Chandigarh

DF-I

CC/984/2022

RAM KARAN AGED ABOUT 70 YEARS S/O SH RAM RAKHA THROUGH SPECIAL POWER OF ATTORNEY KULDEEP CHAND AGED ABOUT 50 YEARS S/O SH RAM KARAN - Complainant(s)

Versus

BARTI AXA LIFE INSURANCE THOUGH MANAGER - Opp.Party(s)

PAWAN SHARMA & SHUBHAM SHARMA

04 Nov 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

                                     

Consumer Complaint No.	:	CC/984/2022
Date of Institution	:	20/12/2022
Date of Decision	:	4/11/2024

 

Ram Karan Since deceased through his LRs.

1. Kuldeep Chand S/o Late Sh. Ram Karan resident of H.No. 2080, Pipliwala Town, Manimajra, Chandigarh(UT).
2. Usha Rani D/o Late Sh. Ram Karan R/o Cholti, Kleri, Tehsil  and District Fatehgarh Sahib, Punjab.
3. Promila D/o late Sh. Ram Karan, resident of H.No.  1459, Phase-5, Mohali

Complainant

VERSUS

 

1.       Bharti Axa Life Insurance through Manager, S.C.O. 208-209, 2nd Floor, Sector-34-A, Chandigarh-160034.

2.       The Insurance Ombudsman, S.C.O. 103-104, 2nd Floor, Batra Building Sector-17-A, Chandigarh -160017.

 

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

 

                                                                               

ARGUED BY	:	Sh. Kuldeep Chand, Legal heir(a) of deceased complainant, also on behalf of legal heir (b&c) of the deceased for complainant
	:	Sh. Gaurav Bhardwaj, Advocate for OP No.1.
	:	None for OP No.2.

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by the complainant (now deceased)  against the opposite parties  (hereinafter referred to as the OPs). During the pendency of the complaint, the complainant (now deceased)  had expired and as such on filing an application by one of the legal heir of the complainant, this Commission vide order dated 8.11.2023 ordered to bring on record the legal heirs of the complainant(now deceased) on record. The brief facts of the case are as under :-
   1. It transpires from the averments as projected in the consumer complaint that  the wife of the complainant(now deceased) Smt. Nirmala Devi taken two policies from OP No.1  i.e. first policy  No.500-2531001  under the policy name Bharti AXA Life Insurance Future Confident and the second one having policy No. 500-2532132   i.e. Bharti AXA Life Insurance  SPOT Surksha (hereinafter referred to be as subject policies). The first policy was issued on 28.12.2008 with sum assured of Rs.1,79,991/-  with model premium of Rs.1000/-  and paid 165 installments upto 5.7.2022. At the time of purchase of the aforesaid first policy, the agent of OP No.1 namely Shaiinder Kumar had assured that the  insured will get an amount of Rs.18,07,758/- but in the policy bond the amount was mentioned as Rs.5,57,410/- only  in case of death.  However, the life insured died on 15.7.2022 and  the complainant (now deceased ) was entitled for Rs.18,07,758/-  out of which the OP No.1 had only paid an amount of Rs.3,52,979/- and  thereby paid less amount of Rs.14,54,779.As per policy bond Rs.5,57,410/-  was payable by the OP No.1 and even on  that account also the OP No.1 paid less amount of Rs.2,04,443/-. Similarly in the second policy, the sum assured was Rs.60,000/-  with annual modal premium of Rs.3852.78 with benefit upto age of 64 years and on the demise of the insured on 15.7.2022, the complainant was entitled to get an amount of Rs.1,15,460/-  but the OP No.1 had paid only Rs.85,372/-  and  an amount of Rs.30088/-  was also paid less by the OP No.1 to the complainant. In this manner OP No.1 has paid the less amount of Rs.14,54,779/- and Rs.30088/- in both the policies and the aforesaid act of OP No.1 amounts to deficiency in service. The complainant sent legal notice to OP No.1  but with no result. In this manner, the aforesaid act amounts to deficiency in service and unfair trade practice on the part of OP No.1. OP NO.1 was requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.
   2. OP No.1 resisted the consumer complaint and filed its written version, inter alia, taking preliminary objections of   maintainability, cause of action, concealment of facts and also that there is no deficiency of service on the part of the answering OP. However it is admitted that two subject policies were issued to the complainant but it was never assured by the OP No.1 that an amount of Rs.18,07,758/-  will paid to the complainant in case of accidental death as alleged by the complainant. It is further alleged that  in fact the entire amount which was payable to the complainant as per terms and conditions of the subject policies was paid and now nothing is payable by the answering OP. It is further averred that the answering OP received two separate duly signed proposal applications dated 26.12.2008, wherein the complainant proposed for two life insurance policies. Accordingly two policies i.e. Bharti AXA Future Confident bearing No. No.500-2531001  and Bharti AXA Life Save Confident  bearing No. 500-2532132   were issued to the complainant and both the policy documents  were dispatched to the complainant and the same was admittedly received by the insured  as the complainant(now deceased) himself placed on record both the policies as Annexure C-3 and C-4.  In the aforesaid policy documents the sum assured in the first policy Annexure C-3 is Rs.1,79,991/-  whereas an amount of Rs.60,000/- is the sum assured in the second policy Annexure C-4. It is averred that since the complainant has duly received the policy and did not cancel the policy within 15 days as per regulation 6(1) of IRDAI and continued  to pay the premium amount, the insured was bound by the terms and conditions of the subject policies.  The OP No.1 has paid the benefit of the subject policies to the complainant as per terms and conditions of the subject policies. On merits, the facts as stated in the preliminary objections have been re-iterated. The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
   3. OP No.2 in its short reply-cum-letter dated 31.1.2023 stated that it is not the interested party in the case in hand and had no role to play.  
   4. In rejoinder, complainant reiterated  the claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.
2. In order to prove their case, complainant and OP No.1 tendered/proved their evidence by way of affidavit and supporting documents. However, as OP No.2 failed to file evidence despite grant of sufficient opportunity, therefore, vide order dated 13.4.2023 of this Commission, opportunity to file the same was closed.
3. We have heard the Kuldeep chand one of legal heir of complainant and OP No.1 and also gone through the file carefully, including the written arguments on record.
   1. At the very outset, it may be observed that when it is an admitted case of the complainant and OP No.1 that the  life assured Nirmala Devi  had obtained  the subject policies from the OP No.1 as is also evident from Annexure C-3 C-4  with sum assured of Rs.1,79,991/- and Rs.60,000/-  respectively and on the death of the life assured the OP No.1 had already paid an amount of Rs.3,52,979/-, the case is reduced to a narrow compass as it is to be determined if  the OP No.1 has  paid less amount to the complainant i.e. less than the sum assured and the complainant is entitled for the relief as prayed for as is the case of the complainant or if the OP No.1 has already paid the amount as per terms and conditions of the subject policies and the complaint being false and frivolous is liable to be dismissed as is the defence of the OP No.1.
   2. In the back drop of the foregoing admitted and disputed facts on record, it is clear that the entire case of the parties is revolving around  Annexure C-3 and C-4 and in order to determine the real controversy between the parties the said documents are required to be scanned carefully.
   3. Perusal of first policy document Annexure C-3 bearing No. 500-2531001   indicates that  the same was issued under Bharti AXA Future Confident Plan and the death benefits are mentioned in Section 3 of the policy which are reproduced as under:-

“SECTION 3: POLICY BENEFITS 3.1) Death Benefit

On admission of the claim, upon the death of the Life Insured, during the Policy Benefit Period provided the Policy is in effect for the full Sum Assured, the Company will pay to the Nominee or to the Policyholder the sum of the:

• Sum Assured as specified in the Policy Specification; and

•Vested Reversionary Bonuses (If any); and

•Terminal Bonus (if any)

In case of the death of the Life Insured during the grace period of 30 days allowed for payment of due premium, the Death Benefit less the unpaid due premium shall be payable and the Policy will be terminated.”

 

4. Similarly in the  second policy bearing NO..500-2532132 i.e. "Bharti AXA Life Save Confident" plan, the death benefits are mentioned in Section 3 of the policy  which is reproduced as under: -

“SECTION-3 POLICY BENEFITS.

3.1 Death Benefit

On admission of claim upon death of the Life Insured, during the Policy Benefit Period, Death Benefit payable to the Nominee will be the higher of:

• The Policy Fund Value; or

• The Sum assured applicable at the time of death less all withdrawals (other than made out of Top Up Premium) made in accordance with the Partial Withdrawals provision of the Policy in the twelve months preceding the death of the Life Insured.

The payment of Death Benefit is made by cancellation of the outstanding Units under the Policy. For the cancellation of Units, the applicable Unit Price would be in accordance with the provisions contained in Section 6.2.

Provided that where the death of the Life Insured takes place before the Policy Anniversary Date, immediately after the Life Insured attaining the Age of 5 years, only the Policy Fund Value shall be payable to the Policyholder, irrespective of the Death Benefit.”

5. The first policy has acquired fund value of Rs.3,53,287.79, which was  higher than  the sum assured of Rs.1,60,000/- and under second policy  the accrued bonus was  of Rs.25,372 and sum assured amount was Rs.60,000/-. Thus it is clear that  OP No.1 has rightly assessed the fund value in case of first policy and the sum assured  for the second policy  of Rs.60,000/- alongwith bonus of Rs.25,372/-, which was paid to the complainant. Hence, it is unsafe to hold that there is any deficiency of service on the part of OP No.1 especially when there is no iota of evidence on record in order to prove that the agent of OP No.1 had assured that an amount of Rs.18,07,758/- will be paid to the insured for the first policy.

4. In the light of the aforesaid discussion, the present consumer complaint, being devoid of any merit, is hereby dismissed leaving the parties to bear their own costs.
5. Pending miscellaneous application(s), if any, also stands disposed off.
6. Certified copies of this order be sent to the parties free of charge. The file be consigned.

Announced 4/11/2024			[Pawanjit Singh] President
mp
			[Surjeet Kaur] Member
			[Suresh Kumar Sardana] Member