Orissa

Rayagada

CC/21/2018

Sri Jagannath Nisika - Complainant(s)

Versus

The Branch Manager, Reliance lIFE iNSURANCE cO. ltd - Opp.Party(s)

Self

27 Aug 2019

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    FORUM, RAYAGADA,

STATE:  ODISHA.

C.C. Case  No.21 / 2018.                                               Date.    27     .     8  . 2019

P R E S E N T .

Dr. Aswini  Kumar  Mohapatra,                      Preident.

Sri  Gadadhara  Sahu,                                           Member.

Smt. Padmalaya  Mishra,                                     Member.

 

Sri Jagannath Nisika, Vill: Konda Kesari, Po: Sundi Dhamuni, Dist:Rayagada  (Odisha).            765 018  Cell No.94393-75299.                        …. Complainant.

Versus.

1.The  Branch Manager, Reliance Life Insurance Co. Ltd., New Colony, Po/ Dist: Raygada, State:Odisha.

2.The  General  Manager, Reliance Life Insurance Co. Ltd., Regd. Office, H.B.Block, Ist. Floor, Dhirubai  Ambani  Knowledge  city,  Navi Mumbai, Maharastra State- 400710.                                                … Opposite parties.

Counsel for the parties:                         

For the complainant: - Self.

For the O.Ps    :- Sri Chinmoy  Patra and associates,

.

JUDGMENT

The  curx of the case is that  the above named complainant alleging deficiency in service  against  afore mentioned O.Ps for  non refund  of balance deposited amount along with  bonus accrued against policy No. 50428278 from 2012 till its final payment  for which  the complainant  sought for redressal of the grievances raised by the complainant. The brief facts of the case  has summarised here under.

Factual matrix  are that the  O.Ps being the statutory authorities in the insurance field has approached  the complainant  with their agent and staff and convinced him that  the amount invested with the O.P  will fetch more money  and maturity  and guarantee in life and it is an economic progress envisaged to the poor persons. Being  convinced they have asked him to join a policy of 5(five) years vide policy No. 50428278  and the annual premium  had  fixed  Rs.15,200.00   which  had began  in the year  30.09.2012 towards  Reliance child plan.  It is submitted that the policy  was continued for 5(five) years as per the terms and  the complainant has paid the premiums during the year 2012, 2013,2014, 2015, 2016   @ Rs.15,000.00 x 5 year premium   Total  deposited  amount  a sum of Rs.75,000/-.. The complainant had received  money back from the O.P.   during the year, 2014  Rs.13,500/-, during the year 2015 for  Rs.13,500/-,During the year 2016 Rs. 13,500/-, during the year 2017 Rs. 19,865/- total amount a sum of Rs.60,365/-. The date of benefit was expired  Dt. 30.09.2017. But  till date the complainant has  not  received   the  balance amount and bonus earned against the said investment with interest.. The  O.Ps have violated the policy condition and directly  looted the money form   a poor   person.  Hence this C.C. case.  The  complainant prays the forum direct   the O.Ps to  pay balance amount along  with  bonus  of  the above policy along  with interest from the respective date of deposit till realization  and  grant such other relief  as the hon’ble forum deems fit and proper under circumstances of the case  for the best interest of justice.

On being noticed the O.Ps appeared through their learned counsel and filed written version refuting allegation made against them.  The O.Ps taking one and another pleas in the written version   sought to dismiss the complaint as it is not maintainable  under the C.P. Act, 1986. The facts which are not specifically admitted may be treated  as denial of the O.Ps. Hence the O.Ps  prays the forum to dismiss the case against  them  to meet the ends of justice.

  Heard arguments from the learned counsel for the    O.Ps and from the complainant.    Perused the record, documents, written version  filed by the parties. 

This forum  examined the entire material on record  and given  a thoughtful consideration  to the  arguments  advanced  before us by  the  parties touching the points both on the facts  as well as on  law.

                                                         FINDINGS.

On perusal of the record it is revealed that there is no dispute that the complainant was a policy holder bearing  policy No. 50428278    opted for flexible finance benefit policy namely product Reliance child plan.   Further  there is no disputes the  above  policy  term and premium payment term   was 05 years.   Again  there is no dispute the complainant had  paid total amount a sum Rs 75,040/-  for the period from Dt.30.09.2012 to Dt. 30.09..2017 towards  05  Nos.  yearly  premium  @ Rs. 15,164/- each premium. (copies of the policy schedule is in the file marked as  Annexure-I).

The main grievance of the complainant is that  he has received a sum of Rs.60,318.00 against the  payment of Rs. 75,040/-  less than the amount paid by him i.e. Rs. 14,722.00 and when asked the reason the O.P. No.1  had  stated  that it is  the surrender value of the said policy and the complainant  is  not entitled anything more. Hence the  C.C. petition filed by the complainant  to get  the  balance amount.

 The O.Ps in their written version     contended  that  the complainant  had paid five   yearly premiums @ Rs.15,000.00  each premium total a sum of  Rs. 75,040/- for policy  bearing No.. 50428278.   It is clearly stipulated  in policy schedule Reliance child plan  of policy document of bearing  No. 50428278 under Benefit payable that “Flexible Finance  Benefit on the 30^th.September    in 2014, 2015, 2016 and 2017 the amount of Rs.13,500.00 each will be payable( copies of the policy documents  are  in the file  which are marked as  Annexure-2).

The O.Ps in their written version   contended  that  the O.Ps  had paid upon survival and maturity benefit of the life assured as per terms and conditions of the policy documents,

The O.Ps in their written version   further   contended  that  the Survival benefit payout  was made to the complainant by the O.Ps the details of the  same are given below. Towards policy  No. 50428278 Survival Benefit  was  paid  to  the complainant   on Dt.30.09, 2014   a sum of Rs. 13,500.00 and  on Dt. 30.09.,2015 an amount of Rs. 13,500/- and on Dt,. 20.09,.2016 an amount of Rs. 13,500.00 in shape of cheque..  Again maturity benefit   along with Revisionary Bonus paid to the complainant   an amount of Rs.19,818/-  on Dt..4.10.2017 sent  through on line money transfer.    The O.Ps as per terms and conditions of the above policy  has paid  the Survival benefits and maturity benefits of the above policy   to the complainant  total amount  Rs. 60,318.00  which was admitted by the complainant  in his petition.

The O.Ps follows the rules and  regulations passed by  the IRDA and further functions of the business is carried in accordance with the settled principle of law.

The O.P. cited  citation in their written version.  It is held and reported  in CPJ 2006 (Iv) 239  in the case of  Prema & others  vrs. Life insurance Corporation of India  the  Hon’ble  National Commission, New  Delhi where in observed  “The O.Ps  do  not authorize  the agents to source policies based on  any allurements or false assurances and the O.Ps have acted as per the terms    and conditions of the policy. It is further submitted    that the IRDA has administrative  control over the agents and that the O.Ps do not authorize the agents to source policies based on any allurements of false assurances. Any act of the agent  can not be fastened on the O.Ps and they can not be held  liable for the act and omissions of the agent”.

Another  citation  cited by the O.Ps in their  written version  It is held and reported in SCC 2010 (10) 567  in the case of Suraj Mala Ram Niwas Oil Mills (P) Ltd. Vrs. United India Insurance Co.Ltd    where  in   the  Hon’ble Supreme Court  observed “ That the terms of policy are in the nature  of a contract  and their interpretation has to be made in accordance with the strict construction of the contract. Thus, the words in an insurance contract must be given paramount importance  and interpreted as expressed without any  addition, deletion or substitution.

The O.Ps  in their written version cited citation.  It is held and reported  in 1999(6) SCC 451 in the cases The oriental Insurance Co. Ltd  Vrs. Sony   Cheriyan where in the Hon’ble Supreme Court  observed  “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  can not claim any thing more than what is covered by the  insurance policy”.

          Similarly in the case of General Assurance Societ Ltd. Vrs. Chandumull Jain and Anr. Reported in  1966 (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 it 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 make it themselves.

Again this forum observed the  O.Ps disputes and deny their liability to pay any  amount and compensation to the complainant  as alleged beyond what has been already paid and admittedly received by the complainant.   It is stated that policy is a legal contract between the policy holder and the insurance  company and the parties to the said contract are bound by its terms and conditions. That the terms of the policy are in the nature of the contract and their interpretation has to be made in accordance with the strict construction of the contract.  Thus, the words in an insurance contract must be given paramount importance and interpreted as expressed without any addition, deletion of substitution,  more so when the parties have already accepted and acted  on the same.  The law in this regard is very well settled and one may  conveniently referred to recent judgement of the  Hon’ble Apex Court in case of Surajmal Ram Niwas Oil Mills Pvt. Ltd. Vrs. United India Insurance Company Ltd. Reported in 2010(10) SCC 567,  the same has clearly stated in the case of  Reliance Life Insurance Company Ltd. Vrs. Madhavacharya (Revision  petition No. 211 of 2009),  wherein it was held by the Hon’ble  National Commission  observed  “That since the insurance between the insurer and the  insured is a contract between  the parties, the terms  of the agreement including applicability    of the provisions and also to its exclusion had to be strictly construed to determine the extent of the liability of the insurer.

It is held and reported in  2008(4) CPJ 156 in the case of  Life Insurance Corporation of India Vrs. Shiva Prasad Das and others where in the Hon’ble National Commission observed “The premium is given  by an insured, to cover the risk  for a given period, and the insurer covers the risk for the period for which the premium  has been paid.  It is not the case of the complainant that the risk was not covered for the period for which the premium was given. If after that the policy  lapsed, under no provision of terms of policy or law, could any for a  direct  for  refund of any premium for the simple reason, as already  started, that the risk stood covered for the period for which premium had been paid.”

The Hon’ble State C.D.R.Commission,Cuttack, Odisha  in F.A. No. 162/2010  in the case of Smt. Abanti Kumar SahuVrs. Bajaj Allianz ) where in observed “ In as much as the policy   which was invested in the share market which is no doubt a speculative gain. The speculative  investment matter does not come under the C.P. Act, 1986.  Since the funds of this policy are also invested in the share market which is subject to speculations.”

Again  it is held and reported in  CPJ 2003(1) 393 in the case of United India Insurance Co. Ltd., Vrs. HarchandRaiChandanial  and in the case of VikramGreentech(I) Ltd. &Anr. Vrs. New India Assurance Co. Ltd-II 2009(2)  CPJ-34 where in the  Hon’ble  Supreme Court  observed “ An insurance policy  is to  be construed strictly as per the terms and conditions of the policy document which is a binding  contract between the parties and nothing can be added  or subtracted  giving a  different meaning to the words   mentioned therein”.

Further it is held and reported  in  2010(4) CPJ 38 in the case of Ram Niwas Oil Mills (P) Ltd. Vrs. United India Insurance Co. Ltd &Anr.  where in tne  Hon’ble Supreme Court  observed  “ It is title that in a contract of insurance, the rights and obligations  are governed by the terms  of the said contract. Therefore,  the terms  of a contract of insurance have to be strictly construed and no  exception can be made on the ground of equity.

Again it is held and reported  2000(1) SCC-66 in the case of Ravneet Singh BaggaVrs. KLM  Royal Dutch  Airlines  the hon’ble Supreme Court   observed “The deficiency in service can not be alleged  without attributing fault, imperfection, shortcoming or inadequacy in the  quality, nature and manner of performance which is required to be performed by a person in pursuance of a contract or otherwise in relation to any service. The burden of proving the deficiency in service in upon the person who alleges it.”

The counter of the OPs has no clarity regarding guaranteed fixed benefits offered to

the complainant on maturity under the plan and simply disowned the liability stating that as per

terms of the policy, they have paid benefits to the complainant. A child is the future of this

country. Reliance child plan is meant for the parents who want to see their child succeed without

any trouble and achieve all that a parent has ever dream for his child. Thus being the intention of

the child plan, a parent is getting the benefit very much less than what he had deposited under the

said plan. When the intention of the plan could not be materialized, then what is the use of opting

the plan by a parent?

 

It is the cardinal principle of insurance law that the insurer is in the position of a trustee as it is managing the common fund for and on behalf of the community of policy holders. It has to ensure that nobody is allowed to take undue advantage of the arrangement. That means the management of the insurance business requires care to prevent entry(into group) of people  whose risks are not of the same kind as well as paying claims on losses that are not accidental. The Management of life insurance companies are required to keep this aspect in mind and make all its decisions in  ways that benefit  the community. This applies also to its investments.  That is why successful insurance companies would not be found investing in speculative ventures. The life insurance policy is a contract, in terms of the Indian Contract Act.  A contract is an agreement between two or more parties to do, or not do, so as to create a legally binding relationship. Here in this case the complainant was asked to pay the  premium  amount  by the agent explaining the benefits contained therein and the entire proposal form was written by the agent in his own hand writing and asked the proposer/complainant to sign on the dotted lines.  The declaration form filled in this case also written by the agent and obtained the signature thereon.  The agent’s responsibility is clearly explained in the IRDA instructions and also U/s 182 and 212 of the Contract Act. Here the agent has failed to discharge the duty as an agent and in order to get his income as commission has falsely represented the rural folks to divert their money. Hence the O.P has clearly violated the norms issued by the IRDA from time to time and as such the O.P is liable to pay the amount paid as premium to the complainant.  In this case the surrender value far below  their amount deposited with the O.P.  The investment is made by the O.Ps for the profit and not by the insurer.  Hence the advise given by the agent and  obtaining a form wherein the risk factor is transferred  in favour of the insurer’s is definitely coming under the purview of unfair trade practice.

When a rural folk invest the money with the assurance of the agent in the insurance and when she came to know that the above investment is not yielding any profit even after years and as such the above investment brought by the agent and accepted by the O.P is not with any intention to give any economic protection but with an intention to grab the money of the rural folks. Hence the plea of the O.Ps can not be accepted.

In view of the discussion above, it is found to be  an unfair trade  practice made by the agent and O.Ps.  The O.Ps  have introduced the agent to do the unfair deal with the rural folk as seen from the counter and as such the complainant is entitled to get  refund of the entire amount deposited by the complainant in the said scheme so as to enable them to invest the same with their choice.

 

On perusal of the record this forum found the complainant had paid a total premium of Rs. 75,040/- and since  it was a   survival benefit policy he  was  received back from the O.Ps  a sum of Rs.60,318/- and  the  O.Ps have kept a sum of Rs.14,722.00 while making final payment.

 

We have gone through the complaint petition and documents available in the record. This forum by relying upon a citation passed by National Commission, New Delhi in the case  of   New India Assurance Co. Ltd., Versus M/s Sukhadham India Pvt. Ltd.,2011(1) CPR 191 where  in  the Hon’ble  National commission  observed  “ Insurance Company must settle claim without delay”.

 

In view of the above discussion relating to the above case and  In Res-IPSA-Loquiture  as well as  in the light of the settled legal position  discussed  as above referring citations the plea of the  O.Ps to avoid the claim  which is Aliance Juris. Hence  we allow the above complaint petition  in part.

Hence  to  meet the  ends of justice, the following order is passed.                                                                                                       ORDER.

In  resultant  the complaint petition stands  allowed  in  part  on contest against the O.Ps 

.

The O.Ps  ordered  to refund the balance  deposited  amount  a sum of Rs. 14,722.00 to the complainant.  Parties   are  left  to bear their own cost. 

            The O.Ps are directed to make the aforesaid payment within 90 days from the date of receipt of this order.

Dictated and corrected by me               Pronounced on this            27th.   Day of  August,  2019.

 

Member.                                                             Member.                                                                             President