Chandigarh

DF-I

CC/590/2022

Suresh Devi - Complainant(s)

Versus

Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd. - Opp.Party(s)

Nirmal Singh Jagdeva

02 Feb 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

                                     

Consumer Complaint No.	:	CC/590/2022
Date of Institution	:	07/06/2022
Date of Decision	:	02/02/2024

Suresh Devi w/o late Sh. Prem Chand r/o H.No.4258, Maloya Complex, Chandigarh UT.

… Complainant

V E R S U S

1. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd., through its Managing Director, Regd. Office Unit No.208, 2^nd Floor, Kanchanjunga Building, 18 Bara Khamba Road, New Delhi 110001, India.
2. Canara HSBC Life Insurance Co. Ltd. through its Branch Manager, SCO No.3, First Floor Madhya Marg, Chandigarh
3. Canara Bank through its General Manager, Plot No.1, Circle Office, Sector 34-A, Chandigarh.
4. Paramjit Chaudhary, Officer Canara Bank, Plot No.1, Circle Office, Sector 34-A, Chandigarh. (deleted vide order dated 16.11.2022)
5. Nisha, Sales Executive, Canara HSBC Life Insurance Co. Ltd., SCO No.3, First Floor, Madhya Marg, Chandigarh.

… Opposite Parties

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

                                                                               

ARGUED BY	:	Sh. Nirmal Singh Jagdeva, Advocate for complainant
	:	Sh. Arjun Kundra, Advocate for OPs 1, 2 & 5
	:	Sh. Nitin Gupta, Advocate for OP-3
	:	OP-4 deleted vide order dated 16.11.2022

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Smt.Suresh Devi, complainant against the aforesaid opposite parties (hereinafter referred to as the OPs).  The brief facts of the case are as under :-

1. It transpires from the allegations, as projected in the consumer complaint, that the deceased husband of the complainant namely Sh.Prem Chand (hereinafter referred to as “DLA”) on 13.10.2018 had obtained insurance policy namely “Canara HSBC Oriental Bank of Commerce Life Insurance Easy Bima Plan” (hereinafter referred to as “subject policy”) with sum assured of ₹2,00,000/-, which was sold by OP-2 through OP-3/bank as the DLA was having his account with OP-3/bank and he had availed a personal loan of ₹5.00 lacs from the said bank.  The DLA had paid first premium of ₹15,402/-  vide receipt dated 13.10.2018 (Ex.C-1). Though the subject policy was availed by the DLA, but, he never told and discussed anything about the same to the complainant and she was totally unaware about the same till she visited the bank for clearance of dues after death of her husband/DLA, who unfortunately expired on 21.2.2022 due to sudden heart attack at night time and copy of death certificate is Ex.C-3.  At that time, the bank officials had disclosed about the details of the policy and one Ms. Paramjit told the complainant to contact Ms. Nisha (OP-5), sales agent of OPs 1 & 2 for more details.  Thereafter the complainant approached Ms. Nisha who after checking the record informed the complainant that her husband had already paid two installments of premium and the third installment of premium was not received and then she asked the complainant to pay the third installment and avail benefits of the policy. The complainant also informed aforesaid Ms.Nisha that she has not received the terms and conditions of the policy and requested to supply the same and also agreed to pay the 3^rd installment of premium.  Thereafter complainant was provided copy of policy in sealed cover and she also paid the premium of ₹15,402/- in cash to said Ms. Nisha. Thereafter, complainant submitted claim documents to OPs 1 & 2 with the help of OPs 4 & 5 by complying all the formalities for processing the death claim of her husband. However, on 15.4.2022 complainant received a message from the bank that an amount of ₹80,000/- has been credited in her bank account by the OPs by way of NEFT payment towards disbursement of the death claim. Copy of the bank statement is Ex.C-4. The complainant failed to understand on what basis OPs 1 & 2 had only paid an amount of ₹80,000/- in lieu of total sum assured of ₹2.00 lacs. The complainant sent a legal notice dated 9.5.2022 (Ex.C-5) to OPs, but, with no result. In this manner, the aforesaid act of the OPs amounts to deficiency in service and unfair trade practice. OPs were requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.
2. OPs resisted the consumer complaint and filed their separate written versions.
3. In their joint written version, OPs 1, 2 & 5, inter alia, took preliminary objections of maintainability, cause of action etc. It is alleged that, in fact, claim of the complainant was processed as per terms and conditions of the subject policy and by taking into consideration the fact that DLA had only paid two installments of premiums of ₹15,402/- each whereas the policy term was ten years and the premium payment term was five years.  Copy of policy document is Annexure OP-1.  It is further alleged that the complainant has made false allegation that she had deposited the third installment of premium after the demise of her husband i.e. DLA.  On merits, the facts as stated in the preliminary objections have been reiterated. The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
4. In its written version, OP-3, inter alia, took preliminary objections of maintainability and cause of action.  However, it admitted that the DLA had availed personal loan of ₹5.00 lacs from the answering OP and there is no privity of contract between the answering OP and the DLA qua the subject policy.  On merits, the facts as stated in the preliminary objections have been reiterated. The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
5. In view of the statement made by counsel for the complainant, name of OP-4 was deleted from the array of OPs vide order dated 16.11.2022.
6. In separate rejoinders, complainant re-asserted 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, contesting parties have tendered/proved their evidence by way of respective affidavits and supporting documents.
3. We have heard the learned counsel for the contesting parties and also gone through the file carefully, including written arguments.
   1. At the very outset, it may be observed that when it is an admitted case of the parties that the deceased husband of the complainant namely Sh. Prem Chand i.e. the DLA had obtained the subject policy from OPs 1 & 2 on payment of premium of ₹15,402/- on 13.10.2018, having policy term of 10 years with premium payment term of five years and sum assured of ₹2.00 lacs, out of which DLA had deposited two premium installments of ₹15,402/- each,  the case is reduced to a narrow compass as it is to be determined if the complainant had deposited the third installment of premium with OPs 1 & 2 through OP-5 and OPs 1 & 2 are unjustified in partially allowing the claim of the complainant to the extent of ₹80,000/- and not the sum assured of ₹2.00 lacs and the complainant is entitled to the reliefs prayed for in the consumer complaint, as is the case of the complainant, or if OPs 1 & 2 are justified in paying an amount of ₹80,000/- to the complainant, as per the terms and conditions of the subject policy, and the consumer complaint, being false and frivolous, is liable to be dismissed, as is the defence of the OPs.
   2. In the backdrop of the foregoing admitted and disputed facts on record, one thing is clear that the entire case of the parties is revolving around the terms and conditions of the subject policy (Annexure OP-1) and the same are required to be scanned carefully for determining the real controversy between the parties.
   3. The welcome letter (Annexure OP-1) issued by OP-1 in the name of the DLA gives the details of the policy and the relevant portion of the same is reproduced below for ready reference :-

Policy Number	0083883318	Premium Payment Mode	Annual
Plan Name	Canara HSBC Oriental Bank of Commerce Life Insurance POS - Easy Bima Plan	Premium Payment Term (Years)(PPT)	5
Policy Term (Years)	10	Maturity Date	13-10-2018
Age admitted	Yes	Next Premium Date	13-10-2019
Risk commencement date	13-10-2018	Last Premium Due Date	13-10-2022
Policy commencement date	13-10-2018	Installment Premium (Rs.)	15,402.00
Death Benefit Sum Assured	2,00,00.00	Return of Premium on date of Maturity	77,010.00
Accidental Death Benefit Sum Assured	2,00,00.00

      

4. It is the case of the complainant that the DLA (her husband) had deposited only two installments of premium of ₹15,402/- each with OPs 1 & 2, out of total five installments, and after the demise of her husband/DLA, she deposited the third installment of premium with OP-5 in cash and the complainant is entitled for the benefits in pursuance to total three installment of premiums deposited with OPs 1 & 2 and as OPs 1 & 2 have only refunded an amount of ₹80,000/-, out of the total sum assured of ₹2.00 lacs, complainant is entitled to the reliefs prayed for in the consumer complaint.
5. Since payment of third installment of premium by the complainant to OPs 1, 2 & 5 is disputed by the said OPs, hence onus to prove the payment of third installment heavily lies upon the complainant to prove that she ever paid an amount of ₹15,402/-  to OP-5 for the said purpose.
6. The learned counsel for the complainant admitted at the time of arguments that no receipt showing that third installment of premium was deposited by the complainant with the aforesaid OPs, is available with the complainant, making further clear that the complainant has failed to prove with the help of any documentary evidence that she ever had made the said payment.
7. Moreover, when it is the case of the complainant that she had approached OP-5 after the demise of her husband/DLA, even otherwise, there was no question of deposit of the third installment of the premium by her with OPs 1, 2 & 5 when the complainant, being nominee of the DLA, was entitled for the death benefits to the extent the DLA had deposited the premium amount.  Hence, it is unsafe to hold that the complainant paid/deposited the third installment of premium with OPs 1, 2 & 5 after the demise of DLA and safe to hold that only two installments of premiums were deposited by the DLA with the aforesaid OPs.
8. Coming to the next question i.e. with regard to death benefit, Part C of subject policy Schedule (Annexure OP-1 at page 18) deals with the same and the relevant portion of the same is reproduced below for ready reference :-

“1.2 Death Benefit :

        xxx                   xxx                   xxx

c) If Life Assured dies during the Policy Term while the Policy is in Paid-up State, We will pay the Paid-up Sum Assured as follows: Death Benefit Sum Assured * (Number of premiums paid/Total number of premiums payable during the Policy Term). However, in case claim is admitted as Accidental Death during the Policy Term, while Policy is in Paid-up State, We will pay Paid-up Sum Assured and an additional benefit equal to Paid-up Accidental Death Benefit Sum Assured as follows: Accidental Death Benefit Sum Assured * (Number of premiums paid/Total number of premiums payable during the Policy Term). On payment of this benefit, the Policy shall terminate and no further benefit shall be payable.”

9. Thus, one thing is clear from the aforesaid clause 1.2 that the policy itself contains the manner in which death benefit is to be paid to the DLA or his/her nominee.  The first part of the same deals with the amount payable on maturity of the policy whereas the second part of the same deals with the accidental death benefits, sum assured and finally the third part i.e. (c) of the same deals with the case where the life assured dies during the policy term while the policy is in paid up state.
10. In the case in hand, admittedly two premium installments to the tune of ₹15,402/- each have been paid by the DLA with the insurer and as per afore-extracted clause (c), insurer will pay Paid-up Sum Assured as follows : “Death Benefit Sum Assured * (Number of premiums paid/Total number of premiums payable during the Policy Term)”.  
11. Since it is an admitted case of the parties that as per the subject policy, death policy benefit sum assured is ₹2,00,000/- and it has also come on record that only two premiums have been paid and the total number of premiums payable during the policy term were five, it is clear that the complainant, being nominee of DLA, was entitled to the amount of ₹2,00,000/- x 2/5 = ₹80,000/-. 
12. Further, when it is an admitted case of the parties that OPs 1 & 2 have already paid the aforesaid amount to the complainant, as per the terms and conditions of the subject policy, we are of the opinion that the complainant has failed to prove any deficiency in service or unfair trade practice on the part of the OPs and she is not entitled to any relief.

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 of accordingly.
6. Certified copies of this order be sent to the parties free of charge. The file be consigned.

02/02/2024 hg	Sd/- [Pawanjit Singh] President
	Sd/- [Surjeet Kaur] Member
	Sd/- [Suresh Kumar Sardana] Member