Delhi

North East

CC/116/2021

Mr. Biresh Jha - Complainant(s)

Versus

M/s Edelweiss Tokio Life - Opp.Party(s)

15 Feb 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 116/21

 

 

In the matter of:

 

	Mr. Biresh Jha S/o R/o A/141, Gali No. 2, Part 2 Sonia Vihar, 1 Pusta, Karawal Nagar, North East, Delhi-110094	Complainant
	Versus
	M/s Edelweiss Tokio Life Through its Prinicipal Officer 06th Floor, Tower-3, Wingh B, Kohinoor City, Kirol Road, Kurla(W), Mumbai-400070	Opposite Party

 

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:               DATE OF DECISION      :

06.09.2021 06.01.2023 15.02.2023

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

Adarsh Nain, Member

ORDER

      Anil Kumar Bamba, Member

The Complainant has filed the present complaint under Section 35 of the Consumer protection Act, 2019.

 

     Case of the Complainant

1. The case of the Complainant as revealed from the record is that an employee of the Opposite Party namely Ms. Akansksha Jain (Code/Licenses No. A01472) who has made telephonically contact to the complainant by her phone no. 0-8742969416/ 0-9953319131 and assured the complainant for providing a loan of Rs. 5,00,000/- with a condition to take an insurance policy. On 31.07.2020 the complainant had paid an amount of Rs. 40,357/- from his account of Indian Bank, Sonia Vihar, Delhi-110094. Then finally, the complainant had taken a policy bearing no. 400292653E and in this regard one letter dated 01.08.2020 was issued by the Opposite Party in the hope of loan of Rs. 5,00,000/-. The complainant had many times talked to the customer care officer of the Opposite Party but no one helped him. The officials of the Opposite party had misrepresented to the complainant under the false promise of arranging the loan amount after taking the insurance policy. The officials of the Opposite Party had been providing bad service by alluring in terms of arranging the loan amount, which amount a wrong things. The complainant had issued one legal notice to the Opposite Party and the legal notice duly served on the Opposite Party as per the procedure but the Opposite Party had not made any reply of the same. The Complainant has prayed for directing the Opposite Party to refund his amount of Rs.40,357/- with 12% interest thereon, Rs. 15,000/- on account of litigation expenses and Rs. 10,000/- on account of harassment.  

Case of the Opposite Party

2. The Opposite Party contested the case and filed written statement.  It is stated by the Opposite Party that the complainant had availed the service of the Insurance from an agent namely “Ms. Akanksha Jain” adviser no. A01472 in sourcing the subject policy. However, the said agent is a necessary party and without whom this Hon'ble Commission cannot come into conclusion of the present case.  Thus, in view of the same the present complaint is liable to be dismissed out rightly for non-joinder of the necessary party. It is submitted that after the Opposite Party received the legal notice from the Policyholder of the subject policy, the Opposite Party cannot grant the loan as per Terms and Conditions of the subject policy to the policyholder. Further, it is submitted that as per Terms and Conditions the Policyholder can avail loan under the said policy by giving a prior written request provided the Policy has acquired a Surrender Value. Surrender Value is acquired only from 2^nd Policy year when full premium for first two policy years is received. Hence, the Opposite Party is not liable to grant any loan amount since the policy had not completed 2 years. It is also stated that it is well settled principle of law that at the time of filling up of the proposal form, the agent/broker acts as the broker of the Insured and no broker can be assumed to have authority from the Insurer to promise something beyond the terms and conditions of the subject policy or to write the answers in the proposal form. It is also stated that the complainant had admitted receipt of policy documents and had also annexed the same with the complaint. The complainant had submitted duly filled and signed proposal form wherein on the face of it the name of the plan, premium payment term and premium amount were categorically mentioned. After receiving the policy documents the policyholder has a provision of 15 days i.e. free look period during which if the policyholder is not satisfied with applicable provisions of the subject policies, he can return the policies to the company. In such circumstances the company would refund back the first premium amount after deducting the necessary charges under policy terms and conditions. Despite receipt of the policy documents, the complainant took a conscious decision of not approaching the company with any discrepancies in the policy, within the mandated Free look Period. The complainant retained the policy document and did not raise any objection towards the policies during the said “Free Look Period”.  Hence, the subject policies continued, implying that the complainant agreed to the policy terms and conditions. It has been determined through catena of judgments passed by the “Hon'ble National Consumer Disputes Redressal Commission New Delhi, in: Shrikant Murlidhar Apte vs. Life Insurance Corporation of India, Revision Petition no. 634 of 2012 decided on 02.05.2013. Further, the 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.” Thus, in concurrence with the proposition settled in the catena of cases, the present complaint deserves to be dismissed on this ground. The onus is on the Policyholder to thoroughly read the contents of the proposal form before applying for the policy, and the Policyholder cannot simply place reliance on oral promises and assurances provided by anyone purportedly on behalf of an Insurance Company. Further, the Insurance Company is under no obligation to issue a policy in accordance with such oral promises and assurances. The Opposite Party is not liable for the acts of the agents which are not specifically authorized by the company, and done solely by the agents in their personal capacity. The insurance agents is a facilitator between the policy proposer and the Insurance Company, therefore the company cannot be aware of what transpired between the agent and the complainant. The Insurance being a contract between the Policyholder and the Company both parties are governed by the Terms and Conditions mentioned in the policy document and all the benefits are payable strictly as per the policy terms and conditions. It is stated that it is settled law that the insurance terms have to be construed strictly and no relief which are beyond the terms of the insurance policy can be granted, hence no case for deficiency in services is made out in this case as there is in breach on the part of the Insurance Company accordingly proposition of law laid down in a catena of judgments by the Hon'ble Supreme court:

1. United India Insurance Co. Ltd V.s Harchand Rai Chand Rai Chandanlal I (2003) CPJ 393 decided that “… The terms of the policy have to be construed as it is and we cannot add or subtract something. Howsoever liberally we may construe the policy but we cannot take liberalism to the extent of substituting the words which are not intended…
2. Export Credit Guarantee Corporation of India Ltd. V/s Garg Sons International 2013 (I) Scale 410 decided that “it is not permissible for the court to substitute the terms of the contract itself, under the garb of construing terms incorporated in the agreement of insurance. No exceptions can be made on the ground of equity. The liberal attitude adopted by the court, by way of which it interferes in the terms of an insurance agreement, is not permitted. The same must certainly not be extended to the extent of substituting words that were never intended to form a part of the agreement.”

3. It is submitted that the present complaint had been filed as a consequence of afterthought to ruse money from the Insurance Company hence, the Opposite Party is not liable to pay any further illegitimate demands as per the whims and fancies of the complainant. Hence, even entertaining the said case would be against the principles of natural justice. The complaint being frivolous and vexatious is liable to be dismissed under section 11 of the Consumer Protection Act, 2019 as the complainant has failed to make out a case of “Deficiency of Service” as alleged or otherwise, within the meaning of Consumer Protection Act, 1986 and hence the present complaint is not maintainable on that score also. The complainant has filed the present complaint with an ulterior motive to harass the answering Opposite Party. Since the DLI has failed to exercise his free look period option despite admitted receipt of the insurance policy hence complaint is liable to be dismissed. Further, it is stated in complaint copy after receiving the letter dated on 24.08.2020 he is hoping for the loan of Rs. 5,00,000/-. It is submitted that the complainant paid only one premium of the said policy. The loan under said policy is applicable when policyholder has paid at least 2 years premiums in full and basis the surrender amount table mentioned in policy terms and conditions. The relevant clause of the policy schedule are reproduced for the perusal of Hon'ble Commission as under respectively:-

Loan under the Policy:

You may take a loan under the Policy by giving us a written request provided the Policy has acquired a Surrender Value.

The maximum loan amount which can be availed varies for different Premium Paying Term. It would be a percentage of Surrender Value (as given in the below Table) which is applicable under the Policy when a request for a loan is received less any outstanding Policy Loan balance on that date including accumulated interest, if any.

Premium Paying Terms (Years)	Max. Loan amount (as a % of Surrender Value)
	60 %
	60 %
	70 %
	70 %

 

If a loan is granted by us under the Policy, then;

1. The rate of interest payable on such loan shall be as prescribed by the Company at the time of taking the loan. Interest loan will be charged on the outstanding loan amount at a rate declared by the Company from time to time based on then prevailing market conditions and will be equal to State Bank of India Base Rate (minimum rate at which SBI lends) + 1.75 %. The current rate of interest on policy loan is 10.20 % per annum, The interest rate methodology is reviewable with prior approval from IRDAI. If the interest rate is revised, the same interest rate will be applied to both existing and new loan from the date of revision.
2. We will give you a written notice when the outstanding loan amount is 95 % of the Surrender Value calculated in accordance with Clause 1 of Part D and you may re-pay the whole or a part of the outstanding loan amount to us.  It at any point of time, the outstanding loan amount is equal to or more than the Surrender Value calculated in accordance with Clause 1 of Part D then the policy will be immediately and automatically terminated and no amount shall be payable by us under the Policy.
3. Any benefit payable by us on the death of the Life Insured, on the surrender of the Policy or on the maturity of the Policy will first be reduced by any outstanding loan under the Policy and accumulated interest, if any.

Rejoinder to the written statement of Opposite Parties

4. The Complainant filed rejoinder to the written statement of Opposite Party wherein the Complainant has denied the pleas raised by the Opposite Party and has reiterated the assertion made in the complaint.

Evidence of the Complainant

5. The Complainant in support of his complaint filed his affidavit wherein he has supported the averments made in the complaint.

Evidence of the Opposite Parties

6. In order to prove its case Opposite Party has filed affidavit of Shri. Nilesh Ramchandani, having office at Edelweiss Tokio Life Insurance Co. Ltd. 6^th Floor, Tower 3, Wing 3 of Kohinoor City Mall, Kirol Road, Kurla (W), Mumbai 400070, wherein the averments made in the written statements of Opposite Party has been supported.

Arguments & Conclusion

7. We have heard the Ld. Counsels for the Complainant and Opposite Party. We have also perused the file. The case of the Complainant is that an representative of the Opposite Party assured the complainant to provide a loan of Rs. 5,00,000/- with a condition to take an insurance policy of the Opposite Party. On 31.07.2020, the complainant took an insurance policy of the Opposite Party by paying premium of an amount of Rs. 40,357/-. On the payment of the premium, policy no. 400292653E was issued to him on 01.08.2020. After receiving the policy document loan of Rs. 5,00,000/- as assured by the representative of the Opposite Party was denied by the Opposite Party. Hence, there is a deficiency of service on the part of the Opposite Party and his prayed for refund of his premium amount of Rs. 40,357/- along with interest and Rs. 25,000/- on account of litigation expenses and harassment.
8. As per the Opposite Party the complainant availed the service of the Insurance from an agent namely “Ms. Akanksha Jain” adviser no. A01472 in sourcing the subject policy. However, the said agent was not made a party in the case. Thus, in view of the same the present complaint is liable to be dismissed out rightly for non-joinder of the necessary party. It is also stated by the Opposite Party that they cannot grant the loan as per Terms and Conditions of the subject policy to the policyholder. As per the Terms and Conditions of the policy, the Policyholder can avail loan under the said policy by giving a prior written request provided the policy has acquired a Surrender Value. Surrender Value is acquired only from 2^nd policy year when full premium for first two policy years is received. Hence, the Opposite Party is not liable to grant any loan amount since the policy had not completed 2 years. It is also stated by the Opposite Party that it is well settled principle of the law that at the time of filling up of the proposal form, the agent/broker acts as the broker of the insured and no broker can be assumed to have authority from the insurer to promise something beyond the terms and conditions of the subject policy. It is also stated by the Opposite Party that the complainant had admitted receipt of policy documents and also annexed the same with the complaint. After receiving the policy documents the policyholder has a provision of 15 days i.e. free look period during which if the policyholder is not satisfied with applicable provision of the subject policies, he can return the policies to the company. In such circumstances, the company would refund back the first premium amount after deducting the necessary charges under policy terms and conditions. Despite receipt of the policy documents, the complainant took a conscious decision of not approaching the company with any discrepancies in the policy, within the mandated Free Look Period. The complainant retained the policy document and did not raise any objection towards the policies continued, implying that the complainant agreed to the policy terms and conditions.
9. It is an admitted fact that the complainant had received a policy documents on 01.08.2020 and since he had received the policy document along with the terms and condition, he was of the knowledge of the Terms and Conditions of the policy. Secondly, he did not approach the Opposite Party for refund of his premium amount within the Free Look Period i.e. within 15 days of the receipt of the policy documents.
10. In view of the above, there is no deficiency on the part of the Opposite Party. Hence, the complaint is dismissed accordingly.
11. Order announced on 15.02.2023.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room.

(Anil Kumar Bamba)           Member

(Adarsh Nain) (Member)

(Surinder Kumar Sharma) President