District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No. 23/2022.
Date of Institution:11.01.2022.
Date of Order: 24.01.2023.
Reeta Gupta aged about 43 years wife of late Shri Pradeep Gupta, R/o House No. C-99, Aggarwal Building, Ali Vihar, Sarita Vihar, South Delhi – 110 076. At present R/o House No. 2305, Sector-8, Faridabad – 121006.
…….Complainant……..
Versus
1. Kotak Mahindra Life Insurance Company Limited Delhi Branch: Ist floor, Situated at 33, Community Centre, New Friends Colony, New Delhi – 110 065 through its ranch Manager/Principal Officer.
Service is also effected at registered office:-
Kotak Mahindra Life Insurance Company Limited, Registered Office: Kotak Towers, 7th floor, Zone-IV Building NO.21, Infinity Park, Off Western Express Highwaty Goregaon, Mulund Link road, Malad East, Mumbai – 400 009 through its Director/Principal Officer.
Service is also effect at Local Branch:
M/s. Kotak Mahindra Life Insurance Company Limited through its Branch Office: SCO-99,2nd floor, Sector-16, HUDA Market, Above FIBI Bank, Faridabad, Haryana – 121002 through its Branch Manager.
…Opposite party……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 201
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Ravinder Nagar, counsel for the complainant.
Sh. Deepak Sharma, counsel for opposite party
ORDER:
The facts in brief of the complaint are that the husband of the
Complainant namely Sh. Pradeep Gupta (since deceased) obtained Life Insurance Policy bearing No. 74242200, proposal NO. 742442200, date of issue 19.03.2020 (product name “Kotak Assured Savings Plan”), premium term 10 years, term of policy 15 years, pemium Rs.95,161/- per annum, guaranteed maturity benefit Rs.14,23,464.80 and accident death benefit of Rs.5,00,000/-. As per policy terms and conditions, the basic death benefits for entry age less than 50 years, higher of :-
- 11 (eleven) times of annualized premium, or
- Guaranteed minimum death benefit, or
- 105% of total premium paid (excluding any extra premium)
There was grace period in making the premium for 30days from the date of due. The period for the payment of next premium was 19.03.2021 and with grace period upto 18.04.2021. Unfortunately, the husband of the complainant suffered from Covid-19 infection and his RT PCR report dated 15.04.2021 found positive, as he gave sample to Apollo Diagnostics on 14.04.2021 and he admitted in ESIC Medical College Hospital, NIT03, Faridabad, on 16.4.2021 and during his treatment, patient (husband of the complainant) died on 20.04.2021 at 01:00 AM. The complainant and her entire family were under great trauma as her husband was suffered from Covid-19 infection of second wave and he was under treatment from 16.04.2021 and died on 20.04.2021, so the question of making policy did not arise at all. After death of husband of the complainant, she submitted all requisite documents for death claim of her husband as per terms and conditions of the above said insurance policy, The opposite party repudiated the claim of the complainant on flimsy ground that “accordingly, in view of provisions of the said policy contract, the policy stood lapsed w.e.f. 18.4.2021. Additionally, in view of the fact that policy had lapsed, prior to acquiring the surrender value, the policy and the premiums there understand forfeited, as per provisions of the said policy contract.” The complainant sent legal notice dated 16.11.2021to the opposite party but all in vain. The aforesaid act of opposite party amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite party to:
a) pay the entire claimed amount of Rs.14,23,464/- alongwith death benefits etc. in respect of above said insurance policy.
b) pay Rs. 1,00,000/- as compensation for causing mental agony and harassment .
c) pay Rs. 11,000 /-as litigation expenses.
2. Opposite party put in appearance through counsel and filed written statement wherein Opposite party refuted claim of the complainant and submitted that the present complaint is not maintainable. In the present case, a policy bearing No. 74242200 was issued to the Life Assured namely Late Pradeep Gupta with policy commencement dated 19.03.2020. The Life assured paid the annual premium amount of Rs.99,501/-. The premium under the said policy was paid till 19.03.2021 and thereafter the Life assured failed to py the premium under the said policy, resulting the subject policy went into lapsed mode w.e.f. 18.4.2021. Accordingly, the opposite party company had sent renewal notice intimation informing therein that the premium under the said policy was due on 1903.2021. The policy holder had ECS facility active, accordingly there was a standing instruction for deduction of future premiums against the said policy. But the premium so due could not be collected through ECS mode due to “Balance insufficient’, communication letter dated 22.03.2021 was sent to the policy holder. Further, lapse notice dated 19.04.2021 was also sent to the DLA which mentioned that due to non receipt of the premium amount so due on 19.03.2021, the policy had been moved to lapse mode w.ef. 18.04.2021. This letter clearly mentioned that as the policy was in lapsed mode, the policyholder was not eligible for any benefits. As per the claim intimation so received, the complainant informed that the Life Assured died on 20.04.2021, on investigating the matter it was found that the policy was not in force at the time of claim event i.e. on the date of death of LA 20.04.2021. Therefore, the complainant was not entitled for any benefit/claim under the subject policy. The complainant was not entitled for any claim or benefit under the subject policy by virtue of Section 64 VB of the Insurance Act, 1938. According to the said provision, no insurer shall assume any risk in respect of any insurance business unless and until the premium payable was received by him. In the present case, the Life Assured was required to pay yearly premiums of Rs.94,736/- under the subject policy. Premium under the subject policy was paid till 19.03.2021. Accordingly, the yearly premium that fell due under the subject policy after the said date of outstanding remained unpaid till date. Accordingly, as per the policy contract, policy stood lapsed w.e.f 18.4.2021. Since the subject policy was not in force on the date of the claim event i.e. 20.4.2021, therefore, the complainant was not entitled for any claim under the subject policy and claim was right rejected on 20.06.2021 by the opposite party company.. It was pertinent to mention that the Life Assured was also holding policy bearing No. 74338161 which was admitted and claim amount had been paid to the complainant on 30th July, 2021. As the said claim was genuine and the same was found to be admissible. Opposite party denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. The parties led evidence in support of their respective versions.
4. We have heard learned counsel for the parties and have gone through the record on the file.
5. In this case the complaint was filed by the complainant against opposite party– Kotak Mahindra Life Insurance Company Limited with the prayer to: a) pay the entire claimed amount of Rs.14,23,464/- alongwith death benefits etc. in respect of above said insurance policy. b) pay Rs. 1,00,000/- as compensation for causing mental agony and harassment . c) pay Rs. 11,000 /-as litigation expenses.
To establish his case the complainant has led in his evidence, Ex.PW1/A – affidavit of Reeta Gupta, Annexure C-1 – letter dated 19.03.2020, Annx.C-2 - RT PCR Repott,, Annx.C-3 – Death summary of Pradeep Gupta, Annx.C-4 – Death Certificate, Annx.C-5 – Employer certificate, Annx.C-6 – Adhaar card of Pradeep Gupta, Annx.C-7 – Adhaar card of Reeta Gupta, Annx.C-8 – Ration card, Annx.C-9 – letter dated 20.06.2021 regarding No Claim under lapsed policy, Annx.C-10 – legal notice, Annx.C-11 to C-13 – postal receipts, Annx.C-14 - reply to legal notice dated 2.12.2021.
On the other hand counsel for the opposite party strongly agitated and
opposed. As per the evidence of the opposite party RW1 – affidavit of Charu Gandhi, Chief Manager – legal, Working at Kotak Mahindra Life Insurance Company Ltd., Kotak Infiniti, 7th floor, Zone-11, Building NO.21, Infiniti Park, Off Western Express Highhway, Goregaon Mulund Link road, General A.K.Vaidya Marg, Malad (E) Mumbai, Annx.R-1 – proposal form, Annx.R/2 – letter dated 19.03.2020, Annx.R-3 – Death claim intimation form, Annx.R/4 – notice for change in fund mandate and methodology of NAV of ULIP funds,, Annx.R/5 – Inland letter card,, Annx.R/6 - letter dated 20.06.2021 regarding No claim under lapsed policy, Annx.R-7 – reply to legal notice
6. In this case, due to investigation of the claim, it was revealed that the subject policy was in lapsed mode w.e.f 18.04.2021 and was not in force on the date of the death of the Life Assured i.e. 20.4.2021. The renewal premium under the policy became due on 19.03.2021. Accordingly, the renewal notice reminder was sent to the policyholder. The policyholder had opted for ECS facility but the same was not honored due to “Blalance Insufficient’ and the communication letter dated 22.03.2021 was sent to him. Eventually, the same remained unpaid. The policy was moved to lapsed mode w.e.f 18.04.2021. It is evident from letter dated 20.06.2021 vide Annexure R/6 in which it has been mentioned that the claim of the complainant was not payable on the ground that on the date of the death of the Life Assured i.e. 20.04.2021, the subject policy was in the lapsed mode and not in force, therefore, as per the terms and conditions, no claim is payable on the death of life assured.
7. After going through the evidence led by the parties, the Commission is of the opinion that no deficiency in service on the part of the opposite party has been proved. Hence, the complaint is dismissed. Copy of this order be given to the parties concerned free of costs and file be consigned to record room.
Announced on: 24.01.2023 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
