SUDESH GUPTA vs Icici Prudential Life Insurance Company Ltd

THIS Revision Petition seeks to challenge the order dated 10.1.2011 passed by the State Consumer Disputes Redressal Commission, Haryana Panchkula (State Commission for short). Relief/award given by the District Consumer Disputes Redressal Forum, Karnal (District Forum for short) vide its order dated 6.12.2007 in favour of the Petitioner/Complainant has been set aside in this order of the State Commission thereby dismissing the complaint. Aggrieved against this reversal order, the Complainant has filed this Revision Petition.

FACTS of the case in brief are that the Petitioner/Complainant''s husband had purchased a life insurance policy for a sum of Rs. 5 lakh allegedly with accidental benefit from the Respondent Life Insurance Company Ltd. During the subsistence of the policy, however, the life assured died in a motor vehicle accident. When the Petitioner being the nominee under the policy made a claim of Rs. 10 lakh, the Respondent Insurance Company paid her only a sum of Rs. 5 lakh on the ground that the life assured had not opted for accident and disability benefit and as such under the terms of the policy no such benefit could be extended to her.

CONTENDING that under the terms of the policy she was entitled to the accidental benefit which has been wrongly denied by the Respondent which amounted to deficiency in service she approached the District Forum by filing a consumer complaint. The complaint was resisted by the Respondent/OP. On appraisal of the evidence adduced by either side before it, the District Forum accepted the complaint and directed the Respondent/OP to pay Rs. 5 lakh on account of accidental benefit to the complainant within a period of 30 days failing which it was to carry interest @ 10% per annum from the date of the order till its payment. The OPs were aggrieved against this finding of the District Forum and filed an appeal resulting in the setting aside of the District Forum order and consequently dismissal of the complaint. It is under these circumstances that the Complainant who is the aggrieved party has filed this Revision Petition.

WE have heard the learned Counsel for the Petitioner. According to him the learned State Commission has failed to appreciate that the definition of ''insured cover'' as given in the definition clause of the insurance policy makes it clear that it included accident and disability benefit as well. He has further referred to the explanation of accidental benefit given in Condition A under head ''accident and disability benefit'' in the Annexure enclosed with the policy document and contends that the mention of "supplementary benefits applicable if opted for" would not ipso facto unsuit the Complainant from receiving the accidental benefit as the General Condition No. 4 did not specifically exclude the accidental benefit.

WE have noted the submissions made by the learned Counsel only to be rejected for the simple reason that the life assured in the proposal form in response to question No. 39(2), under the head "Particulars of Plan Applied for" had responded only for a "sum proposed/death benefit" of Rs. 5 lakh. As clearly observed by the State Commission, the life assured did not add any ''rider'' to avail any supplementary benefits. No extra premium to avail any additional benefit had been paid by him. It has also been clearly brought out that the life assured having not represented against any deficiency in terms and condition of the policy within the period of 15 days prescribed by the Insurance Regulatory and Development Authority, it can only be said that he was not clearly entitled to any accidental benefit. It is only an after-thought and the arguments advanced by the learned Counsel will cut no ice. The terms and conditions in an insurance policy being in the nature of a contract between the parties, the rights and obligations have to be governed by the terms as incorporated and in construing the terms of the insurance policy the words used therein must be given paramount importance and it is not open for any Fora to add, delete or substitute any word. The law on this point is now very well settled and we may respectfully draw support from the Judgment of the Supreme Court in the case of Suraj Mal Ram Niwas Oil Mills (P) Ltd. v. United India Insurance Co. Ltd. and Anr., IV (2010) CPJ 38 (SC)=VIII (2010) SLT 375=IV (2010) ACC 653 (SC)=2011 CTJ 11 (SC) (CP).

AS discussed, we do not find any illegality, material irregularity or jurisdictional error in the order passed by the State Commission and the Revision Petition is, therefore, dismissed in limine. Revision dismissed in limine.