IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MURSHIDABAD AT BERHAMPORE.
CASE No.CC/106/2013
Date of Filing: 26.08.13 Date of Final Order:13.12.18
Complainant: Anuradha Gupta
w/o Rathiranjan Gupta
88, S.N. Sen Road, PO-Khagra,
PS-Berhampore,
Dist-Murshidabad
-Vs-
Opposite Party: 1. Branch Manager,
Tata AIG Life Insurance Company Ltd.
Now named Tata AIA Life Insurance Company Ltd.
Sahid Surya Sen Road,
PO&PS-Berhampore,
Dist-Murshidabad
2. Branch Manager,
Tata AIG Life Insurance Company Ltd.
Now named Tata AIA Life Insurance Company Ltd.
Gopal Bhaban, 37, Parbirhata,
G.T. Road, Near Joy Electronic,
PO&PS-Burdwan, Pin-713101
Agent/Advocate for the Complainant : 1.Sri. Motiul Islam
2. Sri. Sumanta Roy
Agent/Advocate for the Opposite Parties: Sri. Siddhartha Sankar Dhar
Present: Sri Asish Kumar Senapati…………………........President.
Smt. Aloka Bandyopadhyay……………………..Member.
FINAL ORDER
ASISH KR. SENAPATI, PRESIDING MEMBER.
This is a complaint under section 12 of the CP Act, 1986.
One Anuradha Gupta (here in after referred to as the Complainant) filed the case against Branch Manager, Tata AIG Life Insurance Company Ltd and another (here in after referred to as the OPs) praying for compensation alleging deficiency in service.
The sum and substance of the complaint case is as follows
That one Sefali Sain took a policy being No.U022599573 under Tata AIG Life Investment with a hope to get the benefit of the policy for a term of 30 days commencing from 28.06.09 and the sum assured was Rs.4,99,500/- including bonus and other benefits in addition to the risk of life of full payment in case of death of the life insured through the substantiates of policy and the Complainant is the nominee of the said policy. Sefali Sain paid yearly premium @ 99,000/- per month for 3 years and she died on 13.03.12 due to cardio respiratory failure leaving behind her daughter, the Complainant , as her only legal heir. The Complainant informed the OP about death of the insured and submitted a claim of Rs.4,99,500/- including other benefits payable under the said policy in prescribed form but the OPs denied to make payment of Rs.4,99,500/- including other benefits on the plea of lapsed policy. The OPs never intimated the Complainant that the policy would not be survived or the sum would be lapsed in the event of non-payment of premium. There was no scope of non-payment of premium , in case earlier intimation was given for payment of premium, as there was sufficient amount of Sefali Sain in her Bank Account. The Complainant requested the OPs to pay the due amount but the OPs illegally settled the claim at a sum of Rs.37,771.51/-. The settlement of the claim as settled by the OPs is not in accordance with their rules for which the Complainant has not received the said amount. Ultimately, the Complainant is filed the case praying for direction upon the OPs to pay a sum of Rs.79,9,500/- together with interest and the other benefits payable under the policy and a sum of Rs.15,000/- towards mental pain, agony and cost of litigation.
The OPNo 1 put his appearance through an advocate on 31.12.13 and filed written version on 01.04.14, inter alia, denying the material allegations made out in the complaint, contending, that one Sefali Sain had a policy being No. U022599573 for a term of 30years with annual premium payable @99,900/-. It is the specific case of the OP No.1 that the life assured paid 3 premiums but failed and neglected to pay the premium which was payable by 28.06.12. A notice for premium payment was issued on 29.05.12 but the policy was lapsed due to non-payment of premium dated 28.06.12, as per terms and conditions of the policy. On 17.10.12, the OPs received a death claim from the Complainant, being the nominee of the life assured intimating that the life assured died on 1308.12. The policy of Sefali Sain falls under premium holiday. According to premium holiday ‘After payment of atleast three complete years of regular premium, if you failed to pay the regular premium as due, this policy will be maintained in force on premium holiday automatically without paying the regular premium and the policy charges and any other costs will be paid as due by deduction of units at unit price from the total fund value of the policy until the earlier of –
- The total fund value is insufficient to cover the policy charges and cost payable;
- The surrender value false below an amount equivalent to one annual regular premium; or
- Two years from the due date from the first unpaid regular premium unless we have received your written request to continue with the automatic deduction, subject to condition (i) and (ii);
The policy will lapse upon occurrence of condition (i) and (ii) and any remaining total fund value subject to deduction of surrender charge, will be paid ’
In view of the clause as stated above the policy get auto surrendered due to non-payment of premium prior to death of the life assured. In the present policy, the surrendered value fell below one regular annual premium and as such the OP No.1 sent the amount of surrendered value to the Complainant on 26.09.12 vide cheque No.965839 amounting Rs.37,771.51/-. The claim of the Complainant is baseless and speculative. There is no deficiency in service on the part of the OPs. The OPs have prayed for dismissal of the complaint.
The O.P. No.2 did not turn up in spite of service of notice on 20.12.13 as per Postal A/D but one Anupam Halder, Assistant Manager,Legal, East Zone of Tata AIA LIC Ltd filed evidence on behalf of the OPs..
On the basis of the above version the following points are framed for proper adjudication of the case :
Points for consideration
1. Isthe Complainant a consumer under the provision of the CP Act, 1986?
2. Has this Forum jurisdiction to entertain the complaint?
3. Have the OPs any deficiency in service, as alleged?
4. Is the Complainant entitled to get any relief, as prayed for?
Point no.1
The Ld. Advocate for the Complainant submits that the Complainant is a consumer as she is the nominee of Sefali Sain who hired services of the OPNo.1 for consideration.
The Ld. Advocate for the OPNo.1 submits that the Complainant is not a consumer. On going through the complaint, written version and other materials on record and on a careful consideration over the submission of both sides, we find that the Complainant is a consumer in terms of section 2 (I )(d) (ii) of the C.P.Act, 1986.
Point No.2
The Complainant submits that the cause of action arose within the territorial jurisdiction of this Forum and the claimed amount is also within pecuniary limit of the District Forum.
On a careful consideration over the materials on record, we find that the cause of action arose within the territorial jurisdiction of this Forum and this Forum has pecuniary jurisdiction to entertain the complaint.
Point Nos.3&4
The Ld. Advocate for the Complainant submits that Sefali Sain paid 3 yearly premiums @ Rs.99,900/- but the OPs have settled the claim at Rs.37,771.51/- which is absurd and baseless. It is argued that the OP No.1 has not intimated the basis of calculation and the intimation letter dated 29.11.12 as to calculation for settling the claim at Rs.37,771.51/- is not understandable. It is submitted that the OPs have deficiency in service and the OPs may be directed to settle the claim in terms of the condition of the policy. It is further argued that there was no scope for non-payment of the last premium from the life time of the life assured as she had sufficient fund in her Bank Account. It is further argued that Sefali Sain had not received any demand notice intimating her about date of payment of premium by 28.06.12. He argues that the Complainant has been able to establish that the OPs have deficiency in service and the Complainant is entitled to get reliefs including compensation and cost of litigation.
In reply, the Ld. Advocate for the OPNo.1 submits that Sefali Sain (life assured) died on 13.08.12 but her last annual premium payable by 28.06.12 was not paid. It is contended that the premium payment notice (Annexure-C) was issued to Sefali Sain on 29.05.12 but Sefali Sain did not pay her annual premium by 28.06.12. It is further argued that according to the terms of the policy, the policy was lapsed due to non-payment of premium and the present policy falls under premium holiday. It is argued that the settlement of the claim at Rs.37,771.51/- is in accordance with the terms and conditions of the policy.
We have gone through the materials on record and we have also considered the submission of both sides. Admittedly, one Sefali Sain had a policy under the OP No.1 for a term of 30 years with effect from 28.06.09 to 28.06.39 and annual premium was @ 99,900/-.
Admittedly, Sefali Sain paid 3 yearly installments and she failed to pay the annual installment payable by 28.06.12 during her life time. The Complainant has stated in her written complaint that Sefali Sain died on 13.03.12 but it appears from Annexure-F submitted by the OPs that Sefali Sain died on 13.08.12.
The Ld. Advocate for the Complainant has argued that Sefali Sain had sufficient fund in her Bank Account on 28.06.12 and there was no scope for non-payment of premium payable by 28.06.12.
We find no basis in the argument placed by the Ld. Advocate for the Complainant in connection of payment of premium as the Complainant has failed to produce any document showing that Sefali Sain gave any mandate for deduction of her premium from her Bank Account. Therefore, it can be safely held that the policy had been lapsed due to non-payment of yearly premium by the life assured. We also find logic in the argument of the Ld. Advocate for the OP No.1 that the policy falls under auto surrender as the policy has been lapsed due to non-payment of premium. Now it is to be considered whether the settlement of the claim at Rs.37,771.51/- dated 29.11.12 is in accordance with the terms and condition of the policy or not.
Admittedly, the OP No.1 received death claim from the Complainant on 17.10.12 [ Para 5(f) of the written version of the OP No.1 and Annexure-D]. It is not understood why the OP No. 1 issued the letter along with a cheque amounting Rs.37,771.51/- in the name of Sefali Sain who died on 13.08.12 and death claim was filed on 17.01.12 i.e. long before the date of the issuance of the letter dated 29.11.12. According to the terms and conditions of the policy and according to the letter dated 29.11.12(Annexure-G), the policy has been auto surrendered and remaining payable amount is total fund value minus surrender charge. In the present case, the OPs have not stated in the letter dated 29.11.12 that the total fund value and its calculation and the surrender charge. We find that the OPs are duty bound to inform the customers about the basis of their calculation by giving facts and figures and it is very difficult to consume that the Tata AIG Life Insurance Company Ltd. has no deficiency in service in spite of the fact that they issued the notice and the cheque in the name of the dead person specifically knowing that the life assured Sefali Sain was dead.
Considering the facts and circumstances, we find that the Complainant has been able to establish the fact that the OP No. 1 has deficiency in service. We think that the OP No.1 may be directed to settle the claim of the Complainant in accordance with the terms and conditions of the policy by specifying the total fund value and basis of calculation, surrender charges with basis of calculation and payable amount to the Complainant within a period of 30 days. We also think that the OP No.1 may also be directed to pay Rs.10,000/- for deficiency in service and Rs.5,000/- for litigation cost to the Complainant.
Reasons for delay
The Case was filed on 26.08.13 and admitted on 12.12.13 . This Forum tried its level best to dispose of the case as expeditiously as possible in terms of the provision under section 13(3A) of the CP Act,1986. Delay in disposal of the case has also been explained in the day to day order.
In the result, the Consumer case succeeds.
Fees paid are correct. Hence, it is
Ordered
that the complaint Case No.CC/106/2013 be and the same is hereby allowed on contest against the OP No.1 with litigation cost of Rs. 5,000/- and dismissed against the O.P. No.2 without cost.
The OP No. 1 be directed to settle the claim of the Complainant in accordance with the terms and conditions of the policy by specifying the total fund value and basis of calculation, surrender charges with basis of calculation and payable amount to the Complainant within a period of 30 days. The O.P. No. 1 is directed to pay the settled amount to the Complainant within 60 days from the date of this order.
The OP No.1 is also directed to pay Rs.10,000/- for deficiency in service and Rs.5,000/- for litigation cost to the Complainant by 60 days from the date of this order.
Let plain copy of this order be supplied free of cost, to each of the parties / Ld. Advocate/Agent on record, by hand /by post under proper acknowledgment as per rules, for information and necessary action.
The Final Order will also be available in the following Website:
confonet.nic.in
