Chandigarh

StateCommission

A/240/2024

PNB MET LIFE INDIA INSURANCE CO. LTD. - Complainant(s)

Versus

JYOTSANA SHARMA - Opp.Party(s)

MANPREET KANDA

14 Oct 2024

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

Appeal No.	240 of 2024
Date of Institution	13.06.2024
Date of Decision	14.10.2024

 

1]       PNB Met Life India Insurance Co. Ltd.,  Registered Office at Unit No.701, 702, 703, 7^th Floor, West Wing, Raneja Towers, 26/27, M.G. Road, Bangalore through its authorized representative. 

2]       PNB Met Life India Insurance Company Ltd., Office at SCO No.68-69, Third Floor, Sector 17B, Chandigarh.

3]       Sh. Kamal Sachdeva, Branch Manager (Then), PNB Met Life India Insurance Company Ltd., Office at SCO No.68-69, Third Floor, Sector 17B, Chandigarh.

.…..Appellants/Opposite Parties.

Versus

1]       Jyotsana Sharma widow of Gaurav Sharma,

2]       Master Shivansh Sharma son of Late Gaurav Sharma

          Both residents of H.No.933, Sector 9, Panchkula, Haryana. 

...Respondents/Complainants.

 

BEFORE:    JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

                   SH. RAJESH K. ARYA, MEMBER

                  

Argued by:- 

 

Sh.  Manpreet Kanda, Advocate for the appellants.

Sh. Rakesh K. Sharma, Advocate for the respondents.

 

PER RAJESH K. ARYA, MEMBER

              The instant appeal has been filed by the opposite parties (appellants herein), against order dated 02.04.2024, rendered by District Consumer Disputes Redressal Commission-I, U.T., Chandigarh, (hereinafter to be called as the District Commission only), vide which, Consumer Complaint No.46 of 2022 filed by the complainants (respondents herein) has been partly allowed in the following manner:-

“4.   In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and the OPs are directed as under :-

1. to pay the sum assured of ₹1.00 crore to the complainants (less deduction, if any, as per terms & conditions of policy) alongwith interest @ 9% per annum from the date of repudiation i.e. 30.6.2021 onwards.
2. to pay ₹25,000/- to the complainants as compensation for causing mental agony and harassment;
3. to pay ₹10,000/- to the complainants as costs of litigation.

5.    This order be complied with by the OPs within forty five days from the date of receipt of its certified copy, failing which, the payable amounts, mentioned at Sr.No.(i) & (ii) above, shall carry interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.  It is, however, made clear that the aforesaid awarded amount shall be apportioned amongst the complainants in equal share i.e. in the ratio of 50:50 each.”

2]           The case of the respondents/complainants before the Ld. District Commission was that on 30.06.2020, Gaurav Sharma purchased a “PNB MetLife Mera Term Plan” policy (Policy Number: 23352405) with a sum assured of ₹1 crore and an annual premium of ₹22,707.84, payable monthly. The policy allowed a 15 days grace period for premium payments. Gaurav paid his premium for March 2021 on 31.03.2021 i.e. within the grace period. Unfortunately, he fell ill with COVID-19 in April 2021, was hospitalized, and passed away on 28.04.2021. The complainants filed a claim on 20.05.2021, which was denied on 30.06.2021, citing policy lapse due to non-payment of the renewal premium. It was further the case of the respondents/complainants that Gaurav’s premium payment was made within the grace period and therefore, the claim denial constituted a deficiency in service and unfair trade practice on the part of the opposite parties. They sought resolution from the opposite parties but received no satisfactory response, leading to filing of consumer complaint before the Ld. District Commission.

3]           On the other hand, opposite parties No.1 & 3 contested the complaint, by submitting their written response, which included preliminary objections regarding maintainability, concealment of facts, cause of action and claimed that the complainants attempted to mislead the Commission by distorting facts. However, they acknowledged that the deceased life assured (DLA) obtained the policy but asserted that he lastly paid the monthly premium on 28.02.2021. They further claimed that the premium due on 29.03.2021, was not paid within the grace period, resulting in the policy lapsing and justified the repudiation of the claim. While opposite parties No.1 & 3 did not dispute the DLA's death due to COVID-19, they pointed to a lapse notice issued on 08.04.2022, and stated that they informed the complainants on 30.06.2021 that they could not accept any liability due to the policy lapse. Thus, they pleaded that the complainants were not entitled to policy benefits.

4]           Opposite Party No.2 failed to appear before the Ld. District Commission despite being properly served, leading to an ex-parte proceeding as per order dated 10.02.2023.

5]           After hearing the Counsel for the parties and going through the evidence and record of the case, the Ld. District Commission partly allowed the complaint in the manner, as stated above.

6]            The order of the Ld. District Commission has been assailed by the appellants/opposite parties on the ground that the Ld. District Commission has wrongly and illegally held that the subject policy was subsisting at the time of death of DLA by ignoring the fact that the appellants – Insurance Company had produced on record the copy of Policy Lapsed Notice served during the lifetime of DLA; that the Ld. District Commission has wrongly held that the complainants proved the payment receipt dated 31.03.2021, Annexure C-3, whereas the appellants have stoutly and specifically denied the receipt of any renewal premium amount on 31.03.2021; that the Ld. District Commission, without deciding the application moved by the appellants before it to direct the complainants to produce the details of mode/source of payment of disputed renewal premium payment amount against alleged receipt dated 31.03.2021, illegally and arbitrarily gave the finding in favour of the complainants. Lastly prayer for setting aside the impugned order and dismissing the complaint has been made by the appellants.

7]       On the other hand, on behalf of the respondents/complainants, it has been vehemently argued that the Ld. District Commission rightly partly allowed their consumer complaint after appreciating the facts and evidence before it and as such, the appeal filed by the appellants be dismissed.

8]           After considering the rival contentions of the parties and going through the impugned order and material available on record and the written arguments carefully, we are of the considered view that the appeal is liable to be dismissed for the reasons to be recorded hereinafter. At the outset, it is imperative to recognize that both parties concur on several key facts regarding the subject policy (Annexures C-1 and C-2) obtained by the deceased life assured (DLA) on 30.06.2020. This policy featured a risk commencement date of 29.06.2020, a sum assured of ₹1 crore, a monthly premium of ₹1,892.32 and a premium payment term of 45 years. The DLA's death occurred on 28.04.2021, as corroborated by the death summary (Annexure C-4). Subsequently, the appellants repudiated the complainants’ claim on 30.06.2021 asserting that the policy lapsed on 29.03.2021 due to non-payment of the renewal premium. Thus, the crux of the matter revolved around the determination of whether the appellants’ denial of the claim was justified, specifically in relation to whether the premium due on 29.03.2021, was paid within the applicable grace period. The Ld. District Commission has held the premium payment was duly paid by the respondents/ complaints and received by the appellants. The respondents contended that the payment was made timely, while the appellants argued that the policy’s lapse invalidated the respondents’ claim, characterizing it as false and frivolous.

9]           Therefore, in appeal before us, the controversy qua payment of due premium, necessitates a meticulous examination of the documentary evidence provided by both parties. The policy document (Annexure C-2) explicitly indicates that the DLA elected for a monthly premium payment plan, with the last premium payment recorded as being made on 28.02.2021, a fact acknowledged by the appellants. As per Clause 13 of the policy provides policyholders with a safety net, allowing them extra time to pay their premiums while ensuring that their insurance coverage is not jeopardized during this period. It was crucial for policyholders to understand this provision, as it highlights the importance of timely premium payments while also offering a buffer against potential lapses in coverage. We have thoroughly examined the receipt (Annexure C-3), which clearly indicates that the premium due on 29.03.2021 was paid by the deceased life assured (DLA) on 31.03.2021. This payment falls well within the stipulated grace period of 15 days. Although the appellants have contested the authenticity of this receipt, they have failed to provide any evidence that substantiates their claim that the receipt was not issued by them or that it was forged. In light of this evidence, the Ld. District Commission correctly concluded that the DLA made the premium payment within the grace period with the next premium due date specified in the receipt as 29.04.2021. Furthermore, given that the DLA passed away on 28.04.2021, it has been unequivocally established that the policy was valid and in force at the time of his death. The appellants’ repudiation of the claim, which was based solely on the assertion that the policy had lapsed, lacks sufficient justification. The overwhelming evidence on record indicated that the policy was active and valid at the time of the DLA's demise. Therefore, we align with the findings of the Ld. District Commission, which determined that the appellants unjustly repudiated a legitimate claim. Thus, in our considered view, the Ld. District Commission rightly partly allowed the complaint and directed the appellants to pay the sum assured alongwith interest besides awarding compensation and litigation costs.

10]         In view of the facts and circumstances of the case, we do not find any infirmity or material irregularity in the impugned order passed by the Ld. District Commission, which is legal, just and fair.

11]         For the reasons recorded above, this appeal bearing, being devoid of merit, must fail and the same is dismissed with no order as to costs.

12]         Pending miscellaneous application(s), if any, also stands disposed of accordingly.

1.          Certified copies of this order be sent to the parties free of charge.
2.          File be consigned to Record Room after completion.

Pronounced.

14.10.2024.

                           [JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

 

                                                                                

 [RAJESH  K. ARYA]

MEMBER

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