Delhi

New Delhi

CC/287/2013

Hansraj Verma - Complainant(s)

Versus

M/S. Tata Aig Life Insurance Company Ltd. - Opp.Party(s)

19 Feb 2020

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.287/2013                                          Dated:

    In the matter of:

1.        Sh. Hans Raj Verma

S/o Late Sh. M.L. Verma

 

2.    Smt. Sraswati Verma,

W/o Sh. Hans Raj Verma

 

Both residents of:

T-15/8, Aulia Masjid,

Ward No.8, Mehrauli,

New Delhi-30.

                 ……..COMPLAINANTS

VERSUS

         M/s Tata AIA LIFE INSURANCE CO.  LTD.,

         Delphi-B Wingh, 2^nd Floor,

        Orchard Avenue, Hiranandani Business Park,

         Powai, Mumbai-400 076.

         Through its Managing Director.

 

         Also at:

         Ashoka Estate,

        Barakhamba Road,

        Connaught Place, New Delhi-110001.

……..OPPOSITE PARTY

                

NIPUR CHANDNA, MEMBER

ORDER

       

The complainant has filed the present complaint against the OP under section 12 of Consumer Protection Act, 1986.  The gist of the complaint is that the both the complainants wanted to purchase a  mediclaim policy each in which the complainants had to pay the premium of Rs.2,35,000/- for five years  and in return both would be insured for Rs.15 lacs which would be paid on maturity at the end of five years. Complainant-1 issued a cheque for a sum of Rs.50,000/- and the complainant-2 also issued three cheques for total sum of Rs.1,84,999/ to the OP Co.  Both amounts were debited from the complainants’s account, and both complainants had nominated their son Sh. Manish Verma  in the policy proposals. The elder son of complainants Sanjeev Verma received  one Policy No.C028462219 in his name  and his wife and son were appointed as nominee.  The said policy is of Rs.14 lacs with maturity date on 26.8.2072 and premium paying terms was 15 years with an annual premium of Rs.1,26,285/-.  It is alleged that other two policies  were also issued in the name of Sh. Manish Verma and complainant-2 has been shown as nominee in one policy and complainant-1 is shown as nominee in the another policy.  Both the policies are for Rs.5,54,000/- each with maturity date as 17.8.2075 and premium paying terms as 15 years with annual premium of Rs.49,973/- each. It is further alleged that by issuing policies in the name of other persons and using cheques of the complainants  on account of premium, OP benefited itself wrongfully and the complainants have suffered loss wrongfully.  Complainants sent a legal notice dt.10.1.2012 to the OP for issuance of fresh insurance policies in the name of both complainants but OP has neither complied with the requisition of the said notice nor responded the same,  hence this complaint.

2.     Complaint has been contested by OP.  It has filed its written statement, wherein it denied any deficiency in services on its part and stated that the policy terms and conditions specifically provides for a Free Look Period of 15 days, during this 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.  The policy documents were delivered to the complainants on 27.08.201 and the same was duly received by him.  The complainant failed to approach OP for conversion/cancellation for refund of the policy during free-looking period, it was presumed that the contract was legally concluded between the parties.  The OP had acted with utmost care and diligence and as such the complainants are not entitled for any relief prayed.

3.     Both the parties have filed their  evidences by way of affidavit.

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

5.     Some facts are not disputed by the parties such as the policy documents, receipt of the policy documents on 27.8.2012.    Admittedly, the complainant received the policy in the year 2012.  The complainant received the policy documents in the year 2012,  if they were not satisfied with the policy than they ought to have approached the OP for the cancellation of the same. 

6.     As per policy terms and conditions, due to non-payment of further premium, policy in question was in  lapse status.  The complainant has failed to place on record any document which shows that he requested the OP to cancel the policy during free look period.  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.

7.     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.

8.     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.

9.     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.

10.    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.”

11.    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.”

 12.   Having regard to the facts and circumstances of the case, we are of the considered view that since the complainant had deposited a sum of Rs.2,35,000/- against the 1^st premium, they are entitled for refund of the surrender value of the policy in question, although they failed to exercise their right of cancellation of policy in free look  period. The present complaint is disposed off in above terms.

        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  19/02/2020.

 

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

(NIPUR CHANDNA)                                                  (H M VYAS)

       MEMBER                                                                MEMBER