Haryana

Sonipat

CC/63/2015

JAI GOPAL S/O HUKAM CHAND - Complainant(s)

Versus

FUTURE GENERALI INDIA LIFE INSURANCE CO. LTD. - Opp.Party(s)

KULDEEP PANWAR

21 Apr 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

SONEPAT.

 

 

Complaint No.63 of 2015

Instituted on: 03.03.2015                 

Date of order: 21.04.2016

 

Jai Gopal son of Hukam Chand, r/o Nand Lal Wali Gali No.1, Ward no.1, Gohana, tehsil Gohana, distt. Sonepat.

 

…Complainant.           Versus

Future Generali India, Life Ins. Co. Ltd., Ist Floor, Plot no.401-402, Delhi road, Model Town, Rohtak, Haryana, through its Branch Manager.

                                      …Respondent.

 

COMPLAINT UNDER SECTION 12 OF

THE CONSUMER PROTECTION ACT,1986

 

Argued by:Sh.Kuldeep Parmar Advocate for complainant.

          Smt. Kamlesh Khatri, Adv. for respondent.

 

Before    :Nagender Singh-President. 

          Prabha Wati-Member.

         

 

O R D E R

 

          Complainant has filed the present complaint against the respondent therein that Pankaj Kumar, son of the complainant was insured with the respondent vide policy no.00158208 for Rs.2,75,000/- with double accident benefit.  But unfortunately on 9.10.2014 Pankaj Kumar had expired in a road accident.  The complainant visited the office of the respondent and intimated regarding the accidental death of Pankaj Kumar and requested for the release of the sum assured with double accidental benefit, but of no use.  Even the legal notice dated 26.12.2014 has not brought any fruitful result and that amounts to a grave deficiency in service on the part of the respondent. So, he has come to this Forum and has filed the present complaint.

2.        In reply, the respondent has submitted that there is no deficiency in service on the part of the respondent.  The respondent has duly settled the death claim of the complainant by paying the basic sum assured as per terms and conditions of the policy.  The accidental death benefits were not paid since the policy was in a lapsed mode as on the date of the life assured (9.10.2014) since the life assured had failed to pay the renewal premium falling due on 19.6.2014 and hence the accidental death benefit was not payable by the respondent to the complainant.  The complainant was informed that basic sum assured of Rs.2,75,000/- was directly transferred to the complainant’s account via NEFT Transaction dated 8.4.2015 in full and final settlement of the claim under the subject policy.  Thus, it cannot be said that there was any kind of deficiency in service on the part of the respondent and the complainant is not entitled for any relief and compensation and thus, prayed for the dismissal of the present complaint.

3.        We have heard the learned counsel for both the parties at length.  All the documents have been perused very carefully and minutely.

         Ld. Counsel for the complainant that Pankaj Kumar, son of the complainant was insured with the respondent vide policy no.00158208 for Rs.2,75,000/- with double accident benefit.  But unfortunately on 9.10.2014 Pankaj Kumar had expired in a road accident.  The complainant visited the office of the respondent and intimated regarding the accidental death of Pankaj Kumar and requested for the release of the sum assured with double accidental benefit, but of no use.  Even the legal notice dated 26.12.2014 has not brought any fruitful result and that amounts to a grave deficiency in service on the part of the respondent.

          On the other hand, ld. Counsel for the respondent has submitted that there is no deficiency in service on the part of the respondent.  The respondent has duly settled the death claim of the complainant by paying the basic sum assured as per terms and conditions of the policy.  The accidental death benefits were not paid since the policy was in a lapsed mode as on the date of the life assured (9.10.2014) since the life assured had failed to pay the renewal premium falling due on 19.6.2014 and hence the accidental death benefit was not payable by the respondent to the complainant.  The complainant was informed that basic sum assured of Rs.2,75,000/- was directly transferred to the complainant’s account via NEFT Transaction dated 8.4.2015 in full and final settlement of the claim under the subject policy.  Thus, it cannot be said that there was any kind of deficiency in service on the part of the respondent and the complainant is not entitled for any relief and compensation and thus, prayed for the dismissal of the present complaint.

         In the present case, as per the respondent, the payment of basic sum assured to the tune of Rs.2,75,000/- has been directly made to the complainant and the amount was transferred in the complainant’s account via NEFT Transaction dated 8.4.2015 in full and final settlement of the claim under the subject policy.  The claim of the complainant regarding accidental death benefit was denied by the respondent insurance company on the ground that the policy was in a lapsed mode as on the date of the life assured (9.10.2014) since the life assured had failed to pay the renewal premium falling due on 19.6.2014.

          Now the main question arises for consideration before this Forum is whether the complainant is entitled to get the benefit of get the accidental death benefit or not?

          This Forum has failed to understand when as per the respondent, the policy was in lapsed condition, then why the payment of basic sum assured was made to the complainant, whereas the entire claim of the complainant should have been repudiated by the insurance company.  In our view, non-payment of accidental death benefit to the complainant is not justified and that amounts to a grave deficiency in service on the part of the respondent.

          We have perused the terms and conditions of the insurance policy very carefully. Condition no.6.1.2 of the policy is reproduced below:-

 

6.1.2 After paying atleast three years’s premium:   If the due premiums have been paid for atleast three consecutive years and subsequent premiums are unpaid, the insurance cover under the policy shall continue for the full sum assured till the end of revival period of two years from the due date of first unpaid premium.  The insurance and policy administration charges will continue to be deducted from your unit account by cancellation of units.

 

 

          In our view, condition no.6.1.2 of the insurance policy totally speaks in favour of the complainant and this condition  make the complainant entitled for the accidental death benefit in respect of death of his son.  As per the respondent, the life assured had failed to pay the renewal premium falling due on 19.6.2014.  But on the contrary, as per condition no.6.1.2, the insurance cover under the policy shall continue for the full sum assured till the end of revival period of two years from the due date of first unpaid premium.  So, how the respondent can take such a baseless plea that the policy was in a lapsed condition.

          Further as per condition no.6.1.2, the life assured is entitled for the claim amount, if he deposit three years consecutive premium in respect of his policy.  But in the case in hand, deceased life assured Pankaj Kumar has purchased the policy  and has paid five consecutive premiums to the respondent i.e. in the year 2009, 2010, 2011, 2012 and 2013; and unfortunately on 9.10.2014 he has died in a road accident.  In our view, as per condition no.6.1.2 of the policy, the complainant is entitled to get the accidental death benefit.  Thus, taking into consideration the above condition no.6.1.2 of the policy, we hereby direct the respondent insurance company to deduct the amount of premium which was due in 6/2014 from the amount of Rs.2,75,000/- and then to pay the remaining amount to the complainant within a period of 60 days from the date of passing of this order, otherwise, the said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its actual realization.

         With these observations, findings and directions, the present complaint stands allowed.

         Certified copy of this order be provided to

both the parties free of costs.

File be consigned to the record-room.

 

 

 

(Prabha Wati)                (Nagender Singh)

Member, DCDRF                 President

    SNP                       DCDRF SNP.

ANNOUNCED: 21.04.2016