Punjab

Sangrur

CC/600/2014

Gulawanti - Complainant(s)

Versus

Birla Sun LIC - Opp.Party(s)

Shri S.S. Ratol

01 Jun 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

 

                                                Complaint No.    600

                                                Instituted on:      04.11.2014

                                                Decided on:       01.06.2015

 

Gulawanti aged about 60 years wife of Mohan Lal son of Shri Udhay Ram, resident of Ward No.2, VPO Cheema, Tehsil Sunam, District Sangrur.

                                                        ..Complainant

                                        Versus

1.             Birla Sun Life Insurance Company Limited, SCO 131, Cabin No.F-3, 1^st Floor, Chhoti Baradari, Patiala through its Branch Manager.

2.             Birla Sun Life Insurance Company Limited, Registered Office: One Indiabulls Centre, Tower 1, 15&16 Floor, Jupinter Mill Compound, 841, Senapati Bapat Marg, Elphinestone Road, Mumbai-400013 through its Managing Director.

                                                        ..Opposite parties

 

For the complainant    :       Shri S.S.Ratol, Adv.

For OPs                    :       Shri Amit Goyal, Adv.

 

 

Quorum:    Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Gulawanti,  complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that son of the complainant Shri Surinder Kumar obtained the services of the Ops by getting himself insured  under policy bearing number 003041675 for Rs.2,50,000/- and the complainant was the nominee under the policy. It is further averred that the nominee was entitled to get the amount in double in case of accidental death of the life assured.  It is further stated that on 21.5.2012, the son of the complainant Shri Surinder Kumar (referred to as DLA in short) took wrong medicines and as a result of which his condition was deteriorated and was immediately taken to Amrit Hospital, Mansa and on the next day, he was taken to Rajindra Hospital, Patiala, but he died on the way, of which DDR number 13 dated 22.5.2012 was lodged at PS Cheema.  The post-mortem of the deceased was also conducted at Civil Hospital, Sunam.  Thereafter, the complainant lodged the claim with the Ops and submitted all the relevant documents, but the Ops released only the amount of Rs.2,56,600/- on account of natural death on 5.1.2013, but did not pay the accidental benefits to the complainant.  As such, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.2,50,000/- along with interest @ 18% per annum and further claimed compensation and litigation expenses.

 

2.             In reply, preliminary objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no cause of action to file the complaint, that the policy in question is unit linked insurance policy, whereby the investment is made through share market for profit and gains.  It is stated that Shri Surinder Kumar, DLA had submitted to the OPs a proposal/application on 24.6.2009 for the purchase of BSLI Dream Plan and in the said plan the policy premium was Rs.11,998/- per annum, policy term was 20 years and premium paying term was 20 years and the sum assured was Rs.1,62,840/- and maturity benefit Rs.2,76,000/-. It is stated that the DLA had not opted for any enhanced sum assured or any accidental rider.  It is stated that after receipt of the death claim, it was examined by the Ops and a cheque of Rs.1,88,844.70 i.e. Rs.1,62,840/- as basic sum assured and Rs.26004.70 as guaranteed fund value in the terms of the policy documents were sent to the complainant.  It is stated further that since there was no accidental rider in the policy, therefore, she is not entitled to any accidental benefits.  Any deficiency in service on the part of the OPs has been denied.

 

3.             The learned counsel for the complainant has produced Ex.C-1  affidavit, Ex.C-2 copy of DDR, Ex.C-3 copy of payment receipt, Ex.C-4 copy of legal notice, Ex.C-5 to Ex.C-6 copies of postal receipts, Ex.C-7 copy of PMR, Ex.C-8 copy of death certificate and closed evidence. On the other hand, the learned counsel for the Ops has produced Ex.OP-1 affidavit, Ex.OP-2 copy of authority letter/ declaration of power, Ex.OP-3 copy of proposal form, Ex.OP-4 copy of policy, Ex.OP-5 copy of letter dated 31.10.2012, Ex.OP-6 copy of cheque and closed evidence. 

 

 

4.             We have very carefully perused the pleadings of the parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits dismissal, for these reasons.

 

5.             It is an admitted fact between the parties that son of the complainant Shri Surinder Kumar, DLA got himself insured under the policy number 003041675 with the Ops for Rs.2,50,000/-.  It is also not in dispute that the DLA died on 22.5.2012. Further it is not in dispute that the post-mortem on the dead body of the DLA was performed at Civil Hospital, Sunam.  It is also not in dispute that the complainant lodged DDR number 13 dated 22.5.2012 with the PS Cheema.

 

6.             Further it is admitted case of the parties that the complainant being the nominee has received the amount of Rs.2,56,600/- on account of natural death of the DLA from the Ops.  But, the complainant has filed the present complaint only to claim an amount of Rs.2,50,000/- on account of accidental benefits, as the DLA had died an accidental death due to consumption of wrong medicine.  The complainant has also got served a legal notice upon the OPs for payment of Rs.2,50,000/- on account of accidental benefits, but nothing was paid by the Ops to the complainant.  Whereas the stand of the Ops is that the DLA was not covered under any rider benefit of accidental benefits under the policy in question, as such no claim has been paid under the rider benefit of accident.   Now, the only question which arises for determination before us is whether the complainant is entitled to claim the accidental benefits under the policy or not from the OPs.

 

 

7.             We have very carefully perused the whole case file and find nothing on record that the OPs are liable to pay any amount on account of accidental rider, as there is no accidental rider clause in the policy. Moreover, the complainant has not produced any documentary evidence to show that the complainant is entitled to get the accidental benefits of Rs.2,50,000/- from the Ops.  To support such a contention, the Ops have produced Ex.OP-1 affidavit of one Ms. Aakriti Manocha, Assistant Manager, Legal of the OPs, wherein it has been clearly mentioned that the DLA had not opted for any enhanced sum assured or any accidental rider.  It is on the record that the Ops have already paid the natural death claim vide cheque number 467300 dated 31.10.2012 to the complainant. Under the circumstances, we find that the Ops have already paid the rightful claim to the complainant and further find that the complainant is not entitled to any more claim under the accidental rider.  Moreover, the complainant has miserably failed to produce on record any such policy clause entitled him to get the claim under the accidental rider.

 

8.             In view of our above discussion, we find no merit in the complaint and the same is dismissed. However, the parties are left to bear their own costs.  A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                June 1, 2015.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                                (K.C.Sharma)

                                                                    Member

 

                                                          

                                                                (Sarita Garg)

                                                                   Member