By Sri. MOHANDASAN.K, PRESIDENT
Complaint in short is as follows: -
1. The manager of the opposite party approached the complainant to subscribe the insurance policy and introduced the scheme stating that if the complainant subscribes the policy with annual premium of Rs.5,00,000/- for 10 years, he will be eligible to get Rs.1,10,61,000 and if he fails to remit the premium after three years he will be entitled for the double of the remitted premium amount. Convinced with the persuasion of the representative of the opposite party, complainant subscribed the policy and issued a cheque for Rs.5,00,000/- on 20/03/2014 to the opposite party and thereafter the opposite party issued a policy certificate no.51555061 dated 21/04/2014 to the complainant. Subsequently the complainant remitted Rs.4,92,093 on 21/04/2015 and 4,92,093 rupees as third installment premium. The complainant was working abroad during the period and as a result of nationalization movement in the work place, resulted financial crisis to the complainant and he came back from abroad. Due to financial crisis, complainant approached the opposite party for the refund of remitted amount and benefits their own. But the opposite party stated that only the policy holder who remitted the premium without any default up to 10 instalments are only entitled for the benefits. The complainant persuaded the opposite party to have a lenient view and to provide the benefits. The complainant contacted the opposite party, but there was no favorable action except some assurance that they will take necessary steps. The complainant caused letters to the opposite party and the reply was that complainant will be given only 7,26,909/-rupees as surrender value. The complainant submit that he had been in abroad for several years and deposited his hard-earned money with the opposite party. The opposite party really mis-appropriating the sole earnings of the complainant and so he prays for the refund of assured amount and benefit their own. The complainant alleges deficiency in service as well as unfair trade practice on the part of the opposite party and seeking direction to refund an amount of Rs. 14,84,200/-, the deposited amount and also compensation of Rs.4,00,000/- including interest and cost.
2. On admission of the complaint, issued notice to the opposite party and on receipt of notice the opposite party entered appearance and filed version denying the entire averments and allegations in the complaint. The opposite party contended that the complainant availed policy voluntarily and he submitted duly filled and signed proposal form rightly understanding the terms and conditions of the policy and paid the premium amount of his free will. Thereafter the opposite party had issued the policy document, permitting the policy holder to return the policy in case the policy holder is not satisfied with the provisions of the policy during the free look period of 15 days. The complainant herein had never approached the opposite party during the free look period. During filing the proposal form complainant had opted for yearly mode of premium payment under the scheme and he was liable to pay Rs.4,99,580/- annually for a period of 10 years. But he paid only 3 annual premium amounts of Rs.14,85,490/-only. As per the proposal form the complainant is aware of the clause regarding regular payment of premium. There is no veracity for the submission of the complainant that there was oral promises and assurances from somebody purportedly on behalf of the opposite party. The complainant totally failed to produce documents with respect to his claim. The opposite party contended that the insurance terms have to be construed strictly, and no relief which is beyond the terms of insurance policy can be granted and so there is no case of deficiency in service is made out in this complaint and the complaint is liable to be dismissed in limine.
3. The opposite party submitted that they received duly filled signed proposal form for the policy named money multiplayer plan bearing application No. D7046763 and considering the proposal form the opposite party issued a policy bearing No.51555061 on 21/04/2014. As per the policy, sum assured was Rs.33,70,000/- and policy term was 10 years. The annual premium fixed was Rs.4,99,580/-. The opposite party duly sent the insurance policy and other policy documents to the complainant and the same were duly received by the complainant, thus the contract of insurance had concluded between the parties. As per the regulations issued as Insurance Regulatory and Development Authority (Protection of policy holders’ interest) Regulations,2002, that every policy document sent by the opposite party is accompanied with a copy of the proposal form signed by the applicant and a forwarding letter which clearly mentioned that in case policy holder is not satisfied with the features or the terms and conditions of the policy, he can withdraw /returned the policy within 15 days i.e., under the free look period. In this complaint the complainant had received the policy documents in the year 2014, but did not raise any concerns pertaining to the policy until the present complaint. The opposite party contended that a person who is investing such a huge amount of money, will invest only after reading and understanding the policy features and its terms and conditions. It is submitted that the complainant herein slept over the right to cancel the policy and it is only after 5 years has filed present complaint. The opposite party contended that the complainant never approached opposite party for cancellation of the disputed policy within the free look period and so the opposite party is not responsible for the negligence of complaint. Opposite party contended that all the terms and conditions of the policy documents is duly approved by IRDA and so there is no deficiency of service. The opposite party also contended that they had provided insurance cover on the life of the life assured under the policy and the life assured has availed the insurance benefit and not availing free look period option, the complainant has discarded his rights to cancelation of the policy. The opposite party is not liable o refund any amount to the complainant as per the terms and conditions of the policy. The opposite party is taking risk on life of the life assured for the period for which the premium is paid. It is submitted that the complainant had sent letter dated 29/08/2017 for cancellation of policy and refund of three premiums paid by the complainant and there after the opposite party made attempt many times to get in touch with the complainant on his registered mobile number but failed. Thereafter opposite party replied through letter dated 04/09/2017 stating the reason that complainant never approached during 15 days free look period of said policy for cancelation of said policy. The opposite part inspected the signature of the complainant on proposal form and no tampering was found their own. The opposite party submitted that life assured was eligible to receive surrender value as per the policy terms which will be higher of guaranteed surrender value and special surrender value.
4. The submission of the opposite party is that the present complaint is false, malicious, vexatious and incorrect and is nothing but an abuse of the process of the law. The insurance being a contract between the policy holder and the company, both parties are governed by the terms and conditions mentioned in the policy documents and all the benefits are payable strictly as per the policy terms and conditions. So, it is to be construed strictly as per the terms and conditions of the policy document and no deviation from the same is permissible. Hence the prayer of the opposite party is to dismiss the complaint against opposite party in the interest of justice and equity.
5. The complainant and opposite parties filed affidavit and documents. The documents marked on the side of complainant as Ext. A1 to A3. Ext. A1 is insurance policy copy. Ext. A2 is renewal premium receipt dated 21/04/2015. Ext. A3 is reply regarding request for policy cancellation dated 22/03/2019. Opposite party documents marked as Ext. B1 to B3. Ext. B1 is copy of initial premium deposit receipt. Ext. B2 is letter regarding for policy cancellation dated 04/09/2017. Ex.t B3 is copy of letter from complainant to the opposite party to cancel in full returns.
6. Heard complainant and opposite party, perused affidavit and documents. Both sides filed notes of argument also. The following points arise for consideration
- Whether complainant is entitled for the benefit as per the policy?
- Whether there is deficiency in service on the part of opposite party?
- Relief and cost?
7. Point No.1, 2 &3
In this complaint there is no dispute regarding the subscription of policy and also regarding the premium amount. But the contention of the complaint is that the manager who visited the residence of complainant, persuaded to subscribe the policy and had assured that he will be eligible to get twice the amount of premium paid and incidental benefits in case of default after payment of three premium instalments. So, the complainant approached the opposite party after three years for the cancellation of the policy and to refund the premium amount along with benefits. The submission of the complainant is that while he joined in the insurance scheme, he was working abroad and due to some social movements at the work place he was compelled to leave his job and so presently struggling for earnings. Hence finical stringency caused him to approach opposite party for the refund of premium amount and benefits. But the opposite party denied his claim strictly adhering to the principal of insurance contract. The opposite party has placed duly signed proposal form and also policy conditions. The complainant has not disputed the acceptance of policy terms and conditions. According to the opposite party the complainant had received the policy conditions in due time and there was a clause as provided by Insurance Regulatory Development Authority that a free look in period of 15 days. The submission of the opposite party is that the complainant duly verifying and understanding the terms and conditions of the insurance policy, subscribed the scheme and did not care to make any sort of objection during the free look period of 15 days. So, the complainant is strictly bound to follow the contractual terms of insurance and the opposite party is not able to go beyond the terms and conditions of the insurance policy. When there is documentary evidence for the terms and conditions there is no relevance for the so-called oral undertaking given by some body on behalf of the insurance company. Hence, they are prepared to issue legible refundable amount to the complainant.
8. The complaint has stated in the complaint that the opposite party had agreed to issue surrender value of 7,26,909 rupees to the complainant. But the prayer of the complainant is to refund the entire premium amount remitted by him Rs.14,84,200/- along with compensation and cost. But the perusal of the entire documents and averments there is no provision to direct the opposite party to refund the entire premium amount remitted by the complainant. The specific contention of the opposite party is that the opposite party is providing insurance cover on the life of the life insured under the policy and the life assured has availed the insurance benefits as per the policy. So, the commission do not find reason to allow the prayer of the complainant to direct the opposite party to refund the entire premium amount remitted by the complainant.
9. The perusal of the transactions, the complainant could not establish that there was deficiency in service on the part of the opposite party. But the opposite party strictly adhered to the terms and conditions of the insurance policy despite the submission of the complainant that he deposited his hard-earned money to the opposite party. The subscription of insurance policy without thoroughly understanding the terms and conditions, no doubt will end in such unfortunate situation. But the commission can only hold that there is no deficiency in service in the sense of law on the part of the opposite party.
In the light of above facts, we are of the view that the opposite party will issue the legally entitled benefit to the complainant as expeditiously as possible, in a lenient way and this complaint stands dismissed accordingly.
Dated this 17th day of August, 2022.
Mohandasan K., President
Preethi Sivaraman C., Member
Mohamed Ismayil C.V., Member
APPENDIX
Witness examined on the side of the complainant: Nil
Documents marked on the side of the complainant: Ext.A1 to A3
Ext.A1: Insurance policy copy
Ext.A2: Renewal premium receipt dated 21/04/2015
Ext A3: Reply regarding request for policy cancellation dated 22/03/2019.
Witness examined on the side of the opposite party: Nil
Documents marked on the side of the opposite party: Ext. B1 to B3
Ext.B1: Copy of initial premium deposit receipt.
Ext.B2: Letter regarding for policy cancellation dated 04/09/2017.
Ext.B3: Copy of letter from complainant to the opposite party to cancel in full returns.
Mohandasan K., President
PreethiSivaraman C., Member
Mohamed Ismayil C.V., Member
