….………....……..……………. Complainant
V/S
Exide Life Insurance Co.Ltd.…………………..……..……Respondent
COMPLAINT NO: BHP-L-025-1819-0332 ORDER NO: IO/BHP/A/LI/ 0365/2018-2019
1.
Name & Address of the
Complainant
Mohd. Saeed,
House No.B-799 Mulla Colony,
B-Sector, Housing Board,Karond,
BHOPAL
2. Policy No:
Type of Policy
Duration of policy/DOC
03735354
Exide Life Secured Income Ins.
23.02.2018
3. Name of the insured
Name of the policyholder
Mohd. Saeed
-
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 02.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 39,998.42
10. Date of Partial Settlement
11. Amount of relief sought Rs. 39,998.42
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 26.03.2019 at Bhopal
14. Representation at the hearing
y) For the Complainant Mr. Mohd. Saeed
z) For the insurer Mr. Saurav Sharma, SSM
15. Complaint how disposed Dismissed
16. Date of Award/Order 26.03.2019
Mohd.Saeed (Complainant) has filed a complaint against Exide 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
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.
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.
Page 44 of 412
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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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.
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.
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 policy of the complainant and complaint is liable to be dismissed.
The complaint filed by Mr. Mohd. Saeed stands dismissed herewith.
Let copies of Award be given to both the parties.
Dated : March 26, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 45 of 412
Mr. Nar Singh Patel.………………….…....………………. Complainant
V/S
Bharti Axa Life Insurance Co.Ltd.………………….………..……Respondent
COMPLAINT NO: BHP-L-008-1819-0356 ORDER NO: IO/BHP/A/LI/ 0367 /2018-2019
1.
Name & Address of the
Complainant
Mr. Nar Singh Patel,
House No.132, Darogapara Tikrapara,
Darogamuda, Raigarh
2. Policy No:
Type of Policy
Duration of policy/DOC
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,
3. Name of the insured
Name of the policyholder
Ms.Tukanti, Ms. Ekta , Nar singh Patel
Mr.Nar Singh Patel
4. Name of the insurer Bharti Axa Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 16.08.2018
6. Reason for repudiation/Rejection Lapse of free look period
7. Date of receipt of the Complaint 16.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Deposited Amount
10. Date of Partial Settlement
11. Amount of relief sought Deposited Amount
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place
14. Representation at the hearing
aa) For the Complainant Mr. Nar Sing Patel
bb) For the insurer Mr. Abhishek Kiro, Financial Advisor
15. Complaint how disposed Recommendation
16. Date of Award/Order 27.03.2019
Mr. Nar Singh Patel (Complainant) has filed a complaint against Bharti Axa Life Insurance
Co.Ltd. (Respondent) alleging Mis-selling.
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.
Page 46 of 412
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 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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN with enclosures.
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 policy
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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 27, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 47 of 412
Mr. Rakesh Chouhan.…….………....………………. Complainant
V/S
Bharti Axa Life Insurance Co.Ltd.………………..……Respondent
COMPLAINT NO: BHP-L-008-1819-0349 ORDER NO: IO/BHP/R/LI/ 0366 /2018-2019
1.
Name & Address of the
Complainant
Mr. Rakesh Chouhan,
2730-E Sudama nagar,
Near Hawa Banglow, Indore
2. Policy No:
Type of Policy
Duration of policy/DOC
501-2343033
Bharti Axa Life Aajeevan Sampatti
22.08.2014
3. Name of the insured
Name of the policyholder
Mr. Rakesh Chouhan
-same-
4. Name of the insurer Bharti Axa Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 05.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.3,00,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs.3,00,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 27.03.2019 at Bhopal
14. Representation at the hearing
cc) For the Complainant Mr. Rakesh Chouhan
dd) For the insurer Mr. Abhishek Kiro, Financial Advisor
15. Complaint how disposed Recommendation
16. Date of Award/Order 27.03.2019
Mr. Rakesh Chouhan (Complainant) has filed a complaint against Bharti Axa 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
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.
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 on 30.08.2014 with option of free
Page 48 of 412
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.
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
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 policy
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
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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 27, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 49 of 412
Mr. Manohar Patidar..…...…..…….....………………. Complainant
V/S
Life Insurance Corporation of India.……………..……Respondent
COMPLAINT NO: BHP-L-029-1819-0351 ORDER NO: IO/BHP/A/LI/ 0369/2018-2019
1.
Name & Address of the
Complainant
Mr. Manohar Patidar,
Gram Jharkheda,
Dist.Sehore
2. Policy No:
Type of Policy
Duration of policy/DOC
362721555, 362700803, 362700800
Endowment & New Children Money Back Plan
24.03.2018, 24.03.2018, 24.03.2018
3. Name of the insured
Name of the policyholder
Manohar, Harshita & Dinesh Patidar
-same-
4. Name of the insurer Life Insurance Corporation of India
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 13.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim
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 28.03.2019 at Bhopal
14. Representation at the hearing
ee) For the Complainant Absent
ff) For the insurer Mrs. Manisha Bhatnagar, Manager(CRM)
15. Complaint how disposed Dismissed as settled
16. Date of Award/Order 28.03.2019
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
refund of premium amount, but no action was taken by the respondent. The complainant
approached this forum for refund of premium amount.
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.
Page 50 of 412
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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.
Let copies of Award be given to both the parties.
Dated : March 28, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mrs. Kavita Patidar..…...…..…….....………………. Complainant
V/S
Life Insurance Corporation of India.……………..……Respondent
COMPLAINT NO: BHP-L-029-1819-0352 ORDER NO: IO/BHP/A/LI/0370/2018-2019
1.
Name & Address of the
Complainant
Mrs. Kavita Patidar,
Gram Jharkheda,
Dist.Sehore
2. Policy No:
Type of Policy
Duration of policy/DOC
362700801
LIC’s Jeevan Labh
24.03.2018
3. Name of the insured
Name of the policyholder
Mrs. Kavita Patidar
-same-
4. Name of the insurer Life Insurance Corporation of India
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 13.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim
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 28.03.2019 at Bhopal
14. Representation at the hearing
Page 51 of 412
gg) For the Complainant Absent
hh) For the insurer Mrs. Manisha Bhatnagar, Manager (CRM)
15. Complaint how disposed Dismissed as settled
16. Date of Award/Order 28.03.2019
Mrs. Kavita 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 policy was mis-sold to her by
agent of respondent company on pretext of single premium but regular premium policy was
issued. When she came to about factual position, she 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.
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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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
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.
Let copies of Award be given to both the parties.
Dated : March 28, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Page 52 of 412
Mrs. Krishna Patidar..…...…..…….....………………. Complainant
V/S
Life Insurance Corporation of India.……………..……Respondent
COMPLAINT NO: BHP-L-029-1819-0353 ORDER NO: IO/BHP/A/LI/0371/2018-2019
1.
Name & Address of the
Complainant
Mrs. Krishna Patidar,
Gram Jharkheda,
Dist.Sehore
2. Policy No:
Type of Policy
Duration of policy/DOC
362700802
LIC’s Jeevan Labh
24.03.2018
3. Name of the insured
Name of the policyholder
Mrs. Krishna Patidar
-same-
4. Name of the insurer Life Insurance Corporation of India
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 13.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim
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 00.03.2019 at Bhopal
14. Representation at the hearing
ii) For the Complainant Absent
jj) For the insurer Mrs. Manisha Bhatnagar
15. Complaint how disposed Dismissed as settled
16. Date of Award/Order 28.03.2019
Mrs. Krishna 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 policy was mis-sold to her by
agent of respondent company on pretext of single premium but regular premium policy was
issued. When she came to about factual position, she 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.
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
Page 53 of 412
taken & amount payable under cooling off has been made to policyholder through NEFT
24.01.2019.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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
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.
Let copies of Award be given to both the parties.
Dated : March 28, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mr. Praveen Premchandani……....…………………..…. Complainant
V/S
HDFC Standard Life Insurance Co.Ltd.………………..……Respondent
COMPLAINT NO: BHP-L-019-1819-0249 ORDER NO: IO/BHP/A/LI/ 0372 /2018-2019
1.
Name & Address of the
Complainant
Mr. Praveen Premchandani,
Regal 4, Hamilton Court,
Manuabhan Takri, Bhopal
2. Policy No:
Type of Policy
Duration of policy/DOC
Master policy no.PP000092
HDFC Life Group Credit Protect Plus
Insurance Plan
12.04.2016 (commencement of membership)
3. Name of the insured
Name of the policyholder
Mr. Praveen Premchandani
HDFC Ltd.
Page 54 of 412
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 17.09.2018
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
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place 28.03.2019 at Bhopal
14. Representation at the hearing
kk) For the Complainant Mr. Praveen Premchandani
ll) For the insurer Mr. Sudhir Kumar Singh, Asst.Legal Manager
15. Complaint how disposed Dismissed
16. Date of Award/Order 28.03.2018
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
Page 55 of 412
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
while respondent filed SCN and correspondence.
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
Page 56 of 412
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.
Let copies of Award be given to both the parties.
Dated : March 28, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mr. Rakesh Jain..…...…..…….………....………………. Complainant
V/S
PNB Met Life Insurance Co.Ltd.…………………..……..……Respondent
COMPLAINT NO: BHP-L-033-1819-0354 ORDER NO: IO/BHP/R/LI/ 0373 /2018-2019
1.
Name & Address of the
Complainant
Mr. Rakesh Jain
2017/1, New Kanchanpur Adhartal,
Jabalpur
2. Policy No:
Type of Policy
Duration of policy/DOC
22321756
PNB Met life Endowment saving plan plus
22.09.2017
3. Name of the insured
Name of the policyholder
Mr. Rakesh Jain
-same-
4. Name of the insurer PNB Met Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection 03.09.2018
6. Reason for repudiation/Rejection Lapse of free look period
7. Date of receipt of the Complaint 14.11.2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.60,000/-
10. Date of Partial Settlement
11. Amount of relief sought Rs.60,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
Page 57 of 412
13. Date of hearing/place 29.03.2019 at Bhopal
14. Representation at the hearing
mm) For the Complainant Mr. Rakesh Jain
nn) For the insurer Mr. Sandeep Motlani, Regional Manager
15. Complaint how disposed Recommendation
16. Date of Award/Order 29.03.2019
Mr. Rakesh Jain (Complainant) has filed a complaint against PNB Met 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
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.
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 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 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
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 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
complainant/ policy holder w.e.f. current date and with no free look option without any penalty/
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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.
As matter within parties has resolved mutually, hence the complaint is decided in terms of
mediation/mutual agreement between both the parties.
Let copies of this order be given to both parties.
Dated: March 29, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Ms. Pooja Chourasiya…..…………....…………………. Complainant
V/S
HDFC Standard Life Insurance Co.Ltd.……………..……Respondent
COMPLAINT NO: BHP-L-019-1819-0348 ORDER NO: IO/BHP/A/LI/ 0375 /2018-2019
1.
Name & Address of the
Complainant
Ms. Pooja Chourasiya,
Makan no.130, Ward no.02,
Umariya Pan, Katni
2. Policy No:
Type of Policy
Duration of policy/DOC
19879139, 20039996
HDFC SL Progrowth Flexi
31.10.2017,………….
3. Name of the insured
Name of the policyholder
Ms. Pooja Chourasiya
-same-
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection
6. Reason for repudiation/Rejection
7. Date of receipt of the Complaint 05.11.2018
8. Nature of complaint Wrong deduction on cancellation of policy and
mis-selling
9. Amount of Claim
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 29.03.2019 at Bhopal
14. Representation at the hearing
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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
16. Date of Award/Order 29.03.2019
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.
The complainant had filed complaint letter, annex VI A, Policy Copy & correspondence copy
while respondent filed SCN and correspondence.
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.
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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.
Let copies of Award be given to both the parties.
Dated : March 29, 2019 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
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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
1. Name & Address of the Complainant
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.
9. Amount of Claim Rs.1,99,789/-
10. Date of Partial Settlement NA
11. Amount of relief sought Rs.1,99,789/-
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
Page 62 of 412
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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA (UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the Complainant
Sri Subodh Kumar Das, Qrs. No. M/104 Housing Board Colony, Bhimtangi Bhubaneswar- 751002 Bhubaneswar
2. Policy No: Type of Policy Duration of policy/Policy period
5015039240, 20.12.2016
3. Name of the insured Name of the policyholder
Sri Subodh Kumar Das -do-
4. Name of the insurer Bharati Axa Life Insurance Co. ltd
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint
15.03.2018
8. Nature of complaint Mis Sale
9. Amount of Claim Rs.25000/-
10. Date of Partial Settlement NA
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
13. Date of hearing/place 25.03.2019 / Bhubaneswar
14.
Representation at the hearing
ss) For the Complainant Subodh Kumar Das
tt) For the insurer Prasant Kumar Hati
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 26.03.2019
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
Page 65 of 412
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.
Dated at Bhubaneswar on 26th March.2019
(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
Page 66 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA (UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the Complainant
Mr. Vikash Jhajaria, Marwari Para, Sambalpur, 768001.
2. Policy No: Type of Policy Duration of policy/Policy period
5013190482 Life 24.04.2015
3. Name of the insured Name of the policyholder
Sri Vikash Jhajaria. - do-
4. Name of the insurer Bharati Axa Life Ins. Company ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint
06.03.2019
8. Nature of complaint Mis Sale
9. Amount of Claim Rs.200000/- with interest
10. Date of Partial Settlement NA
11. Amount of relief sought Rs.200000/-+Interest @ 18%+Mental torture +Mental toture Rs.1,00,000/- +Policy cost Rs.50,000/-.
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
uu) For the Complainant None
vv) For the insurer Prasant Kumar Hati
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 26.03.2019
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)
INSURANCE OMBUDSMAN FOR THE STATE OF ODISHA
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA (UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the Complainant
Sri Subodh Kumar Das, Qrs. No. M/104 Housing Board Colony, Bhimtangi Bhubaneswar- 751002 Bhubaneswar
2. Policy No: Type of Policy Duration of policy/Policy period
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.
Hence, the complaint is treated as allowed accordingly.
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3. Name of the insured Name of the policyholder
Sri Subodh Kumar Das -do-
4. Name of the insurer Future Generali India Life Insurance
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint
15.03.2018
8. Nature of complaint Mis Sale
9. Amount of Claim Rs.33735/-
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of Premium with Interest
12. Complaint registered under Rule no: of Insurance Ombudsman Rules
13(1)(d)
13. Date of hearing/place 27.03.2019 / Bhubaneswar
14.
Representation at the hearing
ww) For the Complainant
Subodh Kumar Das
xx) For the insurer Vimal Acharya
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 28.03.2019
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.
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, the
insurer is directed to convert the policy to a single premium plan after
receiving an additional amount of Rs.15000/ from the complainant.
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 28th March 2019 (I SURESH BABU)
INSURANCE OMBUDSMAN FOR THE STATE OF ODISHA
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA (UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the Complainant
Mr.Rupesh Kumar Panda. At- Modipara, Near Sparsh Nursing Home, Sambalpur-768002
2. Policy No: Type of Policy Duration of policy/Policy period
52353309 Life 07.09.2015
3. Name of the insured Name of the policyholder
Mr. Rupesh Kumar Panda ---do----
4. Name of the insurer Reliance Nippon Life Ins. Co.ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint
03.02.2019
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.1,50,000/-
10. Date of Partial Settlement NA
11. Amount of relief sought Rs.1,50,000/- with interest
12. Complaint registered under Rule no: of Insurance Ombudsman Rules
13(1)(d)
13. Date of hearing/place 25.03.2019 / Bhubaneswar
Representation at the hearing
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14.
a) For the Complainant None
b) For the insurer Kamrul Bharat
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 26.03.2019
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.
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.
Dated at Bhubaneswar on 26th March.2019
(I SURESH BABU)
INSURANCE OMBUDSMAN FOR THE STATE OF ODISHA
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.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.
Hence, the complaint is treated as allowed accordingly.
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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 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
1. Name & Address of the Complainant
Subodh kumar Das, Qrs. No- M/104, Housing Board Colony, Bhimtangi, Bhubaneswar
2. Policy No: Type of Policy Duration of policy/Policy period
10460841 Life 29.09.2016
3. Name of the insured Name of the policyholder
Mr. Subodh Kumar Das -----do-----
4. Name of the insurer India First Life Insurance Co. ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint
14.03.2018
8. Nature of complaint Mis-sale
9. Amount of Claim Rs.30000/-
10. Date of Partial Settlement NA
11. Amount of relief sought Rs.30000/- with interest
12. Complaint registered under Rule no: of Insurance Ombudsman Rules
13(1)(d)
13. Date of hearing/place 26.03.2019 / Bhubaneswar
14.
Representation at the hearing
a) For the Complainant Subodh Kumar Das
b) For the insurer None
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 27.03.2019
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.
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 27th March 2019 (I SURESH BABU)
INSURANCE OMBUDSMAN FOR THE STATE OF ODISHA
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
1. Name & Address of the
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
3. Name of the insured
Name of the policyholder
Sh Sarvdeep Singh Dhatt
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 30.08.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1.7 lakhs
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Award
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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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Purshotam Dass V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0993
1. Name & Address of the
Complainant
Shri Purshotam Dass
293/2, Gulati Road, Samalkha
2. Policy No:
Type of Policy
Duration of policy/Policy period
10651126
Unit Linked Young Star
10 years
3. Name of the insured
Name of the policyholder
Sh Purshotam Dass
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 16.10.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 3 lakhs + interest
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Award
15 Date & Place of Hearing 06.02.2019/Chandigarh
16) Brief Facts of the Case:
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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17) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
The representative of the Company informed that the policy bearing number 10651126 was
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.
18) The following documents were placed for perusal :-
a) Complaint to the Company
b) Reply of the Insurance Company was sent on 22.03.2019
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 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.
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 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Ajay Kumar Khanijo & 7 others V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0791
1. Name & Address of the
Complainant
Shri Ajay Kumar Khanijo
C/o Amba Rice Mill, Jind Road, Kaithal
2. Policy No:
Type of Policy
Duration of policy/Policy period
14813465, 14813690, 14829034, 14828819,
14833066, 14833626, 14833058, 14870154,
14870632, 14936394, 14958416
Classic Assure Plus, Crest
3. Name of the insured
Name of the policyholder
Sh Sanjeev Kumar, Shri Ajay Kumar, Shri
Sahil Khanijo, Shri Sahab Khanijo, Ms.
Anju Rani, Ms Isha Khanijo, Ms. Deepika
Khanijo, Ms. Anita Rani
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 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.
Hence, the complaint is treated as closed.
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4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 14.08.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 7 lakhs
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins, Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Dismissed
15 Date & Place of Hearing 06.02.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
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 and
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.
Dated at Chandigarh on 7th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Ms. Radha Rani Vs SBI Life Insurance Co. Ltd.
CASE NO- CHD-L-041-1718-0532
1. Name & Address of the
Complainant
Ms. Radha Rani, House No. 43, Ward No. 21,
Chawla Colony, Rohtak, Haryana-124001
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
06030868003/ 27.01.2009
SBI Life-Sudarshan Plan A
3. Name of the insured
Name of the policyholder
Ms. Radha Rani
Ms. Radha Rani
4. Name of the insurer SBI Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 22.06.2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Refund of premium
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13 [1] [d
13. Date of hearing/place 27.12.2018 23.01.2019 & 22.02.2019 / Chandigarh
14. Representation at the hearing
d) For the Complainant Absent
Taking into account the facts & circumstances of the case and the submissions
made by the Company during the course of hearing, there is no need for any
interference and the complaint is dismissed.
Hence, the complaint is treated as closed.
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e) For the insurer Mr. Raman Malhotra
15. Complaint how disposed Dismissed in default.
16. Date of Award/Order 22.02.2019
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
Taking into account the facts & circumstances of the case and the submissions
made by insurance company during the course of personal hearing, the complaint
in respect of policy no. 06030868003. Is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 22.02.2019
Dr. D. K. Verma
INSURANCE OMBUDSMAN
Page 85 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURNCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Harparkash singh V/S Kotak Life Insurance Company Ltd.
COMPLAINT REF: NO: CHD-L-026-1617-0908
1. Name & Address of the
Complainant
Shri Harparkash Singh
245A, Street No. 7
Sant Vihar, Vill Baloke, Ludi]hiana
2. Policy No:
Type of Policy
Duration of policy/Policy period
01904044, 01839703, 01839765, 01862656,
01890267, 01892665, 02292421
Super Advantage, endowment
20 years, 15 years
3. Name of the insured
Name of the policyholder
Ms. Lakhwinder Kaur, Ms. Simran Singh
4. Name of the insurer Kotak Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 26.08.2016
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1.5 lakhs
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Sh. Aditya Singh, Chief Manager Legal
Sh. Manish Mittal, Chief Manager
14 Complaint how disposed Dismissed
15 Date & Place of Hearing 24.09.2018/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
Complainant’s argument:
The complainant re-iterated the contents of his complaint and said that his father was mis-sold
seven policies by forging signatures.
Page 86 of 412
Insurers’ argument:
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.
18) The following documents were placed for perusal :-
a) Complaint to the Company
b) Annexure VI-A
c) 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 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
Page 87 of 412
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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jagdish Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1146
1. Name & Address of the
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
Duration of policy/Policy period
03428870 & 03414764 / 21-10-2016, 22-09-2016
Exide Life Guaranteed Income Insurance Plan
10/20 Yrs/Rs. 19275 & 07/15/Yrs Rs. 60717/-
3. Name of the insured
Name of the policyholder
Mr. Jagdish Singh
Mr. Jagdish Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12-12-2017
8. Nature of complaint Mis-Selling
ORDER
Taking into account the facts & circumstances of the case and the submissions
made by the Company during the course of hearing, there is no need for any
interference and the compliant is dismissed.
Hence, the complaint is treated as closed.
Page 88 of 412
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under the above policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 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 Award
16. Date of Award/Order 12.02.2019
17. Brief Facts of the case:
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.
18) Cause of Complaint:
Complainant’s argument:
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
Page 89 of 412
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.
Insurers’ argument:
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
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 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.
Page 90 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 30 days of the receipt of the award and intimate
compliance of the same to the Ombudsman.
Dated at Chandigarh on 12th
day of February, 2019.
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jarnail Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1142
1. Name & Address of the
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
Duration of policy/Policy period
03467238 & 03467213 / 28-12-2016
Exide Life Income Advantage Plan, Exide Life
Guaranteed Income Insurance Plan
07/16yrs/Rs. 38550/- & 08/16/Rs.38550/-
3. Name of the insured
Name of the policyholder
Mr. Jarnail Singh
Mr. Jarnail Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 06-12-2017
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
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.
Hence, the complaint is treated as closed.
Page 91 of 412
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under the above policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 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 Award
16. Date of Award/Order 12.02.2019
17. Brief Facts of the case:
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
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
and sought cancellation of said policies which is after a lapse of almost 09 months from the receipt
of policy documents.
18) Cause of Complaint:
Complainant’s argument:
Mr. Jarnail 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
Page 92 of 412
above company. The complainant also provided his bank pass book showing the deposit 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.
Insurers’ argument:
The insurer’ representative reiterated the contents of SCN and informed that the complainant has
submitted his complaint almost after a lapse of almost 09 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
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 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.
Page 93 of 412
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
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 03467238 & 03467213, since
inception and refund all the premiums collected there-in without interest and without
deductions of any charges.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
b. 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 12th
day of February, 2019
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Gurmeet Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1143
1. Name & Address of the
Complainant
Mr. Gurmeet Singh
St. No.-11, Sucha Singh Nagar, Bathinda,
Punjab-0
Mobile No.- 9041940732
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
03431008 & 03431023 / 24-10-2016
Exide Life Income Advantage Plan, Exide Life
Guaranteed Income Insurance Plan
08/16yrs/Rs.47224/- &07/15yrs/Rs.48188/-
3. Name of the insured
Name of the policyholder
Mr. Gurmeet Singh
Mr. Gurmeet Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12-12-2017
8. Nature of complaint Mis-Selling
Page 94 of 412
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under the above policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 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 Award
16. Date of Award/Order 12.02.2019
17. Brief Facts of the case:
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
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
and sought cancellation of said policies which is after a lapse of almost 12 months from the receipt
of policy documents.
18) Cause of Complaint:
Complainant’s argument:
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
Page 95 of 412
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.
Insurers’ argument:
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
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 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. 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.
Page 96 of 412
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
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 03431008 & 03431023, since
inception and refund all the premiums collected there-in without interest and without
deductions of any charges.
Hence, the complaint is treated as closed.
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 12th
day of February, 2019
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Malkeet Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1144
1. Name & Address of the
Complainant
Mr. Malkeet Singh S/o Mr. Bhola Singh,
VPO- Sivian, Bathinda, Punjab- 151001
Mobile No.- 8054167927
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
03448995, 03449012 / 22-11-2016
Exide Life Guaranteed Income Insurance Plan,
Exide Life Income Advantage Plan
16yrs/Rs.48183/- & 15yrs/Rs. 48183/-
3. Name of the insured
Name of the policyholder
Mr. Malkeet Singh
Mr. Malkeet Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12-12-2017
Page 97 of 412
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under the above policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 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 Award
16. Date of Award/Order 12.02.2019
17. Brief Facts of the case:
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
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 11 months from
the receipt of policy documents.
18) Cause of Complaint:
Complainant’s argument:
Mr. Malkeet 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
Page 98 of 412
cheques to the above company. The complainant also provided his bank pass book showing the deposit
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.
Insurers’ argument:
The insurer’ representative reiterated the contents of SCN and informed that the complainant has
submitted his complaint almost after a lapse of almost 11 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
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 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. 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
07 yrs 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
Page 99 of 412
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.
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
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 03448995, 03449012 , since inception
and refund all the premiums collected there-in without interest and without deductions of
any charges.
Hence, the complaint is treated as closed.
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 12th
day of February, 2019
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Kaur Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1148
1. Name & Address of the
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
Guaranteed Income Insurance Plan
07/15/Rs. 48187/- & 08/16/Rs. 48187/-
3. Name of the insured
Name of the policyholder
Mr. Kaur Singh
Mr. Kaur Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12-12-2017
Page 100 of 412
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under the above policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 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 Award
16. Date of Award/Order 12.02.2019
17. Brief Facts of the case:
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
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
24.10.2017 and sought cancellation of said policies which is after a lapse of almost 05 months from
the receipt of policy documents.
18) Cause of Complaint:
Complainant’s argument:
Mr. Kaur 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
Page 101 of 412
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
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.
Insurers’ argument:
The insurer’ representative reiterated the contents of SCN and informed that the complainant has
submitted his complaint almost after a lapse of almost 05 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
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 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. 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
07yrs 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
Page 102 of 412
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.
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
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 03562003 & 03560307, since
inception and refund all the premiums collected there-in without interest and without
deductions of any charges.
Hence, the complaint is treated as closed.
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 12th
day of February, 2019
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Gurjit Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1141
1. Name & Address of the
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
Duration of policy/Policy period
03448220 & 03448145 / 07-12-2016, 08-12-2016
Exide Life Income Insurance Advantage Plan,
Exide Life Guaranteed Income Insurance Plan
08/16yrs/Rs.48185/- & 07/15yrs/Rs. 48185/-
3. Name of the insured
Name of the policyholder
Mr. Gurjit Singh
Mr. Gurjit Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
Page 103 of 412
7. Date of receipt of the Complaint 12-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under the above policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 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 Award
16. Date of Award/Order 12.02.2019
17. Brief Facts of the case:
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
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
alleging misselling and sought cancellation of said policies which is after a lapse of almost 10
months from the receipt of policy documents.
18) Cause of Complaint:
Complainant’s argument:
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
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
Page 104 of 412
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.
Insurers’ argument:
The insurer’ representative reiterated the contents of SCN and informed that the complainant has
submitted his complaint almost after a lapse of almost 10 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
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 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. 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
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.
Page 105 of 412
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
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 03448220 & 03448145, since
inception and refund all the premiums collected there-in without interest and without
deductions of any charges.
Hence, the complaint is treated as closed.
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 12th
day of February, 2019
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jagjit Singh Vs Max Life Insurance Co. Ltd.
CASE NO-CHD-L-032-1718-0985
1. Name & Address of the
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
Duration of policy/Policy period
130362486 / 29.11.2016
3. Name of the insured
Name of the policyholder
Mr. Jagjit Singh
4. Name of the insurer Max Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 16-10-2017
8. Nature of complaint Mis-Selling
Page 106 of 412
9. Amount of Claim Refund of deposited amount
10. Date of Partial Settlement NA
11. Amount of relief sought NA
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13 [1] [d]
13. Date of hearing/place 22-02-2019 / Chandigarh
14. Representation at the hearing
f) For the Complainant Self
g) For the insurer Sh. Sanjeev
15. Complaint how disposed Award for refund of premium
16. Date of Award/Order 22.02.2019
17. Brief Facts of the case:
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.
Page 107 of 412
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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 22.02.2019
Dr. D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Sushant Gupta Vs SBI Life Insurance Co. Ltd.
CASE NO-CHD-L-041-1718-0874
1. Name & Address of the
Complainant
Mr. Sushant Gupta, House No. 161, Sector-21,
Faridabad, Haryana-121001,
Mobile No.: 9582826660
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
1K053016301/ 26.05.2016
SBI Life-Smart Wealth Builder Policy
10 years
3. Name of the insured
Name of the policyholder
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
7. Date of receipt of the Complaint 29.08.2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Refund of premium
10. Date of Partial Settlement Na
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13 [1] [d
13. Date of hearing/place 27.12.2018 23.01.2019 & 22.02.2019 /
Chandigarh
14. Representation at the hearing
h) For the Complainant Absent
i) For the insurer Mr. Raman Malhotra
Page 108 of 412
15. Complaint how disposed Dismissed in default.
16. Date of Award/Order 22.02.2019
17. Brief Facts of the case:
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
Taking into account the facts & circumstances of the case and the submissions
made by insurance company during the course of personal hearing, the complaint
in respect of policy no. 1K053016301. Is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 22.02.2019
Dr. D. K. Verma
INSURANCE OMBUDSMAN
Page 109 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D. K. Verma
CASE OF Mr. Prashant V/s Exide Life Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-025-1718-0268
1. Name & Address of the
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
3. Name of the insured
Name of the policy holder
Mr. Prashant
Page 110 of 412
17) Brief Facts of the Case:
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.
18) Cause of Complaint:
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
Rule no: Insurance Ombudsman
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
Page 111 of 412
09/03/2015 Cheque 24999
21/07/2015 Cash 24815
31/03/2016 Cash 51440
31/03/2016 Cash 8535
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) 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 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.
Dated at Chandigarh on 12th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
ORDER
Taking into account the facts & circumstances of the case and the submissions made 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.
Hence, the complaint is treated as closed.
Page 112 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Kamil Abbaas Nakvi Vs Canara HSBC Oriental Bank of Commerce
Life Insurance Co. Ltd.
CASE NO-CHD-L-010-1718-1163
1. Name & Address of the
Complainant
Mr. Kamil Abbaas Nakvi
House No.- 83, Jhampur, Distt.- Mohali, Punjab-0
Mobile No.- 8528609079
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
0013544617 / 31-03-2010
Canara HSBC Oriental Bank of Commerce Life Saral
Bima Plus
07yrs/15yrs/Rs.12000/-
3. Name of the insured
Name of the policyholder
Mr. Kamil Abbaas Nakvi
Mr. Kamil Abbaas Nakvi
4. Name of the insurer Canara HSBC Oriental Bank of Commerce Life
Ins.Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(c)
13. Date of hearing/place 20-02-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Lalit Kumar( Center Manager)
15. Complaint how disposed Dismissed
16. Date of Award/Order 05.03.2019
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
Page 113 of 412
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.
18) Cause of Complaint:
a) Complainant’s argument:
Mr. Kamil Abbaas Nakvi, the complainant attended the personal hearing on 20.02.2019 and reiterated
the contents of basic complaint.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) 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 of the Insurance Company, It is observed that the complainant had opted for 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.
Dated at Chandigarh on 05th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
ORDER
Taking into account the facts & circumstances of the case and the submissions made 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.
Hence, the complaint is treated as closed.
Page 114 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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.
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 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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 05.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 115 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mrs. Meena Kumari V/s Tata AIA Life Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-046-1617-1588
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 05.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 116 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mr. Het Ram Kalia V/S Future Generali India Life Ins. Co. Ltd.
COMPLAINT REF. No. CHD- L-017-1617-1600
17) Brief Facts of the Case:
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
3. Name of the insured
Name of the policy holder
Mrs. Neena Devi
Mrs. Neena Devi
4. Name of the insurer Future Generali India Life Ins. Co. Ltd.(Mumbai).
5. Date of Repudiation NIL
6. Reason for repudiation NIL
7. Date of receipt of the Complaint 02.01.2017
8. Nature of complaint Mis- selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 95, 500/-
12. Complaint registered under
Ombudsman Rules ,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 Complainant Self on 20.02.2019
For the insurer Mr. Vishal Kumar
15 Complaint how disposed Award
16 Date of Award/Order 05.03.2019
Page 117 of 412
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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
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.
Hence, the complaint is treated as closed.
Page 118 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 30 days of the receipt of the award and intimate compliance of the
same to the Ombudsman.
Dated at Chandigarh on 05th
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. Dalbir Singh V/S Future Generali India Life Ins. Co. Ltd.
COMPLAINT REF. No. CHD- L-017-1718-0346
1. Name & Address of the
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
3. Name of the insured
Name of the policy holder
Mr. Dalbir Mr. Rohit
Mr. Dalbir Mr. Dalbir
4. Name of the insurer Future Generali India Life Ins. Co. Ltd. (Mumbai).
5. Date of Repudiation NIL
6. Reason for repudiation NIL
7. Date of receipt of Complaint 11.05.2017
8. Nature of complaint Mis- selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of premium paid
12. Complaint registered under
Ombudsman Rules ,2017
13.1. (c)
13. Date of hearing/place 20.11.2018 & 20.02.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Vishal Kumar SM
Page 119 of 412
17) Brief Facts of the Case:
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.
Annexure VI-A was received on 11.07.2017.
Insurer’s SCN received on 18.02.2019
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
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 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
15 Complaint how disposed Award
16 Date of Award/Order 15.03.2019
Page 120 of 412
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
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 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.
Hence, the complaint is treated as closed.
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 15th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
Page 121 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D. K. Verma
CASE OF Mr. Narender kumar V/S Future Generali India Life Ins. Co. Ltd.
COMPLAINT REF. No. CHD- L-017-1617-1708
17) Brief Facts of the Case:
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
1. Name & Address of the
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
3. Name of the insured
Name of the policy holder
Mr. Narender Kumar
Mr. Narender Kumar
4. Name of the insurer Future Generali India Life Ins. Co. Ltd.(Mumbai).
5. Date of Repudiation NIL
6. Reason for repudiation NIL
7. Date of receipt of the
Complaint
16.02.2017
8. Nature of complaint Mis- selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of premium paid
12. Complaint registered under
Ombudsman Rules ,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 Complainant Self
For the insurer Sh. Vishal Kumar SM
15 Complaint how disposed Dismissed
16 Date of Award/Order 15.03.2019
Page 122 of 412
the complaint on 04.10.2016 but the Insure did not reply. Hence feeling Aggrieved he approached this
office to seek justice.
Annexure VI-A was received on 15.03.2017.
Insurer’s SCN received on 20.09.2018
18) Cause of Complaint:
a) Complainant’s argument:
Mr. Narender Kumar, the complainant attended the personal hearing on 20.02.2019 and reiterated the
contents of basic complaint.
b) Insurers’ argument:
The insurer’s representative reiterated the contents of SCN and submitted that the said policy was issued
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.
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) 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 of the Insurance Company, It is observed that the complainant had opted for policy
mentioned in the complaint in the March 2009. 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.
ORDER
Taking into account the facts & circumstances of the case and the submissions made 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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 15th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
Page 123 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mr. Prem Paul Bajaj V/S Future Generali India Life Ins. Co. Ltd.
COMPLAINT REF. No. CHD- L-017-1617-1838
17) Brief Facts of the Case:
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.
1. Name & Address of the
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.
3. Name of the insured
Name of the policy holder
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).
5. Date of Repudiation NIL
6. Reason for repudiation NIL
7. Date of receipt of the Complaint 22.02.2017.
8. Nature of complaint Mis- selling and cheating
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of premium paid
12. Complaint registered under
Ombudsman Rules ,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 Complainant Mr. Hitesh Bajaj (son of the complainant)
For the insurer Mr. Vishal Kumar
15 Complaint how disposed Award
16 Date of Award/Order 15.03.2019
Page 124 of 412
Annexure VI-A was received on 13.06.2017.
Insurer’s SCN was received on 17.09.2018.
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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
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 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.
Page 125 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 30 days of the receipt of the award and intimate compliance of the same
to the Ombudsman.
Dated at Chandigarh on 15th
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. Mahesh Kumar Vs Aegon Religare Life Insurance Company
COMPLAINT REF. No. : CASE NO. CHD-L-001-1617-1111
1. Name & Address of the
Complainant
Shri Mahesh Kumar,
VPO- Kalyan Malka, Tehsil- Nathana, Distt.- Bathinda
2. Policy No: DOC
Type of Policy
Duration of policy/Premium
160314631738 19.03.2016
Aegon Life Flexi Money Back Advantage Ins.Plan
Rs.22000/-
3. Name of the insured
Name of the policyholder
Shri Mahesh Kumar
Shri Mahesh Kumar
4. Name of the insurer Aegon Religare Life Insurance co ltd
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 29-08-2016
8. Nature of complaint Misselling
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 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.
Hence, the complaint is treated as closed.
Page 126 of 412
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums paid
12. Complaint registered under
Insurance Ombudsman Rules
2017
13.1 (d)
13. Date of hearing/place 12.07.2018,22.11.2018 & 20.02.2019/Chandigarh
14. Representation at the hearing
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
15 Complaint how disposed Award
16 Date of Award/Order 05.03.2019
17) Brief Facts of the Case:
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.
18) Cause of Complaint:
Page 127 of 412
Complainant’s argument:
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.
Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 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
Taking into account the facts & circumstances of the case and the submissions made by
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.
Hence, the complaint is treated as closed.
Page 128 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 30 days of the receipt of the award and intimate compliance
of the same to the Ombudsman.
Dated at Chandigarh on 05th
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. Santosh Kumar Vs Aegon Life Insurance Company
COMPLAINT REF. No. : CASE NO. CHD-L-001-1617-1314
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
Duration of policy/Premium
140714155105, 141014227128 & 150214335512
Rs.25500/- , Rs.35049/- & Rs.20000/-
3. Name of the insured
Name of the policyholder
Mr. Santosh Kumar
4. Name of the insurer Aegon Life Insurance co ltd
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 05-08-2016
8. Nature of complaint Misselling
9. Amount of Claim Rs.80549/-
10. Date of Partial Settlement NIL
11. Amount of relief sought Rs.80549/-
12. Complaint registered under
Insurance Ombudsman Rules 2017
13.1 (d)
13. Date of hearing/place 12.07.2018, 22.11.2018 & 20.02.2019/Chandigarh
14. Representation at the hearing
For the Complainant Self
Page 129 of 412
For the insurer Mr. Ashish K. Ovalekar (AVP Legal)
Present on 12.07.2018 & 22.11.2018
but Absent on 20.02.2019
15 Complaint how disposed Dismissed
16 Date of Award/Order 05.03.2019
17) Brief Facts of the Case:
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:
a) Complainant’s argument:
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.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) Reply of the insurer.
Page 130 of 412
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 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
Taking into account the facts & circumstances of the case and the submissions made by
both the parties, there is no need to interfere with the decision of the insurer. Hence, the
complaint is dismissed.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Parveen Kumar Vs PNB Metlife India Insurance Co. Ltd.
CASE NO-CHD-L-033-1617-1715
1. Name & Address of the
Complainant
Mr. Parveen Kumar
SCO-684, Kesho Ram Complex,
Burail, Sector – 45 C, Chandigarh
Mobile No.- 9915584121
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
21757848 16.12.2015
Met Endowment Saving Plan
10 years/Rs. 50000/-
3. Name of the insured
Name of the policyholder
Mr. Parveen Kumar
Mr. Parveen Kumar
4. Name of the insurer PNB Metlife India Insurance Co. Ltd.
5. Date of Repudiation NIL
Page 131 of 412
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
6. Reason for repudiation NA
7. Date of receipt of the Complaint 13.02.2017
8. Nature of complaint Mis-selling
9. Amount of Claim Rs. 50000/-
10. Date of Partial Settlement NIL
11. Amount of relief sought Rs. 50000/-
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(c)
13. Date of hearing/place 04.09.2018,15.10.2018,10.12.2018 & 20.02.2019/
Chandigarh
14. Representation at the hearing
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
16. Date of Award/Order 05.03.2019
Page 132 of 412
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policy bearing no 21757848, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
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. Neeraj V/s Shriram Life Insurance Co. Ltd.
COMPLAINT REF. No. :CHD-L-043-1718-0215
1. Name & Address of the
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
Name of the policy holder
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/-
Page 133 of 412
17) Brief Facts of the Case:
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.
Insurer’s SCN was received on 01.09.2017.
Annexure VI-A was received on 22.06.2017.
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.
18) Cause of Complaint:
a) Complainant’s argument:
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
12. Complaint registered under
Rule no: Insurance Ombudsman
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
Page 134 of 412
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.
b) Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
20) Result of personal hearing with both parties (Observations & Conclusion)
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 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
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 NN131702016705 , since
inception and refund all the premiums collected there-in without interest and without
deduction of any charges.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
c. 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 15th
day of March, 2019
D.K.Verma
INSURANCE OMBUDSMAN
Page 135 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Ish Vichher Vs Shriram Life Insurance Co. Ltd.
CASE NO-CHD-L-043-1718-1231
1. Name & Address of the
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/-
3. Name of the insured
Name of the policyholder
Mr. Ish Vichher
Mr. Ish Vichher
4. Name of the insurer Shriram Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 29-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums with interest
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 20-02-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Sh. Ravi Sharma, Sr. Executive- Legal
15. Complaint how disposed Award
16. Date of Award/Order 15.03.2019
17. Brief Facts of the case:
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
Page 136 of 412
cancellation of the aforesaid policies but they did not resolve the issue, Hence feeling Aggrieved he
approached this office to seek justice.
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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
policies from which the date of receipt of policy documents could be established.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 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
Page 137 of 412
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
Taking into account the facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, an award is passed with a direction to the
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.
Hence, the complaint is treated as closed.
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 15th
day of March, 2019
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mrs. Lovepreet Kaur V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1718-1245
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.
2. This office pursued the case with the insurance company to re-examine the complaint and
they agreed to reconsider the claim.
Page 138 of 412
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 22.02.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Ms. Neena Mehta Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1209
1. Name & Address of the
Complainant
Ms. Neena Mehta
House No.- 252, Sector- 18, Panchkula,
Haryana- 134109
Mobile No.- 9417034252
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
03367553 / 30-06-2016
Exide Life Guaranteed Income Insurance Plan
20 Years
3. Name of the insured
Name of the policyholder
Ms. Neena Mehta
Ms. Neena Mehta
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 22-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
Page 139 of 412
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
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
Dated at Chandigarh on 5th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
Page 140 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Kuldip Kaushik Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-0881
1. Name & Address of the
Complainant
Mr. Kuldip Kaushik
House No.- 3930, Sector-9 A, Bahadurgarh,
Haryana- 124507
Mobile No.- 8130157766
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
03533733 / 29-03-2017
Exide Life Guaranteed Income Insurance Plan
3. Name of the insured
Name of the policyholder
Mr. Kuldip Kaushik
Mr. Kuldip Kaushik
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 07-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium Rs. 30000/-
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 05.03.2019/Chandigarh
14. Representation at the hearing
For the Complainant Mr. Kuldip Kaushik
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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
Page 141 of 412
cancellation of said policy, his request was declined by the company. 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 03533733 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.
Dated at Chandigarh on 5th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Basant Kumar Vs Exide Life Insurance Co. Ltd.
CASE NO- CHD-L-025-1718-1336
1. Name & Address of the
Complainant
Mr. Basant Kumar
Village- Bhagu Majra, Tehsil- Jagadhri,
Distt.- Yamuna Nagar, Haryana- 135133
Mobile No.- 9992999381
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
03110694, 03051715 & 03121828
18-05-2015, 09-02-2015, & 06-06-2015
Exide Life Guaranteed Income Insurance Plan
12/24/Rs.29100/-,10/20/Rs.19400 &15/30/Rs33738/
Page 142 of 412
3. Name of the insured
Name of the policyholder
Mr Dalwinder Kumar
Mr. Basant Kumar
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 10-02-2018
8. Nature of complaint Misselling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Basant Kumar
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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
Page 143 of 412
with welcome letter were dispatched and duly delivered at complainant’s address.
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.
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.
Dated at Chandigarh on 05th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Harbhant Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1394
1. Name & Address of the
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
Exide Life Guaranteed Income Insurance Plan,
Page 144 of 412
Duration of policy/Policy period
Exide Life Income Advantage Plan
3. Name of the insured
Name of the policyholder
Mr. Harbhant Singh
Mr. Harbhant Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 28-02-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Amanpreet Singh (Son)
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
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 with welcome letter were dispatched and duly delivered at complainant’s
address. However, the company agreed to cancel the policies bearing numbers
Page 145 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.
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.
Dated at Chandigarh on 05th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Harbhant Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1394
1. Name & Address of the
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
Duration of policy/Policy period
02968034, 02980860 & 02996108
31-08-2014, 18-09-2014 & 18-10-2014
Exide Life Guaranteed Income Insurance Plan,
Exide Life Income Advantage Plan
3. Name of the insured Mr. Harbhant Singh
Page 146 of 412
Name of the policyholder Mr. Harbhant Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 28-02-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Amanpreet Singh (Son)
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
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 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
Page 147 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.
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.
Dated at Chandigarh on 05th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Suresh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-0555
1. Name & Address of the
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
3. Name of the insured
Name of the policyholder
Mr. Suresh
Mr. Suresh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the
Complaint
03-07-2017
8. Nature of complaint Mis-Selling
Page 148 of 412
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of Premiums
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(d)
13. Date of hearing/place 07-01-2019,12.02.2019 & 05.03.2019/ Chandigarh
14. Representation at the hearing
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)
15. Complaint how disposed Dismissed in default
16. Date of Award/Order 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.
The Insurer in their SCN dated 12.04.2018, has stated that the above policies were issued after
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.
18. Observations & Findings:-
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
Page 149 of 412
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policies bearing no’s 03133815 & 03259909, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Anoop Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-0851
1. Name & Address of the
Complainant
Mr. Anoop Singh
House No.- 203, Kalhlour Colony, College Road,
Pathankot, Punjab-145001, Mobile No.- 9888665857
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
02991323 / 08-10-2014
Exide Life Guaranteed Income
3. Name of the insured
Name of the policyholder
Mrs. Kusam Lata
Mr. Anoop Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 01-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 07-01-2019, 12.02.2019 & 05.03.2019 / Chandigarh
14. Representation at the hearing
For the Complainant Absent on all the occasions
Page 150 of 412
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)
15. Complaint how disposed Dismissed in default
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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
approached this office to seek justice.
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.
18. Observations & Findings:-
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
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.
Page 151 of 412
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policy bearing no 02991323, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Chandra Pal Sharma Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-0406
1. Name & Address of the
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
Duration of policy/Policy period
03362885 & 03362882 / 12-07-2016 & 28-06-2016
Exide Life Guaranteed Income Insurance Plan
10yrs/ Rs.28912/- & 12yrs/ Rs28912/-
3. Name of the insured
Name of the policyholder
Mr. Chandra Pal Sharma
Mr. Chandra Pal Sharma
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 07-06-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under both policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 07-01-2019, 12.02.2019 & 05.03.2019 / Chandigarh
14. Representation at the hearing
For the Complainant Absent on all the occasions but requested to decide the
complaint on merit basis
For the insurer Mr. Vignesh Ram, Assistant Manager - Legal
Page 152 of 412
(07.01.2019 & 12.02.2019)
Mr. Mukund Sharma- Assistant Manager &
Mr. Muthanna M K –Intern- Legal (05.03.2019)
15. Complaint how disposed Dismissed
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 22.01.2018, has stated that the above policies were issued after
receipt 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. The
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
Page 153 of 412
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
Dated at Chandigarh on 05th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jogender Singh Vs Exide Life Insurance Co. Ltd.
CASE NO- CHD-L-025-1718-1317
1. Name & Address of the
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
Duration of policy/Policy period
03313509 / 22-03-2016
Exide Life Guaranteed Income Insurance Plan
15/30 Years/Rs. 40890/-
3. Name of the insured
Name of the policyholder
Mr. Jogender Singh
Mr. Jogender Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 05-02-2018
8. Nature of complaint Misselling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
Page 154 of 412
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Award
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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
office to seek justice.
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 of the Insurance Company, It is observed that the said policy has been mis-sold
Page 155 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.
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 05th
day of March, 2019.
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Devender Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1284
1. Name & Address of the
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
Duration of policy/Policy period
02968971 / 17-09-2014
Exide Life Guaranteed Income Insurance Plan
15/30 Years Rs. 29100/-
3. Name of the insured
Name of the policyholder
Mr. Devender
Mr. Devender
4. Name of the insurer Exide Life Insurance Co. Ltd.
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 03313509, since inception
and refund all the premiums collected there-in without interest and without deduction of
any charges.
Hence, the complaint is treated as closed.
Page 156 of 412
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 25-01-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Dismissed
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 19.04.2018, 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 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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
Page 157 of 412
b) Insurers’ argument:
The insurer’s representative reiterated the contents of SCN and submitted that the said policy was issued
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.
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) 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 of the Insurance Company, It is observed that the complainant had opted for policy
mentioned in the complaint in September, 2014. 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 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
Taking into account the facts & circumstances of the case and the submissions made 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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
Page 158 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Sandeep Kumar Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1270
1. Name & Address of the
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
Duration of policy/Policy period
03510642 / 11-03-2017
Exide Life Guaranteed Income Insurance Plan
15 Years
3. Name of the insured
Name of the policyholder
Mr. Sandeep Kumar
Mr. Sandeep Kumar
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 08.12.2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Award
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
Page 159 of 412
The Insurer in their SCN dated 18.04.2018, 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 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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 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
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 03510642, since inception
and refund all the premiums collected there-in without interest and without deduction of
any charges.
Hence, the complaint is treated as closed.
Page 160 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 30 days of the receipt of the award and intimate compliance
of the same to the Ombudsman.
Dated at Chandigarh on 05th
day of March, 2019.
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Amandeep Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1173
1. Name & Address of the
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
Duration of policy/Policy period
03482374 / 19-01-2017
Exide Life Guaranteed Income Insurance Plan
15 Years/Rs. 86739/-
3. Name of the insured
Name of the policyholder
Mr. Amandeep Singh
Mr. Amandeep Singh
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 13-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Amandeep Singh
Page 161 of 412
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Award
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 15.03.2018, 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 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.
18) Cause of Complaint:
Complainant’s argument:
Mr. Amandeep Singh, the complainant reiterated the contents of the complaint and submitted that the
above policy has been issued to him fraudulently.
Insurers’ argument:
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.
19) 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 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
Page 162 of 412
delivery of the said policy could not be corroborated by any documentary proof like POD by the
insurer.
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, an award is passed with a direction to the
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.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
b. 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 05th
day of March, 2019.
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Sikander Singh Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-1151
1. Name & Address of the
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
Duration of policy/Policy period
03460221 / 19-12-2016
Exide Life Guaranteed Income Insurance Plan
07/15yrs/ Rs. 38545/-
3. Name of the insured
Name of the policyholder
Mr. Sikander Singh
Mr. Sikander Singh
Page 163 of 412
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 12.02.2019 & 05.03.2019/Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Award
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 05.04.2018, has stated that the above policy was issued after
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
the receipt of policy documents.
18) Cause of Complaint:
Complainant’s argument:
Mr. Sikander Singh, the complainant attended the personal hearing on 05.03.2019, reiterated the
contents of the complaint and submitted that his friend Mr.Gurpal Singh had requested to purchase
Page 164 of 412
above policy 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 transaction in his account and also submitted that he has not signed the proposal forms under
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.
Insurers’ argument:
The insurer’ representative reiterated the contents of SCN and informed that the complainant has
submitted his complaint almost after a lapse of almost 10 months from the receipt of policy
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.
19) The following documents were placed for perusal:-
a) Photocopies of the proposal forms. b) Complaint to the insurer. c) Reply of the company
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 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
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.
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 policy.
Page 165 of 412
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, an award is passed with a direction to the
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.
Hence, the complaint is treated as closed.
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 05th
day of March, 2019
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jai pal Vs Exide Life Insurance Co. Ltd.
CASE NO- CHD-L-025-1718-1423
1. Name & Address of the
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
Duration of policy/Policy period
03003064 / 12-11-2014
Exide Life Guaranteed Income Insurance Plan
20 Years/ Rs. 70000/-
3. Name of the insured
Name of the policyholder
Mr. Jai pal
Mr. Jai pal
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09-03-2018
8. Nature of complaint Misselling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under 13.1.(d)
Page 166 of 412
Rule no: Insurance Ombudsman
Rules, 2017
13. Date of hearing/place 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Dismissed
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 07.03.2018, 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 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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
The insurer’s representative reiterated the contents of SCN and submitted that the said policy was issued
on 12-11-2014 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 almost 03 years from the date of receipt of policy
documents.
Page 167 of 412
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) 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 of the Insurance Company, It is observed that the complainant had opted for policy
mentioned in the complaint in November, 2014. 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 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
Taking into account the facts & circumstances of the case and the submissions made 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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Ramesh Chand Vs Exide Life Insurance Co. Ltd.
CASE NO- CHD-L-025-1718-1424
1. Name & Address of the
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
Duration of policy/Policy period
03008502 / 17-11-2014
Exide Life Guaranteed Income Insurance Plan
20 years/Rs. 47531/-
Page 168 of 412
3. Name of the insured
Name of the policyholder
Mr. Ramesh Chand
Mr. Ramesh Chand
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09-03-2018
8. Nature of complaint Misselling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Dismissed
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 18.05.2018, 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 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.
18) Cause of Complaint:
a) Complainant’s argument:
Page 169 of 412
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.
b) Insurers’ argument:
The insurer’s representative reiterated the contents of SCN and submitted that the said policy was issued
on 17-11-2014 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 almost 03 years from the date of receipt of policy
documents.
19) The following documents were placed for perusal:-
a) Request letter to the insurer. b) 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 of the Insurance Company, It is observed that the complainant had opted for policy
mentioned in the complaint in November, 2014. 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 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
Taking into account the facts & circumstances of the case and the submissions made 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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
Page 170 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Rahul Singla Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-0753
1. Name & Address of the
Complainant
Mr. Rahul Singla
House No.- 3314, Sector- 27 D, Chandigarh,
Mobile No.- 9988385264
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
01916740 / 14-07-2010
Exide Life New Fulfilling Life
16/61/ Rs. 19796/- (paid for 06 yrs)
3. Name of the insured
Name of the policyholder
Mr. Rahul Singla
Mr. Rahul Singla
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 04-08-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement 25334/-
11. Amount of relief sought Refund of premiums with interest
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(c)
13. Date of hearing/place 07-01-2019 & 05.03.2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Vignesh Ram Assistant Manager- Legal 07.01.19
Mr. Mukund Sharma- Assistant Manager &
Mr. Muthanna M K –Intern- Legal 05.03.2019
/Chandigarh
15. Complaint how disposed Award
16. Date of Award/Order 05.03.2019
17) Brief Facts of the case:
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
Page 171 of 412
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
office to seek justice.
The Insurer in their SCN dated 03.05.2018, 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 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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 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
Page 172 of 412
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.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
c. 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 05th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
Page 173 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Shalender Markandey Vs Exide Life Insurance Co. Ltd.
CASE NO-CHD-L-025-1718-0417
1. Name & Address of the
Complainant
Mr. Shalender Markandey
House No.- 1698, Sector-22 B, Chandigarh-160022
Mobile No.- 9873105665
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
03545422 / 31-03-2017
Exide Life Secured Income Insurance Plus
07 yrs/ Rs. 24094/-
3. Name of the insured
Name of the policyholder
Mr. Shalender Markandey
Mr. Shalender Markandey
4. Name of the insurer Exide Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12.06.2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under both policies
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 07-01-2019, 12.02.2019 & 05.03.2019 / Chandigarh
14. Representation at the hearing
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)
15. Complaint how disposed Dismissed in default
16. Date of Award/Order 05.03.2019
17) Brief Facts of the case:
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.
Page 174 of 412
The Insurer in their SCN dated 01.03.2018, 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 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.
18. Observations & Findings:-
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
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policy bearing no 03545422, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Rajender Kumar Vs Bharti AXA Life Insurance Co. Ltd.
CASE NO-CHD-L-008-1718-0892
1. Name & Address of the
Complainant
Mr. Rajender Kumar
V.P.O.- Bani, Distt.- Sirsa, Sirsa, Haryana- 125075
Mobile No.- 9416920755
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
501-2367859 / 31-08-2014
Secure Income Plan
Rs. one Lakh
3. Name of the insured
Name of the policyholder
Mr. Rajender Kumar
Mr. Rajender Kumar
Page 175 of 412
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 13-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Rajender Kumar
For the insurer Mr. Puneet Chataley- TTM
Mr. Raj Kumar (Sales Manager)
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
Page 176 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 the days of receipt
of this order for information and record.
To be communicated to the parties.
Dated at Chandigarh on 05th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Raj Karan Vs Bharti AXA Life Insurance Co. Ltd.
CASE NO-CHD-L-008-1718-0883
1. Name & Address of the
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
Duration of policy/Premium
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,
3. Name of the insured
Name of the policyholder
Mr. Raj Karan, Mr. Rohit Duhan, Ms. Priyanka Devi
Mr. Raj Karan, Mr. Rohit Duhan, Ms. Priyanka Devi
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the
Complaint
08-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums under all the above policies
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(d)
Page 177 of 412
13. Date of hearing/place 05.03.2019/Chandigarh
14. Representation at the
hearing
For the Complainant Mr. Raj Karan
For the insurer Mr. Puneet Chataley- TTM
Mr. Raj Kumar (Sales Manager)
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
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
with welcome letter were dispatched and duly delivered at complainant’s address.
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.
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.
Dated at Chandigarh on 05th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
Page 178 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(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
1. Name & Address of the
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/-
3. Name of the insured
Name of the policyholder
4. Name of the insurer Bharti Axa Life Insurance Co.Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the
Complaint
21.04.2017
8. Nature of complaint Misselling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of above amount under which no policies
were issued
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(h)
13. Date of hearing/place 27.08.2018, 14.11.2018, 08.01.2019 & 05.03.2019
/Chandigarh
14. Representation at the
hearing
For the Complainant Self
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
15. Complaint how disposed Award
16. Date of Award/Order 05.03.2019
17) Brief Facts of the case:
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
Page 179 of 412
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
approached this office to seek justice.
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Complaint to the insurer. b) Annexure Vl-A c) Reply of the company
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 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,
Page 180 of 412
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
Taking into account the facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, an award is passed with a direction to the
insurance company to refund all the amounts received against the cheques bearing ref
no’s MC 021312031112, 021312031428 & 000000000078.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
d. 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 05th
day of March, 2019
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Harinder Kumar Prajapati Vs Bharti AXA Life Insurance Co. Ltd.
CASE NO-CHD-L-008-1718-0904
1. Name & Address of the
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
Duration of policy/Policy period
501-2697065 / 14-01-2015
Samriddhi
Page 181 of 412
3. Name of the insured
Name of the policyholder
Mr. Harinder Kumar Prajapati
Mr. Harinder Kumar Prajapati
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 16-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Puneet Chataley- TTM
Mr. Raj Kumar (Sales Manager)
15. Complaint how disposed Dismissed
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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
approached this office to seek justice.
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.
18) Cause of Complaint:
a) Complainant’s argument:
Page 182 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.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer. c) Reply of the company
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 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
Taking into account the facts & circumstances of the case and the submissions made by
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.
Hence, the complaint is treated as closed
Dated at Chandigarh on 05th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
Page 183 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mrs. Uma Sharma V/s Bharti AXA Life Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-008-1718-0488
17) Brief Facts of the Case:
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
1. Name & Address of the
Complainant
Mrs. Uma Sharma
Shayam Bhawan, Near Mangroo Cottage,
Below RTO, Shimla, Himachal Pradesh- 171004
Mobile No.- 8628882291
2. Policy No:
Type of Policy
Term of policy /Premium
501-5234247 & 501-5234221,
3. Name of the insured
Name of the policy holder
Ms. Mohini Joshi
Ms. Mohini Joshi
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of receipt of the Complaint 15-06-2017
6. Nature of complaint Mis-selling
7. Date of Repudiation NIL
8. Reason for repudiation NA
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017.
13.1.(c.)
13. Date of hearing/place 14.11.2018 ,08.01.2019 & 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Absent on all the occasions
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
16 Date of Award/Order 05.03.2019
Page 184 of 412
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.
18. Observations & Findings:-
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policies bearing no’s 501-5234247 & 501-5234221, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 05th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
Page 185 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Rameshwar Dass Vs Bharti AXA Life Insurance Co. Ltd.
CASE NO-CHD-L-008-1718-0903
1. Name & Address of the
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
Duration of policy/Premium
501-5786642 & 501-5298853 / 16-05-2017, 16-05-2017
Elite Advantage
Rs.46499/ & Rs.46499/-
3. Name of the insured
Name of the policyholder
Mr. Vishal Dhiman
Mr. Rameshwar Dass
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 16-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 05.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Rameshwar Dass
For the insurer Mr. Mukund Sharma- Assistant Manager
Mr. Muthanna M K –Intern- Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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
Page 186 of 412
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.
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.
Dated at Chandigarh on 5th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Shivakumar Ramasamy Vs Bharti AXA Life Insurance Co. Ltd.
CASE NO-CHD-L-008-1819-0472
1. Name & Address of the
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
Duration of policy/Policy
period
501-3984983 / 28-01-2016
Elite Advantage Plan
Rs. 02 Lakhs renewal prem of Rs. 02 lakhs also deducted
3. Name of the insured
Name of the policyholder
Mr. Shivakumar Ramasamy
Mr. Shivakumar Ramasamy
Page 187 of 412
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the
Complaint
12-07-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Rs. 04 Lakhs (including renewal premium)
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(c)
13. Date of hearing/place 05.03.2019/Chandigarh
14. Representation at the hearing
For the Complainant Mr. Shivakumar Ramasamy
For the insurer Mr. Puneet Chataley- TTM
15. Complaint how disposed Agreement
16. Date of Award/Order 05.03.2019
17. Brief Facts of the case:
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.
Page 188 of 412
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.
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 501-3984983 and refund all
the premiums 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.
Dated at Chandigarh on 5th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Gurpal Singh V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1106
1. Name & Address of the
Complainant
Shri Gurpal Singh
#15341A, Dhillon Nagar, Joga Nanad
Road
Bathinda
2. Policy No: 19454911, 19448111
Page 189 of 412
Type of Policy
Duration of policy/Policy period
Super Income Plan
16/8 years
3. Name of the insured
Name of the policyholder
Shri Satbinder Singh (Father)
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 27.11.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 94,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
Page 190 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.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Amandeep Singh V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1171
1. Name & Address of the
Complainant
Shri Amandeep Singh
#165, Churhard Patti, W.No. 8,
Cheema, Distt. Sangrur
2. Policy No:
Type of Policy
Duration of policy/Policy period
18861984
3. Name of the insured
Name of the policyholder
Shri Amandeep Singh
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 13.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 40,000/=
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
Page 191 of 412
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
18) The Company’s offer is accepted by the Complainant.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 192 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Surinder Kaur V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1202
1. Name & Address of the
Complainant
Ms Surinder Kaur
VPO Sandhu Chatha, Kapurthala
2. Policy No:
Type of Policy
Duration of policy/Policy period
14489922
Classic Pension
10/5 years
3. Name of the insured
Name of the policyholder
Ms Surinder Kaur
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 19.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1 lakhs
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
Page 193 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.
18) The Insurance Company has informed that the policy was issued on 11.07.2011 for an yearly
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.
19) The Company’s offer is accepted by the Complainant.
20) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
21) 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.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Mukesh Kumar V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1174
1. Name & Address of the
Complainant
Shri Mukesh Kumar
Gupta Tent House, Main Road
Taraori, Karnal
2. Policy No: 19287419
Page 194 of 412
Type of Policy
Duration of policy/Policy period
3. Name of the insured
Name of the policyholder
Shri Gian Chand
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs.
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Shri Gian Chand, Father
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
18) The Company’s offer is accepted by the Complainant.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
Page 195 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.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Pooran Ram V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1190
1. Name & Address of the
Complainant
Shri Pooran Ram
Jalalabad Road, Pragdas Street, Muktsar
2. Policy No:
Type of Policy
Duration of policy/Policy period
18406654, 18433491, 18486578, 18530961,
18328333
3. Name of the insured
Name of the policyholder
Late Shri Nirmal Singh
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 18.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1.23 lakhs
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Page 196 of 412
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
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.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 197 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Sukhraj Singh V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1170
1. Name & Address of the
Complainant
Shri Sukhraj Singh
#165, Churhard Patti, W.No. 8,
Cheema, Distt. Sangrur
2. Policy No:
Type of Policy
Duration of policy/Policy period
18976085
3. Name of the insured
Name of the policyholder
Shri Sukhraj Singh
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 13.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 86,738/=
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
Page 198 of 412
17) The Insurance Company has informed that the policy was issued on 15.01.2017 for an yearly
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.
18) The Company’s offer is accepted by the Complainant.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Ram Charan Yadav V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1223
1. Name & Address of the
Complainant
Shri Ram Charan Yadav
#1306/3, Sector 30, Chandigarh
2. Policy No:
Type of Policy
Duration of policy/Policy period
18858760
Classic Assure Plus
10/7 years
3. Name of the insured
Name of the policyholder
Shri Ram Charan Yadav
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
Page 199 of 412
7. Date of receipt of the Complaint 27.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 70,000/=
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) At the outset, the Company offered to cancel the policy and refund the premiums paid by the
complainant.
18) The Company’s offer is accepted by the Complainant.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 200 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri G S Dhillon V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1260
1. Name & Address of the
Complainant
Shri G S Dhillon
735, Army Flats, Phase-2
SAS Nagar, Mohali
2. Policy No:
Type of Policy
Duration of policy/Policy period
19843184
Youngstar Udaan
15/7 years
3. Name of the insured
Name of the policyholder
Shri G S Dhillon
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 10.01.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 95,000/= + interest
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
Page 201 of 412
17) At the outset, the Company offered to cancel the policy and refund the premiums paid by the
complainant.
18) The Company’s offer is accepted by the Complainant.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Sandeep Kumar V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1104
1. Name & Address of the
Complainant
Shri Sandeep Kumar
Shiv Colony, Ward No. 15, Samalkha
Panipat
2. Policy No:
Type of Policy
Duration of policy/Policy period
17705224
Click 2 Protect Plus
3. Name of the insured
Name of the policyholder
Late Shri Satpal Sharma
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 27.11.2017
8. Nature of complaint Mis-selling
Page 202 of 412
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 25 lakhs
12. Complaint registered under
Rule no:
13.1(a)
13. Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
The representative of the Company informed that the policy bearing number 17705224 was
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.
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. As per the
Page 203 of 412
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.
The attention of the complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
b. 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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Neena Mehta V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1207
1. Name & Address of the
Complainant
Ms Neena Mehta
#252, Sector 18, Panchkula
2. Policy No:
Type of Policy
Duration of policy/Policy period
18429589, 18468682, 18498547, 18496051,
18525830, 18605335
Classic Assure Plus, Sampoorn Samridhi
3. Name of the insured
Name of the policyholder
Ms Neena Mehta
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 22.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
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 settle the death claim as per terms and conditions of the policy.
Hence, the complaint is treated as closed.
Page 204 of 412
11. Amount of relief sought Rs. 4.13 lakhs
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
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.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 205 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Sh Surinder Kumar Joshi & Ms Seema Sharma V/S HDFC Standard Life Insurance Co.
Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1224
1. Name & Address of the
Complainant
Sh Surinder Kumar Joshi & Ms Seema
Sharma
#12396, Street no. 16, Prabhat Nagar
Ludhiana
2. Policy No:
Type of Policy
Duration of policy/Policy period
15867932, 15869066, 15876731
3. Name of the insured
Name of the policyholder
Ms Seema Sharma
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 27.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1,20,096/=
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Award
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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
Page 206 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.
17) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
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 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.
Page 207 of 412
The attention of the complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
c. 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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Budhu Ram Biswas V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1257
1. Name & Address of the
Complainant
Shri Budhu Ram Biswas
#23, Arjun Nagar, Jalandhar
2. Policy No:
Type of Policy
Duration of policy/Policy period
19571896, 19625472
Classic Assure Plus
15/10 years
3. Name of the insured
Name of the policyholder
Shri Budhu Ram Biswas
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.01.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
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 policies bearing numbers 15867932, 15869066 and 1587673
since inception and refund the premium collected there-under without interest
or deduction of any charges.
Hence, the complaint is treated as closed.
Page 208 of 412
11. Amount of relief sought Rs. 86,000/= + compensation
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Award
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
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 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.
Page 209 of 412
The attention of the complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
d. 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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Ajmer Singh V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1225
1. Name & Address of the
Complainant
Shri Ajmer Singh
#1439/21, Sec-29B, Chandigarh
2. Policy No:
Type of Policy
Duration of policy/Policy period
19294464
3. Name of the insured
Name of the policyholder
Shri Ajmer Singh
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 27.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
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 policies bearing numbers 19571896 and 19625472 since
inception and refund the premium collected there-under without interest or
deduction of any charges.
Hence, the complaint is treated as closed.
Page 210 of 412
11. Amount of relief sought Rs. 40,000/=
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Agreement
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) At the outset, the Company offered to cancel the policy and refund the premiums paid by the
complainant.
18) The Company’s offer is accepted by the Complainant.
19) Accordingly, an agreement was signed between the Company and the complainant on
06.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 7th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 211 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Deebanshu Bharija V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1041
1. Name & Address of the
Complainant
Shri Deepanshu Bharija
#259/28, Jyoti Park, Gali No. 6
Gurugram
2. Policy No:
Type of Policy
Duration of policy/Policy period
19630497
Super Income Plan
3. Name of the insured
Name of the policyholder
Sh Deepanshu Bharija
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.11.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 30,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Resolved by the Company
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
Page 212 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.
To be communicated to the parties.
Dated at Chandigarh on 11th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Shambhu Kumar V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0766
1. Name & Address of the
Complainant
Shri Shambhu Kumar
258/3, Key Line, Near Alpha Power
House
Ambala
2. Policy No:
Type of Policy
Duration of policy/Policy period
18597707, 18170677
Classic Assure Plus
15/5 years, 20/10 years
3. Name of the insured
Name of the policyholder
Sh Shambhu Kumar
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.08.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
Page 213 of 412
11. Amount of relief sought Rs. 74,480/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Dismissed in default
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
Dated at Chandigarh on 15th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
Page 214 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Harisimran Singh Sandhu V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-1168
1. Name & Address of the
Complainant
Shri Harisimran Singh Sandhu
#220, Sector 9C, Chandigarh
2. Policy No:
Type of Policy
Duration of policy/Policy period
15671376, 15670541
Unit Linked Pension
3. Name of the insured
Name of the policyholder
Shri Harisimran Singh Sandhu
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 8.5 lakhs
12. Complaint registered under
Rule no:
13.1(a)
13. Representation at the hearing
For the Complainant None
For the insurer Shri Arpit Higgins,
Manager(Legal&Comp)
Shri Gurpreet Singh, Dy Manager(Legal)
14 Complaint how disposed Dismissed & Closed
15 Date & Place of Hearing 06.03.2019/Chandigarh
16) Brief Facts of the Case:
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
Page 215 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.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
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.
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.49999/- under policy no. 006615682and same has been confirmed by
discharge voucher duly singed by the complainant.
Page 216 of 412
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 08.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 08.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 217 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Ramesh Chand Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1422
1. Name & Address of the
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
Duration of policy/Policy period
006578426, 006559290 / 10-09-2014, 30-07-2014
BSLI Income Assured, Vision Life Income Plan
Annual
3. Name of the insured
Name of the policyholder
Mr. Ramesh Chander, Mr. Shivam
Mr. Ramesh Chander
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09-03-2018
8. Nature of complaint Misselling
9. Amount of Claim
10. Date of Partial Settlement
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 [1][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Ramesh Chand
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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
Page 218 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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Ms. Saroj Bhalla Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1383
1. Name & Address of the
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
Duration of policy/Policy period
007221842 / 28-02-2017
ABSLI Vision Endowment Plus
Annually
3. Name of the insured
Name of the policyholder
Ms. Saroj Bhalla
Ms. Saroj Bhalla
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation
6. Reason for repudiation
7. Date of receipt of the Complaint 28-02-2018
8. Nature of complaint Misselling
9. Amount of Claim
Page 219 of 412
10. Date of Partial Settlement
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 [1][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Amit Bhalla (Son)
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
Page 220 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Chaman Lal Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1377
1. Name & Address of the
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
Duration of policy/Policy period
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
3. Name of the insured
Name of the policyholder
Mr. Chaman Lal, Ms. Anita Sharma
Mr. Chaman Lal, Ms. Anita Sharma
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation
6. Reason for repudiation
7. Date of receipt of the Complaint 26-02-2018
8. Nature of complaint Misselling
9. Amount of Claim
10. Date of Partial Settlement
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 [1][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Chaman Lal
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
Page 221 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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jasbir Singh Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1402
1. Name & Address of the
Complainant
Mr. Jasbir Singh
House No.- 32, VPO- Mangli Uchi,
Tehsil & Distt.- Ludhiana, Punjab-0
Mobile- 9876636060
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
005806846 / 25-10-2012
BSLI Vision Plan
Annually
3. Name of the insured
Name of the policyholder
Mr. Jasbir Singh
Mr. Jasbir Singh
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
7. Date of receipt of the Complaint 01-03-2018
Page 222 of 412
8. Nature of complaint Misselling
9. Amount of Claim
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][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Jasbir Singh [self]
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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/-
18. In personal hearing the company agreed to cancel the policy bearing number 005806846 and
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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
Page 223 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jia Lal Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1403
1. Name & Address of the
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
Duration of policy/Policy period
005585842 / 29-05-2012
BSLI Vision Plan
Semi- annually
3. Name of the insured
Name of the policyholder
Mr. Jia Lal
Mr. Jia Lal
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
7. Date of receipt of the Complaint 01-03-2018
8. Nature of complaint Misselling
9. Amount of Claim
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][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Amar Kumar (Son of Complainant)
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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/-
18. In personal hearing the company agreed to cancel the policy bearing number 005585842 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.
Page 224 of 412
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
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.
To be communicated to the parties.
.
Dated : 08.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 225 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Hawa Singh Vs Birla Sun Life Insurance. Co. Ltd.
CASE NO-CHD-L-009-1718-0964
1. Name & Address of the
Complainant
Mr. Hawa Singh S/o Shri. Harphool Singh,
Village – Aleva, Distt.- Jind,
Haryana-0
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
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
3. Name of the insured
Name of the policyholder
Mr. Hawa Singh, Mr. Amarjit Singh
Mr. Hawa Singh, Mr. Amarjit Singh
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
7. Date of receipt of the Complaint 09-10-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim
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][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Hawa Singh
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
Page 226 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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Syed Ejaz Husain Rizvi Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1262
1. Name & Address of the
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
Duration of policy/Policy period
005797177, 005895020, 006225203 / 02-11-2012,
31-01-2013, 13-09-2013
BSLI Vision Plan
Annual
3. Name of the insured
Name of the policyholder
Mr. Syed Ejaz Husain Rizvi, Mr. Ehtesham Abbas
Rizvi
Mr. Syed Ejaz Husain Rizvi
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
Page 227 of 412
7. Date of receipt of the Complaint 21-12-2017
8. Nature of complaint Misselling
9. Amount of Claim
10. Date of Partial Settlement N.A
11. Amount of relief sought
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 [1][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Dr. Syed Ejaz Husain Rizvi [self]
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
18. In personal hearing the company agreed to cancel the policy bearing number 006225203 and
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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
Page 228 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Balwinder Singh Vs Birla Sun Life Insurance. Co. Ltd.
CASE NO-CHD-L-009-1718-0608
1. Name & Address of the
Complainant
Mr. Balwinder Singh
Kothi No.- 699, Phase- 6, Mohali, Punjab-0
Mobile No.- 9501594534
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
006163618 / 31-08-2013
BSLI Vision Plan
Annual
3. Name of the insured
Name of the policyholder
Mr. Balwinder Singh
Mr. Balwinder Singh
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
7. Date of receipt of the Complaint 11-07-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim
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][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Balwinder Singh [self]
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
18. In personal hearing the company agreed to cancel the policy bearing number 006163618 and
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
Page 229 of 412
for this new single premium ULIP policy. 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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
.
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Hardev Singh Vs Birla Sun Life Insurance. Co. Ltd.
CASE NO-CHD-L-009-1718-0534
1. Name & Address of the
Complainant
Mr. Hardev Singh
House No.- 206/9, Aanand Nagar,
Ward No.- 10, Kharar, Mohali, Punjab-0
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
006021005, 006089902 / 18-03-2013, 30-04-2013
BSLI Vision Plan, BSLI Bachat Money Back Plan
3. Name of the insured
Name of the policyholder
Mr. Hardev Singh
Mr. Hardev Singh
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation Na
6. Reason for repudiation Na
7. Date of receipt of the Complaint 21-06-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Refund of premium
10. Date of Partial Settlement Na
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13 [1] [d]
Page 230 of 412
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Order for refund of premium
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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
Page 231 of 412
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 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
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 policies bearing numbers 006021005 &, 006089902
since inception and refund all the premium collected there-in without interest and without
deduction of any charges.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
e. 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 08.03.2019.
D.K.Verma
INSURANCE OMBUDSMAN
Page 232 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Mohit Agarwal Vs Birla Sun Life Insurance. Co. Ltd.
CASE NO-CHD-L-009-1718-1229
1. Name & Address of the
Complainant
Mr. Mohit Agarwal
House No.- 1748, Sector- 4, Panchkula,
Haryana-0
Mobile No.- 9872098042
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
004374999 / 15-09-2010
BSLI Freedom 58 Base Coverage
Annual
3. Name of the insured
Name of the policyholder
Mr. Mohit Agarwal
Mr. Mohit Agarwal
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
7. Date of receipt of the Complaint 29-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim
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][d]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Mohit Agarwal
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
Page 233 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.
18. In personal hearing the company agreed to cancel the policy bearing number 004374999 and
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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 08th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
.
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
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.
Page 234 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
disposed off accordingly.
Dated : 08.03.2019 Dr. D. K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Agyajit Singh Vs Birla Sun Life Insurance. Co. Ltd.
CASE NO-CHD-L-009-1718-1194
1. Name & Address of the
Complainant
Mr. Agyajit Singh
# 136, Civil Lines, Patiala, Punjab- 147004
Mobile No.- 9478169464
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
004502398 , 004526125, 004483362,004339079 /
16-11-2010, 26-11-2010, 31-10-2010, 29-08-2010
BSLI Bachat Endowment Plan
Annual
3. Name of the insured
Name of the policyholder
Mr. Aekamdeep Singh,
Mr. Agyajit Singh
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 19-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Refund of premium
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13 [1] [D]
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
Page 235 of 412
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Award for Refund & Conversion of policies into
Single Premium Policy.
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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
complaint. He submitted that brokers of the insurance company gave him lucrative offer to invest in
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
numerous calls on the toll Free No. of the insurer but did not get any response. He also added that his
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.
19. The following documents were placed for perusal:
a) Complaint to the Company. b) Proposal Form.
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 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
Page 236 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.
To be communicated to the parties.
Dated at Chandigarh on 08.03.2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Shisha Singh Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1462
1. Name & Address of the
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
Duration of policy/Policy period
004668326, 004763081/ 31-01-2011, 16-03-2011
BSLI Bachat Money Back Plan
3. Name of the insured
Name of the policyholder
Mr. Kanwaldeep Singh, Ms. Gagandeep Kaur
Mr. Shisha Singh
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 15-03-2018
8. Nature of complaint Misselling
9. Amount of Claim Refund of premium
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 [1] [D]
Page 237 of 412
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Award for Conversion of policies into Single
Premium Policy.
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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
complaint. He submitted that brokers of the insurance company gave him lucrative offer to invest in
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
numerous calls on the toll Free No. of the insurer but did not get any response. He also added that his
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 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.
19. The following documents were placed for perusal:
a) Complaint to the Company. b) Proposal Form.
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
Page 238 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.
To be communicated to the parties.
Dated at Chandigarh on 08.03.2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Basant Kumar Vs Birla Sun Life Insurance Co. Ltd.
CASE NO-CHD-L-009-1718-1338
1. Name & Address of the
Complainant
Mr. Basant Kumar
Village- Bhagu Majra, Tehsil- Jagadhri,
Distt.- Yamuna Nagar, Haryana- 135133
Mobile No.- 9992999381
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
006285540, 006220205, 006251610 / 29-10-2013,
16-09-2013, 30-09-2013
Vision Life Income Plan, Bachat Endowment Plan
Annual
3. Name of the insured
Name of the policyholder
Mr. Basant Kumar
Mr. Basant Kumar
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation Na
6. Reason for repudiation Na
7. Date of receipt of the Complaint 10-02-2018
8. Nature of complaint Misselling
9. Amount of Claim Rs.70000/-
10. Date of Partial Settlement Na
11. Amount of relief sought Rs.70000/-
12. Complaint registered under 13 [1] [d]
Page 239 of 412
Rule no: Insurance
Ombudsman Rules, 2017
13. Date of hearing/place 08-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Order for refund of premium
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
18. Cause of Complaint:
a]Complainant’s argument
Mr. Basant kumar, 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 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.
19. The following documents were placed for perusal:
a) Complaint to the Company. b) Proposal Form.
c) Insurer’s SCN
Page 240 of 412
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 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
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 policies bearing numbers 006285540, 006220205
and 006251610 since inception and refund all the premium collected there-in without
interest and without deduction of any charges.
Hence, the complaint is treated as closed.
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 08.03.2019.
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the
Complainant
Sh. Rajinder Singh
R/o H. No. 603-A, New Partap Nagar,
Near Tarmika Property Dealer, Amritsar,
Punjab-0
2. Policy No: 006101192
Page 241 of 412
Type of Policy
Duration of policy/Policy period
BSLI Bachat Endowment
20 yrs./ 20 yrs.
3. Name of the insured
Name of the policyholder
Sh. Rajinder Singh
Sh. Rajinder Singh
4. Name of the insurer Birla Sun Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 13-10-2016
8. Nature of complaint Mis-selling, forgery and cheating
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Refund of Rs. 82,000/- with intt.
12. Complaint registered under
Rule no:- Insurance Ombudsman
Rules, 2017.
13.1(c)
13. Date of hearing/place 04.06.2018, 23.10.2018 & 08.03.2019/
Chandigarh
14. Representation at the hearing
For the Complainant Absent
For the insurer Mr. Kaveesh, Senior- Legal Manager
15 Complaint how disposed Dismissed in default
16 Date of Award/Order 08.03.2019
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.
19. Observations & Findings:-
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
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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
Taking into account the facts & circumstances of the case and the submissions
made by insurance company during the course of personal hearing, the complaint
in respect of policy no. 006101192 is dismissed. Hence, the complaint is treated as
closed.
Dated at Chandigarh on 08.03.2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mrs. Kamla Kumari Vs Birla Sun Life Insurance. Co. Ltd.
CASE NO-CHD-L-009-1718-0276
1. Name & Address of the
Complainant
Mrs. Kamla Kumari
House No.- 311, Sector- 8, Panchkula,
Haryana- 134109
Mobile No.- 8054933511
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
005743392 / 07-09-2012
BSLI Vision Plan
Annual
3. Name of the insured
Name of the policyholder
Mrs. Kamla Kumari
Mrs. Kamla Kumari
4. Name of the insurer Birla Sun Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 31-05-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Refund of premium
10. Date of Partial Settlement
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13 [1] [2]
Page 243 of 412
13. Date of hearing/place 08.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Kaveesh, Senior- Legal Manager
15. Complaint how disposed Order for refund of premium
16. Date of Award/Order 08.03.2019
17. Brief Facts of the case:
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.
18. Cause of Complaint:
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.
19. The following documents were placed for perusal:
a) Complaint to the Company. b) Proposal Form.
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
Page 244 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.
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 08.03.2019.
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Gaurav Agarwal V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0929
1. Name & Address of the
Complainant
Shri Gaurav Agarwal
#2172/3, 1st Floor, Rajiv Nagar,
Gurugram
2. Policy No: 18535791
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 005743392 since inception
and refund all the premium collected there-in without interest and without deduction of
any charges.
Hence, the complaint is treated as closed.
Page 245 of 412
Type of Policy
Duration of policy/Policy period
Sanchay
15 years
3. Name of the insured
Name of the policyholder
Sh Gaurav Agarwal
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 06.10.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 50,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
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
16) Brief Facts of the Case:
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.
Page 246 of 412
18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,
06.03.2019 and 15.03.2019. The case is thus, dismissed in default and closed.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Tejashwini V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0930
1. Name & Address of the
Complainant
Ms Tejashwini
23, 1st Floor, Sukhdev Venue,
Near Rajpura Nagar, Ludhiana
2. Policy No:
Type of Policy
Duration of policy/Policy period
17846034
Pro Growth Plus
10 years
3. Name of the insured
Name of the policyholder
Ms Tejashwini
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 01.10.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 50,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
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
Page 247 of 412
16) Brief Facts of the Case:
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.
17) The Company has informed that the policy bearing number 17846034 was issued on 31.08.2015
for a premium of Rs. 50,000/= to be paid for 10 years. The policy was delivered on 09.09.2015
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.
18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,
06.03.2019 and 15.03.2019. The case is thus, dismissed in default and closed.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Hritik Roshan V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0888
1. Name & Address of the
Complainant
Shri Hritik roshan
#635, GF, Sector 51, Gurgaon
2. Policy No:
Type of Policy
Duration of policy/Policy period
19305936
Classic Assure Plus
10/7 years
3. Name of the insured
Name of the policyholder
Sh Hritik Roshan
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 11.09.2017
Page 248 of 412
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 50,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
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
16) Brief Facts of the Case:
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.
17) The Company has informed that the policy bearing number 19305936 was issued on 16.05.2017
for a premium of Rs. 50,000/= to be paid for 7 years. The policy was delivered on 29.05.2017
and the first complaint was received on 21.07.2017 which was 53 days after the purchase of the
policy.
18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,
06.03.2019 and 15.03.2019. The case is thus, dismissed in default and closed.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri R K Sood V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0994
1. Name & Address of the
Complainant
Shri R K Sood
#425, Sector 29, Faridabad
Page 249 of 412
2. Policy No:
Type of Policy
Duration of policy/Policy period
19379084
Classic Assure Plus
10/7 years
3. Name of the insured
Name of the policyholder
Sh R K Sood
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 24.10.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 80,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
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
16) Brief Facts of the Case:
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.
18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,
06.03.2019 and 15.03.2019. The case is thus, dismissed in default and closed.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
Page 250 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Swati Agarwal V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0859
1. Name & Address of the Complainant Ms Swati Agarwal
Gurugram, Haryana
2. Policy No:
Type of Policy
Duration of policy/Policy period
19330643
Sanchay
15/5 years
3. Name of the insured
Name of the policyholder
Ms Swati Agarwal
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 02.09.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 20,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
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
16) Brief Facts of the Case:
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.
18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,
06.03.2019 and 15.03.2019. The case is thus, dismissed in default and closed.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
Page 251 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Pardeep Dharra V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-019-1718-0845
1. Name & Address of the
Complainant
Shri Pardeep Dharra
#43/1, Sainik Coony, Hisar Road, Rohtak
2. Policy No:
Type of Policy
Duration of policy/Policy period
18938993
Youngstar Super Premium
10 years
3. Name of the insured
Name of the policyholder
Sh Pardeep Dharra
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 28.08.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 25,000/= + interest
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant None
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
16) Brief Facts of the Case:
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.
Page 252 of 412
18) Neither the complainant nor her representatives appeared for the personal hearing on 06.02.2019,
06.03.2019 and 15.03.2019. The case is thus, dismissed in default and closed.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the
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
Duration of policy/Policy
period
283453384
3. Name of the insured
Name of the Policyholder
Sh. Danendra Kumar Jain,
Sh. Danendra Kumar Jain,
4. Name of the insurer Life Insurance Corporation of India
Divisional office- Varansi
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the
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.
10. Date of Partial Settlement Nil
11. Amount of relief sought 2.12 lac with interest.
12. Complaint registered under
Rule no: - Insurance
Ombudsman Rules, 2017.
13(1) (a)
13. Date of hearing/place 15.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant None
For the insurer Ms Poornima Mishra, Manager(CRM)
Page 253 of 412
Ms Shylaja Bodh, AO(CRM)
15 Complaint how disposed Dismissed in Default
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.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURNCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Neha Sharma V/S Aviva Life Insurance Company India Ltd.
COMPLAINT REF: NO: CHD-L-004-1718-1058
1. Name & Address of the
Complainant
Ms Neha Sharma
3rd
Floor, Infinity Tower C
DLF, Phase 2, Gurugram
2. Policy No:
Type of Policy
Duration of policy/Policy period
SCG2183584/01684835
Sachin Century Plan
5 years
3. Name of the insured Shri Desh Bandhu Sharma
Page 254 of 412
Name of the policyholder
4. Name of the insurer Aviva Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 19.09.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 20,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Shri Shikhar Sharma, Cousin
For the insurer Shri Naresh Sharma, Branch Manager
14 Complaint how disposed Dismissed
15 Date and Place of Hearing 15.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
18) The following documents were placed for perusal :-
a) Complaint to the Company
b) Reply of the Insurance Company
Page 255 of 412
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 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.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Balbir Singh V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1489
1. Name & Address of the
Complainant
Shri Balbir Singh
Vill Kait, PO Sabapur, Tehsil
Jagadhari,
Yamunanagar
2. Policy No:
Type of Policy
Duration of policy/Policy period
52229047, 52307002, 52307022
Fixed Savings, Guaranteed Money Back
15/10 years
3. Name of the insured
Name of the policyholder
Shri Anurag Kamboj, Shri Balbir Singh
Shri Balbir Singh
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 23.03.2018
Taking into account the facts & circumstances of the case and the submissions
made by the Company during the course of hearing, there is no need for any
interference and the complaint is dismissed.
Hence, the complaint is treated as closed.
Page 256 of 412
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 2.5 lakhs
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
16) Brief Facts of the Case:
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.
19) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019.
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 days of receipt of this order for
information and record.
Page 257 of 412
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Nalesh H Thaman V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1458
1. Name & Address of the
Complainant
Shri Nalesh H Thaman
Nirmal Sadan, College Road,
Near MC Colony Chowk, Pathankot
2. Policy No:
Type of Policy
Duration of policy/Policy period
51231844, 51225460, 51225494,
51238052
Guaranteed Money Back
15/5 years
3. Name of the insured
Name of the policyholder
Ms. Mini N Thaman, Ms Kashika N
Thaman
Shri Nalesh H Thaman
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 3,76,853/= + interest
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Ms Kashika Thaman, Daughter
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
Page 258 of 412
16) Brief Facts of the Case:
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
approached this office to seek justice.
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.
19) Accordingly, an agreement was signed between the Company and the complainant on
17.01.2019.
Page 259 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.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Ramesh Chand V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1443
1. Name & Address of the
Complainant
Shri Ramesh Chand
Vill Dadoura, Tesil Balh, PO Dhaban
Nar Chowk, Mandi
2. Policy No:
Type of Policy
Duration of policy/Policy period
51632324
Super Money Back
30/15 years
3. Name of the insured
Name of the policyholder
Shri Ramesh Chand
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 30,200/=
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
Page 260 of 412
16) Brief Facts of the Case:
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.
18) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Het Ram V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1381
1. Name & Address of the
Complainant
Shri Het Ram
Vill Dhandhal, Kotli, Mandi
2. Policy No:
Type of Policy
Duration of policy/Policy period
52031797, 52108644
Guaranteed Money Back
15/7 years, 15/10 years
Page 261 of 412
3. Name of the insured
Name of the policyholder
Shri Het Ram, Shri Mukesh Kumar
4. Name of the insurer Reliance Nippon Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 26.02.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 60,000/= + interest
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
16) Brief Facts of the Case:
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.
18) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019.
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 days of receipt of this order for
information and record.
Page 262 of 412
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Jai Pal V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1442
1. Name & Address of the
Complainant
Shri Jai Pal
RRS HAU, Tehsil Bawal, Rewari
2. Policy No:
Type of Policy
Duration of policy/Policy period
51327706, 51329443, 51398070,
51422244, 51559947, 51598231,
51591768, 51398097, 51493558
Guaranteed Money Back
15/5/ years
3. Name of the insured
Name of the policyholder
Shri Jai Pal, Ms Kamla
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 9.34 lakhs
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
16) Brief Facts of the Case:
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,
Page 263 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.
18) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 264 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Rajinder Singh V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1435
1. Name & Address of the
Complainant
Shri Rajinder Singh
Vill Risalwa, Teh Assandh, Distt. Karnal
2. Policy No:
Type of Policy
Duration of policy/Policy period
52999096
Guaranteed Money Back
15/10 years
3. Name of the insured
Name of the policyholder
Shri Rajinder Singh
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 06.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 21,000/=
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
16) Brief Facts of the Case:
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.
18) The Company’s offer is accepted by the Complainant.
Page 265 of 412
19) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Gurmukh Singh Dhaliwal V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1238
1. Name & Address of the
Complainant
Shri Gurmukh Singh Dhaliwal
Ward No.6, Guru Nanak Dev Nagar
Sahnewal, Ludhiana
2. Policy No:
Type of Policy
Duration of policy/Policy period
52843722
Increasing Income
24/12 years
3. Name of the insured
Name of the policyholder
Shri Gurmukh Singh Dhaliwal
4. Name of the insurer Reliance Nippon Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 03.01.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 25,000/=
12. Complaint registered under
Rule no:
13.1(d )
13. Representation at the hearing
Page 266 of 412
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
16) Brief Facts of the Case:
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
deduction of any charges.
18) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 267 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURNCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Shobhit Saksena V/S Reliance Nippon Life Insurance Company Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1215
1. Name & Address of the
Complainant
Shri Shobhit Saksena
203, Royal Retreat-2, Charmwood,
Surajkund, Faridabad
2. Policy No:
Type of Policy
Duration of policy/Policy period
53075871
Fixed Money Guaranteed
15/10 years
3. Name of the insured
Name of the policyholder
Shri Shobhit Saksena
4. Name of the insurer Reliance Nippon Life Insurance
Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 17.12.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 50,000/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Shri Shri Kant Saksena, Father
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2018/Chandigarh
16) Brief Facts of the Case:
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.
17) The Company has informed that the policy bearing number 53075871 was issued on 28.10.2017
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
Page 268 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.
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 days of receipt of this order for
information and record.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Sanam Topchhen Negi V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1465
1. Name & Address of the
Complainant
Shri Sanam Topchhen Negi
VPO Nesang, Tehsil Pooh
Distt. Kinnaur
2. Policy No:
Type of Policy
Duration of policy/Policy period
52025372
Guaranteed Money Back
15/10 years
3. Name of the insured
Name of the policyholder
Ms Tanisha Negi
Shri Sanam Topchhen Negi
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 17.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 3 lakhs
12. Complaint registered under 12.1(c)
Page 269 of 412
Rule no: of RPG rules
13. Representation at the hearing
For the Complainant Self
Shri Tejinder Negi, Son
For the insurer Shri Lalit Saini, Team Leader
14 Complaint how disposed Dismissed
15 Date and Place of Hearing 15.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
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.
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 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
Page 270 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.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Seema Kumar V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1441
1. Name & Address of the
Complainant
Ms Seema Kumar
Rampur, HPS, Vayal Tehsil-Nirmad
Kullu
2. Policy No:
Type of Policy
Duration of policy/Policy period
52416460
Guaranteed Money Back
15/5 years
3. Name of the insured
Name of the policyholder
Ms Seema Kumar
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 09.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1.46 lakhs
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Sr. Team Leader
14 Complaint how disposed Agreement
15 Date of hearing/place 15.03.2019/Chandigarh
Page 271 of 412
16) Brief Facts of the Case:
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.
19) The Company’s offer is accepted by the Complainant.
20) Accordingly, an agreement was signed between the Company and the complainant on
15.03.2019. Foreclosure amount of Rs. 17,942.25 would be returned by the complainant if the
cheque has been encashed by her.
21) 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.
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D.K.VERMA
INSURANCE OMBUDSMAN
Page 272 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Gurpreet Singh Nijher V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1411
1. Name & Address of the
Complainant
Shri Gurpreet Singh Nijher
#1964, St, No, 14, Dashmesh Nagar
Ludhiana
2. Policy No:
Type of Policy
Duration of policy/Policy period
19452635, 19529162, 19584515
Guaranteed Money Back
15/5 years
3. Name of the insured
Name of the policyholder
Shri Gurpreet Singh Nijher, Ms.
Rupinder Kaur
4. Name of the insurer Reliance Life Insurance Company
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 05.03.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1.74 lakhs
12. Complaint registered under
Rule no: of RPG rules
12.1(c)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Team Leader
14 Complaint how disposed Dismissed
15 Date and Place of Hearing 15.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
a) Complainant’s argument:
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.
Page 273 of 412
b) Insurers’ argument:
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.
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 and
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.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
Taking into account the facts & circumstances of the case and the submissions
made by the Company during the course of hearing, there is no need for any
interference and the complaint is dismissed.
Hence, the complaint is treated as closed.
Page 274 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Shri Sunil V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-1310
1. Name & Address of the
Complainant
Shri Sunil
#274, Vill Sangahera, Rohtak
2. Policy No:
Type of Policy
Duration of policy/Policy period
51756372, 51791836
Guaranteed Money Back
15/10 years
3. Name of the insured
Name of the policyholder
Shri Sunil
4. Name of the insurer Reliance Nippon Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 30.01.2018
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 1 lakh/=
12. Complaint registered under
Rule no:
13.1(d)
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Team Leader
14 Complaint how disposed Dismissed
15 Date and Place of Hearing 15.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
a) Complainant’s argument:
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.
Page 275 of 412
b) Insurers’ argument:
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.
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 and
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.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
Taking into account the facts & circumstances of the case and the submissions
made by the Company during the course of hearing, there is no need for any
interference and the complaint is dismissed.
Hence, the complaint is treated as closed.
Page 276 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D K Verma
Case of Ms Om Kalia V/S Reliance Nippon Life Insurance Co. Ltd.
COMPLAINT REF: NO: CHD-L-036-1718-0847
1. Name & Address of the
Complainant
Ms Om Kalia
#1181, Sector 42B, Chandigarh
2. Policy No:
Type of Policy
Duration of policy/Policy period
19979057
Guaranteed Money Back
15/5 years
3. Name of the insured
Name of the policyholder
Shri Puneet Kalia
Ms Om Kalia
4. Name of the insurer Reliance Nippon Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 30.08.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs. 44,000/=
12. Complaint registered under
Rule no:
13.1(d )
13. Representation at the hearing
For the Complainant Self
For the insurer Shri Lalit Saini, Team Leader
14 Complaint how disposed Dismissed
15 Date and Place of Hearing 15.03.2019/Chandigarh
16) Brief Facts of the Case:
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.
17) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
Page 277 of 412
The representative of the Company informed that the policy bearing number 19979057 was
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.
18) The following documents were placed for perusal :-
a) Complaint to the Company
b) Reply of the Insurance Company
20) 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 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.
Dated at Chandigarh on 18th
day of March, 2019
Dr. D K Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
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.
Taking into account the facts & circumstances of the case and the submissions
made by the Company during the course of hearing, there is no need for any
interference and the complaint is dismissed.
Hence, the complaint is treated as closed.
Page 278 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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 18.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Vijay Bahadur Singh Vs Bajaj Allianz Life Insurance Co. Ltd.
CASE NO-CHD-L-006-1718-0686
1. Name & Address of the
Complainant
Mr. Vijay Bahadur Singh
House No. 217, Sector-4, Panchkula,
Haryana-0
2. Policy No: DOC
Type of Policy
Duration of policy/Policy
period
0045518462
3. Name of the insured
Name of the policyholder
Mr. Vijay Bahadur Singh
Mr. Vijay Bahadur Singh
4. Name of the insurer Bajaj Allianz Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the
Complaint
24-07-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Payment of Rs. 33490/-being difference of
maturity payment paid less
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.( f )
13. Date of hearing/place 08-01-2019, 20.02.2019 &18.03.2019 /
Chandigarh
Page 279 of 412
14. Representation at the hearing
For the Complainant Absent on all the occasions
For the insurer Mr. Yogesh Kumar, Zonal Head-Legal
15. Complaint how disposed Dismissed in default
16. Date of Award/Order 18.03.2019
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.
18. Observations & Findings:-
The complainant was given opportunity of personal hearing on 08.01.2019, 20.02.2019 & 18.03.2019
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.
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policy bearing no 0045518462, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
Page 280 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Summitter Singh Sond Vs Bajaj Allianz Life Insurance Co. Ltd.
CASE NO-CHD-L-006-1718-0999
1. Name & Address of the
Complainant
Mr. Summitter Singh Sond
H. No.- HE 61, Phase-5, Mohali, Punjab-0
Mobile No.- 9041695245
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
0329673730
Rs. 55000/-
3. Name of the insured
Name of the policyholder
Mr. Summitter Singh Sond
4. Name of the insurer Bajaj Allianz Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 25-10-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Mis-Selling
10. Date of Partial Settlement NA
11. Amount of relief sought NIL
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
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
For the insurer Mr. Yogesh Kumar, Zonal Head-Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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.
Page 281 of 412
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
with welcome letter were dispatched and duly delivered at complainant’s address.
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.
19. Accordingly, an agreement was signed between the Company and the complainant on
18.03.2019.
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.
Dated at Chandigarh on 18th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Serve Mohit Dalla Vs Bajaj Allianz Life Insurance Co. Ltd.
CASE NO-CHD-L-006-1718-0812
1. Name & Address of the
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
Duration of policy/Policy period
0045189870 / 28-03-2007
Bajaj Allianz Capital Unit Gain
20yrs/Rs. one Lakh
3. Name of the insured
Name of the policyholder
Mr. Serve Mohit Dalla
Mr. Serve Mohit Dalla
4. Name of the insurer Bajaj Allianz Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 23-08-2017
8. Nature of complaint Mis-Selling
Page 282 of 412
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(d)
13. Date of hearing/place 08-01-2019 & 18.03.2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Yogesh Kumar, Zonal Head-Legal
15. Complaint how disposed Dismissed
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
approached them 10 years after the issuance of said policy.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
20) Result of personal hearing with both parties (Observations & Conclusion)
Page 283 of 412
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 complainant had opted for policy
mentioned in the complaint in the March 2007. 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 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
Taking into account the facts & circumstances of the case and the submissions made
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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 18th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mrs. Deepa Sood Vs Bajaj Allianz Life Insurance Co. Ltd.
CASE NO-CHD-L-006-1718-0938
1. Name & Address of the
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
Duration of policy/Premium
0080434986 / 28-12-2007
Bajaj Allianz New Unit Gain Plus-SP
05/Rs. 25000/- DOM 28.12.2012
3. Name of the insured
Name of the policyholder
Mrs. Deepa Sood
Mrs. Deepa Sood
4. Name of the insurer Bajaj Allianz Life Insurance Co. Ltd.
5. Date of Repudiation NIL
6. Reason for repudiation NA
7. Date of receipt of the Complaint 26-09-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NIL
10. Date of Partial Settlement NIL
Page 284 of 412
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(a)
13. Date of hearing/place 08-01-2019 & 18.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Mr. Rohit Chugh(husband of the complainant)
For the insurer Mr. Yogesh Kumar, Zonal Head-Legal
15. Complaint how disposed Award
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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
approached this office to seek justice.
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.
18) Cause of Complaint:
Complainant’s argument:
Mr. Rohit Chugh, husband of the complainant attended the personal hearing on 18.03.2019 and
reiterated the contents of the complaint.
Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer c) Reply of the company
20) Result of personal hearing with both parties (Observations & Conclusion)
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 policy was
Page 285 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.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
f. 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 18th
day of March, 2019.
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Ms. Sukhleen Kaur Loomba Vs Tata AIA Life Insurance Co. Ltd.
CASE NO-CHD-L-046-1718-1370
1. Name & Address of the
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
Duration of policy/Policy period
C156453242 / 14-10-2016
Smart Income Plus
Rs.20000/-
3. Name of the insured Ms. Sukhleen Kaur Loomba
Page 286 of 412
Name of the policyholder Ms. Sukhleen Kaur Loomba
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 21-02-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Ms. Sukhleen Kaur Loomba
For the insurer Mr. Harsimran Singh, Manager-Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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.
19. Accordingly, an agreement was signed between the Company and the complainant on
18.03.2019.
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.
Page 287 of 412
To be communicated to the parties.
Dated at Chandigarh on 18th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mrs. Beenu Bhandari Vs Tata AIA Life Insurance Co. Ltd.
CASE NO-CHD-L-046-1718-1134
1. Name & Address of the
Complainant
Mrs. Beenu Bhandari
House No.- 1408, Sector- 15, Panchkula,
Haryana- 134113
Mobile No.- 7508145173
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
C202842176 / 09-09-2016
Fortune Guarantee
05/15yrs/Rs.51125/-
3. Name of the insured
Name of the policyholder
Ms. Rupali Bhandari
Mrs. Beenu Bhandari
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 05-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mrs. Beenu Bhandari
For the insurer Mr. Harsimran Singh, Manager-Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 18.03.2019
Page 288 of 412
17. Brief Facts of the case:
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.
18. The representative of the company informed that the policy was issued on 09.09.2016 based on
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
deduction of any charges.
19. Accordingly, an agreement was signed between the Company and the complainant on
18.03.2019.
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.
Dated at Chandigarh on 18th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Som Nath Khurana Vs Tata AIA Life Insurance Co. Ltd.
CASE NO-CHD-L-046-1718-1393
1. Name & Address of the
Complainant
Mr. Som Nath Khurana
House No. 202, GH- 67, Sector- 20, Panchkula,
Haryana-0
Mobile No.- 9915510440
Page 289 of 412
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
C279517049 / 30-09-2017
Smart Income Plus
3. Name of the insured
Name of the policyholder
Mr. Raghav Khurana
Mr. Som Nath Khurana
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 28-02-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(c)
13. Date of hearing/place 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Som Nath Khurana
For the insurer Mr. Harsimran Singh, Manager-Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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
office to seek justice.
18. The representative of the company informed that the policy was issued on 30.09.2017 based on
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.
Page 290 of 412
19. Accordingly, an agreement was signed between the Company and the complainant on
18.03.2019.
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.
Dated at Chandigarh on 18th
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. 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 “
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.
To be communicated to the parties
Dated : 18.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 291 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jagat Singh Vs Tata AIA Life Insurance Co. Ltd.
CASE NO-CHD-L-046-1718-1010
1. Name & Address of the
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
Duration of policy/Policy period
U671396651 26.08.2010
Invest Assure Apex Plus
03/10yrs/ Rs. 50000/-
3. Name of the insured
Name of the policyholder
Mr. Jagat Singh
Mr. Jagat Singh
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 26-10-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(d)
13. Date of hearing/place 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Harsimran Singh, Manager-Legal
15. Complaint how disposed Dismissed
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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
approached this office to seek justice.
Page 292 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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
approached them 07 years after the issuance of said policy.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 of the Insurance Company, It is observed that the complainant had opted for 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.
Page 293 of 412
ORDER
Taking into account the facts & circumstances of the case and the submissions made
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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 18th
day of March, 2019.
D.K.VERMA
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Jia Lal Vs Tata AIA Life Insurance Co. Ltd.
CASE NO-CHD-L-046-1718-1397
1. Name & Address of the
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
Duration of policy/Policy period
C244353733, C244353746 / 31-12-2011,
Maha Life Gold
15/92yrs/Rs. 30000/-& Rs. 30000/-
3. Name of the insured
Name of the policyholder
Ms. Mukta Mani, Amar Kumar
Mr. Jia Lal
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 01-03-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(d)
13. Date of hearing/place 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr.Amar Kumar s/o Sh. Jia Lal
For the insurer Mr. Harsimran Singh, Manager-Legal
15. Complaint how disposed Award
Page 294 of 412
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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 Insurer in their SCN dated 28.02.2019 has stated that the policy was issued on 31.12.2011 based on
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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’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
Page 295 of 412
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
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 policies bearing numbers C244353733 &
C244353746, since inception and refund all the premiums collected there-in without
interest and without deduction of any charges.
Hence, the complaint is treated as closed.
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 18th
day of March, 2019.
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Ms. Ramneek Walia Vs Tata AIA Life Insurance Co. Ltd.
CASE NO-CHD-L-046-1718-1047
1. Name & Address of the
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/-
Page 296 of 412
3. Name of the insured
Name of the policyholder
Ms. Ramneek Walia
Ms. Ramneek Walia
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the
Complaint
01-11-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
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 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Absent but requested to consider the complaint
on merit basis
For the insurer Mr. Harsimran Singh, Manager-Legal
15. Complaint how disposed Award
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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 Insurer in their SCN dated 21.11.2017 has stated that the policy was issued on 31.03.2017 based on
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Page 297 of 412
Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
approached them after the expiry of free look period.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer c) Reply of the company
20) Result of personal hearing with both parties (Observations & Conclusion)
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.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
g. 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 18th
day of March, 2019.
D. K. Verma
INSURANCE OMBUDSMAN
Page 298 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mr. Samir Tandon V/s Tata AIA Life Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-046-1718-0402
17) Brief Facts of the Case:
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 Insurer in their SCN dated 23.06.2017 has stated that the policy was issued on 31.10.2013 based on
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
1. Name & Address of the
Complainant
Mr. Samir Tandon
Shri G.R. Tandon, 464/9, Main Bazar,
Gohana, Haryana- 131301
Mobile No.- 9810021959
2. Policy No:
Type of Policy
Term of policy /Premium
C681107018 DOC 31.10.2013
Tata AIA Life Maha Life Gold
Rs. 136000/- paid renewal prem. due oct 2014 also
3. Name of the insured
Name of the policy holder
Mr. Samir Tandon
Mr. Samir Tandon
4. Name of the insurer Tata AIA Life Insurance Co. Ltd.
5. Date of receipt of the Complaint 06-06-2017
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 including renewal prem. also
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017.
13.1.(d)
13. Date of hearing/place 22.11.2018 & 18.03.2019/Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Harsimran Singh, Manager-Legal
15 Complaint how disposed Award
16 Date of Award/Order 18.03.2019
Page 299 of 412
submitted request for cancellation of said policy on 28.03.2016 which was denied being out of free look
period.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
approached them after more than 02 years from the expiry of free look period.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 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
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 C681107018, since inception
and refund all the premiums collected there-in without interest and without deduction of
any charges.
Hence, the complaint is treated as closed.
Page 300 of 412
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
h. 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 18th
day of March, 2019
D.K.Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Balkar Singh Vs PNB Metlife India Insurance Co. Ltd.
CASE NO-CHD-L-033-1718-1182
1. Name & Address of the
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
3. Name of the insured
Name of the policyholder
Mr. Balkar Singh
4. Name of the insurer PNB MetLife India Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 14-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of all premiums paid
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(c)
13. Date of hearing/place 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Balkar Singh
Page 301 of 412
For the insurer Mr. Rajeev Sharma, Sr. Manager Legal
15. Complaint how disposed Agreement
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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.
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 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.
19. Accordingly, an agreement was signed between the Company and the complainant on
18.03.2019.
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.
Dated at Chandigarh on 18th
day of March, 2019
D.K. VERMA
INSURANCE OMBUDSMAN
Page 302 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma CASE OF Mr. Rahul & Suresh V/s PNB Metlife India Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-033-1718-0171
17) Brief Facts of the Case:
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
1. Name & Address of the
Complainant
Mr. Rahul & Suresh
Village- Naina Tatarpue,
Tehsil & Distt.- Sonipat, Haryana- 131024
Mobile No.- 9671053456
2. Policy No: DOC
Type of Policy
Term of policy /Premium
21463340 & 21462230 28/12/2014 & 27/12/2014
Met Smart Platinum
Rs. 10000/- (Mly) & Rs. 10000/-(Mly)
3. Name of the insured
Name of the policy holder
Mr. Rahul , Ms. Saroj
Mr. Rahul , Ms. Saroj
4. Name of the insurer PNB Metlife India Insurance Co. Ltd.
5. Date of receipt of the Complaint 01.05.2017
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 all premiums paid under both the policies
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017.
13.1.(c.)
13. Date of hearing/place 15.10.2018 ,10.12.2018 & 18.03.2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Rahul s/o of Mr. Suresh
For the insurer Mr. Rajeev Sharma Sr. Manager- Legal
15 Complaint how disposed Award
16 Date of Award/Order 18.03.2019
Page 303 of 412
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
The Insurer’s representative reiterated the contents of SCN and submitted that the complainant had
approached them about 02 years after the expiry of free look period.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
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 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
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 policies bearing numbers 21463340 & 21462230,
since inception and refund all the premiums collected there-in without interest and without
deduction of any charges.
Hence, the complaint is treated as closed.
Page 304 of 412
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
i. 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 18th
day of March, 2019
D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Ms. Shakuntla Devi Vs PNB Metlife India Insurance Co. Ltd.
CASE NO-CHD-L-033-1718-1164
1. Name & Address of the
Complainant
Ms. Shakuntla Devi
H. No.- 205, Bank Street Nabha, Distt.- Patiala,
Punjab- 147201
Mobile No.- 9814636461
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
00736734 / 18-12-2008
Met Smart Plus
Rs. 50000/-
3. Name of the insured
Name of the policyholder
Ms. Shakuntla Devi
Ms. Shakuntla Devi
4. Name of the insurer PNB MetLife India Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 08-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premiums
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(c)
13. Date of hearing/place 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mr. Raj Kumar (son of the complainant)
Page 305 of 412
For the insurer Mr. Rajeev Sharma Sr. Manager- Legal
15. Complaint how disposed Dismissed
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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.
18) Cause of Complaint:
Complainant’s argument:
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/-.
Insurers’ argument:
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/-.
19) The following documents were placed for perusal:-
a) Copies of the proposal form. b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
Page 306 of 412
20) Result of personal hearing with both parties (Observations & Conclusion)
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
Taking into account the facts & circumstances of the case and the submissions made by
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.
Hence, the complaint is treated as closed
Dated at Chandigarh on 18th
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 Mrs. Reena V/S PNB Met Life Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-033-1718-1040
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 “
No complaint before the Insurance Ombudsman shall be maintainable on the same subject
Page 307 of 412
matter on which proceedings are pending before or disposed of by any court or Consumer
Forum or arbitrator”, the complaint is closed.
To be communicated to the parties
Dated : 18.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mr. Mohan Lal V/s PNB Metlife India Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-033-1718-0224
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.
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 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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 18.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 308 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
CASE OF Mrs. Sushma Devi V/s PNB Metlife India Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-033-1718-0195
17) Brief Facts of the Case:
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.
1. Name & Address of the
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
3. Name of the insured
Name of the policy holder
Mrs. Sushma Devi
Mrs. Sushma Devi
4. Name of the insurer PNB Metlife India Insurance Co. Ltd.
5. Date of receipt of the Complaint 01.05.2017
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 Rs. Two Lakhs
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017.
13.1.d.
13. Date of hearing/place 15.10.2018, 10-12-2018 & 18.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Absent on all the occasions
For the insurer Mr. Rajeev Sharma Sr. Manager- Legal
15 Complaint how disposed Dismissed in default
16 Date of Award/Order 18.03.2019
Page 309 of 412
The Insurer in their SCN dated 30.07.2017 and received by us on 09.08.2017, has stated that the
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.
18. Observations & Findings:-
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policy bearing no 21880844, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
Page 310 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D. K. Verma CASE OF Mr. Bakha Singh V/s PNB Metlife India Insurance Co. Ltd.
COMPLAINT REF. No. : CHD-L-033-1718-0219
17) Brief Facts of the Case:
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
1. Name & Address of the
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/-
3. Name of the insured
Name of the policy holder
Mr. Bakha Singh
Mr. Bakha Singh
4. Name of the insurer PNB Metlife India Insurance Co. Ltd.
5. Date of receipt of the Complaint 08.05.2017
6. Nature of complaint Mis-selling
7. Date of Repudiation NIL
8. Reason for repudiation NA
9. Amount of Claim Rs.
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017.
13.1. (d)
13. Date of hearing/place 15.10.2018, 10-12-2018 & 18.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Absent on all the occasions
For the insurer Mr. Rajeev Sharma Sr. Manager- Legal
15 Complaint how disposed Dismissed in default
16 Date of Award/Order 18.03.2019
Page 311 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.
18. Observations & Findings:-
The complainant was given opportunity of personal hearing on 15.10.2018, 10-12-2018 & 18.03.2019
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
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
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policy bearing no 20959379, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 18th
day of March, 2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mrs. Kiranjit Kaur Vs PNB MetLife India Insurance Co. Ltd.
CASE NO-CHD-L-033-1718-1127
1. Name & Address of the
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
Duration of policy/Policy period
22144071 / 15-03-2017
Met Guaranteed Income Plan
Rs. 99955.86/-
Page 312 of 412
3. Name of the insured
Name of the policyholder
Mrs. Charanjit Kaur
Mrs. Charanjit Kaur
4. Name of the insurer PNB MetLife India Insurance Co. Ltd.
5. Date of Repudiation 08.11.2017
6. Reason for repudiation Concealment of material facts
7. Date of receipt of the Complaint 04-12-2017
8. Nature of complaint Mis-Selling
9. Amount of Claim Rs. 650000/-
10. Date of Partial Settlement NIL
11. Amount of relief sought Rs. 650000/-
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13.1.(b)
13. Date of hearing/place 18-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Mr. Rajeev Sharma Sr. Manager- Legal
15. Complaint how disposed Dismissed with Refund of premium only
16. Date of Award/Order 18.03.2019
17. Brief Facts of the case:
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.
The Insurer in their SCN dated 19.04.2018 and received by us on 23.04.2018, has stated that the
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.
Page 313 of 412
18) Cause of Complaint:
a) Complainant’s argument:
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
Taking into account the facts & circumstances of the case and the submissions made
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.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
j. 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 18th
day of March, 2019
D. K. Verma
INSURANCE OMBUDSMAN
Page 314 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Sandeep Chauhan Vs ICICI Prudential Life Insurance Co. Ltd.
CASE NO-CHD-L-021-1718-0877
1. Name & Address of the
Complainant
Mr. Sandeep Chauhan
House No. 291, Ward No. 2,
Near Durga Mandir, Tosham, Bhiwani,
Haryana- 127040
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
18926875 / 11-10-2014
ICICI Pru Wealth Builder II
3. Name of the insured
Name of the policyholder
Mr. Sandeep Chauhan
Mr. Sandeep Chauhan
4. Name of the insurer ICICI Prudential Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 31-08-2017
8. Nature of complaint Lock in period 5years
9. Amount of Claim Refund of deposited amount
10. Date of Partial Settlement
11. Amount of relief sought Refund of deposited amount
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 [1] [d]
13. Date of hearing/place 16.10.2018 & 08-02-2019& 20.03.2019 /
Chandigarh
14. Representation at the hearing
For the Complainant Absent
For the insurer Sh. Sukhminder Singh
15. Complaint how disposed Dismissed in default
16. Date of Award/Order 20.03.2019
17. Brief Facts of the case:
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.
Page 315 of 412
18. Arguments of Insurer
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.
19. Observations & Findings:-
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
Taking into account the facts & circumstances of the case and the submissions
made by insurance company during the course of personal hearing, the complaint
in respect of policy no. 18926875 is dismissed in default. Hence, the complaint is
treated as closed.
Dated at Chandigarh on 20.03.2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the
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
Page 316 of 412
17) Brief Facts of the Case:
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.
18. Arguments of Insurer
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.
19. Observations & Findings:-
The complainant was given opportunity of personal hearing on 17.12.2018, 23.01.2019 & 20.03.2019
.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.
3. Name of the insured
Name of the policy holder
Sh. Tajit Kumar
Sh Tajit Kumar
4. Name of the insurer Edelweiss Tokio Life Ins. Co. Ltd.,
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Dt of receipt of the Complaint 11-07-2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement nil
11. Amount of relief sought Refund of premium Rs. 2, 18, 000/-
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017.
13.1.c.
13. Date of hearing/place 17.12.2018 , 23.01.2019 & 20.03.2019/ Chandigarh
14. Representation at the hearing
For the Complainant Absent
For the insurer Ms. Navdeep Kaur
15 Complaint how disposed Dismissed in default
16 Date of Award/Order 20.03.2019
Page 317 of 412
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.
Dated at Chandigarh on 20.03.2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Satish Kumar Vs Edelweiss Tokio Life Insurance Co. Ltd.
CASE NO-CHD-L-014-1819-0487
1. Name & Address of the
Complainant
Mr. Satish Kumar
Village & P.O.- Dadial, Hoshiarpur,
Punjab- 144223
Mobile No.- 8196916408
2. Policy No: DOC
Type of Policy
Duration of policy/Policy period
007048629E, 100021199E / 17-03-2016, 29-04-2016
Edelweiss Tokio Life – GCAP
15 Years
3. Name of the insured
Name of the policyholder
Mr. Satish Kumar
Mr. Satish Kumar
4. Name of the insurer Edelweiss Tokio Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation
7. Date of receipt of the Complaint 13-08-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim
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][d]
13. Date of hearing/place 20-03-2019 / Chandigarh
14. Representation at the hearing
AWARD
Taking into account the facts & circumstances of the case and the submissions
made by insurance company during the course of personal hearing, the complaint
in respect of policy no. 100020151E is dismissed in default.
Page 318 of 412
For the Complainant Mr. Satish Kumar
For the insurer Ms. Navdeep Kaur, Regional Operation Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 20.03.2019
17. Brief Facts of the case:
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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 20th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mrs. Kamla Patial Vs Edelweiss Tokio Life Insurance Co. Ltd.
CASE NO-CHD-L-014-1819-0138
1. Name & Address of the
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
Duration of policy/Policy period
006197191E
3. Name of the insured Ms. Bandana Kumari
Page 319 of 412
Name of the policyholder Mrs. Kamla Patial
4. Name of the insurer Edelweiss Tokio Life Insurance Co. Ltd.
5. Date of Repudiation N.A
6. Reason for repudiation N.A
7. Date of receipt of the Complaint 17-05-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim 99,000/-
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][d]
13. Date of hearing/place 20-03-2019 / Chandigarh
14. Representation at the hearing
For the Complainant Mrs. Kamla Patial
For the insurer Ms. Navdeep Kaur, Regional Operation Manager
15. Complaint how disposed Agreement
16. Date of Award/Order 20.03.2019
18. Brief Facts of the case:
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.
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
information and record.
To be communicated to the parties.
Dated at Chandigarh on 20th
day of March, 2019
(Dr. D.K. VERMA)
INSURANCE OMBUDSMAN
Page 320 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Paramjit Singh V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0043
1. On 11.04.2018, Mr. Paramjit Singh had filed a complaint against Max Life Insurance
Company in respect of policy bearing number 709404420.
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 26.02.2019 that they have already
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Sandeep V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0421
1. On 30.07.2018, Mr. Sandeep had filed a complaint against Max Life Insurance Company in
respect of policy bearing number 125350116.
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 26.03.2019 that they have already
refunded the premium amount Rs. 31,125/- through cheque to the complainant on
Page 321 of 412
16.02.2019 under policy number 125350116 and the same has been confirmed by Mr.
Sandeep telephonically on 28.03.2019.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 322 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Sunil Kumar V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0422
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.
2. This office pursued the case with the insurance company to re-examine the complaint and
they agreed to reconsider the claim.
3. On 26.03.2019, the insurer has informed through mail that they are ready to settle the claim.
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.
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 : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Jasmir Singh V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0739
1. On 08.10.2018, Mr. Jasmir Singh had filed a complaint against Max Life Insurance
Company in respect of policy bearing number 310372966.
2. This office pursued the case with the insurance company to re-examine the
complaint and they agreed to reconsider the claim.
Page 323 of 412
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mrs. Manjit Kaur V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0800
1. On 22.10.2018, Mrs. Manjit Kaur had filed a complaint against Max Life Insurance
Company in respect of policy bearing number 310373675.
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 324 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Parmood Kumar V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0877
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.
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 25.03.2019 that they have already
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Randip Singh V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0169
1. On 10.05.2018, Mr. Randip Singh had filed a complaint against Max Life Insurance
Company in respect of policy bearing number 737696641.
2. This office pursued the case with the insurance company to re-examine the complaint and
they agreed to reconsider the claim.
Page 325 of 412
3. On 26.03.2019, the insurer has informed through mail that they are ready to settle the claim.
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.
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 : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Gurdev Singh V/s Max Life Insurance Company
COMPLAINT REF. No. : CHD-L-032-1819-0235
1. On 07.06.2018, Mr. Gurdev Singh had filed a complaint against Max Life Insurance
Company in respect of policy bearing number 718476179.
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 14.03.2019 that they have already
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.
4. In view of the above, no further action is required to be taken by this office and the
complaint is disposed off accordingly.
Dated : 28.03.2019 D.K. VERMA
PLACE: CHANDIGARH INSURANCE OMBUDSMAN
Page 326 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Kuldip SinghV/s Birla Sun Life Insurance Company
COMPLAINT REF. No. : CHD-L-009-1819-0054
1. On 24-04-2018, Mr. Kuldip Singh had filed a complaint against Birla Sun Life Insurance
Company in respect of policy bearing number 005933719.
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.
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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Jatinder Singh Grewal V/s Birla Sun Life Insurance Company
COMPLAINT REF. No. : CHD-L-009-1819-0027
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.
Page 327 of 412
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.
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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Sekh Giasuddin Mandal V/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-1330
1. On 14.02.2019, Mr. Sekh Giasuddin Mandal had filed a complaint against ICICI Prudential
Life Insurance Company in respect of policy bearing number 26043156.
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 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
agreement letter dated 27.03.2019.
Page 328 of 412
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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Ms. Sumanpreet Kaur V/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-0425
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.
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 25.03.2019 that they have already
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.
4. 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
Page 329 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Ms. Loveleen Kesar V/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-0428
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.
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 25.03.2019 that they have already
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.
4. 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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Karamjeet Singh V/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-0784
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.
2. This office pursued the case with the insurance company to re-examine the complaint and
they agreed to reconsider the claim.
Page 330 of 412
3. Now, the insurer has informed through mail dated 25.03.2019 that they have already
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
agreement letter dated 31.12.2018.
4. 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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Rama Kant Sharma V/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-0964
1. On 17.12.2018, Mr. Rama Kant Sharma had filed a complaint against ICICI Prudential Life
Insurance Company in respect of policy bearing number 25514426.
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 25.03.2019 that they have already
refunded the premium amount Rs. 6,00,000/- to the complainant under policy number
25514426 and the same has been confirmed by settlement agreement letter dated
06.01.2019.
4. 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
Page 331 of 412
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Sudagar SinghV/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-1192
1. On 29.01.2019, Mr. Sudagar Singh had filed a complaint against ICICI Prudential Life
Insurance Company in respect of policy bearing number 12008031.
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 25.03.2019 that they have already
refunded the premium amount Rs. 98,000/- to the complainant under policy number
12008031 and the same has been confirmed by settlement agreement letter dated
11.03.2019.
4. 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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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.
Page 332 of 412
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
PROCEEDINGS BEFORETHE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – SH. D.K.VERMA
CASE OF Mr. Raghbir Singh V/s ICICI Prudential Life Insurance Company
COMPLAINT REF. No. : CHD-L-021-1819-1265
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.
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 25.03.2019 that they have already
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.
4. 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
Page 333 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Dr. D.K.Verma
Case of Mr. Dalvinder Singh v/s DHFL Pramerica Life Insurance Company Ltd.
COMPLAINT REF. No. : CASE NO. CHD-L-013-1617-1604
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.
3. Name of the insured
Name of the policy holder
Dalvinder Singh Baljit Kaur
Dalvinder Singh Baljit Kaur
4. Name of the insurer DHFL Pramerica Life Insurance Company Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 02.01.2017.
8. Nature of complaint Mis-selling
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
14. Representation at the hearing
For the Complainant Absent on all the occasions
For the insurer Mr. Parmal Singh( Manager Legal)
15. Complaint how disposed Dismissed in default
16. Date of Award/Order 29.03.2019
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
Page 334 of 412
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.
Insurer’s SCN was received on 28.02.2017.
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.
18. Observations & Findings:-
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
no option but to close the complaint and the case is being dismissed in default.
ORDER
Taking into account the facts & circumstances of the case and the submissions made by
insurance company during the course of personal hearing, the complaint in respect of
policies bearing no’s 000266877 & 000266876, is dismissed in default.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 29th
day of March, 2019.
Dr. D. K. Verma
INSURANCE OMBUDSMAN
Page 335 of 412
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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)
1. Name & Address of the
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
Duration of policy/Policy period
120713569975 27.07.2012
Rs. 10000/- (Hly)
3. Name of the insured
Name of the policyholder
Mr. Madan Gopal Jindal
Mr. Madan Gopal Jindal
4. Name of the insurer Aegon Religare Life Insurance Co.Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 12.08.2016
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
12. Complaint registered under
Rule no: Insurance Ombudsman
Rules, 2017
13.1.(d)
13. Date of hearing/place 12.07.2018,22.11.2018,20.02.2019 &
18.03.2019 /Chandigarh
14. Representation at the hearing
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
15 Complaint how disposed Dismissed
16 Date of Award/Order 29.03.2019
17) Brief Facts of the Case:
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.
18) Cause of Complaint:
a) Complainant’s argument:
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.
b) Insurers’ argument:
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.
19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
20) Result of personal hearing with both parties (Observations & Conclusion)
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.
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ORDER
Taking into account the facts & circumstances of the case and the submissions made
by both the parties, there is no need to interfere with the decision of the insurer,
hence, the complaint is dismissed.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 29th
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
1. Name & Address of the
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.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 02.03.2017
8. Nature of complaint Mis-selling
9. Amount of Claim NA
10. Date of Partial Settlement NIL
11. Amount of relief sought Refund of premium
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
14. Representation at the hearing
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17) Brief Facts of the Case:
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.
18) Cause of Complaint:
Complainant’s argument:
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.
Insurers’ argument:
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
15 Complaint how disposed Award
16 Date of Award/Order 29.03.2019
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19) The following documents were placed for perusal:-
a) Copies of the proposal forms b) Complaint to the insurer.
c) Annexure Vl-A d) Reply of the company
20) Result of personal hearing with both parties (Observations & Conclusion)
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
Taking into account the facts & circumstances of the case and the submissions made by
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.
Hence, the complaint is treated as closed.
The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
k. 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 29th
day of March, 2019
D. K. Verma
INSURANCE OMBUDSMAN
Page 340 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
1. Name & Address of the
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
7. Date of receipt of the
Complaint
31.10.2018.
8. Nature of complaint Mis-selling
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
Ombudsman Rules, 2017.
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
15. Representation at the hearing
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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
compliance of the same to the Ombudsman.
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
Page 345 of 412
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
Name of the policyholder
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.
6. Reason for repudiation
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
11. Date of Partial Settlement NA
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.
Representation at the hearing
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
18) Brief Facts of the Case:
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.
b) Insurers’ argument:
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.
Page 350 of 412
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
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Athar Parvez .…..…………....…………………………Complainant
COMPLAINT NO: LCK-L-001-1718-0168 Order No. IO/LCK/A/LI/0073/2018-19
Mrs. Nazma Nazeer .…..…………....…………………………Complainant
COMPLAINT NO: LCK-L-001-1718-0169 Order No. IO/LCK/A/LI/0074/2018-19
COMPLAINT NO: LCK-L-001-1718-0170 Order No. IO/LCK/A/LI/0075/2018-19
Mrs. Adila Athar parvez .…..…………....…………………Complainant
COMPLAINT NO: LCK-L-001-1718-0169 Order No. IO/LCK/A/LI/0076/2018-19
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
Duration of policy/DOC
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.
Page 351 of 412
3. Name of the insured
Name of the policyholder
---
---
4. Name of the insurer Aegon Life Ins. Co. Ltd.
5. Date of Repudiation/Rejection ---
6. Reason for repudiation/Rejection Beyond free look period
7. Date of receipt of the Complaint 26.05.2017
8. Nature of complaint Mis-Selling
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
14. Representation at the hearing
b) For the Complainant Absent
c) For the insurer Absent
15. Complaint how disposed Dismissed as settled
16. Date of Award/Order 11.03.2019
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
Page 352 of 412
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
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Dev Narayan Tiwari …..…………....………………. ……………Complainant
V/s
Bharti Axa Life Insurance Co. Ltd...…………………………………Respondent
COMPLAINT NO: LCK-L-008-1718-0331 Order No. IO/LCK/A/LI/0086/2018-19
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
Duration of policy/DOC
501-4141815
Elite Advantage Plan
29.02.2016
3. Name of the insured
Name of the policyholder
Mrs. Chameli Devi
Mr. Dev Narayan
4. Name of the insurer Bharti Axa Life Insurance Co. Ltd
5. Date of Repudiation/Rejection 25.01.2017
6. Reason for repudiation/Rejection Beyond free look period
7. Date of receipt of the Complaint 20.06.2017
Page 353 of 412
8. Nature of complaint Mis-selling
9. Amount of Claim ---
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 14.03.2018 at 11.00 am at Lucknow
14. Representation at the hearing
d) For the Complainant Absent
e) For the insurer Mohd. Imran Siddiqui
15. Complaint how disposed Dismissed
16. Date of Award/Order 14.03.2019
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
COMPLAINT NO: LCK-L-008-1718-0331 Order No. IO/LCK/A/LI/0086/2018-19
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
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. 501-4141815 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
Page 354 of 412
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.
Dated : March 14, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Dev Narayan Tiwari …..…………....………………………….. Complainant
V/s
Bharti Axa Life Insurance Co. Ltd...…………………………………Respondent
COMPLAINT NO: LCK-L-008-1718-0332 Order No. IO/LCK/A/LI/0087/2018-19
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
Duration of policy/DOC
501-5081705
Elite Advantage Plan
20.11.2016
3. Name of the insured
Name of the policyholder
Dev Narayan
Dev Narayan
4. Name of the insurer Bharti Axa Life Insurance Co. Ltd
5. Date of Repudiation/Rejection 25.01.2017
6. Reason for repudiation/Rejection Beyond free look period
Page 355 of 412
7. Date of receipt of the Complaint 20.06.2017
8. Nature of complaint Mis-selling
9. Amount of Claim ---
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 14.03.2018 at 11.00 am at Lucknow
14. Representation at the hearing
f) For the Complainant Absent
g) For the insurer Mohd. Imran Siddiqui
15. Complaint how disposed Dismissed
16. Date of Award/Order 14.03.2019
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
COMPLAINT NO: LCK-L-008-1718-0332 Order No. IO/LCK/A/LI/0087/2018-19
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.
Page 356 of 412
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.
Dated : March 14, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
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
Duration of policy/DOC
501-3958839
Elite Advantage- 12/12
29.01.2016
3. Name of the insured
Name of the policyholder
Mrs. Surya Prabha
Mr. Lalman
4. Name of the insurer Bharti Axa Life Ins. Co. Ltd
5. Date of Repudiation/Rejection 17.06.2017
6. Reason for repudiation/Rejection Beyond free look period
7. Date of receipt of the Complaint 28.07.2017
8. Nature of complaint Mis-selling
9. Amount of Claim 98999/-
Page 357 of 412
10. Date of Partial Settlement ---
11. Amount of relief sought 98999/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place On 15.03.2019 at 11.00 am at Lucknow
14. Representation at the hearing
h) For the Complainant Mr. Lalman
i) For the insurer Mohd. Imran Siddiqui
15. Complaint how disposed Recommendation
16. Date of Award/Order 15.03.2019
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
COMPLAINT NO:LCK-L-008-1718-0339 Order No. IO/LCK/A/LI/0089/2018-19
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.
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 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
Page 358 of 412
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.
Dated : March 15, 2019 (G.S.Shrivastava)
Place : Lucknow Insurance Ombudsman
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Dev Narayan Tiwari …..…………....………………………Complainant
V/s
HDFC Life Insurance Co. Ltd...…………………………………Respondent
COMPLAINT NO: LCK-L-019-1718-0329 Order No. IO/LCK/A/LI/0085/2018-19
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
Duration of policy/DOC
18411111
HDFC Life Super Income Plan
20.04.2016
3. Name of the insured
Name of the policyholder
Mr. Dev Narayan Tiwari
Mr. Dev Narayan Tiwari
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd
5. Date of Repudiation/Rejection 15.05.2017
6. Reason for repudiation/Rejection Beyond free look period
7. Date of receipt of the Complaint 20.06.2017
8. Nature of complaint Mis-selling
9. Amount of Claim ---
10. Date of Partial Settlement ---
11. Amount of relief sought ---
Page 359 of 412
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place On 14.03.2018 at 11.00 am at Lucknow
14. Representation at the hearing
j) For the Complainant Absent
k) For the insurer Mr. Sudhir Kumar Singh
15. Complaint how disposed Dismissed as Settled
16. Date of Award/Order 14.03.2019
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.
In their SCN/reply respondent have stated that the above policy was issued on the basis of proposal form
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
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. 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.
Dated : March 14, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
Page 360 of 412
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Lalman………………..……....………………. Complainant
V/S
IDBI Federal Life Insurance Co. Ltd...…………………………Respondent
COMPLAINT NO:LCK-L-022-1718-0341 Order No. IO/LCK/A/LI/0091/2018-19
1.
Name & Address of the Complainant Mr. Lalman
Daudpur
Jalaun
2. Policy No:
Type of Policy
Duration of policy/DOC
4000227146
IAE&MB Plan
31.08.2010
3. Name of the insured
Name of the policyholder
Mrs. Surya Prabha
Mr. Lalman
4. Name of the insurer IDBI Federal Life Ins. Co. Ltd
5. Date of Repudiation/Rejection 29.09.2016
6. Reason for repudiation/Rejection Beyond free look period
7. Date of receipt of the Complaint 28.07.2017
8. Nature of complaint Mis-selling
9. Amount of Claim 2,75,000/-
10. Date of Partial Settlement ---
11. Amount of relief sought 2,75,000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place On 15.03.2019 at 11.00 am at Lucknow
14. Representation at the hearing
l) For the Complainant Mr. Lalman
m) For the insurer Mr. Sachin Agnihotri
15. Complaint how disposed Dismissed
16. Date of Award/Order 15.03.2019
17. Mr. Lalman (Complainant) has filed a complaint against IDBI Federal 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 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
Page 361 of 412
COMPLAINT NO:LCK-L-022-1718-0341 Order No. IO/LCK/A/LI/0091/2018-19
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.
22. In view of the above facts and circumstances, I come to the conclusion that the insurance company has
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.
24. Let copies of Award be given to both the parties.
Dated : March 15, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
Page 362 of 412
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr.Lalman………………..……....………………. Complainant
V/S
Exide Life Insurance Co. Ltd...…………………………Respondent
COMPLAINT NO:LCK-L-025-1718-0340 Order No. IO/LCK/A/LI/0090/2018-19
1.
Name & Address of the Complainant Mr. Lalman
Daudpur
Jalaun
2. Policy No:
Type of Policy
Duration of policy/DOC
03312943
Guauanteed Income Insurance Plan
29.03.2016
3. Name of the insured
Name of the policyholder
Mrs. Surya Prabha
Mr. Lalman
4. Name of the insurer Exide Life Ins. Co. Ltd
5. Date of Repudiation/Rejection 21.06.2017
6. Reason for repudiation/Rejection Beyond freelook period
7. Date of receipt of the Complaint 28.07.2017
8. Nature of complaint Mis-selling
9. Amount of Claim 49000/-
10. Date of Partial Settlement ---
11. Amount of relief sought 49000/-
12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman Rule 2017
13. Date of hearing/place On 15.03.2019 at 11.00 am at Lucknow
14. Representation at the hearing
n) For the Complainant Mr. Lalman
o) For the insurer Mr. Sanjay Chaudhary
15. Complaint how disposed Dismissed
16. Date of Award/Order 15.03.2019
17. Mr. Lalman (Complainant) has filed a complaint against Exide 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 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.
Page 363 of 412
COMPLAINT NO:LCK-L-025-1718-0340 Order No. IO/LCK/A/LI/0090/2018-19
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 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.
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. 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.
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. Lalman stands dismissed herewith.
24. Let copies of Award be given to both the parties.
Dated : March 15, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
Page 364 of 412
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Dilip Kumar Gupta .…..…………....………………. Complainant
V/S
PNB MET Life Insurance Company Limited...……………………..Respondent
COMPLAINT NO: LCK-L-033-1718-0265 Order No. IO/LCK/A/LI/0077/2018-19
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
Duration of policy/DOC
20753215
Met Suvidha Participating
16.02.2012
3. Name of the insured
Name of the policyholder
Dilip Kumar Gupta
Dilip Kumar Gupta
4. Name of the insurer PNB Met Life Ins Co. Ltd.
5. Date of Repudiation/Rejection 22.02.2017
6. Reason for repudiation/Rejection Beyond Look Up Period
7. Date of receipt of the Complaint 20.06.2017
8. Nature of complaint Mis-selling
9. Amount of Claim --
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 13.03.2019 at 11.00 am at Lucknow
14. Representation at the hearing
p) For the Complainant Mr. Dilip Kumar Gupta
q) For the insurer Mr. Nitin Yadav , Sr. Executive Operation
15. Complaint how disposed Dismissed
16. Date of Award/Order 13.03.2019
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.
Page 365 of 412
COMPLAINT NO: LCK-L-033-1718-0265 Order No. IO/LCK/A/LI/0077/2018-19
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.
19-The complainant has filed complaint latter, annex VIA, Correspondence with respondent and policy
copy while correspondent 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. 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.
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. Dilip Kumar Gupta stands dismissed herewith.
24. Let copies of Award be given to both the parties.
Dated : March 13, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
Page 366 of 412
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Arun Kumar Niranjan .…..…………....………………. Complainant
V/s
PNB Met Life Insurance Com. Ltd....……………………………………Respondent
COMPLAINT NO: LCK-L-033-1718-0271 Order No. IO/LCK/A/LI/0079/2018-19
1.
Name & Address of the Complainant Dr. Arun Kumar Niranjan
H.No-568KH/49,Geetapalli
Alambagh
Dt- Lucknow
2. Policy No:
Type of Policy
Duration of policy/DOC
21735229
Met Money Back
24.11.2015
3. Name of the insured
Name of the policyholder
Arun Kumar Niranjan
Arun Kumar Niranjan
4. Name of the insurer PNB Met Life Ins Co. Ltd.
5. Date of Repudiation/Rejection 28.06.2017
6. Reason for repudiation/Rejection Beyond Free Look Period
7. Date of receipt of the Complaint 09.06.2017
8. Nature of complaint Mis-selling
9. Amount of Claim --
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 13.03.2019 at 11.00 am at Lucknow
14. Representation at the hearing
r) For the Complainant Dr. Arun Kumar Niranjan
s) For the insurer Mr. Nitin Yadav , Sr. Executive Operation
15. Complaint how disposed Dismissed
16. Date of Award/Order 13.03.2019
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.
Page 367 of 412
COMPLAINT NO: LCK-L-033-1718-0271 Order No. IO/LCK/A/LI/0079/2018-19
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.
19-The complainant has filed complaint latter, annex VIA, Correspondence with respondent and policy
copy while correspondent 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. 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.
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 Dr. Arun Kumar Niranjan stands dismissed herewith.
24. Let copies of Award be given to both the parties.
Dated : March 13, 2019 (G.S. Shrivastava)
Place : Lucknow Insurance Ombudsman
Page 368 of 412
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:
1. Name & Address of the Complainant
Mr. Ankit Kumar Mishra, Flat-T, Dev Heights, Friends Enclave, Shahberi, Crossing Republic Road, Greater Noida, UP-201301.
2. Policy No: Type of Policy Duration of policy/Policy period
2028507 HDFC Life Classic Assure Plus Policy Term Insurance of 15 years
3. Name of the insured Name of the policyholder
Ankit Kumar Mishra Ankit Kumar Mishra
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation 01.06.2018
6. Reason for repudiation Beyond Free Look Period.
7. Date of receipt of the Complaint 01.08.2018
8. Nature of complaint Mis-Selling
9. Amount of Claim 30000/-
10. Date of Partial Settlement no
11. Amount of relief sought Refund of premium
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
16 Date of Award/Order 26.03.2019
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
Page 369 of 412
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.
Page 370 of 412
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
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF MR. HARISH KUMAR V/S HDFC STANDARD LIFE INSURANCE COMPANY LTD.
COMPLAINT REF: NO: NOI-L-019-1819-0201
AWARD NO:
1. Name & Address of the Complainant
Mr. Harish Kumar, Street No. 01, Adarsh Colony, Vijay Nagar, Ghaziabad, UP - 201009
2. Policy No: Type of Policy Duration of policy/Policy period
19779425, 19690833 & 19457032 HDFC Life Classic Assure Plus Policy Term Insurance of 15 years
3. Name of the insured Name of the policyholder
Harish Kumar Harish Kumar
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation 25.5.2018
6. Reason for repudiation Beyond Free Look Period
7. Date of receipt of the Complaint 10.09.2018
8. Nature of complaint Mis-Selling
9. Amount of Claim 1,00,000/-
10. Date of Partial Settlement
11. Amount of relief sought Refund of premium
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place 15.03.2019
Page 371 of 412
14. Representation at the hearing Noida
v) For the Complainant Mr. Harish Kumar, Self
w) For the insurer Mr. Ankush Saini, D.M. Legal
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 26.03.2019
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
Page 372 of 412
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
receipt of the acceptance letter of the Complainant and shall intimate the compliance to 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.
Hence, the complaint is treated as disposed off accordingly.
Page 373 of 412
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:
1. Name & Address of the Complainant
Mr. Mahipal Singh Saini, S/o Anup Singh, VPO- Khatauli Jyoti Clinic, Bhoor, Muzaffarnagar, UP-251201.
2. Policy No: Type of Policy Duration of policy/Policy period
1294770 20
1311732 12
1313840 18
1281389 12
1314701 18
1318224 20
1283332 20
3. Name of the insured Name of the policyholder
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
Dimple Saini Dimple Saini
Dimple Saini Dimple Saini
4. Name of the insurer Future Generali Life Insurance Co. Ltd.
5. Date of Repudiation 13.08.2018
6. Reason for repudiation Beyond Free-Look Period
7. Date of receipt of the Complaint 10.09.2018
8. Nature of complaint Mis Selling
9. Amount of Claim 2,95,906/-
10. Date of Partial Settlement n.a.
11. Amount of relief sought Refund of premium
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place 15.03.2019/Noida
14. Representation at the hearing
e) For the Complainant Mr. Mahipal Singh Saini, Self
f) For the insurer Mr. Mukesh Nagar, State Head
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 26.03.2019
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.
Page 374 of 412
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.
20) The following documents were placed for perusal.
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
Page 375 of 412
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.
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.
d) 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 DATE- 26.03.2019 INSURANCE OMBUDSMAN WESTERN U.P. & UTTARAKHAND
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF MR. BHARAT BHUSHAN JAIN V/S BHARTI AXA LIFE INSURANCE COMPANY LTD.
COMPLAINT REF: NO: NOI-L-008-1819-0280
AWARD NO:
1. Name & Address of the Complainant
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.
Page 376 of 412
Duration of policy/Policy period Term Insurance of 12 years
3. Name of the insured Name of the policyholder
Bharat Bhushan Jain Pranjal Jain
4. Name of the insurer Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation 20.1.2018
6. Reason for repudiation Beyond Free Look Period
7. Date of receipt of the Complaint 19.9.2018
8. Nature of complaint Mis-Selling
9. Amount of Claim 60,179/-
10. Date of Partial Settlement no
11. Amount of relief sought Refund of premium
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place 15.03.2019
14. Representation at the hearing Noida
g) For the Complainant Mr. Bharat Bhushan Jain, Self
h) For the insurer Mr. Sanjay Mundhra, Cluster Head
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 29.03.2019
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
Page 377 of 412
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
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 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..
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.
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.
Hence, the complaint is treated as disposed off accordingly.
Page 378 of 412
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
PLACE – NOIDA SANDHYA BALIGA DATE- 29.03.2019 INSURANCE OMBUDSMAN WESTERN U.P. &UTTARAKHAND
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 BHARTI AXA LIFE INS. CO. LTD.
COMPLAINT REF: NO: NOI-L-008-1819-0261
AWARD NO:
1. Name & Address of the Complainant
Mr. Mahipal Singh Saini, S/o Anup Singh, VPO- Khatauli Jyoti Clinic, Bhoor, Muzaffarnagar, UP-251201.
2. Policy No: Type of Policy Duration of policy/Policy period
501-5273351 Bharti AXA Life Elite Advantage Plan Term Insurance of 12 years
3. Name of the insured Name of the policyholder
Mahipal Singh Mahipal Singh
4. Name of the insurer M/s Bharti AXA Life Insurance Co. Ltd.
5. Date of Repudiation 03.08.2018
6. Reason for repudiation Beyond Free-Look Period
7. Date of receipt of the Complaint 10.09.2018
8. Nature of complaint Mis Selling
9. Amount of Claim 42,249.00
10. Date of Partial Settlement n.a.
11. Amount of relief sought Refund of premium
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place 15.03.2019/Noida
14. Representation at the hearing
x) For the Complainant Mr. Mahipal Singh Saini, Self
y) For the insurer Mr. Harpal Singh, F.A.
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 26.03.2019
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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.
19) Cause of Complaint:
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.
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.
d) 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 DATE- 26.03.2019 INSURANCE OMBUDSMAN WESTERN U.P. &UTTARAKHAND
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF SURESH NAGAR V/S PNB MET LIFE INSURANCE COMPANY LIMITED
COMPLAINT REF: NO: NOI-L-033-1819-0126
AWARD NO:
1. Name & Address of the Complainant
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.
The complaint is treated as closed accordingly.
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Duration of policy/Policy period 12 years
3. Name of the insured Name of the policyholder
Sh. Suresh Nagar Sh. Suresh Nagar
4. Name of the insurer PNB MET Life Insurance Company
5. Date of Repudiation 04-06-2018
6. Reason for repudiation Beyond Free Look Period
7. Date of receipt of the Complaint 19-06-2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.28985/-
10. Date of Partial Settlement None
11. Amount of relief sought Rs.28985/-
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place Noid / 15.03.2019
14. Representation at the hearing
z) For the Complainant Sh.Suresh Nagar
aa) For the insurer Sh. Deepak Bakshi
15 Complaint how disposed Award in favour of Insurance company
16 Date of Award/Order 26.03.2019
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.
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
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. & UTTARAKHAND)
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF SH. RAVINDER NAGAR V/S PNB MET LIFE INSURANCE CO. LIMITED
COMPLAINT REF: NO: NOI-L-033-1819-0127
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.
The complaint is treated as closed accordingly.
Page 383 of 412
Type of Policy Duration of policy/Policy period
Life Plan 10 years
3. Name of the insured Name of the policyholder
Ravinder Nagar Ravinder Nagar
4. Name of the insurer PNB Met Life Insurance Co. Limited
5. Date of Repudiation 23-05-2018
6. Reason for repudiation Beyond Free look period
7. Date of receipt of the Complaint 19-06-2018
8. Nature of complaint Mis-Selling
9. Amount of Claim Rs.29755/-
10. Date of Partial Settlement None
11. Amount of relief sought Rs.29755/-
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place Noida
14. Representation at the hearing
c) For the Complainant Sh. Ravinder Nagar
d) For the insurer Sh. Deepak Bakshi
15 Complaint how disposed Award in favour of Insurance company
16 Date of Award/Order 26.03.2019
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.
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
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. & UTTARAKHAND)
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF DINESH KUMAR JAIN V/S PNB MET LIFE INSURANCE COMPANY LTD.
COMPLAINT REF: NO: NOI-L-033-1819-0265
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
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.
The complaint is treated as closed accordingly.
Page 385 of 412
Type of Policy Duration of policy/Policy period
Life Plan 10 years
3. Name of the insured Name of the policyholder
Sh. Dinesh Kumar Jain Sh. Dinesh Kumar Jain
4. Name of the insurer PNB Met Life insurance company
5. Date of Repudiation 12-9-2018
6. Reason for repudiation Beyond Free –Look Period
7. Date of receipt of the Complaint 17-9-2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.50,000/-
10. Date of Partial Settlement None
11. Amount of relief sought Rs.50,000/-
12. Complaint registered under IOB rules
13 (10 (d)
13. Date of hearing/place 29.3.2019/Noida
14. Representation at the hearing
i) For the Complainant Sh. Dinesh Kumar Jain
j) For the insurer Sh. Deepak Bakshi
15 Complaint how disposed Award in favour of Insured.
16 Date of Award/Order 29.03.2019
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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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 (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.
d) 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: 29.03.2019 INSURANCE OMBUDSMAN
(WESTERN U.P. & 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 the policy and refund the premium. Accordingly, the complaint is disposed off.
Page 387 of 412
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF SH. ASHOK KUMAR V/S SBI LIFE INSURANCE COMPANY LTD.
COMPLAINT REF: NO: NOI-L-041-1819-0264
AWARD NO:
1. Name & Address of the Complainant
Sh. Ashok Kumar H.No.124, Gali No. 1, New Defence Colony Muradnagar, Ghaziabad Pin-201206
2. Policy No: Type of Policy Duration of policy/Policy period
1 H 304241110 Life Plan Term 10 years and PPT 5 years
3. Name of the insured Name of the policyholder
Sh. Ashok Kumar Sh. Ashok Kumar
4. Name of the insurer SBI Life Insurance Company
5. Date of Repudiation 2-6-2017
6. Reason for repudiation Beyond Free-look Period
7. Date of receipt of the Complaint 17-9-2018
8. Nature of complaint Mis-selling
9. Amount of Claim Rs.5,00,000/-
10. Date of Partial Settlement None
11. Amount of relief sought Rs.5,00,000/-
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place Noida / 15.03.2015
14. Representation at the hearing
e) For the Complainant Sh. Ashok Kumar
f) For the insurer MS Anjali Chahar
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 26.03.2019
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
Page 388 of 412
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.
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.
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 premium amount to the complainant.
The complaint is treated as closed accordingly.
Page 389 of 412
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.
Place: Noida. SANDHYA BALIGA Dated: 26.03.2019 INSURANCE OMBUDSMAN
(WESTERN U.P. & UTTARAKHAND)
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND
UNDER INSURANCE OMBUDSMAN RULES 2017
OMBUDSMAN – SMT. SANDHYA BALIGA
CASE OF SH. VIJAY KUMAR PATHAK V/S SBI LIFE INSURANCE COMPANY LTD.
COMPLAINT REF: NO: NOI-L-041-1819-0210
AWARD NO:
1. Name & Address of the Complainant
Sh. Vijay Kumar Pathak B-66 D, Rajat Vihar, Sector -62 Noida, Uttar Pradesh-201301
2. Policy No: Type of Policy Duration of policy/Policy period
350108556210 Life Plan 5 years
3. Name of the insured Name of the policyholder
Sh. Vijay Kumar Pathak Sh. Vijay Kumar Pathak
4. Name of the insurer SBI Life Insurance Company Limited
5. Date of Repudiation 27-6-2018
6. Reason for repudiation Beyond free look period
7. Date of receipt of the Complaint 8-8-2018
8. Nature of complaint Mis-selling
9. Amount of Claim RS.1,00,000/-
10. Date of Partial Settlement None
11. Amount of relief sought Rs. ,00,000/-
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place Noida/ 15.03.2019
14. Representation at the hearing
22) For the Complainant Sh. Vijay Kumar Pathak
23) For the insurer Ms. Anjali Chahar
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 26.03.2019
Page 390 of 412
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.
Page 391 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.
Place: Noida. SANDHYA BALIGA Dated: 26.03.2019 INSURANCE OMBUDSMAN
(WESTERN U.P. & UTTARAKHAND)
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 SHRI RAM LIFE INSURANCE COMPANY LTD.
COMPLAINT REF: NO: NOI-L-043-1819-0255
AWARD NO:
1. Name & Address of the Complainant
Sh. Mahipal Singh Saini S/O Anoop Singh, VPO- Khatauli, Jyoti Clinic, Bhoor, Muzaffarnagar, U.P. 251201
2. Policy No: Type of Policy Duration of policy/Policy period
NH 131701008654 NH 131701016501 NH 131702012324 NH 131702012335 Life Plan Life Plan All policies for 10 years
3. Name of the insured Name of the policyholder
Mahipal Singh, Rashi Saini, Vidhi Saini ------------Mahipal Singh----------------------
4. Name of the insurer Shri Ram Life Insurance Company
5. Date of Repudiation 14-8-2018
6. Reason for repudiation
Beyond Free-Look Period
7. Date of receipt of the Complaint 10-9-2018
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.
The complaint is treated as closed accordingly.
Page 392 of 412
8. Nature of complaint Mis-selling
9. Amount of Claim 49800+49800+49180+47042Total Rs.1,95,822/-
10. Date of Partial Settlement None
11. Amount of relief sought Rs. 1,95,822/-
12. Complaint registered under IOB rules
13 (1) (d)
13. Date of hearing/place Noida / 15.03.2019
14. Representation at the hearing
C) For the Complainant Sh. Mahipal Singh Saini
D) For the insurer Sh. Abhinav k. Tripathi, Sr. Legal Executive
15 Complaint how disposed Award in favour of complainant
16 Date of Award/Order 29.03.2019
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
Page 393 of 412
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.
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
receipt of the acceptance letter of the Complainant and shall intimate the compliance to the
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.
The complaint is treated as closed accordingly.
Page 394 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
Ombudsman Rules, 2017
8. Date of receipt of the Complaint 05-Feb-2019
9. Amount of Claim 48149/- & cancellation of policy.
10. Date of Partial Settlement
11. Amount of Partial Settlement 0.00
12. Amount of relief sought 0
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr. Abbas Ali
b)For the Insurer Ms. Juri Hazarika
Page 395 of 412
16. Complaint how disposed Through Hearing
17. Date of Award/Order 06/03/2019
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
Page 396 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:
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.
Dated at Guwahati on 6th
day of March” 2019
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF ASSAM,ARUNACHAL,MIZORAM,
MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA
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-019-1819-0267
AWARD NO.
Page 397 of 412
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
19299237, DOC- 15.05.2017, Premium-
53006/= PPT- 7yrs, Term-10 yrs
Life
3. Name of the insured Abbas Ali
4. Name of insurer HDFC Standard Life Insurance Co. Ltd.
5. Date Occurrence of Loss/claim 15/05/2017
6. Details of Loss:
7. Reason For Grievance According to Rule 17(6) of the Insurance
Ombudsman Rules, 2017
8. Date of receipt of the Complaint 05-Feb-2019
9. Amount of Claim Refund of Rs.53006 & Cancellation of Policy.
10. Date of Partial Settlement
11. Amount of Partial Settlement 0.00
12. Amount of relief sought 0
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr. Abbas Ali
b)For the Insurer Ms. Juri Hazarika
16. Complaint how disposed Through Hearing
17. Date of Award/Order 06/03/2019
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 but both the numbers were switched
off. He has informed all the happenings to the
Page 398 of 412
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.
6) Application
7) SCN
8) Annexure – A ( Copy of Proposal form)
9) Annexure –B ( Copy of Policy document)
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
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 one whereupon the complainant will continue.
During hearing the complainant has stated that he will be
able to continue the policy no 19393229
Page 399 of 412
AWARD
Taking into account facts & circumstances of the case and the submissions made by both the
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.
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.
Dated at Guwahati on 6th
day of February, 2019
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF ASSAM,ARUNACHAL,MIZORAM,
MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA
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 Abdus Sabur Miah V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF:NO: GUW-L-019-1819-0275
AWARD NO.
1. Name & Address Of The
Complainant
Abdus Sabur Miah
S/o Abdul Jubbar Vill & p.o.: Bidyar dabri, PT-II,
2.
Policy No.
Type Of Policy
Policy term/Policy Period
19313884, DOC-22.05.2017,PPT-7yrs,
Premium- 28912/=, Mode- Yly
Life
3. Name of the insured Abdus Sabur Miah
4. Name of insurer HDFC Standard Life Insurance Co. Ltd.
5. Date Occurrence of Loss/claim 22.05.2017
6. Details of Loss:
Page 400 of 412
7. Reason For Grievance According to Rule 17(6) of the Insurance
Ombudsman Rules, 2017
8. Date of receipt of the Complaint 05-Feb-2019
9. Amount of Claim Refund of premium Rs.28912/- and cancellation
of policy
10. Date of Partial Settlement
11. Amount of Partial Settlement 0.00
12. Amount of relief sought 0
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr.Abdus Sabur Miah
b)For the Insurer Ms. Juri Hazarika
16. Complaint how disposed Through hearing
17. Date of Award/Order 06/03/2019
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 but 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 15.11.2018
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
Page 401 of 412
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 30/11/2018 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 04/12/2018 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.
10) Application
11) SCN
12) Annexure – A ( Copy of Proposal form)
13) Annexure –B ( Copy of Policy document)
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
has stated during hearing that he is a school teacher in
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
Taking into account facts & circumstances of the case and the submissions made by both the
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.
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.
Dated at Guwahati on 6th
day of February 2019
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF ASSAM,ARUNACHAL,MIZORAM,
MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA
Page 402 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 Hirendra Kr. Bhattacharjee V/S Birla Sun Life Insurance Co. Ltd.
COMPLAINT REF:NO: GUW-L-009-1819-0289
AWARD NO.
1. Name & Address Of The
Complainant
Hirendra Kr. Bhattacharjee
Kamakhya Colony Pandu,
2.
Policy No.
Type Of Policy
Policy term/Policy Period
001486054
Life
3. Name of the insured Hirendra Kr. Bhattacharjee
4. Name of insurer Birla Sun Life Insurance Co. Ltd.
5. Date Occurrence of Loss/claim 28.05.2014
6. Details of Loss:
7. Reason For Grievance According to Rule 17(6) of the Insurance Ombudsman
Rules, 2017
8. Date of receipt of the Complaint 27-Feb-2019
9. Amount of Claim 0.00
10. Date of Partial Settlement
11. Amount of Partial Settlement 100000.00
12. Amount of relief sought 4,00,000.00
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr. Hirendra Kr. Bhattacharjee
b)For the Insurer Mr. Dipankar Das
Page 403 of 412
16. Complaint how disposed Through hearing
17. Date of Award/Order 26/03/2019
18. Brief Facts of the Case
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
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
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
Page 404 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.
Dated at Guwahati on 26th
day of March 2019
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF ASSAM,ARUNACHAL,MIZORAM,
MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA
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 Naba Kumar Borah V/S SBI Life Insurance Co. Ltd.
COMPLAINT REF:NO: GUW-L-041-1819-0273
AWARD NO.
1. Name & Address Of The
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
Policy term/Policy Period
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.
5. Date Occurrence of Loss/claim 09/09/2018
6. Details of Loss:
7. Reason For Grievance According to Rule 17(6) of the Insurance
Ombudsman Rules, 2017
8. Date of receipt of the Complaint 07-Feb-2019
9. Amount of Claim 50000/=
Page 405 of 412
10. Date of Partial Settlement NA
11. Amount of Partial Settlement 0.00
12. Amount of relief sought 0
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr. Naba Kumar Borah
b)For the Insurer Ms Moumita Das
16. Complaint how disposed Through hearing
17. Date of Award/Order 06/03/2019
18. Brief Facts of the Case
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)
Complainant's Argument:
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
20. The following documents were
placed for perusal.
1)Application
2)Copy of Policy Document
3)SCN
4) Copy of Endorsement
Page 406 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.
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.
Dated at Guwahati on 6th
day of February 2019.
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF ASSAM,ARUNACHAL,MIZORAM,
MANIPUR ,NAGALAND,TRIPURA, MEGHALAYA
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 Sahedul Haque V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF:NO: GUW-L-019-1819-0268
AWARD NO.
Page 407 of 412
1. Name & Address Of The
Complainant
Sahedul Haque
S/o Ukil Ali Vill:Pokalagi,Pt-II P.S. Golakganj
2.
Policy No.
Type Of Policy
Policy term/Policy Period
19353366, DOC- 06.06.2017,PPT-7yrs, Term-
10Yrs, Premium- 28912/- Mode- Yly
Life
3. Name of the insured Sahedul Haque
4. Name of insurer HDFC Standard Life Insurance Co. Ltd.
5. Date Occurrence of Loss/claim 06.06.2017
6. Details of Loss:
7. Reason For Grievance According to Rule 17(6) of the Insurance
Ombudsman Rules, 2017
8. Date of receipt of the Complaint 05-Feb-2019
9. Amount of Claim Refund of Rs.28912/ & cancellation of policies.
10. Date of Partial Settlement
11. Amount of Partial Settlement 0.00
12. Amount of relief sought 0
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr. Sahedul Haque
b)For the Insurer Ms. Juri Hazarika
16. Complaint how disposed Through Hearing
17. Date of Award/Order 06/03/2019
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
Page 408 of 412
Life Bongaigaon Branch and Grievance
Redressal Officer of the insurer on 12.11.2018
but the reply is still awaited. From then the
complainant has felt that he was cheated by
them.
19. Cause Of Complaint
Rule 13(1)d)- Misrepresentation of policy terms
and conditions at any time in the policy
document or policy contract.
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. 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
reply dated 14/12/2018 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.
14) Application
15) SCN
16) Annexure – A ( Copy of Proposal form)
17) Annexure –B ( Copy of Policy document)
Annexure –C ( Copy of letter to the complainant dated
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
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
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 of the complainant, it would be fair to
cancel his policies.
Page 409 of 412
AWARD
Taking into account facts & circumstances of the case and the submissions made by both the
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.
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.
Dated at Guwahati on 6th day
of February 2019
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF,ARUNACHAL,MIZORAM, MANIPUR
,NAGALAND,TRIPURA, MEGHALAYA
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE
OF ,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 Sahedul Haque V/S HDFC Standard Life Insurance Co. Ltd.
COMPLAINT REF:NO: GUW-L-019-1819-0269
AWARD NO.
1. Name & Address Of The
Complainant
Sahedul Haque
S/o Ukil Ali Vill: Pokalagi,P-II P.S. Golakanj
2.
Policy No.
Type Of Policy
Policy term/Policy Period
19483203, DOC-26/07/2017,PPT-7yrs,
Term- 10yrs, Premium- Rs.34,105/= Mode- Yly
Life
3. Name of the insured Sahedul Haque
4. Name of insurer HDFC Standard Life Insurance Co. Ltd.
5. Date Occurrence of Loss/claim 26/07/2017
6. Details of Loss:
7. Reason For Grievance According to Rule 17(6) of the Insurance
Page 410 of 412
Ombudsman Rules, 2017
8. Date of receipt of the Complaint 04-Feb-2019
9. Amount of Claim Refund of Rs.34105/= & Cancellation of Policy
10. Date of Partial Settlement
11. Amount of Partial Settlement 0.00
12. Amount of relief sought 0
13. Complaint registered under Rule
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
15. Representation at the hearing
a)For the Complainant Mr. Sahedul Haque
b)For the Insurer Ms. Juri Hazarika
16. Complaint how disposed Through Hearing
17. Date of Award/Order 06/03/2019
18. Brief Facts of the Case
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
Life Bongaigaon Branch and Grievance
Redressal Officer of the insurer on 12.11.2018
but the reply is still awaited. From then the
complainant has felt that he was cheated by
them
19. Cause Of Complaint
Rule 13(1)d)- Misrepresentation of policy terms
and conditions at any time in the policy
document or policy contract
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
Page 411 of 412
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. 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
reply dated 14/12/2018 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.
18) Application
19) SCN
20) Annexure – A ( Copy of Proposal form)
21) Annexure –B ( Copy of Policy document)
Annexure –C ( Copy of letter to the complainant dated
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
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
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 of the complainant, it would be fair to
cancel his policies.
AWARD
Taking into account facts & circumstances of the case and the submissions made by both the
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.
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.
Dated at Guwahati on 6th day
of February 2019
.............................
INSURANCE OMBUDSMAN
FOR THE STATE OF,ARUNACHAL,MIZORAM, MANIPUR
,NAGALAND,TRIPURA, MEGHALAYA
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