Punjab

Faridkot

CC/17/123

NIRMALJEET KAUR - Complainant(s)

Versus

BRANCH MANAGER L.I.C OF INDIA - Opp.Party(s)

RANJIT SINGH KAKKAR

31 Aug 2017

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :     123

Date of Institution: 7.04.2017

Date of Decision :   31.08.2017

 

Nirmaljeet Kaur wife of Jagsir Singh,s/o Gurdev Singh r/o  V Dhab Guru Ki, P.O. Koharwala, District Faridkot.                                           

                                                                                      ...Complainant

Versus

The Branch Manager, Life Insurance Corporation of India, Ferozepur Road, Faridkot.

                                                                        .............OP

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh. Ajit Aggarwal, President,

               Sh P Singla, Member.

 

Present: Sh R S Kakkar, Ld Counsel for Complainant,

              Sh Lakhwinder Singh, Ld Counsel for OP.

(Ajit Aggarwal, President)

                                                Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against  OPs seeking directions to OPs to make remaining payment of Rs. 2 lacs of insurance claim with interest alongwith instalments and for further directing OPs to pay Rs.50,000/- as compensation for deficiency in service and harassment alongwith litigation expenses of Rs.7,500/-.

2                                                        Briefly stated, the case of the complainant is that her husband purchased an Insurance Policy bearing no.132783627 dt 16.01.2009 for sum assured of Rs.2 lacs and he used to pay premiums of Rs.5,574/- every half yearly. As per terms and conditions of the policy, policy was payable on maturity or in case of death and in case of accidental death, double the amount of insurance value plus premiums already paid were to be paid to the nominee of the policy. It is submitted that husband of complainant died on 1.05.2016 in a motor vehicular accident and after his death, complainant being nominee of her husband lodged claim with OPs and also surrendered original policy alongwith copy of FIR, post-mortem report etc to OPs. Complainant completed all the formalities and submitted all the requisite documents with Ops to obtain the insurance claim. OP credited Rs.2 lacs in the account of complainant on account of insurance claim lodged by her and did not pay the remaining claim amount of Rs. 2 lacs + amount of instalments deposited by her deceased husband with OPs, which amounts to deficiency in service. Complainant has made several requests to OP to make payment of remaining insurance claim, but all in vain. They keep lingering on the matter on one pretext or the other, which amounts to deficiency in service and has caused harassment and mental tension to complainant. Complainant has prayed for directing the OPs to pay Rs.50,000/- as compensation alongwith litigation expenses besides the main relief. Hence, the complaint.

3                                                         The counsel for complainant was heard with regard to admission of the complaint and vide order dated 27.04.2017, complaint was admitted and notice was ordered to be issued to the opposite party.

4                                                        On receipt of the notice, the OP filed written statement wherein took preliminary objection that on the date of death of Jagsir Singh, the policy in question was lying in lapsed mode and thus as per terms and conditions of the Insurance Policy, Double Accident Benefit is not payable under the policy. However, on merits they have denied all the allegations of complainant being wrong and incorrect, but admitted before the Forum that deceased Jagsir Singh husband of complainant was insured with them and he was paying premiums of Rs.5,574/-every half yearly. Policy was payable on maturity or in case of death only. It is also admitted that after death of insured Jagsir Singh, his wife lodged claim with them and submitted all the requisite documents for obtaining insurance claim. Op averred that they admitted the insurance claim and their liability to pay the insurance claim on account of death of Jagsir Singh and duly paid the basic sum assured of Rs. 2 lacs to complainant. They credited Rs. 2 lacs in the account of complainant and now nothing is due towards them pertaining to insurance policy in question. It is further averred that Double Accident Benefit is not payable to complainant as at the time of death of Jagsir Singh husband of complainant, the policy in question was in lapsed condition and thus, as per terms and conditions of policy, Double Accident Benefit is not admissible. There is no negligence or deficiency in service on the part of OPs. All the other allegations and allegation with regard to relief sought too were refuted with a prayer that complaint deserves to be dismissed with costs.

5                                                        Parties were given proper opportunities to prove their respective case. Counsel for complainant tendered in evidence her affidavit Ex.C-1 and documents Ex C-2 to C-7 and then, closed their evidence.

6                                                         In order to rebut the evidence of the complainant, Counsel for OP tendered in evidence affidavit of C S Bhivani as Ex OP-1  and documents Ex OP-2 to 9 and then, evidence of OP was closed by order of this Forum.

7                                                        We have heard the ld counsel for complainant as well as OPs and have carefully gone through evidence and documents placed on record by respective parties.

8                                                         Ld Counsel for complainant vehementally argued that husband of complainant purchased an Insurance Policy from OP for sum of Rs.2 lacs and he used to pay premiums of Rs.5,574/- every half yearly. As per terms and conditions of the policy, policy was payable on maturity or in case of death and in case of accidental death, double the amount of insurance value plus premiums already paid were to be paid to the nominee of the policy. It is submitted that husband of complainant died on 1.05.2016 in a motor vehicular accident and after his death, complainant being nominee of her husband lodged claim with OPs and also surrendered original policy alongwith copy of FIR, post-mortem report etc to OPs. Complainant completed all the formalities and submitted all the requisite documents with OP to obtain the insurance claim. OP credited Rs.2 lacs in the account of complainant on account of insurance claim lodged by her and did not pay the remaining claim amount of Rs. 2 lacs + amount of instalments deposited by her deceased husband with OPs, which amounts to deficiency in service. Complainant has made several requests to OP to make payment of remaining insurance claim, but all in vain. It amounts to deficiency in service and has caused harassment and mental agony to complainant. She has prayed for accepting the present complaint.

9                                              To controvert the allegations of complainant, ld counsel for OP asserted that on the date of death of Jagsir Singh, the policy in question was lying in lapsed mode and thus as per terms and conditions of the Insurance Policy, Double Accident Benefit is not payable under the policy. OP have denied all the allegations of complainant being wrong and incorrect, but admitted before the Forum that deceased Jagsir Singh husband of complainant was insured with them and he was paying premiums of Rs.5,574/-every half yearly. Policy was payable on maturity or in case of death only. It is also admitted that after death of insured Jagsir singh, his wife lodged claim with them and submitted all the requisite documents for obtaining insurance claim. Op averred that by admitting the insurance claim and their liability to pay the insurance claim on account of death of Jagsir Singh, they have already paid Rs. 2 lacs as basic sum assured to  complainant and have credited the same in the account of complainant and now nothing is due towards them pertaining to insurance policy in question. Double Accident Benefit is not payable to complainant as at the time of death of husband of complainant, the policy in question was in lapsed condition and thus, as per terms and conditions of policy, Double Accident Benefit is not admissible. There is no negligence or deficiency in service on the part of OPs. All the other allegations are refuted with a prayer to dismiss the complaint.

10                         The case of the complainant is that husband of complainant purchased an insured policy for Rs. 2 lacs, who died in a motor accident and after his death, complainant being nominee duly completed all formalities and submitted requisite documents with them to obtain insurance claim. OP credited Rs.2 lacs in the account of complainant. Grievance of complainant is that OP have paid less amount to her because as per terms and conditions of the policy, policy was payable on maturity or in case of death and in case of accidental death, double the amount of insurance value plus premiums already paid were to be paid to the nominee of the policy. There is deficiency in service on the part of OP in not making payment of remaining Rs.2 lacs alongwith amount of premiums deposited by her husband. On the other hand, OP stressed mainly on the point that Double Accident Benefit is not payable to complainant as at the time of death of husband of complainant, the policy in question was in lapsed condition and thus, as per terms and condition no. 4 of policy, Double Accident Benefit is not admissible. The condition no. 4 of the policy is reproduced hereunder as “ Non Forfeiture Regulations: If after atleast two full years premiums have been paid and any subsequent premium be not duly paid, full death cover shall continue for a period of two years from the due date of first unpaid premium (FUP). This period of two years from FUP shall be called Auto Cover Period, the Life Assured can pay one or more instalments of premiums with interest without submission of any evidence of health. On payment of part or full arrears of premiums with interest, the Auto Cover Period of two years from the due date of new FUP shall again be available during the term of the policy.

Not withstanding what is stated above, if after at least three full years premiums have been paid in respect of this policy, any subsequent premium be not duly paid, this policy shall not be wholly void after the expiry of two years Auto Cover Period from the due date of first unpaid premium, but shall subsist as a paid up policy (excluding any extra/optional premium) less the survival benefits paid earlier, if any. This amount shall be called as Paid UP Value. This paid up value shall be payable on the date of expiry of policy term or at Life Assured’s prior death. No survival benefit shall be payable under paid up policies. The policy, thereafter, be free from all liabilities for payment of the within mentioned premiums.

The Accident Benefit Rider will cease to apply if the policy is in lapsed condition. During the Auto Cover Period, the Accident Benefit Rider shall not be available”.

OP admitted the claim and their liability to pay sum assured and therefore they have  already credited the amount of Rs.2 lacs in the account of complainant. There is no deficiency in service on their part and  have prayed for dismissal of complaint.

11                                            Ld Counsel for Ops argued that Jagsir Singh deceased husband of complainant paid last premium on 4.12.2015 which was due on July/15 and next premium was due in January/2016, but he did not pay the instalment of premium due in January, 2016 as such, his policy turned into lapse mode and still at the time of his death, the policy was in lapsed mode. As such, as per terms and conditions of the policy, the policy goes into Auto Cover Period and as per terms and conditions under the Auto Cover Period, the insured is only entitled for basic sum assured and not for other benefits admissible under the policy including accidental death rider. Accordingly, the OPs correctly settled the claim of complainant and paid Rs.2 lacs as basic sum assured to her and she is not entitled for anything more than this.

12                                      From the above discussion, we do not find any merit in the present complaint and we are of considered opinion that  as per terms and conditions of insurance policy, complainant is not entitled for Double Accident Benefit as at the time of death of her husband, policy in question was on lapsed mode and therefore, nothing more is admissible to her. Ops have already admitted their liability and paid the amount of Rs.2 lacs to complainant which is already admitted by her. Therefore, we do not find any merit in present complaint and hence, complaint in hand is hereby dismissed being devoid of any merits. Copy of order be given to parties free of cost under rules. File be consigned to record room.

Announced in Open Forum

Dated : 31.08.2017

                                                Member                   President

                                               (P Singla)              (Ajit Aggarwal)