Order by:
Sh.Amrinder Singh Sidhu, President
1. The complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (now under section 35 of the Consumer Protection Act, 2019) on the allegations that the agent of Opposite Parties approached him and told to have a policy and only one time, the complainant has to pay premium of Rs.25,000/- and on the allurement of agent of the Opposite Parties, the complainant purchased policy bearing No. 1556173 commencing from 09.11.2012 from the Opposite Parties against the paid up premium of Rs.25,000/- on 09.12.2012, but again on the next year, the Opposite Parties raised the demand of premium of second year and in this way, the Opposite Parties misguided the complainant and sold their policy, but the complainant does not want to continue the said policy and wants to get the refund of this amount of Rs.25,000/- deposited by him with the Opposite Parties. In this regard, the complainant approached the Opposite Parties to refund the same by closing the policy in question, but the Opposite Parties did not turn up and as such, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) The Opposite Parties may be directed to refund the amount of Rs.25,000/- and also to pay Rs.20,000/- on account of compensation for causing him mental tension and harassment or any other relief to which this District Consumer Commission may deem fit be also granted.
Hence, the Complainant has filed the present complaint for the redressal of her grievances.
2. Opposite Parties No.1 & 2-Insurance Company appeared through their counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the present complaint is not maintainable and is liable to be dismissed as there is no deficiency in service on the part of the Opposite Parties. In fact, the complainant submitted an electronic/ online proposal form dated 07.11.2012 for the purchase of HDFC SL ClassicAssure Plan having annual premium of Rs.25,000/- with policy term for 10 years, pay term of 7 years and having sum assured of Rs.1,48,999/- and consequently, the insurance policy bearing No. 15561673 was issued on 09.11.2012 (Commencing from 07.11.2012) and before acceptance of the proposal form by the Opposite Parties, the contents of the proposal and illustrations were read and explained to the LA and on the basis of the information furnished in the application form, the proposal was processed by the Opposite Parties and thereafter, the policy was issued to the LA. Moreover, the complainant himself has admitted the receipt of the policy documents in the complaint and hence, the LA was have period of 15 days within which he could have returned the policy to the Opposite Parties and the act and conduct of the LA in not returning/ surrendering the policy within the given time signified his acceptance of the terms and conditions mentioned in the said policy documents. Not only this, it is relevant to mention here that on page No.11 of the policy, Lapsed Policy, paid up and reinstatement has been explained that if any premium remains unpaid 15 days after the due date during the first 3 years of the policy, the policy will be altered to lapsed status and no benefits would be payable. In this case, after 2012 the complainant never approached the Opposite Parties in this regard, and hence this complaint is time barred. On merits, Opposite Parties took up almost the same and similar pleas as taken by them in the preliminary objections and it was prayed that the complaint may be dismissed with costs.
3. In order to prove his case, the complainant has tendered into evidence his affidavit Ex.C1 alongwith copies of documents Ex.C2 ad Ex.C3 and closed the evidence on behalf of the complainant.
4. On the other hand, Opposite Parties No.1 to 2-Insurance Company also tendered into evidence the affidavit of Sh.Arpit Higgins Ex.Ops1 & 2/1 and copies of documents Ex.OP1 & 2/2 to Ex.OP1 & 2/ 5 and closed their respective evidence.
5. We have heard the complainant and ld.counsel for the Opposite Parties and also gone through the documents placed on record.
6. During the course of arguments, the complainant as well as ld.counsel for Opposite Parties have mainly reiterated the facts as narrated in the complaint as well as written reply respectively. We have perused the rival contentions of the parties and also gone through the record on file. The main contention of the complainant is that the Opposite Parties by misguiding and wrongly issued the policy in question by keeping him in dark by saying that this policy is for making one time premium, and due to his wrong misrepresentation, now the complainant wants to get the refund of the said amount. On the other hand, ld.counsel for the Opposite Parties has specifically denied this fact and contended that the ccomplainant himself has submitted an electronic/ online proposal form dated 07.11.2012 for the purchase of HDFC SL ClassicAssure Plan having annual premium of Rs.25,000/- with policy term for 10 years, pay term of 7 years and having sum assured of Rs.1,48,999/- and consequently, the insurance policy bearing No. 15561673 was issued on 09.11.2012 (Commencing from 07.11.2012) and before acceptance of the proposal form by the Opposite Parties, the contents of the proposal and illustrations were read and explained to the LA and on the basis of the information furnished in the application form, the proposal was processed by the Opposite Parties and thereafter, the policy was issued to the LA. Moreover, the complainant himself has admitted the receipt of the policy documents in the complaint and hence, the LA was have period of 15 days within which he could have returned the policy to the Opposite Parties and the act and conduct of the LA in not returning/ surrendering the policy within the given time signified his acceptance of the terms and conditions mentioned in the said policy documents. It is not the denial of the complainant that he never received the policy, rather he admitted in his complaint that he has received the policy on 09.11.2012 and moreover, the complainant has nowhere its terms and conditions and as per the terms and conditions of the policy, the complainant was provided a free look period of 15 days from the date of receipt of the policy, to cancel the policy in case there are any discrepancies in the policy. Opposite Parties No.1 and 2 as per the regulation 8(1) and 19(1) (i) of the IRDA (Protection of Policy holder’s interest) Regulations, 2017 erstwhile clause 4(1) and 6(2) of the IRDA (Protection of Policy holder’s interest) Regulation, 2002 sent the policy documents of the policy to the complainant which was admitted by the complainant thereby by giving him an opportunity to review/ cancel the policy within free look period, but despite receipt of the policy documents alongwith the terms and conditions, the complainant failed to approach the Opposite Parties No.1 and 2 within free look period with any grievances with respect to the terms and conditions of the policy, thereby implying that the terms and conditions of the policy were in order. The complainant has nowhere denied that he did not receive the policy in question alongwith its terms and conditions. Moreover, the complainant was given the entire knowledge about the terms and conditions and that being happily agreed and purchased the product, wherein it was clearly agreed upon that once the product is sold, can not be returned back and as such there will be no refund and this version has nowhere denied by the Complainant by filing any cogent and convincing evidence to prove that the Complainant never accepted such terms and conditions of the Opposite Party while purchase the policies in question. In this regard, we find force in the judgment of Hon’ble Supreme Court in the case of Grasim Industries Ltd. Vs. Agarwal Steel, 2009(4) CCC598 (SC), wherein it was observed that the person who signed the documents, there is presumption that he understood the document and only then he signed it specifically he is an educated person unless contrary is proved that it was obtained under some threat, pressure or coercion. It is well settled principle of law that the parties are bound by the terms and conditions of the Insurance Policy, and none of the parties can seek any relief beyond those terms and conditions. In this regard reference may be made to the observation made by the Hon’ble Apex Court in case cited as Suraj Mal Ram Niwas Oil Mills (P) Ltd. Versus United India Insurance Co. Ltd and another, 2011 CTJ 11 (Supreme Court) (CP) wherein the Division Bench of the Hon’ble Apex Court consisting of Hon’ble Mr. Justice D.K. Jain and Hon’ble Mr. Justice T.S. Thakur, held that:-
“22. Before embarking on an examination of the correctness of the grounds of repudiation of the policy, it would be apposite to examine the nature of a contract of insurance. It is trite that in a contract of insurance, the rights and obligations are governed by the terms of the said contract. Therefore, the terms of a contract of insurance have to be strictly construed, and no exception can be made on the ground of equity………..”
“24. Thus, it needs little emphasis that in construing the terms of a contract of insurance, the words used therein must be given paramount important, 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 risk covered by the policy, its terms have to be strictly construed to determine the extent of liability of the insurer. Therefore, the endeavour of the court should always be to interpret the words in which the contract is expressed by the parties.”
The facts and circumstances of the instant case are fully attracted to Suraj Mal Ram Niwas Oil Mills (P) Ltd case (Supra). Same view has also been expressed by Hon'ble State Consumer Disputes Redressal Commission, Punjab at Chandigarh in First Appeal No.485 of 2019 in case Reliance Nippon Life Insurance Company Limited, Versus Atma Singh, decided recently on 11.11.2021.
7. Moreover, there was sufficient time with the Complainant to get cancel the policies in question within free look period of 15 days after the receipt of the policy. As per the terms of the policy contract if the policy is not suitable, the policy holder may get his/her policy reviewed by returning the policy and policy documents within 15 days (Free Look Period) from the day the policy holder received the policy. The insurance company will return the premium paid to the complainant after making certain deductions specified therein. In the present case, the policy was sent to the complainant and the he complainant after the receipt of the subject policy documents did not approach the Opposite Parties and got his subject policy reviewed/cancelled within Free Look period implying that the complainant duly accepted the subject policies and its documents with its terms and conditions. As such, the complainant is now estopped from raising the issues/ grievances with respect to refund of premium of the subject policy. The complainant is bound by the policy contract and given up /relinquish / waved his right by not exercising the Free look Provision. Thus, the complaint is devoid of any merit and is liable to be dismissed. In view of the Judgements passed by the Hon’ble National Commission in Prema & Ors. Vs. Life Insurance Corporation of India, IV (2006) CPJ 239 (NC) and in Kishore Chandrakant Rathod v. Managing Director, ICICI Prudential Life Insurance Co Ltd and Ors, (Revision Petition No. 3390 of 2013, NCDRC), the onus was on the Complainant to read the contents of both the documents. In the case titled as “Pramod Kumar vs. SBI Life Insurance Co.” decided by DCDRF, (North-West) New Delhi, on 18/02/2014 (Case No.-935/2012) it has been held as under : -
“…We have heard arguments advanced at the bar and have perused the record. The applicant has admitted that he had received the policy bond from which he had learned that he has being issued with another policy rather than the one for which he had made an application. If it was so the applicant had the option to reject the policy bond received by him within the Free Look period of 15 days. Since the applicant didn’t exercised the said option he cannot now raise a grievance about the same. In view of the judgement cited above we hold that there is no deficiency of service on the part of the OP…”.
Furthermore it has been determined through catena of judgments passed by the Hon’ble National Consumer Disputes Redressal Commission New Delhi, in Mohan Lal Benal v/s ICICI Prudential Life Insurance Co. Ltd. and Harish Kumar Chadha v/s Bajaj Allianz Life Insurance Co. Ltd. that if the insured/Applicant is not satisfied with the policy taken, then he/she should avail the option of returning the policy within 15 days of receipt i.e. within “the Free-look Period”. The said proposition has also been clearly laid down in the case Shrikant Murlidhar Apte vs. Life Insurance Corporation of India, Revision Petition no. 634 of 2012 decided on 02.05.2013. Further, Hon’ble National Commission concurred with the findings of Maharashtra State Consumer Disputes Redressal Commission, Mumbai that “Once 15 days ‘cooling off’ period is over, policy documents become binding on both the parties and the contents therein are also biding on both of them.”
8. In view of the aforesaid facts and circumstances of the case, we find no deficiency in service on the part of the Opposite Party and hence, the instant complaint stands dismissed. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.
9. Reason for delay in deciding the complaint.
This complaint could not be decided within the prescribed period because the State Government has not appointed any of the Whole Time Members in this Commission for about 3 years i.e. w.e.f. 15.09.2018 till 27.08.2021 as well as due to pandemic of COVID-19.
Announced in Open Commission.
Dated:07.06.2022.
