Orissa

Rayagada

CC/162/2021

Sujata Kumari Raulo - Complainant(s)

Versus

The Manager, Reliance Life Insurance Co Ltd., - Opp.Party(s)

Self

22 Aug 2022

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    COMMISSION,, RAYAGADA,

STATE:  ODISHA.

C.C. Case  No. 162  / 2021.                                      Date.    26.        8. 2022.

P R E S E N T .

Dr. Aswini  Kumar Mohapatra,                                             President

Sri    Satis  Kumar  Panigrahi,                                               Member.

 

Smt. Sujata  Kumari  Rawlo,  C/O: Sri Rabindra nath  Rowlo, Vidya  Nagar, 4^th. Lane,  Rayagada. 765  001, Po/ Dist:Rayagada  (Odisha). 

Cell No.9583343651                                                                     …. 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.

For the complainant:- Self.

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

                                                            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 the balance deposited  amount a sum of Rs. 21,598/-  with bonus  towards policy No. 19293975 after maturity  date  for which  the complainant  sought for redressal of the grievances raised by the complainant. The brief facts of the case  has summarized here under.

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 10(Ten) years vide policy No.19293975 and the annual premium  had  fixed  Rs.17,373/-   which  had began  in the year  08.9.2011.   It is submitted that the policy  was continued for 10(Ten) years as per the terms &  conditions of the policy and   the complainant had paid the premium total  deposited  amount  a sum of Rs.1,74,838/-. The complainant had received  money back from the O.P.   during the year 2015 on Dt.21.09.2015 a sum of    Rs.38,333.33  and during the year 2018 on DT.25.09.2018  a sum of    Rs.38,333.33 and during the year  2021 on Dt. 15.09.2021 a sum of Rs.76,573.79 grand total amount a sum of Rs.1,53,240.45.  But  till date the complainant has  not  received   the  balance  deposited  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 commission  direct   the O.Ps to  pay balance deposited  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 District commission 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,  The facts which are not specifically admitted may be treated  as denial of the O.Ps. Hence the O.Ps  prays the commission  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 commission  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.19293975 opted for Reliance life insurance family income benefit policy namely product Reliance cash flow plan.   Further  there is no disputes the  above  policy  term and premium payment term   was 10 years.   Again  there is no dispute the complainant had  paid total amount a sum Rs. 1,74,838/- for the period from Dt. 08.9.2011 to Dt. 05.9.2020 towards  10  Nos.  yearly  premium  @ Rs. 17,373/- each premium. (copies of the policy schedule  is available in the file marked as  Annexure-I).

The main grievance of the complainant is that  he has received a sum of Rs. 1,53,240.45  against the  payment of Rs. 1,74,838/-   less than the amount paid by him i.e. Rs. 21,597..00 interalia 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 contended that relating facts of the case the complainant  had paid 10(Ten)  yearly premiums Grand  total a sum of   Rs. 1,74,838/- towards policy  bearing No. 19293975.  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 available   in the file  which are marked as  Annexure-2).  Further the O.Ps 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  stressed upon   facts of the case inter alia   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. 19293975   Survival Benefit  was  paid  to  the complainant   an amount  of Rs. 38,333.29 on DT.21.09.2015. Another Survival benefit was paid to the complainant an amount of Rs.38,333.29 on Dt.25.09.2018..      Again maturity benefit   along with Revisionary Bonus paid to the complainant   an amo.unt of Rs. 76,573.79 on Dt. 15.09.2021..   The O.Ps as per terms and conditions of the above policy  has paid  the Survival benefits and maturity benefits of the  policy No.  19293975     to the complainant  total amount  Rs. 1,53,240/- 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 the O.Ps contended  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.Ps. relied  the findings.

 Held and reported  in CPJ 2006 (Iv) 239  in the case of  Prema  & otrs  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”.

In Another  citation  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 Commission  observed the  O.P 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 Sahu  Vrs. 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,.  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. Harchand Rai Chandanial  and in the case of Vikram Greentech(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 Bagga    Vrs. 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 Ist. Question whether the complainant qualifies to be a Consumer?   The contention of the O.Ps that the complaint is not maintainable under the C.P. Act  is longer res integra inview of the decisions of the Hon’ble National Commission, New Delhi  in case of Neelavasant  Raje  Vrs. Amagh Industries and Another  reported  in 1993 (3) CPR page No.343 where in  it has been held that where a company or firm  invites deposits promising attractive rate of interest, it amounts  to rendering  of financial  services as it receives deposits  from customers/consumers and pays interest  therein. The consideration for the  hiring of the service is the payment of deposit  amount  so as to enable the company to invest or utilize the money for  earning profits.  Therefore the deposit holder the complainant  would be a consumer within the meaning of the  C.P. Act. Further when a deposit has been accepted to be repaid with interest and admissible  benefits.   It is a service to be rendered and failure  to repay the amount, amounts to deficiency in service under the C.P. Act. The O.Ps have in the instant case accepted the deposit and agreed to render service by way of  returning the principal  with  interest and admissible benefits.  The consideration being the   deposit amount. Having regard to the aforesaid circumstances of the case we do not find much force in the contention of the  O.Ps  as the complaint petition is not maintainable under the C.P. Act.

Further this commission gone through the complaint petition and documents available in the record. This  commission  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.,   reported  in  2011(1) CPR 191  where in  observed- “ Insurance Company must settle claim without delay”. In the light of the above decision of law we allow the case.

            On perusal of the record this commission found the complainant had paid a total premium of Rs. 1,74,838/- and since  it was a   survival benefit policy the  complainant  was  received back from the O.Ps  a sum of Rs.38,333/- on Dt. 21.9.2015, a sum of Rs.38,333/- on DT.25.09.2018  and   maturity value Rs.76,573/-on Dt.15.09.2021. Thus the O.Ps have  made a total payment of Rs. 1,53, 240/- against the received  premium amount a sum of   Rs. 1,74,838 /- and  the  O.Ps have kept a sum of Rs. 21,597.00 while making final payment.

During the course of hearing the  complainant vehemently argued that  in the present case at the time of  filled up   proposal form the complainant was asked  by the agent  of the O.Ps to  sign on the doted lines without explaining  the benefits of the  scheme and  the entire proposal form was written by the agent in his own hand writing.  The agents responsibility is clearly explained in the IRDA instructions and also U/S- 182 and 212 of the contract Act. Here the agents had 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 OPs had clearly violated the  norms  issued by the IRDA from time to time and as such the OPs  are  liable to refund  the amount paid by the complainant.

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

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 are  ordered  to refund the balance  deposited  amount  a sum of Rs.21,597/-  to the complainant.  Parties   are  left  to bear their own cost. 

            The O.Ps are directed to make the aforesaid payment within 45 days from the date of receipt of this order.  Service the order to the parties as per rule.

Dictated and corrected by me               Pronounced on this         26th.   Day   of  August,  2022.

 

                                                                Member.                                                                             President