Delhi

New Delhi

CC/483/2014

Ganga Lalwani - Complainant(s)

Versus

M/S. Aviva LIC - Opp.Party(s)

10 Dec 2019

ORDER

 

 

CONSUMER DISPUTES REDRESSAL FORUM-VI

                                              (DISTT. NEW DELHI),

                                               ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE,

                                                                               NEW DELHI-110001

 

Case No.C.C.483/2014                                                Dated:

           In the matter of:

Mrs. Ganga Lalwani,

W/o Sh. Vasdev Lalwani,

           R/o C-2, Takshshila Apartments,

          57, IP Extension,

           Delhi-110092.

…… Complainant

 

Versus

Aviva Life Insurance Co. India Ltd.,

                 2^nd Floor Prakash deep Building,

7 Tolstoy Marg,

New Delhi.

 

……. Opposite party.

 

NIPUR CHANDNA, MEMBER

 

O R D E R

 

The complainant has filed the present complaint against the O.P u/s 12 of Consumer Protection Act, 1986. The facts as alleged in the complaint are that on 29.12.2004, the complainant purchased two policies bearing Nos.CLG 1134890 & CLI 1134895 with sum assured of Rs.60,000/- from the OP, covering the incident of accidental death and dismemberment with an annual premium of Rs.6,000/- each policy.   

 

2.     The complainant paid four premiums regularly per year and as such paid a total sum of Rs.48,000/- against the above said policies.  After completion of four years, the complainant being a lady could not deposit the premium and as such policies in question moved to  lapsed status.  Despite of lapse of the above policies for non-payment of premium, OP did not refund the amount deposited by the complainant.  The complainant approached the OP Co. for refund of amount against the policies in question.  The complainant was directed to submit request form for surrender of payout of premium, accordingly, the complainant submitted two request form for surrender for payment of premium on 10.3.2014. 

 

3.     On 14.3.2014, the complainant received three cheques from the OP Co. for a sum of Rs.7,097 and  Rs.8144/- respectively against the policies in question and in addition a sum of Rs.1194/-  towards the bonus on policy No.CLI 1134895.  After receiving the aforesaid cheques,  vide letter dt. 15.4.14 complainant approached the OP and enquired about the refund amount Rs.15241/- received by her against deposit of Rs.48000/-.  OP vide its reply dt. 29.4.2014 has sent detailed chart which shows that OP Co. has been deducting certain charges such as mortality charge, policy administration charge, regular management charge and rider charge etc. whereas the complainant was never informed that the deposits can also result in loss to the complainant in any incident.  The above conduct of OP amounts to deficiency in services, hence this complaint.

 

4.       Complaint has been contested by the OP.  In its written statement OP has stated that on the basis of Proposal Form bearing No.CA6168644 dt. 24.12.2004, the complainant was issued above policies by the OP commencing from 29.12.2004 with annual premium of Rs.6,000/- each.   At the time of issuance of policies, the complainant was provided with the policy documents consisting of policy schedule and Standard Terms and Conditions, which clearly indicates the charge and nature of policies, which cannot be disputed by the complainant at this later  stage.    It is stated that the policy terms and conditions specifically provides for a Free Look Period of 15 days, during which period the policy owner is entitled to review the policy terms and conditions and request for a cancellation,  if dissatisfied with the terms and conditions of the policy. Admittedly, the complainant purchased the policies on 29.12.2004, The complainant failed to exercise his right and approach OP for surrender of the policies  and accordingly, the request of the complainant was entertained and a total sum of Rs.15,241/- was paid to the complainant against the policies in question, hence nothing left as alleged and further prayed for the dismissal of the complaint.

5.     Complainant has filed her evidence by way of affidavit wherein she has corroborated the contents of her complaint.  On the other hand,  OP filed its evidence by way of Affidavits.  

6.     We have heard argument advance at the Bar and have perused the record.

7.     Some facts are not disputed by the parties such as the policies documents, payment of premiums.    Admittedly, the complainant received the policies in the year 2004.  She has also paid four premiums against the policies in question.  The complainant received the policies documents in the year 2004, if she was not satisfied with the policies than she ought to have approached the OP for the cancellation of the same.  Admittedly, after four premiums, the complainant failed to pay the further premium and as such the policies moved to lapse status.  OP sent three cheques for a sum of Rs.15,241/- to the complainant against the policies in question on account of auto foreclosure. 

8.     As per policy terms and conditions, due to non-payment of further premium, policies moved to lapse status and as such the OP cancelled the policies and sent the surrender value to the complainant.  The surrender value was calculated by the OP as per the terms and conditions of the policy.   Insurance is a contract between the insured and insurer and both the parties are bound by the terms contained therein. The Hon’ble NCDRC in the matter of National Insurance Co. Ltd. vs. Vinod Puri as reported in I [2014] CPJ 341 (NC) is pleased to hold as under:

Insurance contract has to be construed like any other contract on basis of its terms and conditions and outside aid for construction of insurance policy is impermissible.

9.     The Hon’ble Apex Court in the case of Oriental Insurance Co. Ltd. versus Sony Cheryan reported in (1999) 6 SCC 451 is pleased to hold as under:

The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy.

10.    Similarly in the case of General Assurance Society Ltd. vs. Chandumull Jain and Anr., reported in (1996) 3 SCR, 500, the Constitution Bench has observed that the policy document being a contract and it has to be read strictly. It was observed:

In interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties, because it is not for the court to make a new contract, however, reasonable, if the parties have not made it themselves. Looking at the proposal, the letter of acceptance and the cover notes, it is clear that a contract of insurance under the standard policy for fire and extended to cover floor, cyclone etc. had come into being.

11.    The Hon’ble NCDRC in the matter of Ind Swift Ltd. versus New India Assurance Co. Ltd. reported in IV[2012] CPJ 148 (NC) is pleased to rule as under:

Construction of the policy is to be construed strictly as per the terms and conditions of the policy document which is binding contract between the parties and nothing can be added or subtracted by different meaning.

12.    Similarly in LIC versus Banwarilal Yadav reported in IV[2013] CPJ 38 (NC) the Hon’ble NCDRC observed as under:

“Forum has no jurisdiction to go beyond terms and conditions of the Policy.”

13.    The NCDRC in yet another matter in the matter of Morien Chemicals Ltd. versus UCO Bank reported in III [2013] CPJ 261 (NC) is pleased to hold as under:

“Insurance Company is not liable to pay damages which are not covered under the policy.”

14.    Having regard to the facts and circumstances of the case and  discussion heard, we are of the considered view that there exists no infirmity in the decision of the Insurance Company as the surrender value was calculated as per the terms and conditions of the policy and courts are not meant to add or delete the terms of contract.  The above cited judgments  are squarely applicable in the present case. 

15.    In view of the above discussion, we  direct OP to  pay to the complainant  the surrender value of the policies in question  along with litigation cost of Rs.10,000/-.

A copy of this order each be sent to both parties free of cost by post.  This final order be sent to server (www.confonet.nic.in ). File be consigned to Record Room.

Announced in open Forum on 10/12/2019.

 

 

 

            (ARUN KUMAR ARYA)

                        PRESIDENT

                     (NIPUR CHANDNA)                                                  (H M VYAS)

                           MEMBER                                                                MEMBER