Delhi

New Delhi

CC/12/2013

K.S. Nagar - Complainant(s)

Versus

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

15 Jul 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.12/2013                        Dated:

    In the matter of:

K.S. Nagar,

R/o 184, Khichripur Village,

Delhi-110091.

                            ……..COMPLAINANT

VERSUS

          Aviva Life  Insurance Co. India Pvt. Ltd.

         2^nd Floor, Prakash Deep Building,

           7, Tolstoy Marg,

             New Delhi-110001.

 

     Also at :

 

      5^th Floor, JMD Regent Square,

      Gurgaon,  Mehrauli Road,

      Gurgaon(Haryana)-122001.

 

      Aviva Tower, Sector Road,

      Opp. Golf Road Course,

      DLF, Ph.V,

      Sec.43, Gurgaon-122001.

 

……..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 complainant purchased the policy bearing No.WLG1318775 commencing from 23.09.2006 for a sum assured of  Rs.4,56,000/- to be paid through annual premium of Rs.24,000/-.  The complainant continuously deposited the premium against the policy in question till 2009.  Due to some financial crisis, he was unable to pay the next two premiums. In the month of May, 2012, the agent of the OP approached complainant and  assured him that if he will deposit two premiums amount then his policy would be reinstated and all the benefits accrued therein would be restored.  On his assurance, the complainant deposited a sum of Rs.48,000/- against the receipt bearing No.111973 dt. 28.5.2012. The OP refunded the aforesaid amount i.e. Rs.48,000/- due to which the policy could not be reinstated. The complainant made several requests to the OP to reconsider his request but all in vain.  Vide letter dt. 4.9.2012, the OP Co. refunded a cheque of Rs.24,000/- against the earlier deposit of Rs.1,20,000/- under the pretext that, since the surrender value of the policy is less than first year premium hence the policy got auto foreclose as per its terms and conditions.  The complainant sent a legal notice dt. 29.9.2012 thereby calling upon the OP to refund the amount deposited along with interest but till date the OP neither replied the legal notice nor had  refunded the deposited amount, 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 complainant failed to approach OP for cancellation of policy/refund of the premium deposited  during free-looking period, it was presumed that the contract was legally concluded between the parties.  On 29.5.2012, OP received reinstate request from the complainant vide letter dt. 1.6.2012, the complainant was requested to complete certain formalities such as payment of outstanding premium amount and fulfilling certain medical requirements.  The complainant had not taken any steps to fulfill the medical requirements as such, on 27.6.2012, the OP Co. returned the cheque of reinstatement amount to the complainant, thereby leading the policy in question moved into auto foreclosure and accordingly surrender value of Rs.24,000/- was calculated as per policy terms and conditions was dispatched to the complainant and was duly received and encashed by him.  It is further stated that OP had acted with utmost care and diligence in dealing with the complainant’s claim and the surrender value was rightly paid to him as per policy terms and conditions and hence, the complainant is 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.    Admittedly, the complainant received the policy in the year 2007,  if he was not satisfied with the policy than he 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 complete the formalities asked by the OP vide its letter dt. 1.6.2012 due to which the policy could not revive and moved to auto foreclosure.    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.    In view of the above discussion and judgments cited above, we are of the considered view that,  the payment of surrender value paid  by the OP to the  complainant on account of auto foreclosure of the policy due to non-payment of the premium is justified.  The complainant failed to establish the case of deficiency in services against the OP, as alleged in his complaint. We find no merits in the present complaint, same is hereby dismissed.  File be consigned to Record Room.

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 ).

Announced in open Forum on  15/07/2019.

 

 

 

ARUN KUMAR ARYA)

PRESIDENT

(NIPUR CHANDNA)                                                                                  (H M VYAS)

       MEMBER                                                                                            MEMBER