Order by:
Sh.Amrinder Singh Sidhu, President
1. This Consumer Complaint has been received by transfer vide order dated 26.11.2021 of Hon’ble President, State Consumer Disputes Redressal Commission, Punjab at Chandigarh under section 48 of CPA Act, vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2021 from District Consumer Commission, Ludhiana to District Consumer Commission, Moga to decide the same in Camp Court at Ludhiana and said order was ordered to be affected from 14th March, 2022.
2. The complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (now section 35 of Consumer Protection Act, 2019) on the allegations that on the allurement of agent of the Opposite Parties, Sh.Malook Singh husband of the complainant purchased life insurance policy bearing No.16892722 from the Opposite Parties for a sum assured of Rs.6,54,420/- and the premium was payable semi annually, but no terms and conditions ever issued to the complainant or deceased life assured of the above said policy. Unfortunately, Malook Singh, life assured expired a natural death on 25.10.2014 and thereafter, being the nominee and widow of said deceased life assured Malook Singh lodged the claim with the Opposite Parties and completed all the requisite formalities of the Opposite Parties, but till date, the Opposite Parties have not settled the claim of the complainant. The complainant approached the Opposite Party time and again for making the insurance claim, but to no affect. As such, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) The Opposite Parties may be directed to release the claim amount to Rs.6,54,420/- alongwith interest @ 18 % per annum and also to pay of Rs.50,000/- on account of compensation due to mental tension and harassment caused by the complainant and also to pay any other relief to which this District Consumer Commission may deem fit be also granted.
3. Opposite Parties appeared through counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this District Consumer Commission. It is submitted that mere giving the intimation qua death of husband of the complainant does not amount to lodging the claim. After giving intimation of death of deceased life assured Malook Singh, the complainant was required to first complete the requisite formalities and then to lodge the claim on prescribed format with the Opposite Parties alongwith documents, but the complainant did not do so. On merits, it is alleged that each insurance policy is issued against specific terms and conditions and the same also forms part of the policy. The complainant did not lodge the claim with the Opposite Parties at any point of time, nor submitted any original or photo copy of the alleged documents with the Opposite Parties, so the question of giving alleged assurance by the Opposite Parties to the complainant for considering, processing and sanctioning the claim does not arise. Hence, the complaint may be dismissed with costs.
4. In order to prove her case, the complainant has tendered into evidence her affidavit Ex.CW-1 alongwith copies of documents Ex.C1 to Ex.C6 and closed the evidence on behalf of the complainant.
5. On the other hand, to rebut the evidence of the complainant, Opposite Parties also tendered into evidence the affidavit of Ms.Arpit Higgins, Senior Manager Ex.RW1 alongwith copies of documents Ex.R1 and Ex.R2 and closed the evidence.
6. We have heard the ld.counsel for the parties and also gone through the documents placed on record.
7. Ld.counsel for the Complainant has mainly reiterated the facts as narrated in the complaint and contended that on the allurement of agent of the Opposite Parties, Sh.Malook Singh husband of the complainant purchased life insurance policy bearing No.16892722 from the Opposite Parties for a sum assured of Rs.6,54,420/- and the premium was payable semi annually, but no terms and conditions ever issued to the complainant or deceased life assured of the above said policy. Unfortunately, Malook Singh, life assured expired a natural death on 25.10.2014 and thereafter, being the nominee and widow of said deceased life assured Malook Singh lodged the claim with the Opposite Parties and completed all the requisite formalities of the Opposite Parties, but till date, the Opposite Parties have not settled the claim of the complainant. The complainant approached the Opposite Party time and again for making the insurance claim, but to no affect. As such, there is deficiency in service on the part of the Opposite Parties.
8. On the other hand, ld.counsel for the Opposite Parties has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this District Consumer Commission. It is submitted that mere giving the intimation qua death of husband of the complainant does not amount to lodging the claim. After giving intimation of death of deceased life assured Malook Singh, the complainant was required to first complete the requisite formalities and then to lodge the claim on prescribed format with the Opposite Parties alongwith documents, but the complainant did not do so. On merits, it is alleged that each insurance policy is issued against specific terms and conditions and the same also forms part of the policy. The complainant did not lodge the claim with the Opposite Parties at any point of time, nor submitted any original or photo copy of the alleged documents with the Opposite Parties, so the question of giving alleged assurance by the Opposite Parties to the complainant for considering, processing and sanctioning the claim does not arise and the claim of the complainant is pre mature and the same is liable to be dismissed.
9. Perusal of the record shows that the complainant has not placed any document to prove that he ever lodged the claim for the insurance claim with the Opposite Parties. On the other hand, the main contention of the ld.counsel for the Opposite Parties is that complainant did not lodge the claim with the Opposite Parties at any point of time, nor submitted any original or photo copy of the alleged documents with the Opposite Parties, so the question of giving alleged assurance by the Opposite Parties to the complainant for considering, processing and sanctioning the claim does not arise and the claim of the complainant is pre mature. So, we are of the view that although, as alleged by the complainant that he has already submitted the required documents with the Opposite Parties, but to settle the claim case of the complainant, it is no hitch to the complainant, if the required documents are again submitted with the Opposite Parties. We are also supported with a case law Oriental Insurance Company Ltd. Vs. Rajbir Kaur, in First Appeal No. 711 of 2013 decided on 27.2.2015 of Hon’ble State Commission, Punjab, Chandigarh, wherein in similar case, the Hon’ble State Consumer Disputes Redressal Commission, Punjab at Chandigarh has directed the Insurance Company and stated that as per the regulations/ instructions issued by the IRDA, the claims made under the insurance policies are ordinarily to be settled within one month of the submission of the claim.
10. In such circumstances, we direct the Opposite Party to process and settle the claim of the complainant either way, positively within further 30 days as per IRDA guidelines from the date of receipt of required documents from the complainant and consequently, the complaint stands disposed of accordingly. However, the complainant shall be at liberty to file the fresh complaint after the final settlement of his claim, if he still remains not satisfy with the decision of the Opposite Parties. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost and thereafter, the file be consigned to record room after compliance.
11. Reason for delay in deciding the complaint.
This Consumer Complaint was originally filed at District Consumer Disputes Redressal Forum (Now Commission) at Ludhiana and it keep pending over there until Hon’ble State Consumer Disputes Redressal Commission, Punjab vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 has transferred the instant Consumer Complaint alongwith Other Complaints to District Consumer Commission, Moga with directions to work on this file onward from 14th March, 2022 and accordingly District Consumer Commission, Moga has decided the present complaint today at Camp Court, Ludhiana, as early as possible as it could decide the same
Announced in Open Commission at Camp Court, Ludhiana.
Dated:27.06.2022.
