Haryana

Karnal

CC/112/2020

Seema - Complainant(s)

Versus

DHFL Pramerica Life Insurance Company Limited - Opp.Party(s)

Sanjeev Kumar

17 Nov 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 112 of 2020

                                                        Date of instt.19.02.2020

                                                        Date of Decision:17.11.2022

 

Smt. Seema wife of late Shri Ashok son of Shri Kalu Ram, resident of Peepalwali Gali, Kishanpura, District Panipat.

                                               …….Complainant.

                                              Versus

 

DHFL Pramerica Life Insurance Company Limited, through its Branch Manager, 2^nd floor, SCO no.227 Sector 12, Urban Estate, Karnal.

 

                                                                      …..Opposite Party.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Sanjeev Kumar, counsel for the complainant.

                    Shri Akshat Sharma, counsel for the opposite party.

 

                    (Jaswant Singh President)

ORDER:   

                

                 The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that husband of complainant namely Ashok had taken the Life Insurance Policy from the OP, vide policy no.00545291 in the year 2017 for a sum of Rs.3,57,500/- and the yearly installment was fixed as Rs.33,576/-. In the year 2017 the husband of the complainant paid the premium of Rs.35,046/- on 27.11.2017 for one year. Thereafter, husband of complainant could not deposit the installment with the OP due to some unavoidable circumstances in the family. In the month of 2019, the husband of complainant renewed the said policy by depositing the amount of Rs.34,300/- as installment with the OP and the said policy was renewed by the OP. On 29.05.2019 the husband of complainant died due to heart attack. After the death of her husband, complainant  being nominee approached the office of OP and intimated regarding the death of her husband and submitted the death claim. After waiting a long period the complainant received a letter dated 21.08.2019 and complainant shocked to know that her claim has been repudiated and only Rs.4875/- was refunded to the complainant as final settlement for policy no.00545291. Thereafter, complainant approached the OP several times and requested to settle the claim but OP did not pay any heed to the request of the complainant. In this way there is deficiency in service on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objection with regard to maintainability; cause of action and concealment of true and material facts. On merits, it is pleaded that Late Mr. Ashok (deceased life insured) himself applied for insurance policy by submitting proposal form alongwith KYC documents with the OP and on the basis of proposal form the policy in question was issued. It is further pleaded that in order to take the benefit of the insurance coverage the deceased life assured was supposed to make the payment of renewal premium on annual basis, however, the DLI knowingly and willfully escaped from making payment of the renewal premium not only by the due date but within the grace period also. Consequently, as per terms and conditions of the policy the policy lapsed on 30.12.2018. Thereafter, deceased life assured died on 29.05.2019 and insurance claim was lodged with OP on 18.07.2019. the complainant had confirmed and the date of death was 29.05.2019 and time of death was 2.00 p.m. in the claim form submitted by the complainant. On receipt of intimation regarding the death of life assured, the claim was evaluated to verify the veracity of the claim. On the basis of available record and after evaluation of claim documents, it was decided to repudiate the claim, vide repudiation letter dated 21.08.2019 because the policy was not in force at the time of death of life assured. The claim of the complainant was repudiated and an amount of Rs.4875/- was credited in the bank account of the complainant on 21.08.2019. Since the policy was lapsed and the grace period also expired on 30.12.2018, therefore, as per terms and conditions of the insurance policy the liability of the OP shall be limited to refund of 15% of the premium received. It is further pleaded that on 29.05.2019 Mr. Surjeet visited the office of OP and made entry in the visitor entry register at the branch at 3.12 p.m. and exit entry at 3.25 p.m. and also signed the said register. In order to play fraudulently the premium in respect to the subject policy was paid in cash on 29.05.2019 at 3.12 p.m. by somebody named Mr. Surjeet on behalf of the policyholder; despite of the fact that the policyholder was already died at 2.00 p.m. on 29.05.2019 i.e. just 1 hour 12 minutes prior to deposit of premium for revival. Since the policyholder died on 29.05.2019 at 2.00 p.m. as per the claim form, when the insurance policy was not in force and the premium for revival was deposited by Mr. Surjeet on behalf of the policyholder after the death of policy holder at 3.12 p.m. on 29.05.2019. It is further pleaded that on the basis of the premium received in cash on 29.05.2019 from Mr. Surjeet on behalf of policyholder, the policy was revived by the OP with effect from 31.05.2019, vide revival letter dated 02.06.2019. However, lateron the death claim was lodged on 18.07.2019 and it came to light the policy was paid exactly on the date of death of the policyholder in order to gain unlawfully and to cause unlawful loss to the OP. Hence, the OP is justified and lawfully repudiated the claim of the complainant.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of proposal deposit acknowledgement receipt Ex.C1, copy of smart income certificate Ex.C2, copy of acknowledgement receipt Ex.C3, copy of application form Ex.C4, copy of claim disbursement Ex.C5, copy of death certificate of Ashok Ex.C6, copy of Aadhar card of complainant Ex.C7 and closed the evidence on 16.03.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Mr.Parmal Singh Manager Ex.OP1/A, copy of authority letter Ex.OP1, copy of proposal form Ex.OP2, copy of insurance policy Ex.OP3, copy of death claim form Ex.OP4, copy of repudiation letter dated 21.08.2019 Ex.OP5, copy of register entry and receipt dated 29.05.2019 Ex.OP6, copy of revival letter dated 02.06.2019 Ex.OP7 and closed the evidence on 03.02.2022 by suffering separate statement.

6.             We have heard the learned counsel for the parties and have gone through the record available on the file carefully.

7.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that husband of complainant namely Ashok had taken the Life Insurance Policy from the OP in the year 2017 for a sum of Rs.3,57,500/- and the yearly installment was fixed as Rs.33,576/-. In the year 2017 the husband of the complainant paid the premium of Rs.35,046/- on 27.11.2017 for one year. Thereafter, husband of complainant could not deposit the installment with the OP due to some unavoidable circumstances in the family. In the month of May 2019, the husband of complainant renewed the said policy by depositing the amount of Rs.34,300/- as installment with the OP and the said policy was renewed by the OP. On 29.05.2019 the husband of complainant died due to heart attack. After the death of her husband, complainant being nominee submitted the death claim with the OP but OP did not pay the claim and repudiated the same, vide letter dated 21.08.2019 on the false and frivolous ground and only Rs.4875/- was refunded to the complainant and prayed for allowing the complaint.

8.             Learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that on 29.05.2019 Mr. Surjeet visited the office of OP and made entry in the visitor entry register at the branch at 3.12 p.m. and exit entry at 3.25 p.m. and also signed the said register. The premium of the policy in question was paid in cash on 29.05.2019 at 3.12 p.m. Mr. Surjeet on behalf of the policyholder; despite of the fact that the policyholder was already died at 2.00 p.m. on 29.05.2019 i.e. just 1 hour 12 minutes prior to deposit of premium for revival. Since the policyholder died on 29.05.2019 at 2.00 p.m. as per the claim form, when the insurance policy was not in force and the premium for revival was deposited by Mr. Surjeet on behalf of the policyholder after the death of policy holder at 3.12 p.m. on 29.05.2019. On the basis of the premium received in cash on 29.05.2019 from Mr. Surjeet on behalf of policyholder, the policy was revived by the OP with effect from 31.05.2019, vide revival letter dated 02.06.2019. The death claim was lodged on 18.07.2019. He further argued that the claim of the complainant was repudiated and an amount of Rs.4875/- was credited in the bank account of the complainant on 21.08.2019. Since the policy was lapsed and the grace period also expired on 30.12.2018, therefore, as per terms and conditions of the insurance policy the liability of the OP shall be limited to refund of 15% of the premium received and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the husband of complainant purchased the policy in question in the year 2017 and the date of commencement was 30.11.2017. It is also admitted the complainant is the nominee in the said policy.  It is also admitted that the coverage sum assured life was Rs.3,57,500/- and mode of payment was annual. It is also admitted that the policy in question has been lapsed on 30.12.2018 for non-payment of premium amount. It is also admitted that the life assured expired on 29.05.2019.  It is also admitted that an amount of Rs.4875/- was credited by the OP in the bank account of complainant.

11.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.OP5 dated 21.08.2019 on the ground that life assured expired on 29.05.2019 and policy was already lapsed on date of death. Renewal premium was due on 30.11.2018 and renewal premium was not received and policy moved to lapse after completion of grace period on 30.12.2018. Policy was lapsed on the date of death and lapsed benefit amount is payable as per policy terms and conditions of the policy. 15% premium paid of Rs.4875/- is being refunded towards final settlement for the policy.

12.           As per version of the OP, on 29.05.2019 Mr. Surjeet visited the office of OP and made entry in the visitor entry register at the branch at 3.12 p.m. and exit entry at 3.25 p.m. and also signed the said register. The premium of the policy in question was paid in cash on 29.05.2019 at 3.12 p.m. by Mr. Surjeet on behalf of the policyholder; despite of the fact that the policyholder had already died at 2.00 p.m. on 29.05.2019 i.e. just 1 hour 12 minutes prior to deposition of premium for revival of policy. Since the policyholder died on 29.05.2019 at 2.00 p.m. as per the claim form and at that time the insurance policy was lapsed mode. To prove its version, OP has relied upon the visitor register. On perusal of the said register it reveals that said Surjeet has entered in the office of the OP at about 15.12 and exit out 15.25. The abovesaid entry register also bears the signature of said Surjeet as well as of all the other visitors. It is also evident from the death intimation form Ex.OP4 dated 18.07.2019 life assured expired on 29.05.2019 at 2.00 p.m. The premium was deposited after his death and at the time of death the policy in question was in lapsed mode. Hence, it has been proved on file that complainant has got renewed the policy in question after the death of life assured just to get the benefit of the claim.

13.           Thus, in view of the above, the present complaint is devoid of any merits and deserves to be dismissed and same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:17.11.2022.                                                                    

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

 

       

                (Dr. Rekha Chaudhary)                                                      

               Member

 

 

Sushma

Stenographer