Mis-selling of insurance policies is a violation of consumer rights, and consumers are entitled to additional remedies even after prior proceedings with alternate forums.

PER RAJESH K. ARYA, PRESIDING MEMBER

The brief facts of the case are that on 28.12.2007, the complainant, who is an NRI, obtained Aviva Life Insurance Policy, namely, Life Saver Plus, from the opposite parties – Insurance Company by paying huge amount of 19,00,000/-. The complainant was under the impression that the policy was a single premium plan but when the opposite parties, after expiry of one year, asked the complainant to pay second installment of the premium of 19,00,000/-, the complainant came to know that it was not one time investment policy. It has further been averred that the complainant protested and stated that he had not opted for any regular premium policy. It has further been averred that as the dispute was not settled between the parties, the complainant approached the Insurance Ombudsman. The Insurance Ombudsman passed an order on 20.05.2009 whereby it was directed to issue fresh policy having single premium plan. It has further been averred that the opposite parties instead of complying with the order of Insurance Ombudsman dated 20.05.2009, had mis-sold a pension plan to the complainant. It has further been averred that as the opposite parties consented to the award passed by Insurance Ombudsman to issue a single premium policy to the complainant, he could not even anticipate that the insurance company would willingly go contrary to the award and would engage in mis-selling the policy. It has further been averred that after completion of five years on 28.12.2012, when the complainant applied for maturity, he came to know about the fraud played upon him by the opposite parties as they had gone contrary to the award passed by the Insurance Ombudsman and had given him a pension plan. It has further been averred that aggrieved by non-compliance, the complainant approached the Insurance Ombudsman. It has further been averred that since the Insurance Ombudsman has the maximum pecuniary limit up-to 20,00,000/-, it passed an order on 13.03.2015 directing the opposite parties to cancel the policy and refund the premium received from the complainant.

2] In the instant case, the grievance of the complainant is that the opposite parties received funds from the complainant on 28.12.2007 and made the refund on 11.07.2015 and the policy was changed by the Insurance Company after one year of inception and the fresh policy so issued matured on 28.12.2012 but no interest or fund addition was paid to the complainant. It has further been averred that opposite party No.1 sent Maturity Intimation Letter to the complainant, Annexure C-5, wherein the maturity value of the policy No.OPG2802578 was mentioned as 21,38,011/- as on 26.12.2013, 07.03.2014 and 08.09.2014. It has further been averred that the amount of premium was not the basic premium paid by the complainant in 2007 but it included the enhancements made from time to time and the market rate went upto four times. It has further been averred that the complainant is entitled to 76,00,000/- being policy maturity value besides compensation and cost of litigation. In alternative, the complainant has prayed for the balance maturity value of the current policy amounting to 2,38,011/- i.e. [ 21,38,011.00 – 19,00,000.00] besides interest @24% from 28.12.2007 till the date of refund of the principal amount i.e. 11.07.2015, compensation and cost of litigation.

3] The opposite parties contested the allegations made in the complaint, by filing their reply, wherein, while admitting the factual matrix of the case, it has been pleaded that pursuant to order dated 09.04.2015 of Insurance Ombudsman, the complainant submitted a consent letter through email dated 29.04.2015, Annexure OP-1/3 Colly., to the opposite parties whereby he gave his unconditional acceptance to the award in full and final settlement in respect of his complaint and requested the opposite parties to comply with the said order at the earliest. It has further been stated that accordingly, the opposite parties refunded th