DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

BATHINDA (PUNJAB)

CC No. 191 of 09-05-2011

Decided on : 30-11-2011

Gurjeet Singh aged about 28 years S/o Saudagar Singh R/o Village Datewas, Near Tauba, Budhlada 151502.

.... Complainant

Versus

HDFC Standard Life Insurance Co. Ltd., Ground Floor, 3038-A, Dalip Singh Walia Complex, Guru Kashi Marg, Bathinda, through its Branch Manager.

..... Opposite party

Complaint under Section 12 of the Consumer Protection

Act, 1986.

 

QUORUM

Smt. Vikramjit Kaur Soni, President

Sh. Amarjeet Paul, Member

Smt. Sukhwinder Kaur, Member

For the Complainant : Sh. Naresh Garg, counsel for the complainant

For the Opposite parties : Sh. Vinod Garg, counsel for the opposite party.

O R D E R

VIKRAMJIT KAUR SONI, PRESIDENT

1. The instant complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended upto date (here-in-after referred to as 'Act'). Briefly stated the case of the complainant is that the mother of the complainant purchase one Life Insurance ULIP Policy No. 12100871 from the opposite party for the sum insured of Rs. 2,50,000/-. The complainant is the nominee and Class I heir as son of the deceased in the said Insurance policy. The complainant alleged that the mother of the complainant Malkeet Kaur signed the blank proposal form and the insurance was commenced from 30-09-2008. The policy No. 12100871 was issued w.e.f. 30-09-2008 for the sum Insured of Rs. 2,50,000/- against the annual premium of Rs. 50,000/- per annum. The said policy is for 15 years and the last date of the premium is 30^th September, 2022. The said policy is ULIP policy and the opposite party took Rs. 289.27 as Life Risk Charges for the sum assured of Rs. 2,50,000/-. The opposite party out of Rs. 50,000/- (1^st premium) invested only Rs. 20,000/- in the Growth fund, Rs. 60/- as policy charges, Rs. 289.27 as Life Risk charges and Rs. 3,751/17 as statutory charges i.e. Total Rs. 24,100.44. The balance payment of Rs. 25,899.56 is lying with the opposite party as deposit of insured out of Ist premium Rs. 50,000/- deposited on 30-09-2008. The policy holder also paid Rs. 50,000/- IInd premium on 20-10-2009 to the opposite party in time under Grace period and the same is also lying with the opposite party as deposit. The complainant alleged that the opposite party charged 50% for their own and only allocated about 50% from the first premium. As per clause 1.4, it is very much clear that the allocation charges are not much than 10% but the opposite party in this policy charged allocation charges about 50% against the terms and conditions. The complainant paid all the premiums in time, but however all of sudden in the year 2010, the policy holder suffered from paralysis attack and her total body paralyzed and she was 100% bedridden. From 02-09-2010 till her death i.e. 13-11-2010 she was neither able to speak nor was in sense. The complainant approached many hospitals but all in vain and ultimately, she died on 13-11-2010 at her house. The last premium of year 2010 was due on 30-09-2010 and this fact was only in the knowledge of policy holder, but she became out of senses and bedridden w.e.f. 02-09-2010 till her death, as such the last premium was not paid to the opposite party. The complainant further alleged that the opposite party never sent notice or reminder regarding the due premium of year 2010. After the death of policy holder, when the complainant searched her belongings, he found the said policy and accordingly, he lodged the claim with the opposite party alongwith the original death certificate and original policy etc., The opposite party never intimated to the policy holder regarding the lapse of policy during her life time. The complainant received a letter dated 17-01-2011 from the opposite party vide which they repudiated the claim of the complainant on the illegal ground and paid only part payment of Rs. 44,931.27 against the deposit of Rs. 1,00,000/-. The complainant alleged that the opposite party can deduct Rs. 4,389.71 out of Rs. 1,00,000/-. Rs. 95,610.29 was lying with the opposite party till the death of insured out of which Rs. 44,931.08 was paid by the opposite party vide letter dated 17-01-2011 as such balance of Rs. 50,679.21 is still lying with the opposite party. In support of his version, the complainant has mentioned various authorities on different aspects of matter. The complainant approached the opposite party many times and demanded his balance amount of Rs. 50,769/- and Rs. 2,50,000/- as sum insured, but they did not listen the same and said that the claim has already been rejected vide letter dated 17-01-2011. Hence, the complainant has field the present complaint seeking directions to the opposite parties to pay the balance amount of Rs. 50,769/- and Rs. 2,50,000/- as sum assured with bonus etc., alongwith compensation and cost.

2. The opposite party filed its written reply and admitted that the policy No. 12100871 was issued w.e.f. 30-09-2008 for the sum Insured of Rs. 2,50,000/- against the annual premium of Rs. 50,000/- per annum was issued to Malkit Kaur, deceased mother of the complainant. The said policy is for 15 years and the last date of the premium is 30^th September, 2022. The said policy is ULIP policy. It has been pleaded that all the details/descriptions about all the charges and deductions have been mentioned in the policy document and the same were duly supplied to the deceased. The total amount of allocation charges for the whole policy period of 15 years is about 6.2% per year. The allocation charges are levied in such a manner that the policy holder is to pay maximum amount of charges in the first year so that the charges in the remaining terms of the policy remain at a nominal level of about 2-3%. The complainant has presented a very wrong and confusing perception of charges in case of an insurance policy only to twist the facts so tht the same are squarely fit into the matter to serve the purpose of the complainant. The opposite party denied that Rs. 25,899.56 was lying with opposite party as deposit of the insured. Rather, the same was adjusted towards the unit fund and charges. The renewal premium of Rs. 50,000/- was paid by the insured. The insurance company deducts a 'risk charge' on account of cover provided to the policy holder. The said risk charge in calculated agewise and the rate if different at different age. Further the said risk charge is calculated per thousand of the sum insured provided to the policy holder. The opposite party has pleaded that claim of the complainant was repudiated vide letter dated 17-01-2011 and a cheque of Rs. 44,932.08 was sent to the complainant. The payment was made as remaining fund value, which was only payable in the present Insurance policy.

3. Parties have led their evidence in support of their respective pleadings.

4. Arguments heard. Record alongwith written submissions submitted by the parties perused.

5. These are undisputed facts between the parties that Malkit Kaur deceased mother of the complainant purchased one Life Insurance ULIP Policy No. 12100871 from the opposite party for the sum insured of Rs. 2,50,000/-w.e.f. 30-09-2008 against the annual premium of Rs. 50,000/- per annum. The said policy is for 15 years and the last date of the premium is 30^th September, 2022. The deceased insured paid only two premiums in the year 2008 and 2009. Next premium was due on 30-09-2010 which was not paid within 30 days grace period or even thereafter.

6. The learned counsel for the complainant submitted that mother of the complainant suffered from paralysis attack due to which she became senseless and was unable to speak, hence the premium could not be paid to the opposite party as the renewal of the policy was only in the knowledge of Malkit Kaur, the deceased insured. After her death, on searching her belongings, the policy in question, came in the knowledge of the complainant and accordingly, he filed the complaint, but the opposite party rejected the claim of the complainant illegally. In support of his arguments, he placed reliance on the law laid down by the Hon'ble Supreme Court in the case titled 1999 (4) RCR (Civil) 366 Life Insurance Corporation of India Vs. Raj Kumar Rajgarhia.

7. On the other hand, the learned counsel for the opposite party submitted that complainant obtained the policy by submitting duly filled and signed proposal Form after duly understanding terms and conditions of the policy and also signed illustration of benefit. The complainant paid only two premium in the year 2008 and 2009. Next premium was due on 30-09-2010 which was not paid within 30 days grace period or even thereafter. The complainant has already received the admissible benefit i.e. unit value and no other amount is payable to him. He submitted that the complainant is having knowledge of the premium, sum insured and due dates of premium but wrongly mentioned in his complaint that the deceased insured was in the knowledge regarding the payment of premium as in para No. 3 of his complaint he himself has mentioned that at the time of selling the said policy the opposite party also checked the health of the policy holder as per rules.

8. A perusal of Ex. R-2 i.e. Insurance policy in question of Mr. Malkiyat Kaur (Malkeet Kaur, deceased mother of complainant) reveals that date of commencement of policy is 30^th September, 2008; sum insured Rs. 2,50,000/-; original annual premium Rs. 50,000/- and term of the policy is 15 years. Clause 4 Premium of the policy reads as under :-

   “.....(ii) If any premium remains unpaid 15 days after the due date, your policy will become Surrendered or Paid-up as described in provision 5”

   Provision 5 of the policy is reproduced hereunder :-

   “5. Surrendered, Lapsed, Paid-up Policies

   (i) Surrender

   a. Surrender in the first three years of the policy

   A policy may be surrendered at any time in the first three years of the policy. On request, for surrender, the Life Assured will not be covered for the death benefits and any Extra Health Benefits, as described in provision (3)(i) with immediate effect.”

9. As per aforesaid terms and conditions of the policy, since the policy has already lapsed due to non-payment of premium on 30^th September, 2010, the death benefit claim was not payable to the complainant. However, as per policy conditions, the complainant was entitled for fund value which was paid to him vide cheque No. 794092 dated 14-01-2011 for Rs. 44,931.08. The contention of the complainant that the deceased insured has suffered paralysis attack due to which she could not pay the premium is not tenable as the premium can be paid/deposited by any person.

10. The case law cited by the learned counsel for the complainant Life Insurance Corporation of India Vs. Raj Kumar Rajgarhia (supra) is not applicable to the case in hand as the facts and circumstances of that case are different because in that case the loan facility was availed by the insured and the terms and conditions of insurance policy read with terms of loan bond whereas in the present case, the clauses reproduced above of the insurance policy in question makes the position crystal clear.

11. In view of what has been discussed above, we found no deficiency in service on the part of the opposite party. Thus, the complaint fails and is hereby dismissed with no order as to costs.

A copy of this order be sent to the parties concerned free of cost and the file be consigned to record.

Pronounced

30-11-2011

(Vikramjit Kaur Soni)

President

(Amarjeet Paul)

Member

(Sukhwinder Kaur)

Member