BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, SAHARANPUR, UTTAR

PRADESH

CC No.25 of 2022

IN THE MATTER OF:-

Dharampal Singh Complainant

Versus

Aditya Birla Sun Life Insurance Company Ltd & Ors ..Opposite
Parties

WRITTEN ARGUMENTS ON BEHALF OF THE OPPOSITE PARTIES

NO.1, NO.2 & NO.3 I.E. ADITYA BIRLA SUN LIFE INSURANCE
COMPANY LTD IN RESPONSE TO THE COMPLAINT FILED BY THE
COMPLAINANT).

MOST RESPECTFULLY SHOWETH:

BRIEF FACTS:

1. It is submitted that Mr. Dharampal Singh (hereinafter referred

to as the “policyholder/ Life Assured/DLA”) approached the
Answering Opposite Party for issuance of Insurance Policies with
policy Nos. 006485512 , 006019270, 006122259,
006373951, 006518935 and 006534516 commencing on
25.04.2014, 16.03.2013, 04.06.2013, 20.01.2014, 31.05.2014
and 24.06.2014. That the Life Assured also signed a Declaration
& Authorization wherein it was declared that he has understood
the product features and the importance of all declarations and
that the company stated it in the terms and conditions.

2. It is submitted that on basis of the declaration and information

provided in the proposal form along with the documents
submitted by Aditya Birla Sun Life Insurance Company Ltd & Ors
 ..Opposite Parties, issued the Policy bearing Nos.
006485512 , 006019270, 006122259, 006373951,
006518935 and 006534516 for premium payment term of 10,
15, 20, 15, 18 and 20 years . The total premium paid for the
same are

Rs 26,000.04, Rs.35,700.25, Rs. 84,000, Rs. 29999.96, Rs.

18,000.32, Rs. 1,14,499.97 respectively.

3. In the present case, That the Complainant was required to pay

the renewal premium annually for a period of 10, 15, 20 and 18
years respectively however, the Complainant paid only the initial
premiums under the policies and not hereafter therefore the
policies lapsed and was terminated on 25.04.2017, 16.03.2016,
04.05.2016, 25.01.2O17, 04.05.2077 & 30.06.2017 i.e. after the
expiry of the revival period.

4. That the complainant for the first time approached the company
after more than 6 years from the date of issuance of policy by
way of legal notice dated 19.03.2019 for cancellation of policy.
That the company received the legal notice of the complainant
on 28.03.2019 and thereafter reply to the said legal notice was
sent to the complainant on 24.04.2019 wherein the request of
the Complaint was declined being beyond the freelook period.

5. THAT THE COMPLAINANT HAS FAILED TO APPROACH THE

OPPOSITE PARTIES WITHIN THE FREE LOOK PERIOD OF
15 DAYS FROM THE DATE OF RECEIPT OF THE POLICY
DOCUMENT:

That in accordance to Clause 8 (1) & 10 (1) of the Insurance

Regulatory and Development Authority (Protection of
Policyholder’s Interests) Regulations, 2017, every Policy
document sent by the answering Opposite Party is accompanied
with a copy of the Proposal Form signed by the applicant and a
forwarding letter which clearly mentions that in case Policy
holder is not satisfied with the features or the terms and
conditions of the Policies he can withdraw/return the Policies
within 15 days i.e. under the “Free Look Cancellation
Period”. It is submitted that the answering Opposite Party had
sent the Policy Documents of all the six policies at the Registered
Address of the Complainant which were received by the
Complainant on 02.05.2014, 25.03.2013, 13.06.2013,
20.02.2014, 17.06.2014 & 07.07.2014. It is pertinent to
mention, that the Complainant did not approach the answering
Opposite Party with any discrepancies with regard to the Policy
terms and conditions, neither did he approach the answering
Opposite Party for cancellation of the Policies during the Free
Look Period thereby implying that he had agreed to all the terms
and conditions of the Policy. Therefore, the subject policy
continued as per the prevailing policy terms and conditions. It is
submitted that after receiving the policy documents the
Complainant remained silent therefore the policy continued. The
complainant for the first time approached the company after
more than six years from the date of issuance of policy by way
of legal notice dated 19.03.2019. This clearly demonstrates that
the complainant was fully aware of the terms and conditions of
the said policy.
That it has been determined through various judgments passed
by the Hon’ble National Consumer Disputes Redressal
Commission New Delhi, specifically in case of Ketki Arora vs.
Kotak Mahindra Old Mutual Life Insurance Company ||
REVISION PETITION NO. 3519 OF 2016 || Order dated
October 3, 2018 that the burden of proof to show late receipt
of policy documents on the Complainant and since the
Complainant was not able to either produce the envelope
received by him or any document evidencing the late receipt of
Welcome kit. It was assumed that the policy documents were
sent by the Company in time.

The Complainant herein retained the policy documents and never

approached the Company for any rectification or discrepancy
with respect to the same. This implied that the Complainant had
verified and consented to all the details stated in the Proposal
 Forms. That it has been determined through various judgments
passed by the Hon’ble National Consumer Disputes
Redressal Commission New Delhi, in Mohan Lal Benal Vs
ICICI Prudential Life Insurance Co. Ltd. (R.P. No.
2870/2012 Decided on 16.10.2012) and Harish
Kumar Chadha Vs Bajaj Allianz Life Insurance Co. Ltd.
(Decided on 07.10.2013 in Revision Petition No. 3271 of
2013) that if the Insured/Complainant is not satisfied with the
Policy taken, then he/she should avail the option of returning the
Policy within 15 days of receipt i.e. within “the Free-look Period”.
Furthermore it has been determined through catena of
judgments passed by the Hon’ble National Consumer
Disputes Redressal Commission New Delhi, in
Mohan Lal Benal v/s ICICI Prudential Life Insurance Co.
Ltd. and Harish Kumar Chadha v/s Bajaj Allianz Life
Insurance Co. Ltd. that if the insured/Applicant is not satisfied
with the policy taken, then he/she should avail the option of
returning the policy within 15 days of receipt i.e. within “the
Free-look Period”. The said proposition has also been clearly
laid down in the case Shrikant Murlidhar Apte vs. Life
Insurance Corporation of India, Revision Petition no. 634
of 2012 decided on 02.05.2013. Further, the National
Commission concurred with the findings of Maharashtra State
Consumer Disputes Redressal Commission, Mumbai that “Once
15 days ‘cooling off’ period is over, policy documents become
binding on both the parties and the contents therein are also
biding on both of them.”

6. THAT THE POLICY IS A LEGAL CONTRACT BETWEEN THE

POLICYHOLDER AND INSURANCE COMPANY AND THE
PARTIES TO THE SAID CONTRACT ARE BOUND BY ITS
TERMS AND CONDITIONS:
It is submitted that, the Policy is a contract and the parties to
the said contract are bound by the terms of the policy. The
relevant extract of the policy terms are as follows:

Policy No. 006485512 &. 006534516 (Income Assured

Plan)

Premium Discontinuance If you are unable to pay the

installment premium by the due date, you will be given a grace
period of 30 days (15 days for monthly mode) during which time
all benefits under the policy will continue.

(a) Until 2 full years premium for premium paying term of 5/ 7

years and 3 full years premiums for premium paying term of 10
years are paid: If we do not receive the entire installment
premium by the end of the grace period, this policy will be
deemed lapsed and all benefits will cease immediately. The lapse
date is the date the first unpaid premium was due. You will be
given a period of two years from the lapse date to reinstate your
policy.

Surrender Benefit At any time while your policy is in effect and

after all due installment premiums for at least two policy years
(for premium paying term of 5/7 years) and three policy years
(for premium paying term of 10 years) have been paid you can
request to surrender this policy for its Surrender Benefit.

Policy No. 006373951 & 006518935( Vision Life income

Plan)

Premium Discontinuance If you are unable to pay the

installment premium by the due date, you will be given a grace
period of 30 days (15 days for monthly mode) during which time
all benefits under the policy will continue. (a) Until 3 full years
installment premiums are paid: If we do not receive the entire
installment premium by the end of the grace period, this policy
will be deemed lapsed and all benefits will cease immediately.
The lapse date is the date the first unpaid premium was due.
You will be given a period of two years from the lapse date to
reinstate your policy. (b) Once 3 full years installment premiums
have been paid: If we do not receive the entire installment
premium by the end of the grace period, this policy will be
deemed paid-up and benefits will continue as per the Policy Paid-
Up provision. The paid-up date is the date the unpaid premium
was due. You will be given a period of two years from the paid-
up date to reinstate the policy for its full benefits

Surrender Benefit Your policy will acquire a surrender value

after all due installment premiums for at least three policy years
are paid. At any time thereafter you can request to surrender
this policy for its Surrender Benefit.

Policy Nos 006019270, 006122259, ( Vision Plan)

Premium Discontinuance If you are unable to pay the
installment premium by the due date, you will be given a grace
period of 30 days during which time all benefits under the policy
will continue. (a) Until 3 full year installment premiums are paid:
If we do not receive the entire installment premium by the end
of the grace period, this policy will be deemed lapsed and all
benefits will cease immediately. The lapse date is the date the
unpaid premium was due. You will be given two years from the
lapse date to reinstate your policy.

Your policy will acquire a surrender value after the completion

of three policy years with all due premiums paid for at least
three policy years. At any time thereafter you can request to
surrender this policy for its Guaranteed Surrender Value
provided the life insured’s attained age is 18 years or older.

In the present case, the Complainant was required to pay the

renewal premium annually however the Complainant paid only
one premium each the policies. Therefore, the policies lapsed.
 The Complainant also failed to revive the policies within the
revival period therefore the policies were terminated. Since the
Complainant has paid only one premium each under the said
policies; the policies have not acquired any surrender value.
Hence the Complainant is not entitled for any amount.

It is stated that the policy is a legal contract between the policy

holder and 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 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
law in this regard is very well settled and one may conveniently
refer to a recent judgment of the Hon’ble Apex Court in the case
of Suraj Mal Ram Niwas Oil Mills (P) Ltd. Vs. United India
Insurance Co. Ltd. [(2010) 10 SCC 567]. The same has been
clearly stated in the case of Reliance Life Insurance Co. Ltd
Vs Madhavacharya (Revision petition no: 211 of 2009),
wherein it was held by the National Commission 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 provision and also its exclusion had to be
strictly construed to determine the extent of the liability of the
insurer”

7. THAT THE COMPLAINT HAS FAILED TO SHOW ANY

DEFICIENCY IN SERVICES OR UNFAIR TRADE PRACTICE
ON THE PART OF OPPOSITE PARTIES

It is submitted that there is no deficiency of service or

negligence on the part of the replying Opposite Party.
“Deficiency” as defined under section 2(11) of the Consumer
Protection Act, 2019 means any fault, imperfection, shortcoming
or inadequacy in the quality, nature and manner of performance
which is required to be maintained by or under any law or has
been undertaken to be performed by a person in pursuance of a
contract or otherwise in relation to any service. In the present
case, the Complainant failed to approach the Opposite Party
within the freelook period. Further the Complainant paid only the
initial premiums and failed to pay all subsequent renewal
premiums, therefore the policies got lapsed and eventually got
terminated on 25.04.2017, 16.03.2016, 04.05.2016,
25.01.2O17, 04.05.2077 & 30.06.2017 respectively as per the
Terms and Conditions. Therefore, there is no deficiency in
services or unfair trade practice on the part of the Answering
Opposite Party as laid down in the case of Ravneet Singh
Bagga v. KLM Royal Dutch Airlines (2000) 1 SCC 66 the
Hon'ble Supreme Court has laid down the test of deficiency in
service by stating that “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 tortious 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 wilful 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 person or authority rendering
service had taken all precautions 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.”

8. THAT THE COMPLAINANT IS NOT ENTITLED FOR ANY

RELIEF:

It is submitted that the complainant for the first time approached

the company after more than 6 year from the date of issuance of
policy by way of legal notice dated 19.03.2019 for cancellation of
policy. That the company received the legal notice of the
complainant on 28.03.2019 and thereafter reply to the said legal
notice was sent to the complainant on 24.04.2019 wherein the
request of the Complaint was declined being beyond the freelook
period. As per the terms and conditions of the policies the
Complainant is not entitled for refund of the premium. It is
denied that the Complainant has committed any fraud or
cheated the Complainant. It is denied that there is any deficiency
in services on the part of the Opposite Parties. The Complainant
enjoyed the benefits under the subject policy till the time the
policies were in force now cannot be permitted to wriggle out
from the same and claim the refund of the premium paid under
the policies as it is not the case of the Complainant that the risk
on is life was not covered by the answering Opposite Party.

It is therefore most respectfully prayed that this Hon’ble

Commission may kindly be pleased to dismiss the Complaint of
the Complainant with exemplary cost in favour of the answering
Opposite Party and against the Complainant;

Opposite Party No. 1 & No. 2

through
 Counsel for the Opposite Party No.1, No.2 & No.3
Mohammad Imran Advocate
Chamber No. 231, Civil Court Saharanpur,
Place: Patna Uttar Pradesh-247001
Dated: M. No. +91-9759000387
Dated:02.06.2022