Order dictated by:

Sh.S.S. Panesar, President.

1.       Sh.Parnam Singh has brought the instant complaint under section 11 & 12 of the Consumer Protection Act, 1986 on the allegations that he is permanent resident of Amritsar and is law abiding citizen and peace loving senior citizen of India. The complainant opted three Fixed Deposit schemes for his grand daughters named Amrit kaur aged about 9 years and Harsimrat Kaur aged about 8 years, both daughters of Harpreet Singh vide policies (i) bearing No. 02992869 dated 27.10.2014 for an amount of Rs.75,000/- for the period of 15 years, (ii)policy bearing No. 0301531 dated 1.12.2014 for an amount of Rs.1,25,000/- for the period of 15 years  and (iii) policy bearing No.0301447 dated 15.1.2015 for an amount of Rs.1,18,027/- for the period of 15 years. But the policies in question when received were of insurance, but not Fixed Deposits and the complainant immediately informed and sent the letter dated 15.1.2015 for canceling the said policies within the period of 15 days on receipt of the same and a notice dated 24.9.2015 through his counsel was also sent to the Opposite Parties, the reply dated 30.9.2015 of the said notice was received by the complainant. The policy bearing No. 03010447 was got cancelled and the amount of said policy Rs.1,18,027/- was received by the complainant, but the cancellation amount of other two policies bearing No. 0301531 and 020992869 of Rs.1,25,000/- and Rs.75,000/- respectively has not been received by the complainant till date.  The complainant has prayed for grant of following reliefs vide instant complaint:-

a)       Opposite Parties be directed to pay the cancellation amount of policy bearing No. 029922869 dated 27.10.2014 for an amount of Rs.75,000/- and policy bearing No. 0301531 dated 1.12.2014 for an amount of Rs.1,25,000/- alongwith interest @ 18% per annum.

b)      To pay compensation of Rs.50,000/- to the complainant on account of causing great harassment, inconvenience, mental pain and agony by the Opposite Parties.

c)       To pay litigation expenses to the tune of Rs.15,000/-.

Hence, this complaint.

2.       Upon notice, Opposite Parties appeared and contested the complaint by filing  written statement taking preliminary objections therein inter alia that  the present complaint is barred by jurisdiction of this Forum as said matter has been adjudicated twice for same cause of action between the same parties; the Opposite Party denies all the allegations and averments  made in the instant complaint, except those which are specifically admitted in this written statement and nothing stated in the complaint should be deemed to be admitted merely because the same is not specifically traversed. It is also stated that  anything mentioned in the complaint contrary to and / or inconsistent with what is stated in the present written statement is deemed to be expressly denied; that the present complaint is false, malicious and incorrect and the complaint is filed with malafide intention and is nothing but an abuse of the process of law and it is an attempt to waste the precious time of this Forum of this Forum, as the same has been filed by the complainant just to avail undue advantage/ undue financial gain; that complainant being an educated person had availed three life insurance policies from Opposite Parties and in this regard submitted proposal forms dated 13.10.2014, 31.10.2014 and 21.11.2014 proposing for “Exide Life Guaranteed Income Insurance Plus Plan” (hereinafter referred as ‘policy’)  which is duly approved by the Insurance Regulatory Development Authority of India (in short ‘IRDA’) a statutory body constituted by the Act of the Parliament. The features of the above mentioned plan were duly explained in detail and only after understanding the same in its entirety, the complainant had opted for the said policy by choosing premium amount, premium paying term and sum assured in proposal form. The complainant had confirmed these facts  in his declaration  made in the proposal forms dated above. The copy of the proposal forms and declaration filled up and submitted by the complainant himself are attached; that as per Regulation 6(2) of (Protection of Policy holder’s Interest) Regdulation2002 issued by IRDAI, the policy holder/ proposer 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 receipt of policy bond (free look period). In such a case, the company shall refund the premium received for this policy (after deducting the proportionate risk premium for the period of risk cover and expenses incurred by the company on account of medical examination and on stamp duty charges). The said facts were clearly intimated in the welcome letter issued to the complainant/ proposer alongwith the policy schedule and terms and conditions; that thereafter the complainant approached Opposite Party on 15.1.2015 and submitted the Free  Look Cancellation Request for policy bearing No.03001531 and 03010447.  A copy of the Free Look Cancellation Request Forms is produced. However, policy pertaining to 03010447 was within free look period, hence the same was processed by Opposite Parties  and amount of Rs.1,02,914.90 paisa was duly transferred to the complainant bank account which was also duly acknowledged by the complainant in the present complaint. It is submitted that the complainant in the month of August 2015 approached the Opposite Parties  and submitted the indemnity bond requesting for issuance of the duplicate insurance bonds for policy bearing No. 02992869 as same was duly lost by him. A copy of indemnity bond is produced herewith.  It is  relevant to mention here that, when complainant had approached the Opposite Parties  for first time i.e. 15.1.2015 requesting for cancellation of supra policies, he never raised any concerned about the policy bearing No. 02992869 which itself raises the doubt of bonafide complaint. It is submitted that the complainant had not approached the Opposite Party within 15 days of the receipt of the policy document for policy bearing No. 02992869 and 03001531,   hence the same was rejected as per policy terms and conditions. It is submitted that contract of life insurance which was entered between Opposite Party and the complainant/ proposer becomes legally concluded and it was presumed that the complainant/ proposer was satisfied with terms and conditions so issued to him if he did not come within 15 days. Therefore, the complainant/ proposer as such is legally estopped from disputing the terms and conditions of legally concluded contract of life insurance especially after Opposite Party  has performed their part of contract by covering  the risk of the life of the life insured i.e. for a substantial period from the date of commencement of the policy till date. On merits, the   facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint with cost was made.

3.       In his bid  to prove the case, complainant tendered into evidence his affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C8 and closed his evidence. 

4.       On the other hand, to rebut the evidence of the complainant, the Opposite Party tendered into evidence the proposal form alongwith documents Ex.OP1 alongwith copies of documents Ex.OP2 to Ex.OP11 and closed the evidence on behalf of the Opposite Party.

5.       We have heard the ld.counsel for the parties and have carefully gone through the evidence on record.

6.       Ld.counsel for the complainant has vehemently contended that  the  complainant opted three Fixed Deposit schemes for his grand daughters named Amrit kaur aged about 9 years and Harsimrat Kaur aged about 8 years, both daughters of Harpreet Singh vide policies (i) bearing No. 02992869 dated 27.10.2014 for an amount of Rs.75000/- for the period of 15 years, (ii)policy bearing No. 0301531 dated 1.12.2014 for an amount of Rs.1,25,000/- for the period of 15 years  and (iii) policy bearing No.0301447 dated 15.1.2015 for an amount of Rs.1,18,027/- for the period of 15 years. But the policies in question when received were of insurance, but not Fixed Deposits, so the complainant opted for cancellation of the said policies and wrote letter to the Opposite Parties. It  was the further case of the complainant that policy bearing No. 03010447 was got cancelled and the amount of said policy Rs.1,18,027/- was received by the complainant, but the cancellation amount of other two policies bearing No. 0301531 and 020992869 of Rs.1,25,000/- and Rs.75,000/- respectively has not been received by the complainant till date. It is the case of the Opposite Parties  that admittedly the complainant purchased three insurance policies in dispute. But lateron the complainant approached Opposite Party on 15.1.2015 and submitted the Free  Look Cancellation Request for policy bearing No.03001531 and 03010447.  However, policy to 03010447 was within free look period, hence the same was processed by Opposite Parties  and amount of Rs.1,02,914.90 paisa was duly transferred to the complainant bank account which was also duly acknowledged by the complainant in the present complaint. But for the remaining two policies, the complainant himself has  not approached the Opposite Party within 15 days of the receipt of the policy document for policy bearing No. 02992869 and 03001531, hence the same was rejected as per policy terms and conditions. It is submitted that contract of life insurance which was entered between Opposite Party and the complainant/ proposer becomes legally concluded and it was presumed that the complainant/ proposer was satisfied with terms and conditions so issued to him if he did not come within 15 days. Therefore, the complainant/ proposer as such is legally estopped from disputing the terms and conditions of legally concluded contract of life insurance especially after Opposite Party  has performed their part of contract by covering  the risk of the life of the life insured i.e. for a substantial period from the date of commencement of the policy till date. Ld.counsel for the Opposite Parties  contended that since remaining policies  have not been surrendered within 15 days i.e. free look period, therefore, the claim of the refund of premium filed on behalf of the complainant has to be repudiated. Ld.counsel for the Opposite Parties  has further contended that the  terms and conditions of the policy in question are binding inter se parties and while interpreting documents relating to contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties, because it is for the court to make or construe as it is and we can not add or subtract anything from the policy terms and conditions. Reliance in this regard has been placed on Bawa Singh Vs. M.D. India Health Care Services & Others 2015(2) CLT page 418 of Hon’ble Punjab State Commission, wherein it has been laid down that:-

Firstly taking the plea whether the terms and conditions were not supplied to the complainant, the perusal of the complaint there is no reference that he was not given the copy of the terms and conditions of the policy. In case the complainant is basing his claim on the basis of policy taken by him, there is presumption that he must have gone through the terms and conditions of the policy. A reference can be made to the judgement given by Constitutional bench of our Hon’ble Apex Court reported in 1966(7) CPSC 44 “General Assurance Society Limited Vs. Chandmull Jain” wherein it has been observed in para 11  (relevant extract as under):-

          “…..The policy not only defines the risk and its duration but also lays down the special terms and conditions under which the policy may be enforced on either side. Even if the letter of acceptance went beyond the cover notes in the matter of duration , the terms and conditions of the proposed policy would govern the case because when a contract of insuring property is complete, it is a material whether the policy is actually delivered after the loss and for the same reasons the rights of the parties are governed by the policy to be, between acceptance and delivery of the policy. Even if no terms are specified the terms contained in a policy customarily issued in such cases, would apply.”

7.       Since in this case, the complainant has not exercised the volition of surrendering the policy within the stipulated ‘free look period’ of 15 days from the date of receipt of the insurance policy, the Opposite Party was justified in declining the request for refund of the premium amount. It is further contended that there is no deficiency in service on the part of the Opposite Party. Instant complaint is nothing but an abuse of process of law and the complaint merits dismissal accordingly.

8.       But however from the perusal of the terms and conditions of the insurance policy in dispute, there is term and condition No.4.4.2 which pertained to surrender of policy and the same is reproduced for ready reference as under:-

“4.4.2 Surrender the Policy

If at least one full year’s premium is paid the GSV payable is 20% of premiums paid excluding the service tax and premium for extra mortality rating, if any.

For policies that have paid at least two (2) full years’ premiums in case of seven (7) years PPT and at least three (3) full years’ premiums in case of more than seven (7) years PPT, the Guaranteed Surrender Value (GSV) is payable equal to the GSV Factor times the total amount of premiums paid excluding the service tax and  the premium for extra mortality rating, if any less the survival benefits already paid, if any.

 The policy cannot be surrendered after the death of the Life Assured. Upon payment of  the Surrender Value, the policy shall stand terminated with no further benefits payable under the policy. The company shall be relieved and discharged from all obligations under this Policy thereafter.”

9.       From the bare reading of the  term and condition stated above, it becomes quite evident that the surrender of the policy was tenable if atleast one full year’s premium is paid the GSV payable is 20% of premiums paid excluding the service tax and premium for extra mortality rating, if any, which shows that the complainant was legally entitled to get the surrender  value of the insurance premium in the given circumstances, but the Opposite Party has refused to oblige him without following the  terms and conditions of the insurance policy in dispute. If the complainant is bound by the terms & conditions of the insurance contract, the insurance company is also bound by the terms and conditions of the insurance contract. The insurance company cannot be allowed to wriggle out from the contractual obligations of the policy. As such,  the complainant  is entitled to get the refund of  premium amount of remaining two policies i.e. policy bearing No. 02992869 and 03001531, as per the term and condition No. 4.4.2 of the policy in question, after deducting stamp charges, medical charges, if any, and the mortality charges of the missing period.  

10.     From the aforesaid discussion, it emerges that Opposite Parties are deficient in service and as such, the  Opposite Parties are directed to refund the premium amount of remaining two policies i.e. policy bearing No. 02992869 and 03001531, as per the term and condition No. 4.4.2 of the policy in question, after deducting stamp charges, medical charges, if any, and the mortality charges of the missing period, within a period of 30 days from the date of receipt of copy of this order; failing which the complainant shall be entitled to interest @ 9% p.a from the date of filing of the complaint until full and final recovery. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Announced in Open Forum

Dated: 30.08.2016.