Orissa

Rayagada

CC/117/2017

Mr. Kummari Raghu - Complainant(s)

Versus

The Branch Manager, Reliance Life Insurance Company - Opp.Party(s)

Self

25 Sep 2021

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    FORUM, RAYAGADA,

STATE:  ODISHA.

C.C. Case  No. 117  / 2017                                          

P R E S E N T .

Dr. Aswini  Kumar  Mohapatra,                      President.

Sri  Gadadhara  Sahu,                                           Member.

Smt. Padmalaya  Mishra,                                     Member.

 

Mr. Kummari  Raghu, S/O: Kummari  Damburu, Marathiguada, At/Po:Gunupur, Dist:Rayagada  (Odisha).                                                                          …. Complainant.

Versus.

1.The Manager, Reliance life Insurance Company  Ltd.,  Mumbai       

2.The  Branch   Manager, Reliance life Insurance Company  Ltd.,  Rayagada(Odisha).                                                                                                                   .…..Opp.Parties

Counsel for the parties:                         

For the complainant:  Self.

For the O.P No.1   : Sri  Biraja  Prasad  Patra, Advocate, Rayagada.

 

JUDGEMENT

                The  crux 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.18180827 from 2010 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.

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 No. 18473241     opted for Reliance child plan..   Further  there is no disputes the  above  policy  term and premium payment term   was 06 years.   Again  there is no dispute the complainant had  paid total amount a sum Rs 1,26,545/-  for the period from Dt.29.1.2011 to Dt. 18.02.2016 towards  6  (six)   yearly  premium   Rs. 20,982/- 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.1,08,851/- against the  payment of Rs. 1,26,545/-  less than the amount paid by him i.e. Rs. 17,694.00  inter alia has not received  accrued bonus  and when asked the reason the O.P. No.1  had  stated  that it is  the survival   and maturity  benefit 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 submitted  that the complainant  had paid 6  (six)    yearly premiums  Rs. 20,982/- each premium total a sum of   Rs.1,26,545/-   paid  towards policy  bearing No. 18473241. The complainant is under solemn obligation and legally duty bound to abide the terms and conditions of the insurance policy document ( copies of the policy documents  are  in the file  which are marked as  Annexure-2).

The O.Ps in their written version  stated about facts of the case 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    contended  that  the Survival benefit payout  was made to the complainant by the O.Ps   and  the details of the  same are given below. Towards policy  No. 18473241. Survival Benefit  was  paid  to  the complainant through  payout cheque No. 833351 Dt.29.1.2014  an amount  of Rs. 23,850/- was dispatched  in shape of speed post  vide postal receipt  No.EA 630617257 IN. Further Survival benefit was paid to the complainant through  payout cheque No.234248 Dt.29.1.2015 an amount of Rs. 23,850/-  was  dispatched in shape of  speed post vide Postal receipt No. EA  628936420  IN. .  Again Survival benefit was paid to the complainant payout cheque No.853215 Dt.22.1.2016  an amount of Rs. 7,949/-  was  dispatched in shape of  speed post vide Postal receipt No. EM  8892339241 IN. .  Again Survival benefit was paid to the complainant payout cheque No.767621 Dt.9.2.2016  an amount of Rs. 15,900/-  was  dispatched in shape of  speed post vide Postal receipt No. EA  062817885 IN.   Again maturity benefit   along with Revisionary Bonus paid to the complainant  through  on line  TRF vide HDFC NEFT Ref No.N033170240581809  an amount of Rs. 37,303.00..  .The O.Ps as per terms and conditions of the above policy  has paid  the Survival benefits and maturity benefits of the  policy No. 18473241    to the complainant  total amount  Rs.1,08,851/-  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.

Again this forum observed  in fact, the original policy bond was with the  complainant, it was mentioned that the policy was related  to the share market.  As per the terms and conditions of the policy, 15 days time was given to the complainant, which is known  as Free Look period as per the guidelines of IRDA and if he want to say anything  with  regard to the terms and conditions, and if those were not  acceptable to him, he could ask for the cancellation of the policy but the complainant failed to exercise that option.

The O.P. cited  citation in their written version.  It is held and reported  in CPJ 2006 (Iv) 239  in the case of  Prema&orsvrs. 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.

This forum observed the complainant has not substantiate any evidence that the O.Ps have not acted pursuant to the terms and conditions of the policies. In absence of any evidence the present  petition  shall be dismissed.

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 Honble  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.

Further  It is held  in  Revision petition No.3271 of 2013  decided on 7.10.2013 in the case of Mohan Lal Benal  Vrs. ICICI Prudential life insurance Co. Ltd.  Where in the National  Commission observed  If the insured is not  safisfied with policy taken, then he she should avail option of returning policy within 15 days  of receipt i.e. within  free-lock-period.

 

Again  It is held and reported in  CPC 2006(2) page No. 668 in the case of Oriental Insurance  Co. Ltd. Vrs.  Munimahesh Patel where in the Hon’ble Apex court observed the proceedings before the  National Commission were essentially summary  in nature.  It ws further held that in view  of the complex factual position, the matter could not be examined by the Consumer Forum and the appropriate forum was the Civil court.

Further It is held and reported in Revision petition  No.2479  of 2008 decided on 24.7.2013 in the case of UCO Bank Vrs. S.D. Wadhwa   the Hon’ble National Commission where in observed Complaint involves complicated and complex questions which  require elaborate evidence hence dispute not adjudicable in summary jurisdiction  therefore complainant  not maintainable”.

Again  It is held and reported   in CPJ 1992(2) page No.487 in the case  of Panalal Vrs. Bank of India  & others where  in the  Apex  Court  observed It is evident from the  above that the  complainants is not a simple case of deficiency  in service rendered by the bank. It involves a determination of complex  questions of facts and law which can not be satisfactorily determined by this  commission in the time frame provided under the Act.  It would be better for the complainant to seek redress of his grievances in Civil Court if so advised.

Further  it is held and reported  in SCC 2000(1) page No.66 where in the Hon’ble Apex court   observed The  deficiency  in service  can not be alleged  without attributing falt, 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 is upon the person who alleges it.

 

This forum completely agreed with views taken  and the documents, Citations filed by the O.Ps in  the present case. Hence  this forum  feel the complainant is not entitled any  relief from this forum and   liable to be dismissed. To meet the ends of justice the following order is passed.

ORDER.

In  resultant the complaint petition stands  dismissed. In the circumstances there is no order as to cost.  The complainant  is free to approach the court of competent  having  its jurisdiction.  Accordingly the case  is disposed of.

Dictated and corrected by me              

Pronounced on this        25^th   Day of     September,  2020.

 

Member.                                             Member.                                                             President