Order by:
Sh.Amrinder Singh Sidhu, President
The complainant has filed the instant complaint under section 35 of Consumer Protection Act, 2019 on the allegations that in the month of August, 2018 the agent of Opposite Party namely Nitin Arora allured Okar Singh husband of the complainant for the purchase of the policy and himself filled the proposal form. Further alleges that Okar Singh husband of the complainant paid Rs.14,372/- on account of first premium of the policy and in this regard, the Opposite Party issued policy bearing No.180814827070 under the Plan Aegon Life Term Insurance Plan (138N039V020 commenced w.e.f. 24.08.2018 having duration of the policy upto 24.08.2052 and the maturity value of the said policy was Rs.35 lakhs. Further alleges that said Okar Singh policy holder i.e. husband of the complainant expired on 14.11.2019 and in this regard, the complainant informed the Opposite Party. Thereafter, the complainant sent all the filled forms and original copy of insurance policy to the Opposite Party for settlement of claim being as nominee of deceased insured Okar Singh. But the complainant stunned to receive a letter dated 07.01.2020 from the Opposite Party in which the Opposite Party stated that policy holder while filing the proposal form did not disclose that he is having another insurance policies and on the basis of this, the Opposite Party repudiated the claim of the complainant. But at the time of filling the proposal form said agent of the Opposite Party did not ask any question regarding holding other policies by the deceased insured. Not only this, the policy holder was not able to read or written in English as he was not much educated. Further, said Nitin Arora agent also admitted and gave affidavit declaring that he did not ask any question to policy holder about other policies and hence, the aforesaid letter of repudiation is illegal, null and against the laws and same is not binding upon the legal rights of the complainant. Thereafter the complainant made so many requests to the Opposite Party to admit her rightful claim, but to no affect. Not only this, the complainant also served legal notice through his advocate on 02.10.2020 in this regard, but the Opposite Party has been keeping on dilly dallying the matter on the one pretext or the other. As such, there is deficiency in service on the part of the Opposite Party and this act of the Opposite Party has caused lot of mental agony, harassment, inconvenience. Vide instant complaint, the complainant has sought the following reliefs.
- To pay the claim amounting to Rs.35 lakhs alongwith interest @ 9% per annum and also to pay Rs.50,000/- as compensation for causing him mental tension and harassment besides Rs.11,000/- as costs of litigation and
- Any other relief which this Hon’ble District Commission may deem fit and proper may be awarded to the complainant.
Hence this complaint.
2. Upon notice, none has appeared on behalf of Opposite Party despite service, hence Opposite Parties were proceeded against exparte vide order dated 12.03.2021 of this District Commission.
3. In order to prove her case, the complainant tendered into evidence her affidavit Ex.C1, copy of policy schedule Ex.C2, copy of the death certificate of policy holder Okar Singh Ex.C3, copy of letter Ex.C4, copy of affidavit of agent Nitin Arora Ex.C5, copy of legal notice Ex.C6, copy of aadhar card Ex.C7 and closed the evidence.
4. We have heard the ld.counsel for the Complainant and have carefully gone through the evidence on record.
5. From the appraisal of the evidence on record, it becomes evident that in the month of August, 2018 the agent of Opposite Party namely Nitin Arora allured Okar Singh husband of the complainant for the purchase of the policy and himself filled the proposal form. Further alleges that Okar Singh husband of the complainant paid Rs.14,372/- on account of first premium of the policy and in this regard, the Opposite Party issued policy bearing No.180814827070 under the Plan Aegon Life Term Insurance Plan (138N039V020 commenced w.e.f. 24.08.2018 having duration of the policy upto 24.08.2052 and the maturity value of the said policy was Rs.35 lakhs. Further alleges that said Okar Singh policy holder i.e. husband of the complainant expired on 14.11.2019 and in this regard, the complainant informed the Opposite Party. Thereafter, the complainant sent all the filled forms and original copy of insurance policy to the Opposite Party for settlement of claim being as nominee of deceased insured Okar Singh. But the complainant stunned to receive a letter dated 07.01.2020 from the Opposite Party in which the Opposite Party stated that policy holder while filing the proposal form did not disclose that he is having another insurance policies and on the basis of this, the Opposite Party repudiated the claim of the complainant. But at the time of filling the proposal form said agent of the Opposite Party did not ask any question regarding holding other policies by the deceased insured. Not only this, the policy holder was not able to read or written in English as he was not much educated. Further, said Nitin Arora agent also admitted and gave affidavit declaring that he did not ask any question to policy holder about other policies and hence, the aforesaid letter of repudiation is illegal, null and against the laws and same is not binding upon the legal rights of the complainant. Thereafter the complainant made so many requests to the Opposite Party to admit her rightful claim, but to no affect. Not only this, the complainant also served legal notice through his advocate on 02.10.2020 in this regard, but the Opposite Party has been keeping on dilly dallying the matter on the one pretext or the other.
6. It is not the denial of the case that Onkar Singh husband of the complainant purchased the policy bearing No.180814827070 from the Opposite Party under the Plan Aegon Life Term Insurance Plan (138N039V020 commenced w.e.f. 24.08.2018 having duration of the policy upto 24.08.2052 and the maturity value of the said policy was Rs.35 lakhs and paid first premium of Rs.14,372/-. The case of the complainant is that a the time of purchasing the policy, Nitin Arora agent of the Opposite Party himself filled the proposal form in which he did not ask any question regarding having any other policies in favour of policy holder Onkar Singh. The complainant herself placed on record the repudiation letter Ex.C4 in which the Opposite Party has specifically mentioned that the policy holder had concealed the material facts pertaining existing insurance policies prior to applying with them and on this ground only, they have repudiated the claim of the claim by declaring said policy as null and void ab-initio and however, considering the case on humanitarian grounds, the Opposite Party has refunded the premium paid of Rs.28,744/- dated 3rd January, 2020 vide NEFT reference No.N003201025959812 and this receipt of refund of Rs.28,744/- has nowhere denied by the complainant. In this way, in terms of the policy contract and the declarations made in the proposal form, the Opposite Party has declared the policy in question as Null and void ab-initio.
7. The case of the complainant is that Nitin Arora, agent of the Opposite Party has himself filled the proposal form and he did not ask any question pertaining existing insurance policies prior to applying with them and in this regard, the complainant has also placed on record the copy of duly sworn affidavit Ex.C5 of said Nitin Arora and as such, we hold that by keeping the policy holder Onkar Singh in dark, said agent has allured him due to his greediness of earning hefty amount on account of commission and filled the proposal form by misstating the true facts, but said agent has not been impleaded by the complainant in this complaint as necessary party against whom, this District Consumer Commission could pass some appropriate order. However, the complainant is at liberty to take legal action and file a complaint for the redressal of his grievance against said erroring agent, if she so desire. But this District Consumer Commission finds no deficiency in service on the part of the Opposite Party-Insurance Company because in this instant case, the insured Onkar Singh has suppressed the material facts pertaining existing insurance policies prior to applying with the Opposite Party for issuance of the policy in question and hence, violated the terms and conditions of the policy in question. It is well settled principle of law that the parties are bound by the terms and conditions of the Insurance Policy, and none of the parties can seek any relief beyond those terms and conditions. In this regard reference may be made to the observation made by the Hon’ble Apex Court in case cited as Suraj Mal Ram Niwas Oil Mills (P) Ltd. Versus United India Insurance Co. Ltd and another, 2011 CTJ 11 (Supreme Court) (CP) wherein the Division Bench of the Hon’ble Apex Court consisting of Hon’ble Mr. Justice D.K. Jain and Hon’ble Mr. Justice T.S. Thakur, held that:-
“22. Before embarking on an examination of the correctness of the grounds of repudiation of the policy, it would be apposite to examine the nature of a contract of insurance. It is trite 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………..”
“24. Thus, it needs little emphasis that in construing the terms of a contract of insurance, the words used therein must be given paramount important, and it is not open for the Court to add, delete or substitute any words. It is also well settled that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risk covered by the policy, its terms have to be strictly construed to determine the extent of liability of the insurer. Therefore, the endeavour of the court should always be to interpret the words in which the contract is expressed by the parties.”
The facts and circumstances of the instant case are fully attracted to Suraj Mal Ram Niwas Oil Mills (P) Ltd case (Supra). Since the life assured Onkar Singh-husband of the complainant accepted the terms and conditions of the insurance policy and did not disclose regarding pertaining the existing insurance policies prior to applying with the Opposite Party for issuance of the policy in question and hence, violated the terms and conditions of the policy in question.
8. In view of the aforesaid facts and circumstances, the insured had violated the basic terms and conditions of the policy in question and hence the present complaint is not maintainable and the same stands dismissed. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs.Copies of the orders be furnished to the parties free of cost. File is ordered to be consigned to the record room.
Announced in Open Commission.
Dated: 25.01.2022.
