PER:

Charanjit Singh, President;

1        The present complaint has been received from the District Consumer Disputes Redressal Commission Amritsar by the order of the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh for its disposal.

2        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 and 13 against the opposite parties on the allegations that the opposite party No. 1 is a private limited company offering insurance services across India through its outlets and the opposite party No. 2 is the office of the opposite party No. 1 at Amritsar. The opposite parties have established a network of agents who are selling their insurance products and one of such agents had contracted the complainant for selling an insurance policy of the opposite parties to which the complainant agreed and his proposal form for the insurance alongwith the first installment of Rs. 1,00,000.04 Paise was duly submitted with the opposite parties on 20.9.2016 and an insurance policy bearing No. 00447300 was issued in favour of the complainant by the opposite parties. There exists a relationship of consumer and service provider between the complainant and the opposite parties. Thereafter, the complainant remained in contact with the agent through whom the said proposal form and the initial premium was paid for the whereabouts of the issuance of the policy document however, the said agent remained dilly delaying the matter on one pretext or the other. When the complainant did not receive a satisfactory reply from the said agent about the policy document, he established contact with the opposite parties through the toll free number promulgated by them in the month of November 2016, wherein the representative of the opposite parties who received the complainant’s call informed the complainant that they need some time to investigate the matter with their courier partner. Thereafter, the complainant did not receive any response from the opposite parties regarding the policy document. The complainant kept on calling the toll free number who aired the same response that they require some time to look in to the issue. And one day the complainant was informed by a telecalling representative, that the policy had been delivered, however, neither anyone amongst the family of the complainant or the complainant had received the said policy, when the complainant asked the telecalling representative of the opposite parties about to whom the said policy was delivered he did not give a satisfactory reply. Thereafter, the complainant informed telecalling representative of the opposite parties that neither he nor his family members had received the policy and asked them to show him the signatures of the person who received the said policy, as it is a matter of a breach of privacy of the complainant as there was vital information about the complainant in the policy document which could be misused, the complainant even asked the opposite party to provide him a copy of the receipt of the policy document from the courier company, however, the opposite parties did not pay any heed to the genuine grievance and the concerns of the complainant and remained making lame excuses, that the said policy had been delivered. The complainant had bought the said policy from the opposite party and not the courier company and hence, the opposite party was responsible and accountable to respond to the complainant in a satisfactory manner and address the concern and grievance of the complainant, however, the opposite party had behaved in an irresponsible manner by making lame excuses and not providing the counterfoil of the delivery receipt of the said policy. On repeated calling of the complainant, the opposite party assured the complainant to deliver the said policy again. Thereafter the policy document was actually delivered to the complainant in the month of January 2017. Meanwhile in view of the irresponsible behavior on part of the opposite party, the complainant’s faith and interest in the opposite party was lost, hence, the complainant opted for returning the said policy within the free look period. The free look period starts from the day of delivery of the policy document to the consumer and hence, the request of the complainant made in the month of January, 2017 within 7 days of the receipt of the policy was well within the free look period. On the request of the complainant for returning the policy in the  free look period the opposite parties again came back and reiterated the same old story that the policy document alongwith welcome letter was delivered to the complainant in the month of November 2016 to which the complainant in turn asked the opposite parties to show the receipt/ signatures of the person to whom the said delivery was made, however, he got no satisfactory response from the opposite parties. Even after multiple calls made by the complainant in this regard thereafter no plausible and cogent solution of the request and grievance of the complainant has been reached due to the irresponsible and negligent behavior of the opposite parties. Due to such behavior of the opposite parties the complainant had suffered mental tension, pain and agony and such an event caused inconvenience, embarrassment and discomfort to the complainant on various occasions. Thereafter, the complainant frequently contacted the opposite party telephonically but to no avail. Thereafter, the complainant has forwarded his grievance to the customer care email id contact Us <Contactus@dhflpramerica.com> on 17.8.2017 and was informed that the issue had been raised and he shall be contacted by the concerned department in 2-3 days, however, none contacted the complainant in this regard till date and the grievance has not been resolved till date and the opposite parties had not returned the money of the complainant due to which the complainant is facing harassment, inconvenience and suffering. The complainant has prayed that the opposite parties be directed to resolve the grievance of the complainant and refund the premium received by them of Rs. 1,00,000.04 Paise from the complainant through receipt and shall also be directed to compensate the complainant with Rs. 50,000/- on account of losses incurred and mental harassment and agony alongwith Rs.21,000/- as cost of this litigation.

3        The opposite parties appeared through counsel and has filed written version by interalia pleadings that the above complaint is neither maintainable in law nor on facts and the same is liable to be dismissed in limine. The complainants have not approached this commission with clean hands. After duly deliberating upon the understanding of all the terms and conditions of the DHFL Pramerica Roz Sanchay and after being satisfied with the plan Mr. Rahul Sharma with the intention to purchase the policy submitted duly filled and signed application forms bearing No. AF004590069 dated 20.9.2016 giving all relevant details and information in the prescribed form, for an assured sum of Rs. 8,03,816/-. Under the said policy a premium of Rs. 96,385.58 Paise was to be paid annually for the period of 12 years. The complainant being a chartered accountant by profession after understanding all the terms and conditions had signed the proposal form wherein he has confirmed that he has understood all the terms and conditions and provided correct information. In order to proceed further with the above mentioned application forms the complainant himself provided with the requisite and relevant documents such as copies of Driving License and Tax Return which itself speaks the volume that the complainant himself after duly understanding terms and conditions opted for the policy and have applied for the same. As required under the IRDA (Protection of Policy Holder’s interest) regulations 2002 issued by IRDA, the Policyholder is at liberty to review the terms and conditions of the policy and has the option to cancel the policy by stating the reason for his/her objection within 15 days of the receipt of policy bond (Free Look Period). In such cases the opposite party company is entitled to deduct charges like stamp duty etc. and refund the balance premium to the policyholder. Thereafter the receipt of premium amount the policy bearing No. 447300 was issued with the commencement date 5.10.2016. The policy was dispatched vide OVERNITE Express AWB number 8554698235 and same were delivered on 12.11.2016.  Thereafter in order to cover up his own defect and to take undue advantage sent a letter dated 19.12.2016 requesting for reissue of policy documents falsely stated therein that the policy documents were not delivered. On the basis of said request letter from the complainant, the company reissued duplicate copy of the policy documents and duplicate copy of policy documents were delivered on 11.1.2017. Complainant sent a request letter dated 13.1.2017 for the cancellation of policy as complainant is not satisfied with the services of opposite parties and terms of policy was also different as explained to him earlier. This letter was duly replied by opposite parties vide letter dated 26.1.2017 and it was explained that policy was issued on the basis of duly signed application form received by the company along with the necessary supporting documents for Life insured and Policy Holder. The policy documents delivered to you clearly contained the details of policy features and benefits of the product. The policy documents were also delivered at the registered mailing address, as provided in application forms and address proofs which was duly signed by policy holder. In case complainant was not satisfied with any aspect of the policy he could have returned back the policy documents to the company with the request for cancellation as per the free look period as per Section 6(2) of Insurance Regulatory Development of India (Protection of Policy holder’s interest) Regulation 2002. Therefore the request was denied being raised outside the Free Look Period. As the contract of insurance is a contract of Uberime fide and as we have performed out part of the contract by providing our services and we are covering the risk of the life of the complainants from the date of commencement  of policy and as such, the complainant is estopped from challenging the contract as such at such a belated stage. The complainants have approached the court with utmost unclean hands and has misrepresented the court by twisting the facts. The opposite party has denied the other contents of the complaint and prayed for dismissal of the same.

4        To prove his case, the Ld. counsel for the complainant has tendered in evidence affidavit of complainant Ex. C-1 along with documents i.e. policy document Ex. C-2, copy of mail Ex. C-3, C-4, original post receipt Ex. C-5 and closed the evidence. On the other hands, Ld. counsel for the opposite party tendered in evidence affidavit of Parmal Singh Ex. OP1,2/1, copy of Proposal form Ex. OP1, 2/2, copy of policy Ex. OP1,2/3 and closed the evidence.

5        We have heard the Ld. counsels for the parties and have carefully gone through the record.

6        Ld. counsel for the complainant contended that an insurance policy bearing No. 00447300 was issued in favour of the complainant by the opposite parties. The complainant remained in contact with the agent through whom the said proposal form and the initial premium was paid for the whereabouts of the issuance of the policy document however, the said agent remained dilly delaying the matter on one pretext or the other. The complainant did not receive any response from the opposite parties regarding the policy document. The complainant kept on calling the toll free number who aired the same response that they require some time to look into the issue. One day the complainant was informed by a telecalling representative, that the policy had been delivered, however, neither anyone amongst the family of the complainant or the complainant had received the said policy, when the complainant asked the telecalling representative of the opposite parties about to whom the said policy was delivered he did not give a satisfactory reply. On repeated calling of the complainant, the opposite party assured the complainant to deliver the said policy again. Thereafter the policy document was actually delivered to the complainant in the month of January 2017. Meanwhile in view of the irresponsible behavior on part of the opposite party, the complainant’s faith and interest in the opposite party was lost, hence, the complainant opted for returning the said policy within the free look period. The free look period starts from the day of delivery of the policy document to the consumer and hence, the request of the complainant made in the month of January, 2017 within 7 days of the receipt of the policy was well within the free look period. On the request of the complainant for returning the policy in the  free look period the opposite parties again came back and reiterated the same old story that the policy document along with welcome letter was delivered to the complainant in the month of November 2016 to which the complainant in turn asked the opposite parties to show the receipt/ signatures of the person to whom the said delivery was made, however, he got no satisfactory response from the opposite parties. The complainant has forwarded his grievance to the customer care email id contact Us <Contactus@dhflpramerica.com> on 17.8.2017 and was informed that the issue had been raised and he shall be contacted by the concerned department in 2-3 days, however, none contacted the complainant in this regard till date and the grievance has not been resolved till date and the opposite parties had not returned the money of the complainant due to which the complainant is facing harassment, inconvenience and suffering and prayed that the present complaint may be allowed.

7        Ld. counsel for the opposite party contended that  after duly deliberating upon the understanding of all the terms and conditions of the DHFL Pramerica Roz Sanchay and after being satisfied with the plan Mr. Rahul Sharma with the intention to purchase the policy submitted duly filled and signed application forms bearing No. AF004590069 dated 20.9.2016 giving all relevant details and information in the prescribed form, for an assured sum of Rs. 8,03,816/-. He further contended that under the said policy a premium of Rs. 96,385.58 Paise was to be paid annually for the period of 12 years. The complainant being a chartered accountant by profession after understanding all the terms and conditions had signed the proposal form wherein he has confirmed that he has understood all the terms and conditions and provided correct information. In order to proceed further with the above mentioned application forms the complainant himself provided with the requisite and relevant documents such as copies of Driving License and Tax Return which itself speaks the volume that the complainant himself after duly understanding terms and conditions opted for the policy and have applied for the same. As required under the IRDA (Protection of Policy Holder’s interest) regulations 2002 issued by IRDA, the Policyholder is at liberty to review the terms and conditions of the policy and has the option to cancel the policy by stating the reason for his objection within 15 days of the receipt of policy bond (Free Look Period). In such cases the opposite party company is entitled to deduct charges like stamp duty etc. and refund the balance premium to the policyholder. Thereafter the receipt of premium amount the policy bearing No. 447300 was issued with the commencement date 5.10.2016. The policy was dispatched vide OVERNITE Express AWB number 8554698235 and same were delivered on 12.11.2016.  He further contended that in order to cover up his own defect and to take undue advantage sent a letter dated 19.12.2016 requesting for reissue of policy documents falsely stated therein that the policy documents were not delivered. On the basis of said request letter from the complainant, the company reissued duplicate copy of the policy documents and duplicate copy of policy documents were delivered on 11.1.2017. The complainant sent a request letter dated 13.1.2017 for the cancellation of policy as the complainant is not satisfied with the services of opposite parties and terms of policy was also different as explained to him earlier. This letter was duly replied by opposite parties vide letter dated 26.1.2017 and it was explained that policy was issued on the basis of duly signed application form received by the company along with the necessary supporting documents for Life insured and Policy Holder. The policy documents delivered to you clearly contained the details of policy features and benefits of the product. The policy documents were also delivered at the registered mailing address, as provided in application forms and address proofs which was duly signed by policy holder. In case complainant was not satisfied with any aspect of the policy he could have returned back the policy documents to the company with the request for cancellation as per the free look period as per Section 6(2) of Insurance Regulatory Development of India (Protection of Policy holder’s interest) Regulation 2002. Therefore the request was denied being raised outside the Free Look Period. As the contract of insurance is a contract of Uberime fide and as we have performed out part of the contract by providing our services and we are covering the risk of the life of the complainants from the date of commencement  of policy and prayed for dismissal of the complaint.

8        In the present complaint it is not disputed that the complainant has purchased the insurance policy from the opposite party and it is also not disputed that the complainant has made the payment of premium to the opposite party. The dispute in the present complaint is that according to complainant the opposite party has not delivered the policy documents to the complainant within time, therefore, he could not avail the option of free look period. But on the other hands, But according to opposite party the policy documents have been delivered to the complainant well within time and he has failed to opt for the benefit of free look period. To prove his case, the complainant has placed placed on record emails  Ex. C-3 which is dated 17.8.2017,  email Ex. C-4 dated 19 Sept 2017 and the complainant has also placed on record one receipt dated 14.1.2017 but has not placed on record any letter / document which sent through that postal receipt. However, the complainant himself has placed on record one document Ex. C-2 which is dated 6.10.2016 in which it is specifically mentioned that:-

If you are not satisfied with any aspect of the policy, you can return it to us within 15 days(30 days in case the policy is sold through distance marketing) of receipt by stating the reason for return. We will refund the premium paid less risk premium for the period covered and the expenses incurred on medical examination and stamp duty charges. 

In this letter it is clearly mentioned to return the policy within 15 days of receipt of this letter. The complainant has not sent any letter within 15 days of receipt of this letter. On the other hands, according to opposite party policy bearing No. 447300 was issued with the commencement date 5.10.2016. The policy was dispatched vide OVERNITE Express AWB number 8554698235 and same were delivered on 12.11.2016.  It is admitted by the opposite party that they have received the letter dated 13.1.2017 from the complainant for cancellation of the policy but the said letter is also beyond the free look period of the issuance of the policy.  The complainant cannot take the plea that he is not aware about the terms and conditions of the policy. The complainant cannot take plea that he has not received the policy documents. As per judgments of case Prema & Ors. v. Life Insurance Corporation of India IV (2006) CPJ 239 (NC) and Kishore Chandrakant Rathod v. MD ICICI Prudential Life Ins. Co. RP No.3390 of 2013 decided by the Hon’ble National Commission vide order dated 21.05.2014, the onus was on the complainant to read all the contents of both the documents i.e. policy and terms and conditions thereof. The complainant is bound by the policy contract as he gave up/relinquished/waived off his right by not exercising the “Free Look Period” option.  

9        In other judgments of the Hon’ble National Commission of case Mohan Lal Benal v. ICICI Prudential Life Ins. Co. RP No.2870 of 2012 decided on 16.10.2012 and R.P. No.3271 of 2013 (Harish Kumar Chadha v. Bajaj Allianz Life Insurance Co. Ltd.) decided on 07.10.2013, it has been held that in case the insured/complainant is not satisfied with the policy taken, then he/she should avail the option of returning the policy with a period of 15 days of receipt i.e. “Free Look Period”. 

10      The complainant has signed the policy documents after admitting the contents of the same as correct. The terms and conditions of the Insurance Policy have to be strictly construed. Hon’ble Supreme Court in the case of Export Credit Guarantee Corporation of India vs. Garg Sons International 2013 (1) SCALE 410 (SC) held in Para Nos.8 to 11 as under:

“8.  It is a settled legal proposition that while construing the terms of a contract of insurance, the words used therein must be given paramount importance, and it is not open for the Court to add, delete or substitute any words. It is also well settled, that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the policy, its terms have to be strictly construed in order to determine the extent of the liability of the insurer. Therefore, the endeavour of the Court should always be to interpret the words used in the contract in the manner that will best express the intention of the parties. (Vide: M/s. Suraj Mal Ram Niwas Oil Mills (P) Ltd. v. United India Insurance Co. Ltd., (2010) 10 SCC 567). 

9.  The insured cannot claim anything more than what is covered by the insurance policy. The terms of the contract have to be construed strictly, without altering the nature of the contract as the same may affect the interests of the parties adversely. The clauses of an insurance policy have to be read as they are consequently, the terms of the insurance policy, that fix the responsibility of the Insurance Company must also be read strictly. The contract must be read as a whole and every attempt should be made to harmonize the terms thereof, keeping in mind that the rule of contra proferentem does not apply in case of commercial contract, for the reason that a clause in a commercial contract is bilateral and has mutually been agreed upon. (Vide : Oriental Insurance Co. Ltd. v. Sony Cheriyan AIR 1999 SC 3252; Polymat India P. Ltd. v. National Insurance Co. Ltd., AIR 2005 SC 286; M/s. Sumitomo Heavy Industries Ltd. v. Oil & Natural Gas Company, AIR 2010 SC 3400; and Rashtriya Ispat Nigam Ltd. v. M/s. Dewan Chand Ram Saran AIR 2012 SC 2829). 

10.   In Vikram Greentech (I) Ltd. & Anr. v. New India   Assurance Co. Ltd. AIR 2009 SC 2493, it was held:  “An insurance contract, is a species of commercial transactions and must be construed like any other contract to its own terms and by itself. The endeavour of the court must always be to interpret the words in which the contract is expressed by the parties. The court while construing the terms of policy is not expected to venture into extra liberalism that may result in rewriting the contract or substituting the terms which were not intended by the parties. (See also: Sikka Papers Limited v. National Insurance Company Ltd & Ors. AIR 2009 SC 2834).” 

11.  Thus, it is not permissible for the court to substitute the terms of the contract itself, under the garb of construing terms incorporated in the agreement of insurance. No exceptions can be made on the ground of equity. The liberal attitude adopted by the court, by way of which it interferes in the terms of an insurance agreement, is not permitted. The same must certainly not be extended to the extent of substituting words that were never intended to form a part of the agreement.” 

11.   In another case of National Insurance Co. Ltd. v. Rameshwar Lal Revision Petition No.1751 of 2017 decided on 18.09.2020 by relying upon various judgments held that the contract of insurance is to be construed as it is written in the policy documents. 

12      The complainant himself has placed on record one document Ex. C-2 in which it is clearly written that “If you are not satisfied with any aspect of the policy, you can return it to us within 15 days(30 days in case the policy is sold through distance marketing) of receipt by stating the reason for return.”

13      In view of the above discussion, there is no merit in the present complaint and the same is hereby dismissed. The parties are left to bear their own costs. Copy of order will be supplied by the District Consumer Disputes Redressal Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar.  

Announced in open Commission

06.09.2022