Presented by Miss R. Pattnayak, President .

(1) Brief facts of the case are that, the Complainant being allured with the benefits of the scheme by the agent had obtained 4(four) numbers of policy DPLI Assure Money+ plan in the year 2011 in the names of his minor grand sons and daughter namely Sibananda Dash bearing Policy No. 65460, Abhaya Panigrahi bearing Policy No.66564, Amar Mohapatra bearing Policy No.84895 and in the name of Beauty Panda bearing Policy No.65459, individually for a sum of Rs.1,54,610/-(Rupees one lakh fifty four thousand six hundred ten)only with guaranteed benefit of Rs.2,89,893/-(Rupees two lakh eighty nine thousand eight hundred ninety three)only each for which they paid initial premium of Rs.10,000/-(Rupees ten thousand)only each. All the above policies are for coverage of death benefit of the respective insured. During the subsistence of the said policies, one of the insured/policy holder namely Sibananda Dash died on Dt.03/01/2012. So the Complainant being the Nominee of the deceased holder lodged a claim against this policy with the Opposite Parties along with relevant document as per requirement, but the Opposite Parties instead of making payment of the contract assured amount only returned back the premium amount with interest of Rs.20,245/-(Rupees twenty thousand two hundred forty five)only vide cheque No.030981, Dt.06/12/2012. On receipt of the cheque, the Complainant immediately rushed to the Opposite Party No.3(three) in order to protest against the less payment but the Opposite Party No.3(three) advised the Complainant to agitate the matter before the Opposite Party No.4(four). When the Complainant approached the Opposite Party No.4(four), he stated that the amount has been paid as per the policy condition i.e. as the life assured has died before attaining the age of 8(eight) years, accordingly the payment has been made taking in to the consideration of the total premium paid together with interest at the rate as determined by the Company. It is further submitted by the Complainant is that Opposite Parties provided to him the policy bond much after receipt of the initial premium amount and the Complainant has got no opportunity to know about the details of term and condition of the policy which he is liked to get nor the same is informed by his commission agent (Opposite Party No.4(four)). Non disclose about conditions of the policy by the Opposite Party No. 4(four) to the Complainant at the time of taking initial premium as well as obtaining signature of the Complainant in the proposal form amount to suppression facts. There being master and agent relationship between Opposite Party No.1(one) and 2(two) to the Opposite Party No.4(four), the master is liable for the act of commission and omission of its agent. As accordingly to the complaint. As accordingly to the Complainant since the Opposite Parties have cheated him and since the Opposite Parties failed to render proper service to the satisfaction of the Complainant, the same amounts to restrictive trade practice and deficiency in service on their parts, as such filed this complaint claiming:-

1. 1. The sum assured amount of the policy i.e. Rs.1,54,610/-(Rupees one lakh fifty four thousand six hundred ten)only towards death benefit along with its accrued interest.

   2. Rs.50,000/-(Rupees fifty thousand)only towards damage.

   3. Rs.10,000/-(Rupees ten thousand)only towards litigation expenses along with other equitable relief as the Forum fit and proper.

(2) The Complainant is support of his case has filed the following documents.

1. Copy of policy bond bearing No.000065460 stands in the name of Sibananda Dash.

2. Copy of proposal/Application form.

3. Copy of money receipt No.73873 Dt.29/03/2011.

4. Copy of Premium receipt Dt.30/04/2011.

5. Copy of statement for refund of amount vide cheque No.030981 Dt.06/12/2012.

(3 ) The Complainant also filed written argument along with the decisions of Hon'ble Supreme Court and National Consumer Disputes Redressal Commission, New Delhi, which are attached to the case record.

(4) Notices were duly served on the Opposite Parties and after Notice being served, only the Opposite Parties No.1(one), No.2(two) and No. 3(three) appeared and filed their version jointly and also Affidavit of evidence Opposite Party No.3(three) through appeared did not contest the case. Opposite Party No.4(four) did not appeared. So the Opposite Party No.3(three) and 4(four) both declared as ex-parte on Dt.02/12/2013.

(6) Opposite Party No.1(one) and No.2(two) in their version resisted complaint and submitted that upon receipt of the required documents and after the detailed evaluation of the policy contract, they accepted the claim of the Complainant as Rs.20,245/-(Rupees twenty thousand two hundred forty five)only and the said fact was intimated to the Complainant vide letter Dt.10/12/2012 along with cheque bearing No.03098. As such there is no deficiency of the service on their part as they have acted as per the terms and condition of the policy and hence prayed to dismiss the complaint in the interest of justice.

In support of their case the Opposite Parties filed certain documents and decisions:-

1. Copy of Application / Proposal from.

2. Copy of policy document along with policy bond and schedule.

3. Copy of Death claim from.

4. Copy of last Medical Attendants Report.

5. Copy of Death Certificate of Sibananda Dash.

6. Copy of statement for refund of amount along with copy of cheque.

    

Heard learned counsel for the parties and perused the record.

Perusal of the record clearly reveals that the Complainant took the policy in favour of his minor grand son namely Sibananda Dash bearing policy No.65460 for a period of 25(twenty five) year and paid the initial annual premium amount of Rs.10,000/-(Rupees ten thousand)only which is admitted fact. It is also reveals from the policy bond and death certificate that the date of birth of the Deceased policy holder Dt.23/02/2009, date of death Dt.03/01/2012 and the date of Commencement of policy Dt. 30/04/2011. So the age of the deceased life insured (DLI) is approximately two year and two month and seven days at the time of filing of the application form.

We perused the Section- Four (a)(i) of the policy document which reads as under ;

“ If life insured dies before attaining the age of 8(eight) years last birth day as at the last policy anniversary, the total premium paid (excluding underwriting extra (if any), service tax and education cess) shall be paid to the Nominee together with interest at a rate as determined by the Company from time to time ”

The Opposite Parties after receiving the required documents for death claim, refunded Rs.20,245/-(Rupee twenty thousand two hundred forty five)only towards full and final settlement as follows:-

1. Premium with interest Rs.10,347/-(Rupee ten thousand three hundred forty seven)only

2. Refund of premium received after Life Assured death Rs.9,898/-(Rupee nine thousand eight hundred ninety eight )only

As per Section-4 (a) (i) of the terms and condition of the policy is right, because it, the settled principle of law that the terms of the contract are binding on the parties. The terms incorporated in the policy are agreement between the parties for all intents and purposes and the parties are bound by them. Subsequent to entering into such agreement, none of the parties can go behind the terms of such agreement or allege that the conditions were not fair. So it needs no interference on our part. The allegation of the Complainant is that, the agent of the Opposite Parties Company i.e.(Opposite Party No.4(four)) has fraudulently taken the signature of the Complainant in the proposal form by suppressing the material facts regarding the terms and conditions of the policy. Had the agent (Opposite Party No.4(four)) disclosed about the terms and condition then the Complainant might not have taken any such policy from Opposite Parties. He has signed the proposal form only on the good faith as disclosed by the agent. It is the fault of the agent of the insurer who has suppressed the materials facts. But these pleas of the Complainant can not be acceptable by the Forum as the Complainant is a teacher, an educated person in the society. The Opposite Party No. 4(four) fraudulently taken the signature of the Complainant in the proposal from and Complainant signed the proposal form in good faith can not be believable. Regarding the fraudulent activities of Opposite Party No.4 (four) the Complainant has not adduce any oral or documentary evidence to prove the same. No where in the Complaint petition it is mentioned that, the Complainant after receiving the policy bond and documents approached the Opposite Party No.1(one) and 2(two) and not filed any correspondence letter to Opposite Party No.1(one) and No.2(two) showing that he has complaint regarding this to them. Another point is that after receipt of the policy document, the Complainant had an option to cancel the policy within 15(fifteen)days and he has also not availed this facility. Further the Complainant is still continuing before the Opposite Parties the other three policies. So it can not be presumed that, the Opposite Party No. 4(four) fraudulently taken the signature of the Complainant in the proposal/ application form.

In the light of above discussion, it becomes clear that, the Opposite Parties have not committed, any wrong and have acted strictly and issued the cheque amounting to Rs.20,245/-(Rupees twenty thousand two hundred forty five)only in accordance with the policy terms and condition, as such there is no deficiency in service on the part of Opposite Parties.

With these observations, the complaint case filed by the Complainant is here by dismissed.

There shall be no order as to costs.

Case is disposed off accordingly.

Typed to my dictation

and corrected by me.

             I     agree,                                                          I agree,                                                        I agree,                                                  (Miss Rajlaxmi Pattnayak)                                   (Smt. Anjali Behera)                                    ( Sri Pradeep Kumar Dash)

           P r e s i d e n t.                                                M e m b e r.                                                       M e m b e r.