The contract’s conditions must be strictly followed and given natural meaning. Once a policy has been specifically excluded, it cannot be reinstated under any situation. However, the Complainant was found to have not followed the definition provided. This was observed in the matter of MD & CEO ING Vysya Life Insurance Co Ltd v. G.H Govindappa, [ A/641/2017], before Hon’ble Mr. Ravishankar (Presiding Member) and Hon’ble Mrs. Smt. Sunita Channabasappa Bagewadi (Member).
The brief facts of the case are as follows, the Complainant bought two insurance policies from the Opposite Party, after which the insurance company sent the original policy bond and a booklet containing the terms and conditions. Soon after, the complainant contacted the OP but did not receive a satisfactory response. In 2014, the complainant asked for a refund, which the company did not repay, therefore, the complainant sent a legal notice to the company saying he did not want to continue with the policies he bought. The Company did not respond to him. It was contended by the OP that the complaint is unmaintainable and deserved to be dismissed. The OP brought it to the notice of the Commission that, the complainant had given his declaration that he understood the terms of the policy and paid the premium amounts. As per Regulation 6(2) of the IRDAI, the policy holder can cancel the policy mentioning the reasons within 15 days from the day the policy is received, this is called the “free look period”. However, the complainant never approached the company within the said period, bur approached the OP after one and half years. On April 21, 2014, the complainant issued a letter stating that he was unable to pay additional premiums due to crop failure in 2013-14 that caused his financial hardship. The Opposite Party dismissed the complainant’s request on June 12, 2014, in accordance with the policy terms and conditions.
The District Commission had allowed the Complaint even though the complainant failed to pay the renewal premiums that were due in 2013, causing the policies to lapse. Furthermore, the opposing party sent frequent reminders via SMS/letters, but the complainant still failed to redo the policies. After referring the District Commission’s decision, and the relevant documents presented by both parties, the State Commission came to the following conclusion: “It is settled law that terms of the policy shall governed the contract between the parties. They have not abided by the definition given therein. Hence, the terms of the contract have to be strictly read and natural meaning be given to it. Once there is specific exclusion of the policy, the same cannot be permitted under any circumstances. Hence, in our opinion, the complainant violated the terms and conditions as per the policy bonds in both policies. Hence, the Opposite Party was fully justified in cancelled the both policies. Moreover, as per the terms and conditions of the policies, the complainant has opportunity to cancel the policy, but, the complainant has not cancelled the policies within free look period of 15 days and the complainant has not renewed the policies during 2013 even after the course of period and reminders made by the Opposite Party also. Hence, for the reasons stated above, the order passed by the District Commission cannot be sustained in same as hereby set aside.”
Judgement Reviewed by Vagisha Sagar