State Consumer Disputes Redressal Commission
Icici Prudential Life Insurance ... vs Balwinder Kaur on 18 May, 2022
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.383 of 2021
Date of institution : 29.10.2021
Date of decision : 18.05.2022
ICICI Prudential Life Insurance Company Limited, The Concerned
Officer, near Abny Building Mall Road, Amritsar.
....Appellant/Opposite Party
Versus
Balwinder Kaur wife of Sh. Jagir Singh, resident of House No.150,
V.P.O. Jeobala, Tehsil & District Tarn Taran.
.....Respondent/Complainant
Appeal under Section 41 of the Consumer
Protection Act, 2019 against the order dated
26.08.2021 passed by the District Consumer
Disputes Redressal Commission, Tarn
Taran.
Quorum:-
Hon'ble Mrs. Justice Daya Chaudhary, President
Mr. Rajinder Kumar Goyal, Member
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No Argued by:-
For the appellant : Sh. K.S. Cheema, Advocate
For the respondent : None
.................................................................................. JUSTICE DAYA CHAUDHARY, PRESIDENT The appellant-opposite party i.e. ICICI Prudential Life Insurance Company Limited has filed the present appeal under Section 41 of the Consumer Protection Act, 2019 (in short the 'Act') to challenge the impugned order dated 26.08.2021 passed in Consumer Complaint No.40/2018 by the District Consumer Disputes Redressal First Appeal No.383 of 2021 2 Commission, Tarn Taran (in short the "District Commission"), whereby the complaint filed by the complainant was partly accepted against opposite party (hereinafter referred as 'OP').
2. Briefly the facts of the case as made out in the complaint by respondent/complainant are that husband of the complainant sold some land and she deposited the amount for fixed period in ICICI Bank, opposite SDM Office, Tarn Taran. The Bank officials advised her to deposit the amount in the policy and it would be doubled within a period of 5 years. Accordingly, she purchased ICICI Pru Guaranteed Savings Insurance Plan UIN 105N114V02 for an amount of Rs.97,000/- dated 19.10.2013 from OP. The appellant/OP issued policy No.17094634 in favour of the complainant. The policy was to be matured within a period of 5 years. On the expiry of maturity date of the policy, the complainant approached concerned branch office of OP for payment of the amount on a number of occasions but no payment was released and she was having no option except to file complaint. The complainant prayed in the complaint to pay Rs.2,00,000/- the double of the deposited amount of Rs.1,00,000/- and also to pay Rs.70,000/- as compensation.
3. Said complaint was contested by the appellant/OP by raising a preliminary objection that the complaint was barred by limitation in view of Section 24-A of the Act. The policy was issued in the year 2012 and the complaint was filed in the year 2018 which was after a period of 6 years. Certain other objections were also raised on First Appeal No.383 of 2021 3 merits as well. The complaint was also contested on terms and conditions of the policy.
4. On appreciation of the contents of the complaint as well as reply filed by the OP, the complaint was partly allowed and OP was directed to refund the amount with interest and also awarded Rs.3000/- as compensation on account of harassment and mental agony and Rs.2500/- as litigation expenses. Said order was to be complied within a period of 1 month from the date of receipt of copy of the order failing which the complainant was held entitled for interest @9% per annum on the awarded amount from the date of complaint till its realization.
5. Said order dated 26.08.2021 passed by the District Commission in the complaint filed by the complainant has been challenged by the appellant/OP by raising a number of arguments.
6. There was delay of 17 days in filing of the appeal. M.A. No.1219 of 2021 was filed which was supported by an affidavit. The delay in filing the appeal was condoned vide order dated 03.11.2021. M.A. 1219 of 2021 was disposed of accordingly.
7. Learned counsel for the appellant submits that the appellant Company received the Proposal Form which was duly filled up and signed by the proposer/complainant for ICICI Pru Guaranteed Savings Income Plan of the Company of annual premium of Rs.1,00,000/- payable for a period of 7 years and term of the policy was 15 years. On the basis of said information the policy was issued First Appeal No.383 of 2021 4 on 19.10.2012. Learned counsel further submits that the appellant Company after receipt of duly filled up Proposal Form alongwith other requisite documents and also on payment of first yearly premium deposited issued the policy and it was only the complainant who opted for yearly/annual premium as it was clearly mentioned in the Proposal Form itself. Learned counsel further submits that the Proposal Form was duly signed by the complainant and it was clear that the Form was pertaining to life insurance policy and not a Fixed Deposit. The policy documents were sent by the appellant on 26.10.2012 vide speed post stating the terms and conditions of the policy alongwith copy of Proposal Form. The complainant retained the policy documents and nothing was brought to the notice of the Company with regard to any discrepancy regarding premium payment, benefits, foreclosure, surrender of policy and also about policy terms and conditions. The complainant also did not approach the appellant Company for cancellation of the policy during FREE LOOK PERIOD which clearly reflected that the complainant had agreed to all the terms and conditions of the policy. Even the Proposal Form was voluntarily tick marked about the plan and also that the premium was to be paid yearly. Learned counsel further submits that the policy certificate and the premium deposit receipt have clearly reflected that the premium payment was yearly and next premium was due on 19.10.2013. Learned counsel further submits that the impugned order passed by the District Commission is not based on documents and pleading on record and the same has been passed without taking into consideration the issue of limitation as a specific objection raised. The First Appeal No.383 of 2021 5 findings recorded by the District Commission are contrary to terms and conditions of the policy and in view of those terms and conditions, the respondent/complainant was not entitled to the relief as sought in the complaint but still the complaint was allowed. Learned counsel further submits that as per averments made in the complaint, the amount was deposited for a fixed period but the same was contrary to record as the complainant herself placed on record document Ex.C-2 i.e. policy highlights, Ex.C-3 policy certificate, terms and conditions of the policy, Ex.C-4, the first premium receipt and statement of account. All these documents were produced by the complainant herself which clearly shows that the amount was not deposited in the shape of FDR. It has further been argued that the complainant had to deposit an amount of Rs.97,000/- on 7 occasions upto 19.10.2018. Even a period of 15 days was provided as Free Look Period but the complainant did not approach the appellant/OP for cancellation of the policy. At the end, learned counsel for the appellant submits that the District Commission has not taken into consideration the terms and conditions of the policy, Proposal Form and also the fact of not exercising option during Free Look Period by the complainant and still the complaint was allowed by the District Commission. Learned counsel has relied upon order passed by this Commission in F.A. No.183 of 2021 titled as "Bharti AXA Life Insurance Company Limited & another Vs. Gangu Ram Kumra & another" decided on 09.02.2022 in support of his arguments, whereby the appeal filed the appellant Insurance Company was allowed and order passed by the District Commission was set aside.
First Appeal No.383 of 2021 6
8. Notice was sent through registered post to the respondent/complainant on 09.11.2021. Neither R.C. nor A.D. was received back on the expiry of period of 30 days. It was presumed to be a proper service. Case was called on several times but still respondent/complainant was not presented. As per Regulation No.13(2) of The Consumer Protection (Consumer Commission Procedure) Regulations, 2020, the counsel for the appellant was directed to file written submissions at least two days before the adjourned date in the Registry. Neither written submissions were filed nor respondent/complainant was present or Advocate representing the complainant inspite of service.
9. We have carefully perused the contents of complaint filed by the respondent/complainant as well as the order passed by the District Commission in favour of the respondent/complainant.
10. Facts relating to filing of the complaint by respondent/complainant, filing reply thereto and the order dated 26.08.2021 passed by the District Commission whereby the complaint filed by the complainant/respondent was partly allowed and also filing of appeal by the appellant/OP are not disputed. The relevant portion i.e. para no.9 and 10 of the order passed by the District Commission are reproduced as under:-
"9. Now the question is that the complainant has made the payment of Rs.97,000/- to the opposite party which has been admitted by the opposite party. The said amount is lying with the opposite party. The opposite party has failed to place on record any letter and its postal receipt showing that the opposite party First Appeal No.383 of 2021 7 has intimated that the policy has been lapsed and money of Rs.97,000/- has been forfeited. As such, the amount of Rs.97,000/- is lying with the opposite party of the complainant which is trust of the complainant. The opposite party has not refunded the amount to the complainant for a long time, it constitutes deficiency in service on the part of the opposite party.
10. In view of the above discussion, the present complaint is partly accepted and the opposite party is directed to refund the fund value with interest prevalent time to time. The complainant is also entitled to Rs.3,000/- (Rs.Three thousand only) as compensation on account of harassment and mental agony and Rs.2,500/- (Rs.Two thousand and five hundred only) as litigation expenses. Opposite party is directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realization. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room."
11. On perusal of said part of the order whereby the complaint was partly allowed it has been mentioned that the respondent/complainant had made payment of Rs.97,000/- to the appellant/OP and said amount was lying with the OP. It has further been mentioned that OP failed to place on record any letter and postal receipt showing that the OP had intimated that the policy had been lapsed and amount of Rs.97,000/- had been forfeited. By considering this fact a direction was issued on the ground that the amount of Rs.97,000/- was lying with the appellant/OP and said amount was not refunded to the respondent/complainant for a longer period which was stated to be a case of 'deficiency in service' on the part of the appellant/OP. Meaning thereby a finding had been recorded that an First Appeal No.383 of 2021 8 amount of Rs.97,000/- was deposited by respondent/complainant and no intimation was sent to the complainant for cancellation. Said amount remained deposited with the appellant/OP for which the complainant was held entitled for refund as well as interest.
12. The appellant Company after receipt of filled up Proposal Form by the respondent/complainant alongwith certain requisite documents had issued policy and respondent/complainant herself had opted for yearly premium as has been clearly mentioned in the Proposal Form which was duly signed by the complainant herself. The Proposal Form was bearing logo of ICICI Prudential Life Insurance Company. From which it was evident that the Form was pertaining to Life Insurance and not fixed deposit. As per stand of appellant Company the policy documents were sent on 26.10.2012 vide speed post AWB No.EW084926856IN stating the terms and conditions of the policy alongwith copy of Proposal Form. The policy documents were retained by the complainant and no discrepancy was pointed out to the appellant Company including terms and conditions of the policy. Even the respondent/complainant never approached the appellant for cancellation of policy during the free look period. Meaning thereby the respondent/complainant was agreed to all the terms and conditions of the policy. Even the receipt of the policy documents was also not in dispute as complainant had herself attached the policy documents alongwith complaint filed before the District Commission. In the Proposal Form, the complainant had voluntarily tick marked the plan type as regular premium and not a single premium. The payment of Premium was also tick marked as yearly. The question VII, 2 & 3 of the First Appeal No.383 of 2021 9 Proposal Form (Ex.R-1) was duly filled up and signed by the complainant, which is as under:-
"VII. Particulars of Products Applied For:
2) Mode (for regular / limited premium payment plan) :
√Yearly Half yearly Monthly Product Policy Term Premium Modal Premium Name (in yrs) Paying Term GSIP 15 7 yrs. 97,000/-
13. It is also relevant to mentioned here that the Policy Certificate and 1st premium deposit receipt which was received by the Complainant has clearly reflected the periodicity of premium "YEARLY" and next premium was due on 19.10.2013.
14. Moreover, in view of Clause 6(2) of the Insurance Regulatory and Development Authority of India (Protection of Policy Holder's Interest) Regulations, 2002 every policy document is sent accompanied by forwarding letter mentioning that in case the policy holder is not satisfied with the features and the terms and conditions of the policy, he/she can withdraw/return the policy within a period of 15 days i.e. under the "FREE LOOK PERIOD". The respondent/complainant has duly signed the Proposal Form and the Policy documents were also duly received. Meaning thereby an opportunity was given to the policy holder/complainant to understand the terms and conditions and to approach the Company in case there was any discrepancy. The complainant retained the policy documents and did not raise any objection towards the policy. Even during Free First Appeal No.383 of 2021 10 Look Period also the complainant never reached/contacted appellant Company with any grievance in case any grievance was there or the complainant was not happy with the terms and conditions of the policy.
15. It is apparent that respondent/complainant had slept over her right even during period of Free Look Period and filed the Complaint just to take benefit of her own negligence. Even the Complainant had failed to provide any documentary evidence to show that any false assurance was given to her or she did not receive the terms and conditions of the policy. Meaning thereby it can safely be presumed that the complainant was well aware of the terms and conditions of the Policy and filled up the Proposal Form with open mind and eyes. It is not the case of the respondent/complainant that she was illiterate and she did not understand the terms and conditions and presumed something else. Even respondent/complainant has not disputed her signatures on the Proposal Form. There is no denial about the receipt of registered letter whereby policy documents were sent. Even as per submissions made that communications were sent at the registered address and a number of SMS were also sent on the mobile of the complainant but despite receipt of the policy documents and also receipt of communications and SMS, the complainant did not approach the appellant Company with her alleged grievance. Copy of SMS Tracker is also annexed as Annexure A-3 with the appeal. The respondent/complainant had deposited only the first premium which was valid upto 19.10.2013 and thereafter she failed to deposit the renewal premium for the subject policy for premium payment term of 7 years. The due date for payment of next premium was 19.10.2013. In First Appeal No.383 of 2021 11 case of non deposit of the premium, the policy was foreclosed on 19.10.2015 as per the terms and conditions of the policy and no foreclosure payment was made as per terms and conditions of the policy. Even the intimation was sent to the complainant regarding the non-payment premium on 19.10.2013. The claim of respondent/complainant of double of the amount in 5 years from issuance of the policy is totally baseless and without any evidence and also contrary to the terms and conditions of the policy. All these factors have not been taken into consideration by the District Commission and the complaint filed by the complainant was partly allowed by ordering the release of double of the amount. Clause 3 of the terms and conditions of policy is also relevant which is reproduced as under:-
"Clause 3: Payment of Premiums:
i. Premiums under the policy can be paid on yearly, half yearly or monthly basis as per the frequency chosen by the Policyholder and as mentioned on the Policy certificate. ii. Premiums as mentioned on the Policy certificate along with service tax and education cess is required to be paid on the premium due date.
iii. A grace period of not more than 30 days, where the mode of premium is other than monthly.... is allowed from the premium due date for payment of premiums.First Appeal No.383 of 2021 12
iv. If the premium is not paid within the grace period during the first three policy years, the policy shall lapse and no benefits would be payable....
v. We are not under any obligation to remind you about the premium due date, except as required by applicable regulations."
16. The District Commission in Para No.2 of the impugned order has acknowledged the fact that the SMS Tracker has been tendered as Ex.R-3. More importantly the letter dated 20.10.2015 has also been placed on record before the District Commission wherein it has clearly been stated that the policy has been foreclosed (Terminated) and no benefits were payable under the policy. The said letter was also acknowledged by the District Commission in Para No.2 as Ex.R-4. As such findings recorded by the District Commission are totally contrary to evidence and facts available on record and available on the file.
17. It is a settled proposition of law that the clauses and terms of an agreement of insurance have to be strictly interpreted and the Courts cannot rewrite the same to the advantage of any party. Insurance being a contract between the policyholder and the Insurance Company, Both are governed by the terms and conditions mentioned in the policy documents and all the benefits are payable strictly as per the policy terms and conditions. The Hon'ble Supreme Court of India has held in plethora of judgments i.e. "General Assurance Society Limited Vs. Chandumull Jain & another" First Appeal No.383 of 2021 13
1966(3)SCR-500, "Suraj Mal Ram Niwas Oil Mills(P) Limited Vs. United India Insurance Co. Ltd." 2010(10)SCC-567, "Export Guarantee Corporation of India Limited Vs. Garg Sons International" 2013(1)SCALE-410 that while construing the terms of an insurance contract, paramount importance must be given to the words in which the contract has been expressed by the parties, and the same is required to be interpreted as expressed, without any addition, deletion or exclusion. It is not for the Court to make a new contract, however reasonable if the District Commission has wrongly passed the order against the appellant/OP against the terms and conditions of the policy. The District Commission has totally changed the version of the case by some hypothetical averments which have no relevance. Without going into detailed terms and conditions, the District Commission has directed the appellant/OP to refund the fund value with interest prevalent time to time, which is totally perverse and out of context. No benefit is payable to the respondent/complainant under the policy and the District Commission has wrongly held it to be a case of 'deficiency in service' whereas the respondent/complainant failed to make out a case of 'deficiency in service' on the part of the appellant.
18. The Hon'ble National Commission in judgment of case "Reliance Life Insurance Co. Limited Vs. Madhavacharya (Revision PetitionNo.211 of 2009) held as under:
"Since the insurance between the insurer and the insured is a contract between the parties, the terms of the agreement First Appeal No.383 of 2021 14 including applicability of the provision and also its exclusion had to be strictly construed to determine the extent of the liability of the insurer."
19. In judgment of case titled as "Ravneet Singh Bagga Vs. KLM Royal Dutch Airlines" 2000(1)SCC-66, the Hon'ble Supreme Court has held as under:-
"The deficiency in service cannot 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 is upon the person who alleges it. The complainant has, on facts, been found to have not established any willful fault, imperfection, shortcoming or inadequacy in the service of the respondent. The deficiency in service has to be distinguished from the tortuous acts of the respondent. In the absence of deficiency in service the aggrieved person may have a remedy under the common law to file a suit for damages but cannot insist for grant of relief under the Act for the alleged acts of commission and omission attributable to the respondent which otherwise do not amount to deficiency in service. In case of bona fide disputes no willful fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance in the service can be informed (sic.). If on facts it is found that the persons or authority rendering service had taken all precautions First Appeal No.383 of 2021 15 and considered all relevant facts and circumstances in the course of the transaction and that their action or the final decision was in good faith, it cannot be said that there had been any deficiency in service. If the action of the respondent is found to be in good faith, there is no deficiency of service entitling the aggrieved person to claim relief under the Act. The rendering of deficient service has to be considered and decided in each case according to the facts of that case for which no hard and fast rule can be laid down. Inefficiency, lack of due care, absence of bona fides, rashness, haste or omission and the like may be the factors to ascertain the deficiency in rendering the service.
20. The District Commission has miserably failed to correctly interpret the terms and conditions of the policy in question. The terms and conditions clearly state that once the policy is foreclosed then no benefits shall be payable to the policy holder. Once the policy is foreclosed no rights, interest and claims shall be paid to the policy holder or anyone claiming through him/her with respect of the subject policy.
21. The Hon'ble National Commission in judgment of case "Kishore Chandrakant Rathod Vs. Managing Director, ICICI Prudential Life Insurance Co. Limited & others" (Revision Petition No.3390 of 2013) has held as under:-
"It must be borne in mind that the petitioner is an educated person. He was supposed to read each and every terms and conditions of the policies. There are no oral rules and conditions First Appeal No.383 of 2021 16 of the policy. One has to act in accordance with the frame work of the policy. The complainant is not a gullible person who could have been taken up garden path. It appears that he did not act prudently. He used the ink but not this brain. It is well settled that man may tell lies but the documents cannot. Everywhere he has mentioned that he was informed by a Bank official. The name of that Bank official did not see the light of the day. His story does not just stack up. No deficiency can be attributed to the respondent. They have acted in accordance with the Law on the other hand the complainant swallowed the bait."
22. The District Commission has simply relied upon the frivolous averments of the respondent/complainant. The respondent/complainant in a very clever manner has manipulated the facts and the documents in order to mislead the District Commission. The terms and conditions are clear and in simple language and the same were also explained to policy holder at the time of taking the policy. The appellant/OP contradicted the averments and grounds of the complaint in its written statement and by way of leading evidence but the District Commission has not considered the same. The findings recorded by the District Commission are totally illegal and perverse and are liable to be set aside. The District commission has committed an error in Law in not appreciating the fact that the complainant/respondent failed to make out a case of 'deficiency in service' against the appellant/OP. The controversy involved in the present case is squarely covered by the order passed by this Commission in Bharti AXA Life Insurance Company Limited's case First Appeal No.383 of 2021 17 (Supra) whereby the appeal filed by the appellant Insurance Company was allowed and the order passed by the District Commission was set aside.
23. In view of facts and detailed discussion as mentioned above, we are of the considered view that the impugned order dated 26.08.2021 passed by the District Commission is totally contrary to facts and evidence as available on the record. The District Commission has not applied its judicious mind while partly allowing the complaint filed by the respondent/complainant and the findings recorded in the impugned order are contrary to the terms and conditions of the policy and even contrary to the facts as the stand taken in the written reply filed before the District Commission has not been taken into consideration. Even a specific objection was raised regarding limitation in filing the complaint and other documents where signatures of the complainant were there but still those documents have not been taken into consideration and it appears that even no efforts have been made to peruse those documents. The stand taken in the reply to the complaint was also ignored. Accordingly by finding merit in the contentions raised by learned counsel for the appellant/OP, the appeal filed by the appellant/OPs is allowed and the impugned order dated 26.08.2021 passed by the District Commission Tarn Taran is hereby set aside. Resultantly the complaint is dismissed.
24. The appellant had deposited an amount of Rs.5500/- at the time of filing of the appeal with this Commission. Said amount, First Appeal No.383 of 2021 18 alongwith interest which has accrued thereon, if any, shall be remitted by the Registry to the appellant by way of crossed cheque/demand draft after the expiry of limitation period in accordance with law.
25. The appeal could not be decided within the stipulated period due to heavy pendency of Court cases and due to pandemic of Covid-19.
(JUSTICE DAYA CHAUDHARY) PRESIDENT (RAJINDER KUMAR GOYAL) MEMBER May 18, 2022.
MM