Haryana

Yamunanagar

CC/522/2010

Ram Parkash S/o Chetan Dass - Complainant(s)

Versus

Kotak Mahindera Old Mutual Life Insurance Ltd. - Opp.Party(s)

Manoj Khurdi

22 Dec 2016

ORDER

BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR AT JAGADHRI.

                                                                                    Complaint No.522 of 2010.

                                                                                    Date of institution: 27.05.2010

                                                                                    Date of decision:22.12.2016

1. Ram Parkash aged about 35 years son of Sh. Chetan Dass,
2. Sapna aged about 30 years wife of Sh. Ram Parkash, both residents of village Nagal, Sub Tehsil Radaur, Tehsil Jagadhri, District Yamuna Nagar.                                                                                                      

                                                                                                                    …Complainant.

                                             Versus

Kotak Mahindera Old Mutual Life Insurance Limited, Godrej Coliseum 8^th floor, Behind Everard Nagar, Sion Trombay Road Mumbai, through its Branch Manager, Branch Sector 17 Urban Estate Jagadhri, District Yamuna Nagar.

 

                                                                                                                    …Respondent.

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                         SH. S.C.SHARMA, MEMBER.

 

Present: Sh. Manoj Khurdi, Advocate, counsel for complainants.

              Sh. G.S.Reen, Advocate, counsel for respondent. 

           

ORDER

 

1.                       Complainants have filed the present complaint under section 12 of the Consumer Protection 1986.  

2.                     Brief facts of the present complaint, as alleged by the complainants, are that complainants had a daughter aged about 4 years. The agent and representative of the respondent (hereinafter referred as OP) induced the complainants to take the child policy of the OP Insurance Company stating that as per policy, if the complainants deposits Rs. 75,000/- in three (3) annual installments of Rs. 25,000/- each then on attaining the age of 25 years by the insured child, the company shall pay a sum of Rs. 25,00,000/- to the insured/complainants. Considering the future of his daughter, the complainants took insurance policy in the name of their daughter Riya bearing policy No. 00788244 and paid 2 installments of Rs. 25,000/- each first in November, 2007 and second in December,2008. The agent of the OP Insurance Company had further assured the complainants that in case the insured dies during the policy period, then the company shall also pay a sum of Rs. 2,50,000/- to the complainants. Unfortunately, on 12.08.2009, the daughter of the complainants namely Riya met with a road side accident and died and in this regard an FIR bearing No. 129 dated 13.08.2009 was registered in the police station Radaur. After the death of insured Riya, the complainants filed a regular claim with the OP Insurance Company and completed all the formalities but despite completing all the formalities, the OP Insurance Company only paid only Rs. 50,000/- to the complainants and put off the matter on one pretext or the other and have refused to pay the balance amount of Rs. 2,00,000/- to the complainant without disclosing any reason. The complainants have made so many requests to the OP Insurance Company to pay the remaining amount of Rs. 2,00,000/- but all in vain. Lastly, prayed for directing the OP to pay the balance amount of Rs. 2,00,000/- alongwith interest and also to pay compensation as well as litigation expenses. Hence, this complaint.

3.                     Upon notice, OP Insurance Company appeared and filed its written statement by taking some preliminary objections such as the complainants in the present complaint has claimed the relief which is beyond the terms and conditions of the policy, it is settled principle of law that Hon’ble Forum cannot grant any relief which is beyond the agreed terms and conditions of the contract entered into between the parties; complainants have not substantiated their allegations by any cogent and corroboratory evidence and on merit it has been admitted that after thoroughly understanding the features, terms and conditions of the Kotak Safe Investment Plan, the complainant Mr. Ram Parkash had proposed for the Life Insurance Policy vide proposal form bearing No. 00788244 dated 15.11.2007(Annexure R-1). Accordingly, the OP Insurance Company in accordance with the facts and information provided in the said proposal form had duly issued a life insurance policy bearing No. 00788244 on 27.11.2007 (Annexure R-2). It has been further submitted that as per Regulation 6(2) of the IRDA Regulation, 2002 and in accordance with the clause 17 of the terms and conditions of the policy contract, the complainants have a time of 15 days from the date of receipt of the policy contract to seek cancellation of the policy, in case of their disagreement with any terms and conditions of the policy. The complainants, however, continued with the policy and as such it can safely be concluded that the complainants were well aware of the terms and conditions of the policy and were in agreement of the same. Further, it has also been submitted that a bare perusal of the proposal form at column No.3 would reveal that premium payment frequency chosen by the complainants were “yearly” the premium payment term was chosen as “full term” and the terms of the policy was clearly mentioned as “20 years” and as such the allegations of the complainants that the premium payment term was for 3 years is nothing but false and vexatious statement. Further, it has been admitted that sum insured under the policy was Rs. 2,50,000/-. However, the same was payable subject to the terms and conditions of the insurance policy. Further, it is submitted that in accordance with the clause “Death benefits” on page No.3 of the said policy contract clearly stipulates that “ if the death occurs within 5 years of the date of commencement and the life insured has not attained the age of 18 years, the benefits payable will be equal to, premium paid upto the date of death, or the fund value of the main account as on the date of intimation of death whichever is higher.” Further, it is also submitted that admittedly in the present case life assured on the date of death had not attained the age of 18 years and the policy has also not completed 5 years from the date of commencement, under the circumstances, the sum assured of Rs. 2,50,000/- was not payable as per terms and conditions of the Insurance policy. However, as the complainant had paid two (2) premiums under the policy in question amounting to Rs. 50,000/- only and as such the same was paid to the complainant vide cheque bearing No. 086251 dated 26.02.2010 drawn on HDFC Bank (Annexure R-3 and R-4) being higher of the fund value and premium paid under the policy. Rest contents of the complaint were denied and lastly prayed for dismissal of complaint.

4.                     In support of their case, counsel for the complainants tendered into evidence affidavit of complainant Ram Parkash as Annexure CX and documents such as photo copy of forwarding letter dated 26.02.2010 sending the cheque of Rs. 50,000/- as Annexure C-1, Photo copy of counter part of cheque of Rs. 50,000/- as Annexure C-2 and closed the evidence on behalf of complainants.

5.                     On the other hand, counsel for the OPs Insurance Company tendered into evidence affidavit of Sh. Sakil Ahmed Chief Manager (legal) as Annexure RW/A and documents such as photo copy of proposal form as Annexure R-1, Photo copy of forwarding letter sending the insurance policy dated 27.11.2007 alongwith receipt of Rs. 25,000/- of first premium and terms and conditions of the insurance policy consisting pages 12 as Annexure R-2, photo copy of forwarding letter sending the cheque of Rs. 50,000/- as Annexure R-3 photo copy of cheque of Rs. 50,000/- as Annexure R-4 and closed the evidence on behalf of OP Insurance Company.

6.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

7.                     The only plea of the complainant is that the OP Insurance Company paid Rs. 50,000/- out of total sum insured of Rs.2,50,000/-  and has wrongly and illegally withheld the remaining amount of Rs. 2,00,000/- and draw our attention towards the forwarding letter Annexure C-1 and Counter Part of the cheque  sent by the OP Insurance Company amounting to Rs. 50,000/- as Annexure C-2. Learned counsel for the complainants also referred the case law titled as Oriental Insurance Company Ltd. Versus Sapal Singh & Others, 2014(2) CLT page 305 NC and New India Assurance Company Ltd. New Delhi Versus Pabbati Sridevi & Others, 2013(1) CLT page 589 and argued that in the present case also no terms and conditions of the insurance policy were supplied to the complainants by the OP Insurance Company and prayed for acceptance of complaint.

8.                     On the other hand, counsel for the OP Insurance Company hotly argued at length that claim of the complainants has been rightly settled by the Op Insurance Company as per terms and conditions of the insurance policy and draw our attentions towards the proposal form Annexure R-1 and terms and conditions of the insurance policy Annexure R-2 in which under the head of “Death benefits” as well as benefits payable at page No.3 and 5 of the terms and conditions of the insurance policy, it has been mentioned that if death occurs within 5 years of the date of commencement and the life assured has not attained the age of 18 years, the benefits will be payable equal to premium paid (excluding all rider and extra premiums) up to the date of death, or the fund value of the main account as on the date of intimation of death whichever is higher plus the fund value in the top up account as on the date of intimation of death. Learned counsel for the Op Insurance Company further draw our attentions towards the photo copy of forwarding letter dated 26.02.2010 and photo copy of cheque of Rs. 50,000/- Annexure R-3 and R-4 and argued that as per terms and conditions of the insurance policy, the amount of Rs. 50,000/- had already been paid to the complainants, hence there is no deficiency in service or unfair trade practice on the part of the OP Insurance Company. Learned counsel for the Op Insurance Company further draw our attention towards the photo copy of forwarding letter dated 27.11.2007 Annexure R-2 vide which the OP Insurance Company sent the insurance policy alongwith first premium receipt as well as other terms and conditions of the insurance policy alongwith first premium receipt as well as other terms and conditions of the insurance policy and argued that in the forwarding letter it was specifically mentioned that “ in case you wish to reconsider your decision to hold the policy, you have the option of returning the original policy to us, within 15 days from the date of receipt of the policy. We would refund the premium paid by you after deducting stamp duty, medical expenses and proportionate risk premium for the period of cover” and argued that complainants never returned the original insurance policy to the OP Insurance Company nor they objected any terms and conditions of the policy in question in the prescribed period of 15 days. Meaning thereby that the complainants were agreed with the terms and conditions of the insurance policy in question.  Learned counsel for the OP Insurance Company further argued that insurance policy in question is an agreement between the parties and both the parties are bound by its terms and conditions and referred the case law titled as Export Credit Guarantee Corpn. of India Ltd. Vs. Garg Sons International delivered in civil appeal No. 1542 to 1553 & 1555 to 1559  of 2004 decided on 17.1.2013 ( Supreme Court) wherein it has been held that “ Terms of insurance policy have to be strictly construed in order to determine extent of liability of Insurer.”

9.                     Learned counsel for the OP further referred the case law titled as Col. T.S. Bakshi Retd. Versus Star Health & Allied Insurance Co. Ltd. 2014(2) CLT page 490  wherein it has been held that Insurance Claim- Free look period- Exclusion clause- Plea of petitioner that terms of insurance contract was not explained to him- Held- the petitioner has no case because clause 10 of the insurance contract under the heading “ conditions”, “free Look Period” was given to the petitioner with option to seek cancellation of policy if he was not agreeable to the terms and conditions of the Insurance Policy- If the insured was not agreeable to the terms and conditions, he had an option to seek cancellation of the policy with refund of his premium- the insured had not opted for cancellation of the policy- Therefore, now he cannot be allowed to claim that he is not bound by the Exclusion Clause because it was not explained to him when he remitted the cheque for payment of insurance premium and also referred the case law titled as Resham Devi Versus The New India Assurance Co. ltd. & Others, 2014(3) CLT Page 328. 

10.                   After hearing both the parties and going through the case law referred above, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of the OP as the complainant has totally failed to convince this Forum that as per terms and conditions of the insurance policy Annexure R-2 complainants were entitled to get the total sum insured of Rs. 2,50,000/- instead of Rs. 50,000/- which had already been paid by the OP Insurance Company to the complainants. The plea of the complainant is that no terms and conditions of the insurance policy ever supplied to the complainants and now the OP Insurance Company cannot take the benefits of the terms and conditions of the insurance policy and withhold the remaining amount of Rs. 2,00,000/- is not tenable as the complainants have not taken this plea in their complaint. We have gone through the complaint very minutely but not a single iota of word has been mentioned in the complaint that the OP Insurance Company never supplied the terms and conditions of the insurance policy to the complainants. Further the plea of the complainants is falsified as the complainants had already paid two (2) installments of Rs. 25,000/- each to the OP Insurance Company an never wrote any letter to the OP Insurance Company for sending or demanding the insurance policy in question whereas on the other hand, from the perusal of forwarding letter Annexure R-2 dated 27.11.2007, it is duly evident that OP Insurance Company issued the insurance policy in question alongwith terms and conditions to the complainants in which it was specifically mentioned by the OP Insurance Company that “in case you wish to reconsider your decision to hold the policy, you have the option of returning the original policy to us, within 15 days from the date of receipt of the policy. We would refund the premium paid by you after deducting stamp duty, medical expenses and proportionate risk premium for the period of cover”. The law referred by the counsel for the complainant is not disputed but not helpful in the present case whereas the law referred by the counsel for the OP Insurance Company titled as Export Credit Guarantee Corpn. of India Ltd. Vs. Garg Sons Internationa (supra) is fully applicable to the present case.

11.                   Resultantly, in the circumstances noted above, we are of the considered view that there is no merit in the present complaint and the same is hereby dismissed with no order as to costs. A copy of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court 22.12.2016.

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

                                                                                     

 

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.