Punjab

Tarn Taran

RBT/CC/17/524

Davinder Kumar - Complainant(s)

Versus

Edelweiss Tokyo Life Insurance Co. - Opp.Party(s)

Aman Parasher

26 May 2022

ORDER

 

Davinder Kumar son of Ganpat Rai c/o M/s Ganpat Rai Vishwamitter, Majith Mandi, Amritsar. (78376-16502)

                                                                             …Complainant

                                                Versus

1. Edelweiss Tokyo Life Insurance Company Limited, having its Regd. Office at Edelweiss House, Off C.S.T. Road, Kalina, Mumbai-400098, service through its Branch Office at 3^rd Floor, SCO-128 District Shopping Centre, Ranjit Avenue Amritsar through its branch Manager/ Principal Officer, 
2. SMC Insurance Brokers Private Limited, having its Corporate office at Parsavnath Metro Mall, Near Metro Station, Partap Nagar, New Delhi, service through its Amritsar office at 2^nd Floor, Central Mall, Mall road, Amritsar through its Office Incharge/ Principal Officer. 

                                                                             …Opposite Parties

Complaint Under Section 11 and 12 of the Consumer Protection Act.

Quorum:               Sh. Charanjit Singh, President

Ms. Nidhi Verma, Member

For Complainant                     Sh. Aman Prashar Advocate

For Opposite Party No.1                  Sh. Pardeep Arora Advocate

For Opposite Party No.2                  None

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 11 and 12 against the opposite parties on the allegations that the opposite party No. 1 had approached the complainant through officials of opposite party No. 2 in the month of January 2016 and allured the complainant about life insurance policy of opposite party No. 1 with allurement that if the complainant would pay an amount of Rs. 49,990/- as single premium then on maturity of policy after a period of one year the company i.e. opposite party No. 1 would pay an amount of Rs. 1,00,000/- to the complainant for policy. Under the influence and as per the assurances given by the opposite parties, the complainant had purchased two policies bearing No. 007152882E and 100021193E having commencement date 19.2.2016 and 29.2.2016 respectively after paying Rs. 49,999/- for the each policy, as such, the complainant has availed the services of the opposite parties and he is consumer qua the opposite parties. The opposite parties had allured the complainant to purchase the above said policy of the opposite parties as the opposite parties are endeavoring to enhance financial future of their customers by providing them the best services at all times. The officials of opposite parties allured the complainant that there is one single premium life insurance plan in which the complainant has to pay only single premium and he will get life cover for handsome sum assured. The complainant fell prey and accordingly, he purchased above mentioned policies from the opposite parties. At that time the official of the opposite parties took the signatures of the complainant on application form, the required details of which were not filled at that time, as it was told by the officials to fill the same by themselves. As per the directions of concerned officials of the opposite parties, the complainant paid Rs. 49,999/- as single premium towards the policies in question. The official of opposite parties after receiving premium and necessary documents along-with photographs from the complainant went back with the assurance that the complainant will receive the policies through a registered post from the office of opposite parties. The complainant got astonished after receiving letter from the office of opposite party No. 1 in the month of February 2017 demanding Rs. 49,999/- for second year premium towards each policy. After receiving above mentioned letter, the complainant had approached the office of opposite party No. 1 at Amritsar and inquired about the demand raised by opposite parties through the letter received by him, the officials of the opposite party No. 1 at Amritsar told the complainant that the policies purchased by the complainant was  regular premium paying policies for which the complainant was to pay premium for seven consecutive years and the policies would mature after fifteen years from the date of commencement of policies.  The complainant shocked after learning the facts that the opposite parties had sold their policies to the complainant by misguiding and misrepresentation about the terms and conditions of the policies, which clearly indicates about the unfair trade practice adopted by the opposite parties. The complainant had even moved a request letter with the opposite parties which was duly received by the office of opposite party No. 1 on 27.2.2017 and also visited the office of opposite parties frequently & regularly, but opposite parties had paid no heed to the genuine requests of the complainant. The complainant never approached for such policies and he purchased the above mentioned policies with his hard earned money by paying towards single premium policies as assured/ narrated by the official of the opposite parties, but said officials misguided/ cheated the complainant and duped the amount of complainant in above said plan as per their own wish . The complainant time and again approached the office of opposite parties and requested to refund the amount paid by him in purchase of above said policies as he is not interested to purchase the said policies as the same was not the policies so explained by the opposite parties at the time of selling it to the complainant, but no heed was paid to the genuine and legitimate request of the complainant. The complainant has prayed that the present complaint may be allowed and the opposite parties may kindly be directed to pay to the complainant:-

(a)     An amount of Rs. 1,00,000/- with interest @24% per annum on the amount given by the complainant and close the policies bearing No. 00712582E and 100021193E.

(b)     Rs. 1,00,000/- as compensation for harassment, mental pain and agony

(c)      Rs. 22,000/- for litigation expenses. 

3        After formal admission of the complaint, notice was issued to Opposite Parties and opposite party No. 1 appeared through counsel and filed written version and contested the complaint by interailia pleadings that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this commission. This commission has no jurisdiction to entertain the present complaint. The complainant has failed to demonstrate any deficiency in service on the part of the opposite party No. 1. Deficiency means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance; which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service. The terms of a policy are in the nature of a contract and their interpretation has to be made in accordance with a strict construction of the contract. Thus, the words in an insurance contract must be given paramount importance and must be interpreted as expressed without any addition, deletion or substitution. The complaint is devoid of any material particulars, and has been filed merely to harass and gain undue advantage and unjustified monies from the opposite party No.1, and hence the complaint deserves to be dismissed in limine. The complainant has not acted in good faith with respect to the subject of this complaint and has approached this commission with unclean hands, whereas it is a settled legal preposition that “One who seeks equity must come with clean hands” the complainant has concealed, suppressed and misrepresented the material and relevant facts of the case and is guilty of supressio veri suggestio falsi.    The complainant has failed to set up a nexus between the damages claimed in the present complaint and the damages actually suffered by him. The compensation claimed is arbitrary, without basis and is an abuse of process of law. The complainant was duly informed that in case the complainant is not satisfied with the features or the terms and conditions of the policy , the complainant can return the policy to the opposite party No.1 within 15 days from the date of receipt of policy under the ‘Free Look Period”. The complainant retained the policy documents and did not raise any objection towards the policy during the said “Free Look Period” with any grievance regarding the policy or terms and conditions, meaning thereby that the complainant had agreed to the policy and their terms and conditions, and the policy was to the agreement and satisfaction of the complainant.  Since the present complaint involves allegations of cheating and miss-selling, the same cannot be adjudicated under summary proceedings and can only be adjudicated in a civil court after holding a proper trial and leading substantive evidence. The proceedings before this commission are essential summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated, and hence the present complaint deserves to be dismissed on this ground as well.  The complainant in the complaint has mentioned that he was induced by opposite party No. 2 to propose for the subject policies. The opposite party No. 2, SMC Insurance Brokers Pvt. Ltd. is not an agent of opposite party No. 2 but is an independent insurance Broker licensed and registered with the Insurance Regulatory & Development Authority of India (IRDAI) who advises their customers on their insurance needs and thereafter arranges insurance policies from any insurance company as per their own judgment and as per the customer’s choice.  The company was in receipt of duly filled up and signed proposal forms, the details of which are given below 

 

Policy No.	100021193E	007152582E
Date of Proposal Form	26.02.2016	04.02-2016
Proposer/ Policyholder	Davinder Kumar	Davinder Kumar
Life Assured	Monika Mehra	Monika Mehra
Plan	Edelweiss Tokio Life GCAP	Edelweiss Tokio Life GCAP
Death Benefit	5,30,750	5,30,750
Premium (Rs.)	49,999/-	49,999/-
Policy Term	15 Years	15 Years
Premium Paying Term	07 years	07 years
Premium Payment Frequency	Annual	Annual

 

          The complainant had provided a declaration in the proposal forms stating that “I/we declare and warrant on my behalf and on behalf of the person whose life is to be insured that I/we have read/ been interpreted this proposal form, the sales literature and benefit illustration and that the same have been explained to me and I have fully understood the product and the significance of the proposed policy. I / we declare the answers given in the response to the questions above and the statements made in this proposal form or otherwise in support of this proposal are true correct and complete in all respects and there is no other information material to this proposal that has been withheld by me/ us. Copies of the proposal form are Annexure Ex. R-1, R-2 The complainant had also signed the benefit illustration which mentions the very same features of the insurance plan as stated in the proposal form which are mentioned herein above. Copies of benefit illustration are annexure Ex. R-3, R-4. The company, believing the information given by the complainant in the proposal form to be true and correct in all aspects, and as per the underwriting norms of the company, issued life insurance policies bearing No. 100021193E and 007152582E. A mere perusal of the policies schedule would reveal that the policies have been issued strictly in accordance with the proposal form and benefit illustration. Copies of the letter forwarding the policy, first premium receipt, policy schedule and terms and conditions are Ex. R-5, R-6. The policy bound for policy No. 100021193E was dispatched to the complainant on the very same address as mentioned by the complainant in proposal form on 3.3.2016 through Speed Post Airway Bill No. EM878435483IN and received by the complainant on 9.3.2016 and the policy bound for policy No. 007152582E was dispatched to the complainant on the very same address as mentioned by the complainant in proposal form on 23.2.2016 through Speed Post Airway Bill No. EM878463630IN and received by the complainant on 29.2.2016.. In consonance with clause 8(1) of the Insurance Regulatory and Development Authority of India (Protection of Policy holders’ Interests) Regulations, 2017, the company sends a copy of proposal form alongwith the policy document to the policyholder. The company had sent the policy document stating the policy terms and conditions alongwith a copy of proposal form to the communication address of the complainant and the same were duly received on the dates as mentioned above. The complainant retained the policy documents and neither approached the company with any discrepancies regarding premium payment, premium allocation charges, benefits, surrender, foreclosure and any assured benefits under the policy terms and conditions, nor did the complainant approached the company for cancellation of the policy during the free look period thereby implying that he had agreed to all the terms and conditions of the policy. The complainant also submitted a duly signed benefit illustration at the time of taking the policy from which it clear that he very well knew about the terms of the policy. It is strange to note that a person who has agreed to invest money in an insurance policy, invests without even reading and understanding its terms and conditions and consecutively fails to read and understand the same even after receiving the policy documents from the company. The complainant has provided a declaration in the proposal form stating that the complainant understood the policy terms and conditions of the Proposal for insurance. In accordance to clause 10 of the insurance Regulatory and Development Authority of India (Protection of Policy Holder’s Interests) Regulations, 2017 every policy document sent by it is accompanied by a forwarding letter which clearly mentions that in case Policyholder is not satisfied with the features or the terms and conditions of the policy he can returned the policy within 15 days of receipt of the policy documents i.e. under the Free Look Period provision. The opposite party No. 1 further submits that as per regulation 8(1) of the Insurance Regulatory and Development Authority of India (Protection of Policy holder’s interests) Regulations, 2017 a copy of the proposal form duly signed by the policy holder and the life insured were also sent to the policy holder i.e. the complainant and was duly received alongwith  the policy document thereby giving an opportunity to the complainant to understand the terms and conditions and approached the company, if any discrepancy. The complainant retained the policy documents and did not raise any objection towards the policy. The complainant had not approached the opposite party No. 1 during the free look period with any of his grievances regarding the policy or its terms and conditions. Meaning thereby that the complainant agreed to the policy and its terms and conditions.  The complainant had duly received the policy documents including the terms and conditions and hence it was the complainant’s duty to read and understand the same and approach the opposite party No. 1, if not satisfied. The complainant inspite of receiving premium reminder notice for the policy failed to deposit the premium amounts and accordingly, the policy  has acquired a reduced paid up status due to nonpayment of premiums as per clause 3(c) (ii) of the Policy terms and conditions. The opposite party No. 1 further states that a mechanism namely Pre Issuance Verification Call  prior to issuing the policy and the core objective of exercise is to conform and satisfy at the company’s end that the policy holder has understood the key features of the policy without any ambiguity and has no grievance in this regarding. In the present complaint as well, the company had effected PIVC for the policy and in the said call, the complainant did not raise any concern or issue and was in complete agreement with the terms and conditions of the policy.  The opposite party No.1  would like to bring to notice of this commission that all the policies and the plans introduced by it are all in concord with the IRDAI rules and guidelines and that all of its products are duly approved by IRDAI. The company has solely and strictly acted as per the terms and conditions of the policy document. In view of above, the company is not liable to refund the amount as demanded by the complainant but is liable to pay only the surrender value and that too solely in accordance with the policy terms and conditions . Insurance being a contract between the policyholder and the company and both are governed by the terms and conditions mentioned in the policy document and all the benefits are payable strictly as per the policy terms and conditions. The opposite party No. 2 SMC Insurance brokers Pvt. Ltd. is not an agent of the opposite party No. 1 but it is an independent broker licensed and registered with the Insurance Regulatory & Development Authority of India (IRDAI), who advise their customers on their insurance needs and thereafter arrange insurance policies from various insurance companies as per their own Judgment and as per the customer’s choice.  The opposite party No. 1 has denied the other contents of the complaint and prayed for dismissal of the same. 

4        The opposite party No. 2 appeared through counsel and filed written version by interlia pleadings that the present complaint is gross misuse of process of law and devoid of any merit as such, there is no cause of action for the complainant against the opposite party No. 2.   The opposite party No. 2 is a company registered under the provisions of the companies Act and is a direct insurance broker licensed with IRDA and provides the broking services to the different insurance companies for their life as well as general insurance products being represented by Mr. Jitesh Kumar Jha. The opposite party No. 2 has been falsely arrayed as the opposite party No. 2 in the present complaint. The complainant does not fall within the meaning and definition of consumer as defined in Section 2(1)(d) of the Consumer Protection Act, 1986 for the reasons that the complainant entered in to the disputed transactions i.e. purchase of insurance policy from the opposite party No. 1.  The complainant purchased the insurance policies bearing No.  0017152582E and 100021193E. The policy purchased by the complainant under which the complainant was entitled to receive certain returns from opposite party No. 1 on maturity date which is mentioned on the policy documents under the policy according to the terms and conditions of the policy issued by the opposite party No. 1 subject to payment of regular premiums under the policy. Therefore, this makes it clear that the primary purpose of entering in to the disputed transaction was for investment which is clearly a commercial purpose and commercial investment and therefore, the complainant cannot be regarded as a consumer dispute under the provisions of the Consumer Protection Act, 1986. The present complaint does not attract the provisions contained in Section 2(1) (d) or 2(1)(g), hence the present dispute is not maintainable and, therefore, the same deserves to be rejected being the same cannot be decided by this commission. The complaint is bad for misjoinder of parties, as there is no cause of action ever arose against the opposite party No. 2 as there is no privity of contract between the complainant and opposite party No 2 and is ought to be deleted from the array of parties as it is not maintainable against the opposite party  No. 2. The impleadment of the opposite party No. 2 in the present complaint is uncalled for and, therefore, the same name of the opposite party No. 2 deserves to be deleted from the array of parties. The complainant has misused the process of law with the sole intention to harass the opposite party No. 2 without first approaching the Grievance Redressal form created by the Insurance Regulatory and Development authority (IRDA). The opposite party No. 2 is a licensed insurance broker duly licensed by the insurance regulatory and development authority which is a regulatory body controls and regulates the matters relating to the insurance. Under the insurance Regulatory and Development Authority (Insurance Brokers) Regulations, 2013 framed by the Insurance Regulatory and Development Authority and Section 51(3) enumerated there provides that any disputed relating to insurance shall be dealt in accordance with the procedure mentioned in these Regulations to be followed by Insurance Regulatory and Development Authority. Therefore, the complainant ought to have first approach the insurance Regulatory and Development Authority in regard to his grievances under the Grievance Redressal Forum created by Insurance Regulatory and Development Authority. The complainant has directly filed the present complaint without seeking alternative remedy or approaching Grievance Redressal Forum of Insurance Regulatory and Development Authority. The present complaint is not maintainable. The present complaint filed by the complainant is an absolute derogation of the established principles of law. As per the insurance Regulatory and Development Authority Circular dated 03.09.2010 a new integrated grievance management system has been developed to facilitate the insurance policy holders to redress their complaint with Insurance Companies and held the Insurance Regulatory and Development Authority to monitor these complaints. In case of grievance insurance matters, the policy holders have the option to first approach the grievance Cell of the respective insurance company. If the aggrieved policy holder is not satisfied with the response of the insurance company, then he has option of approaching call centre of Insurance Regulatory and Development Authority to register his complaint or integrated grievance management system of Insurance Regulatory and Development Authority which is the standard forum to resolve Policy holder’s grievances or the policy holders can approach the Ombudsman created under Redressal of Public Grievances Rules, 1998 by the government of India for quick disposal of the grievances of the policy holder out of the court system in a cost effective efficient an impartial manner. The complainant has never approached either the Grievance Cell of the respective insurance company nor approached the integrated Grievance Management System Insurance Regulatory and Development Authority or Insurance Ombudsman before filing this complaint which clearly manifest the complainant’s intention to harass the agent/ broker of the opposite party No.1. Pre login variation call was done for confirming the complainant’s willingness to purchase the policy and to verify if he understands the rights and obligations under the policy well enough. The following matters were specifically clarified in the PLVC conducted.  (a) It was confirmed from the complainant whether they have themselves signed the application Form, Customer Declaration Form and Benefit Illustration and whether they are aware of all terms of premium and policy. All the major terms and conditions of the policy were reiterated to the complainants. (b) It was specifically informed to the complainants that neither the complainants would be provided with any bonus, commission, in this new policy in return of any old policy nor any money from any previous policy would be adjusted in new policy. It was also informed clearly to him that no extra benefit, like credit card, O.D, free loan etc. would be provided in this policy (c) The email id of the complainant, proposer name, life insured’s name, amount already paid as premium, term of premium, term of policy was confirmed to the complainants.  (d)It was specifically conformed from the complainants if their cheque should be deposited in the bank for encashment towards premium amount. (e)  The complainant was informed of all benefits that would be provided to them and their obligations under the policy and was asked if they are satisfied with the information provided. The complainants were also informed that the policy is the regular premium policy for which they will have to pay premium every year until the premium paying term gets over. (f) The complainants were cautioned and warned that if they have received/ or receives in future any call from anyone promising any additional benefits on this policy like loan or claiming to be representative/ official of IRDAI committing special offer or bonus or loan, or asked him to remain quiet during this verification call, he can disclose the same in the current call or in future so that proper action can be taken by opposite party No. 2 in this regard. (g) the complainant was also informed that he can cancel the policy within 15 to 30 days from signing the policy bonds if he is not satisfied with the terms and conditions of the policy documents (known as free look period) 

After the completion of formalities like PLVC and encashment of premium of cheque, the representative of opposite party No. 2 conducted a pre issuance verification call from their end. This call is similar to PLVC conducted by opposite party No.2.  The pre Issuance Verification Call conducted by Insurance companies, each insurance company issues the policy bond and dispatched it at the address of the policy holder. Thereafter, a final welcome call was given to the complainants by the opposite party again confirming about details of the complainants for final conformation that their policy papers are dispatched at their address. The complainants were advised to read through the policy bonds and check the copy of application form attached herein filled and signed by him to ensure all the details are the same as they had opted while purchasing the policy. The complainant was also informed that they can cancel the policy within 15 to 30 days after receiving the policy documents in case they are not satisfied with the terms and conditions of the policy documents or finds any discrepancy/ doubt in the same. The aforementioned procedure is strict and standard procedure in full conformity with rules, regulations and guidelines of IRDAI which is followed by opposite party No. 2 for its every client/ customer. It is clear from the recording of PLVC and Welcome Call (final confirmation Call after issuing the policy), the complainants had not shown any kind of dissatisfaction or doubt regarding the policy or any terms of policies and were totally inclined and cooperative towards the policy before purchasing the policy. The complainant was also well aware of the terms and conditions of the insurance policy before purchasing the same. Apart from the aforementioned standard verification procedures, for the purpose of ensuring that complainants understand their rights and obligations under each and every policy, the complainant was made sign a one page client declaration form (CDF) in which the following main terms and benfits of the policy were clearly mentioned 

          a.       Premium paying term under the policy

          b.       Main benefits under the Policy

c.       Declaration of the complainants that they understand that the premium has to be paid every year.  

d.       Declaration of the complainants to the effect that they understand that the present policy is not links to any other insurance plan. 

The complainant have signed the above said client declaration form pertaining all the policies of the respective insurance companies after carefully reading and understanding the same.  While sourcing the aforementioned policies to the complainant, meticulous verification was done by the opposite party No. 2 and opposite party No. 1. The opposite party No. 2 sourced the policies only after being assured by the complainants and the said respective insurance company that the complainants have fully understood the terms and conditions of the policies and has financial capacity to pay the premium. For this purpose, several verification emails were exchanged between the representatives of the opposite party No. 1 and the opposite party No. 2. The role of the opposite party No. 2 is in the process Insurance Policies is very limited. The present complaint is devoid of any merits against the opposite party No. 2 and has been made simply to give colour to unfound allegation. The same is once again summarily narrated for knowledge of the commission. The complainant does not come under the ambit of Consumer Protection Act, 1986.  The present complaint filed under the Consumer Protection Act is not maintainable and deserved to be dismissed out rightly. The opposite party No.2 is not necessary party. The address of the opposite party No. 2 is clearly mentioned on the policy which is M/s SMC Insurance Brokers(P) Ltd., 9 B Netaji Subhash Marg, Daryaganj, Delhi but the complainant filed the present complaint before this commission only to harass and to harm the goodwill of the opposite party No.2. The opposite party No.2 has reiterated the stand as taken in the preliminary objections and has denied the other contents of the complaint and prayed for dismissal of the same. 

5        To prove his case, the complainant had tendered in evidence his affidavit Ex. C-1, copy of complaint given to Branch Manager Ex. C-2, welcome letter Ex. C-3, Copy of first premium receipt Ex. C-4, copy of policy schedule Ex. C-5, copy of the welcome letter Ex. C-6, copy of first premium receipt Ex. C-7, copy of policy schedule Ex. C-8  and closed the evidence. On the other hands, opposite party No. 1 has tendered in evidence affidavit of Ankur Chadda Ex. OP1/A, copies of Proposal forms Ex. OP1/1, OP/2, copies of benefit illustrations Ex. OP1/3, OP1/4, copy of the terms and conditions Ex. OP1/5 and OP/6 and closed the evidence. The opposite party No. 2 has tendered in evidence affidavit of Sh. Jitesh Kumar Ex. OP2/1. 

6        From the combined and harmonious reading of pleadings and documents placed on record going to prove that the complainant has purchased two insurance policies i.e. policy No. 100021193E commencement date 26.2.2016 and policy No. 007152582E commencement date 4.2.2016 from the opposite party No. 1 with allurement that if the complainant would pay an amount of Rs. 49,999/- and Rs. 49,999/- as a single premium then on maturity of policy after a period of one year the opposite party No.1 would pay an amount of Rs. 1,00,000/- to the complainant for each policy. According to the complainant at the time of inception of policies, the official of the opposite party took signatures of complainant in application form, the required details of which were not filled at that time, as it was told by the officials to fill the same by themselves.  Thereafter, the complainant got astonished after receiving letter from the office of opposite party No.1. In the month of Feb 2017 a second year premium for Rs. 49,999/- was due. After receiving the above said letter, the complainant approached the office of opposite party No. 1 and inquired about the demand raised by the opposite party No.1 and he was told by the opposite party No. 1 that the complainant has purchased regular premium paying policy and he had to pay premium for 7 consecutive years and policy would mature after 15 years from the date of commence of policy. According to the complainant, the opposite party has sold the above said policy by misguiding and misrepresentation about the terms and conditions of the policies which clearly indicates unfair trade practice on the part of the opposite parties. The complainant visited time and again to the office of opposite parties with the request to refund the amount paid by him for the purchase of above said policy but the opposite parties refused to refund the amount to the complainant. In nutshell we are of the opinion that the complainant has invested the money by taking above said insurance policy. As per version of the complainant this policies were issued by opposite parties by misguiding and misrepresentation about the terms and conditions of the policy and further the complainant was under impression that it is a single premium policy and he would get an amount of Rs. 1,00,000/- after one year for each policy. 

7        The whole controversy in the present case revolves around the point as to whether the opposite parties have sold the above said policies by misguiding and misrepresentation? We are not agreed with the complainant that the opposite parties have sold the above said policies by misrepresentation and misguiding because the complainant has placed on record copies of welcome letters which have been exhibited by the complainant himself as Ex. C-3 and C-6. The welcome letters clearly show the plan name, policy term i.e. for 15 years and policy paying premium i.e. 7 years. The complainant himself has placed on record a policy schedule as Ex. C-5 and C-8 and  which clearly shows that the policy commencement date as 29 Feb 2016, 19 Feb 2016 respectively and next premium due date as 28.2.2017 and 19.2.2017 and as per this policy schedule, the policy term is for 15 years and premium paying term is 7 years,. As per Opposite party No. 1 copy of proposal form was also sent to the complainant and in this welcome letter it was clearly requested by the opposite party No. 1 as under:- 

“We request you to go through your policy in detail and check the accuracy of information provided. A free look period of 15 days from the date of receipt of the policy is provided to you to review the terms and conditions of the policy. You may return the policy to us within 15 days from the date of receipt of the policy if you disagree with any of the terms and conditions by giving us written reasons for your objection. We will refund an amount as mentioned in the free look clause of the policy terms and condition.” 

But the complainant has not availed the benefit of free look period of 15 days. Had he gone through policy terms and conditions as well as welcome letter, he would have returned the policy within free look period but the complainant failed to do the same and at the stage, the complainant cannot raise the plea that the policy was for the period of one year.  The opposite party No. 1 has placed reliance upon Mohan Lal Benal Vs ICICI Prudential Life Insurance Co. Ltd. (R.P. No. 2870 / 2012 decided on 16.010.2012) and Harish Kumar Chadha Vs Bajaj Allianz Life Insurance Co. Ltd. (Decided on 7.10.2013 in revision Petition No. 3271 of 2013, Shrikant Murlidhar Apte Vs Life Insurance Corporation of India, Revision Petition No. 634 of 2012 decided on 2.5.2013. The opposite party No. 1 has raised the contention that the complainant has failed to demonstrate in deficiency in service on the part of the opposite party No. 1. Deficiency means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance; which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of the contract or otherwise in relation to any service. The terms and conditions of the policy are in the nature of a contract and their interpretation has to be made in accordance with a strict construction of contract and in this regard the opposite party No. 1 has placed reliance on Suraj Mal Ram Niwas Oil Mills (P) Ltd. Vs United India Insurance Co Ltd. (2010) 10 SCC 567), Life Insurance Co. Ltd. Vs Madhavacharya (Revision Petition No. 2111) of 2009, Ravneet Singh Bagga Vs KLM Royal Dutch Airlines (2000) 1 SCC 66. Further the opposite party No. 1 has relied upon the Judgment Life Insurance Corporation of India Vs Siba Prasad Dash, reported as IV (2008) CPJ 156(NC). As per this Judgment, the opposite party No. 1 has covered the complainant under the policy in question.  The premium which was paid by the complainant was to cover the risk for given period and opposite party No. 1 has duly covered the risk for which the premium has been paid. Moreover, the complainant has signed the policy documents himself and at this stage he cannot take plea that it was not explained to him. The above said policies were duly dispatched to the complainant on his mentioned address through Speed Post Airway Bill No. EM878435483IN and 007152582E  and after going through the said policies the complainant has never approached to the opposite party for cancellation of the same if he was not agreed with the terms and conditions of the policy. Moreover, both parties are bound to obey the terms and conditions of the policy as it is a contract between both the parties. Reliance has been placed upon Suraj Mal Ram Niwas Oil Mills (P) Ltd. Vs United India Insurance Co. Ltd. (2010) 10 SCC 567 and Reliance Life Insurance Co. Ltd. Vs Madhavacharya (Revision Petition No. 211 of 2009),  wherein it was held by the National Commission that “Since the insurance between the insurer and the insured is a contract between the parties, the terms of the agreement including applicability of the provision and also its exclusion had to be strictly construed to determine the extent of the liability of the insurer.  The opposite party No. 2 has placed on record of pre logging verification call which was done for confirming the complainant’s willingness to purchase the policy and to verify if he understands the rights and obligations of the policy well enough. The opposite party No. 2 has placed on record two C.Ds of voice recording of Pre Logging Verification Call and conversation which was done between the complainant and opposite party No.2, whereby it was explained to the complainant that he has to pay the premium for 7 years and the terms of policy was 15 years and complainant as per the pre logging verification call was agreed with the same. Now at this stage, the complainant cannot say that he was never explained the terms and conditions of the policies. The complainant cannot raise the voice that he has only signed the papers and rest of detail was filled up by the opposite parties. He is an educated person and cannot be supposed to sign the documents without going through the contents. The complainant was given sufficient time i.e. free look period to go through the terms and conditions of the policies which were duly supplied by the opposite parties. The opposite parties have placed on record various documents as well as record of Pre Logging Verification Call which clearly shows that the opposite parties have taken every measure to explain the terms and conditions of the policies. The opposite party No. 1 in its reply admitted that company is not liable to refund the amount as demanded by the complainant but is liable to pay only surrender value that to solely in accordance with terms and conditions of the policies. As such as per admission and pleading of the opposite party No. 1, the complainant is entitled to only surrender value as per terms and conditions of the policies. 

8        In view of above discussion, we partly allow the present complaint and the complainant is entitled to surrender value as per terms and conditions of the two policies from the opposite party No.1. Hence, opposite party No. 1 is directed to refund the fund value of the two policies. The present complaint against the opposite party No. 2 is 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

26.05.2022