Order by:
Sh.Mohinder Singh Brar, Member
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 on the allegations that Jujhar Singh s/o Kulwinder Singh nominated beneficiary of the deceased and has filed the present complaint to claim the death benefit of deceased Jaswinder Singh under Unit Linked Plan namely HDFC Life Sampuran Samridhi Plus. The complainant is minor and as such his natural guardian i.e. mother Sandeep Kaur has filed the present complaint on his behalf. The policy holder Jaswinder Singh died wifeless and issueless and Harminder Singh i.e. Father of the deceased Jaswinder Singh has also died. The said Jaswinder Singh, deceased purchased the unit linked plan namely HDFC Life Sampuran Samridhi Plus having policy no.20544382 on 12.07.2018 for a sum assured of Rs.3,30,875/- and made the payment of premium of Rs.37,259/- annually and has made payment of two premiums first in the year, 2018 and second in the year, 2019. Unfortunately in the month of May, 2020 Jaswinder Singh suffered from various health problems and was got admitted in Satguru Partap Singh, Hospital, Ludhiana and thereafter went to Comma. Deceased Jaswinder Singh also got treatment from Satyam Hospital, Jallandhar and Garg Hospital, Moga and unfortunately died on 28.09.2020 due to his illness at Garg Hospital, Moga. Further alleged that against the death claim of Jaswinder Singh, Opposite Party has paid only Rs.89766 instead of death benefit of Rs.3,30,875/- as per plan/policy purchased. The Opposite Party No.1 denied to make the payment of remaining amount under the excuse that deceased Jaswinder Singh died on 28.09.2020 and at that time, he did not pay the premium of third installment of policy/plan which was due in the month of July, 2020. Further alleged that when the deceased was under Comma, then how he can make the payment of the premium of the policy. Further alleged that there is deficiency in service on the part of Opposite Party No.1. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite Party may be directed to pay an amount of Rs.3,30,875/- as death benefit under the policy in question.
b) To pay an amount of R.60,000/- as compensation and litigation cost.
c) And any other relief which this Commission may deem fit and proper be granted to the complainant in the interest of justice and equity.
2. Opposite Party No.1 filed written version taking preliminary objections therein inter alia that the complainant has no locus standi or cause of action to file the present complaint; the intricate questions of law and facts are involved in the present complaint which requires voluminous documents and evidence for determination which is not possible in summary procedure under the Act and appropriate remedy, if any, lies only in the Civil Court. The complainant has concealed material facts and documents from this Commission as well as from Opposite Party, therefore, the complainant is not entitled to any relief. The complainant has concealed the fact that as per record on the basis of illustrations of benefits, proposal form and addendum thereto, the answering Opposite Party had issued HDFC Life Sampooran Samridhi Plus policy bearing no.20544382 in the name of deceased Jaswinder Singh. The risk commencement date was 12.07.2018 with annual premium payable on 12th July every year. However, the life assured had paid only two premiums of 2018 and 2019 on dated 13.07.2018 and 18.07.2019. However, third premium was due on 12.07.2020. The premium due on 12.07.2020 was not paid and thus policy was in paid-up status at the time of death of life assured. The date of death is 28.09.2020. Thus, the claim was settled as per policy terms and conditions i.e. by making payment of proportionate sum assured to the amount of premiums paid against total premiums payable under the policy. The amount of Rs.89,766.20 has been paid on 05.11.2020. No more amount is due and payable as per policy terms and conditions. Further averred that it is settled law that the insurance policy is a contract between the parties and both the parties are bound by the terms and conditions thereof. Further the terms and conditions of the policy have to be construed/interpreted strictly in determining the rights and liabilities of the parties. Further averred that the policy in question is a unit linked policy, hence this Commission has got no jurisdiction to try and decided the present complaint. The complainant is not the consumer of Opposite Party. The complaint is not maintainable. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.
3. Opposite Party No.2 filed written reply taking objections therein inter alia that the complaint under reply is liable to be dismissed qua the Opposite Party No.2 as same is an abuse of the process of law qua the Opposite Party No.2. The present complaint is baseless, frivolous and has been formulated on wrong and misleading facts and is devoid of any merits whatsoever. Hence, the Opposite Party No.2 denies each and every allegation made in the complaint under reply against the answering Opposite Party unless admitted or commented therein. Further averred that there is no evidence documentary or otherwise which points out any fault on the part of the answering Opposite Party. Complaint under reply is liable to be dismissed as there is no deficiency in service and unfair trade practice on the part of Opposite Party No.2. The complainant has not come before this Commission with clean hands. The complainant has presented an incorrect and wrong version of the facts before this Commission. No cause of action, either wholly or in part has ever arisen in favour of the complainant and against Opposite Party No.2 and the present complaint is nothing but an abuse of the process of this Commission. The complainant is not the consumer of Opposite Party No.2. Nothing stated in the complaint shall be deemed to be admitted by the answering Opposite Party on account of non-traverse. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.
3. In order to prove the case, complainant tendered in evidence her affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C9 and Ex.C4/A.
4. To rebut the evidence of complainant Opposite Party No.1 tendered in evidence copies of documents Ex.OP1/1 to Ex.OP1/5 and affidavit of Sh.Gurpreet Singh, Manager Legal, HDFC Standard Life Ins. Co. Ltd. Ex.OP1/6. Whereas, Opposite Party No.2 tendered in evidence affidavit of Sh.Gaurav Jand, Branch Manager, HDFC Bank Ltd. Ex.OP2/1
5. We have heard the counsel for the parties and gone through the written arguments submitted on behalf of Opposite Party No.1 and also gone through the documents placed on record.
6. The case of the complainant is that complainant Jujhar Singh nominated beneficiary of the deceased Jaswinder Singh. The said Jaswinder Singh purchased the unit linked plan namely HDFC Life Sampuran Samridhi Plus having policy no.20544382 on 12.07.2018 for a sum assured of Rs.3,30,875/- and made the payment of premium of Rs.37,259/- annually and has made payment of two premiums first in the year, 2018 and second in the year, 2019. Unfortunately in the month of May, 2020 Jaswinder Singh suffered from various health problems and was got admitted in Satguru Partap Singh, Hospital, Ludhiana and thereafter went to Comma. Deceased Jaswinder Singh also got treatment from Satyam Hospital, Jallandhar and Garg Hospital, Moga and unfortunately died on 28.09.2020 due to his illness at Garg Hospital, Moga. Further alleged that against the death claim of Jaswinder Singh, Opposite Party No.1 has paid only Rs.89766/- instead of death benefit of Rs.3,30,875/- and denied making the payment of remaining amount under the excuse that deceased Jaswinder Singh died on 28.09.2020 and at that time, he did not pay the premium of third installment of policy/plan which was due in the month of July, 2020.
7. Ld. counsel for the Opposite Party No.1 has repelled the aforesaid contentions on the ground that Opposite Party no.1 issued HDFC Life Sampooran Samridhi Plus policy bearing no.20544382 in the name of deceased Jaswinder Singh. The risk commencement date was 12.07.2018 with annual premium payable on 12th July every year. However, the life assured had paid only two premiums of 2018 and 2019 on dated 13.07.2018 and 18.07.2019. However, third premium was due on 12.07.2019. The premium due on 12.07.2020 was not paid even upto the death of insurer and thus policy was in paid-up status at the time of death of life assured. The date of death is 28.09.2020. Thus, the claim was settled as per policy terms and conditions and amount of Rs.89,766.20 was paid on 05.11.2020.
8. Whereas, ld. counsel for the Opposite Party No.2 contended that there is no evidence documentary or otherwise which points out any fault on the part of the Opposite Party No.2. There is no deficiency in service and unfair trade practice on the part of Opposite Party No.2. The complainant has presented an incorrect and wrong version of the facts before this Commission. No cause of action, either wholly or in part has ever arisen in favour of the complainant and against Opposite Party No.2.
9. There is no dispute that complainant Jujhar Singh nominated beneficiary of the deceased Jaswinder Singh under the policy in question and said Jaswinder Singh purchased the unit linked plan namely HDFC Life Sampuran Samridhi Plus on 12.07.2018 for a sum assured of Rs.3,30,875/-. Under the policy in question deceased policy holder paid two premiums only i.e. in the year, 2018 and 2019. It is also not disputed that in the month of May, 2020 Jaswinder Singh suffered from various health problems and was got admitted in Satguru Partap Singh, Hospital, Ludhiana, Satyam Hospital, Jallandhar and Garg Hospital, Moga and thereafter died on 28.09.2020. However, the main grievance of the complainant that Opposite Party No.1 has paid only Rs.89766/- instead of death benefit of Rs.3,30,875/-.
10. We have perused the rival contentions of ld. counsel for the parties and gone through the affidavits /documents submitted by the complainant as well as Opposite Parties. As per record, Jaswinder Singh purchased the HDFC Life Sampuran Samridhi plus-Unit Linked Plan bearing no.20544382 (Ex.C2) on 12.07.2018 by paying first premium of Rs.37,529/-. The second premium of the policy was paid by him on 18.07.2019 (Ex.C4). Thereafter premium was due on 12.07.2020, but he did not pay the third premium, even upto the grace period i.e. 12.08.2020 and this fact is also not denied by the complainant. The deceased Jaswinder Singh was died on 28.09.2020 (Ex.C3). We have perused the terms and conditions of the policy attached with Ex.C2, as per Part C (2) under heading Death Benefit, it is mentioned that the death benefit is payable only if all the premiums which have fallen due before death are paid. Further as per clause Part C (7) for a paid up the death benefits and maturity benefits shall be as described in Part D, Clause 2 (Lapsed Policies and Paid-Up Policies), which is reproduced as under:-
Lapsed Policies and Paid-Up Policies
(1) XXX
(2) XXX
(3) If any premium remains unpaid after the expiry of grace period and your policy has acquired a minimum Guaranteed Surrender Value. Your policy’s status will be altered to paid-up status.
(4) Once your policy is altered to paid-up status, the Sum Assured on Death/Maturity will reduce to paid-up Sum Assured on Death/Maturity, paid-up guaranteed additions and bonuses accrued till the date of becoming paid-up. Your Policy will cease to quality for addition of any future bonuses. The guaranteed additions shall be reduced by multiplying the additions payable during the policy Term by the ratio of the Premiums paid to the Premium payable under the Policy. Simple Reversionary Bonus accrued to the Policy at the date the policy is made paid-up will continue to remain attached. Accidental death benefit will be and additional sum equal to paid-up Sum Assured on Death.
Since, the deceased life assured Jaswinder Singh paid only two premiums and failed to pay the third premium due on 12.07.2020. So, we are of the view of that the Opposite Party No.1 rightly settled the claim of the complainant and paid the amount of Rs.89,766.20 to the nominee as per terms and conditions of the policy. This fact is also admitted by the complainant in his complaint that he has received the amount of Rs.89,766.20/-.
11. In view of the above facts and circumstances, we have not found any deficiency in service on the part of the Opposite Parties. Hence, the present complaint is hereby dismissed. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copy of the order be supplied to the parties free of costs. File be consigned to record room after compliance.
Announced in Open Commission
