Haryana

Karnal

CC/321/2019

Mohit - Complainant(s)

Versus

Bajaj Allianz Life Insurance Company Limited - Opp.Party(s)

R.K. Chauhan

05 Jul 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 321 of 2019

                                                        Date of instt.07.06.2019

                                                        Date of Decision:05.07.2022

 

Mohit son of Ishwar Jangra, resident of House no.287/10 MC Road Taroari, District Karnal.

 

                                               …….Complainant.

                                              Versus

 

Bajaj Allianz Life Insurance Company Ltd, through its Divisional Manager Sector-12, Karnal.

 

                                                                      …..Opposite Party.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.

              Sh. Vineet Kaushik……Member 

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri R.K. Chauhan, counsel for the complainant.

                   Shri Vikas Bakshi, counsel for the opposite party.

 

                    (Jaswant Singh President)

ORDER:   

                

                 The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that the mother of the complainant namely Maya Devi was holder of an life insurance policy bearing no.0366020485 dated 16.01.2019 in her name and complainant is nominee in the said policy. The insurance policy was covering the risk of life of mother of the complainant upto 5,00,000/- as per term and conditions mentioned in the cover note. The mother of the complainant died on 03.02.2019 after simple ailment during treatment at PGI Chandigarh. The complainant had given proper intimation to the company in this regard, but the OP has repudiated the abovesaid policy claim by returning Rs.10,000/- of the premium paid by the mother of the complainant. The mother of the complainant has already intimated the OP regarding her ailment and treatment in Hospital through her son. The complainant lodged a death claim alongwith the necessary documents  to OP within time. Thereafter, complainant has requested the OP so many times to make the payment of his due claimed amount, but OP did not pay any heed to the request of complainant and lingered the matter on one pretext or the other and lastly repudiated the claim of the complainant on the false and frivolous grounds. In this way there is deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action and concealment of true and material facts. On merits, it is pleaded that deceased Smt. Maya Devi “Life Assured” had submitted to the OP a proposal/application for the purchase of insurance policy and the proposal was accepted on the standard rates based on the information provided by the life assured and thereafter the policy was issued to the deceased life assured. The necessary guidance was also provided by the concerned financial consultant/agent and was duly explained to the life assured. As per the terms and conditions of the insurance policy, the policy provided/had a waiting period of 90 days from the risk commencement dated i.e. 16.01.2019 till 16.03.2019 during which if the life assured died then as per the clause 4(a) “if the death of the life assured during the waiting period for cause of death other than accident, if the policy is in force as on date of death and as applicable all the due have been received in full, all regular premiums received till date shall be payable as the death benefit” that as per the said provision an amount of Rs.10,000/- the only premium paid by the deceased Smt. Maya Devi “Life Assured” has been processed and paid to the complainant being nominee on the said policy. It is further pleaded that the policy term of 10 years and premium payment period of 7 years and the sum insured under the policy was Rs.1,00,000/- and not Rs.5,00,000/- as alleged in the complaint. There is no deficiency in service on the part of the OP. The other allegations made in the complaint have been denied by the OP and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of death certificate Ex.C2, copy of medical certificate of cause of death Ex.C3 and Ex.C4, copy of certificate of treatment Ex.C5, copy of PAN Card Ex.C6 and closed the evidence on 04.08.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Swati Seth, Manager Ex.OPW1/A, copy of authority letter Ex.OP1, copy of insurance policy Ex.OP2, copy of proposal form Ex.OP3, copy of claim letter Ex.OP4, copy of medical certificate of cause of death Ex.OP5 and closed the evidence on 19.04.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and also have gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of complaint, has vehemently argued that the mother of the complainant namely Maya Devi was holder of an life insurance policy and complainant is nominee in the said policy. The insurance policy was covering the risk of life of mother of the complainant upto 5,00,000/-. The mother of the complainant died on 03.02.2019 after simple ailment during treatment at PGI Chandigarh. The complainant being nominee lodged the death claim of his mother with the OP, but the OP has repudiated the claim of complainant by returning Rs.10,000/- of the premium and prayed for allowing the complaint.

8.              Per contra, learned counsel for OP, while reiterating the contents of written version, has vehemently argued that a life insurance policy was issued to the deceased life assured on the information provided by the life assured. As per the terms and conditions of the insurance policy, the policy provided/had a waiting period of 90 days from the risk commencement dated i.e. 16.01.2019 till 16.03.2019 during which if the life assured died then as per the clause 4(a) an amount of Rs.10,000/- the only premium paid by the deceased Smt. Maya Devi “Life Assured” has been processed and paid to the complainant being nominee on the said policy. The amount of Rs.10,000/- has already paid to the complainant as per terms and conditions of the insurance policy and prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the policy in question was purchased by the mother of the complainant (since deceased) and complainant is nominee in the said policy. It is also admitted after the death of life assured, the OP has paid Rs.10,000/-  to the complainant.

11.           The claim of the complainant has been denied by the OP on the ground that the policy provided a waiting period of 90 days from the risk commencement dated i.e. 16.01.2019 till 16.03.2019 during which if the life assured died then as per the clause 4(a) an amount of Rs.10,000/- the only premium paid by the deceased Life Assured has been processed and paid to the complainant being nominee on the said policy and the said amount has already paid by the OP to complainant.

12.           The onus to prove his case was lied upon the complainant, but complainant has miserably failed to prove his version by leading any cogent and convincing evidence. Rather, it is evident from the clause 4(a) of insurance policy Ex.OP2 if the death of life assured occurred during waiting period, the premiums received till date shall be payable as the death benefit. The clause 4 (a) of the insurance policy, reproduced as under:-

“if the death of the life assured during the waiting period for cause of death other than accident, if the policy is in force as on date of death and as applicable all the due have been received in full, all regular premiums received till date shall be payable as the death benefit”

Furthermore, the exclusion and waiting period mentioned in clause 12(b) of insurance policy Ex.OP2. The clause 12(b) of waiting period reproduced as under:-

        b) Waiting Period

The policy has a Waiting Period of ninty (90) days from the Date of Commencement of Risk. During the period, the benefit  payable on the death of the Life Assured as mentioned Section 4(a) above.      

 In the present case, the mother of complainant had purchased the policy in question on 16.01.2019 and as per terms and conditions of policy, the waiting period was of 90 days completed on 16.03.2019. The life assured died on 03.02.2019. The death of the life assured was occurred during the waiting period. Thus, complainant is not entitled for claim under the policy in question. Hence, there is no deficiency in service on the part of the OP.

13.           In view of the above, present complaint is devoid of any merits and same deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated the order accordingly, and the file be consigned to the record room, after due compliance.

Announced

Dated:05.07.2022.

                                                                      

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

       

                (Vineet Kauhik)                 (Dr. Rekha Chaudhary)      

                      Member                               Member