Before the District Consumer Disputes Redressal Forum, Room No. 208 2nd Floor, District Administrative Complex, Tarn Taran
Consumer Complaint No : 82 of 2017
Date of Institution : 13.10.2017
Date of Decision : 09.10.2019
- Dalbir Kaur wife of Hardeep Singh,
- Rajbir Kaur widow of Rajbir Singh,
- Jagmeet Kaur minor daughter of Rajbir Singh,
- Gurmanjot Singh minor son of Rajbir Singh (complainant Nos. 3 and 4 through mother and natural guardian Rajbir Kaur complainant No. 2 all residents of village Nathoke, Tehsil Khadur Sahib, District Tarn Taran.
...Complainants
Versus
Life Insurance Corporation of India, through its Branch Manager, Tarn Taran.
…Opposite Party.
Complaint Under Section 11, 12, 13 and 14 of the Consumer Protection Act, 1986.
Quorum: Sh. Charanjit Singh, President
Smt. Jaswinder Kaur, Member
For Complainants Sh. G.S. Walia Advocate
For Opposite Party Sh. Bhupinder Singh Chawla Advocate
ORDERS:
Charanjit Singh, President;
1 The complainants Dalbir Kaur etc. have filed the present complaint under Section 11, 12, 13 and 14 of the Consumer Protection Act (herein after called as 'the Act') against Life Insurance Corporation of India, through its Branch Manager, Tarn Taran (Opposite Party) on the allegations of deficiency in service and negligence in service on the part of opposite parties with prayer to direct the opposite party to pay the accidental death claim of sum of Rs. 1,00,000/- of Rajbir Singh deceased as mentioned in the insurance policy alongwith interest @12% P.A to the complainants and the complainants have also prayed Rs. 15,000/- as compensation and Rs. 15,000/- as litigation expenses.
2 The case of the complainants in brief is that Rajbir Singh son of Hardip Singh i.e. son of complainant No. 1, husband of complainant No. 2, father of complainant Nos. 3 and 4 took a life insurance policy bearing No. 471547531 on 28.3.2005 from the opposite party. The deceased Rajbir Singh hired the services of the opposite party and as such, was consumer of the opposite party. Rajbir Singh died on 27.12.2015 and opposite party failed to pay death claim to the complainants being legal heirs and successors of Rajbir Singh. As such, the complainants being the legal heirs and successors of Rajbir Singh are competent to file the present complaint. Rajbir Singh was working with Bureaus Facilities Services Private Limited as security supervisor and died in road accident on 27.12.2015 and DDR No. 11 dated 28.12.2015 was registered at Police Station Verowal under Section 174 Cr.P.C and other required formalities were done by the police. Post Mortem was also conducted of the body of the deceased Rajbir Singh at Civil Hospital Tarn Taran. As per insurance policy in question, in case of accidental death of the insurer, the claim will be double of the sum insured plus vested bonus. In the present insurance policy, the sum assured is Rs. 1,00,000/- as such the claim in the present case will be sum assured Rs. 1,00,000/- plus accidental claim Rs. 1,00,000/- plus vested bonus as Rajbir Singh died in road accident. The complainants submitted the claim form alongwith the original policy, death certificate of deceased Rajbir Singh, DDR No. 11 dated 28.12.2015, Post Mortem Report and other required documents with the opposite party. The opposite party made payment of Rs. 1,36,795/- through bank on 27.4.2016 as insurance claim of the deceased, but the present case due to accidental death of the insurer, the claim is to be double of the sum assured plus vested bonus. The complainants requested the opposite party to admit accidental claim of the deceased and to make payment of remaining amount but opposite party refused and declined their requests. The complainant Nos. 3 and 4 are minors, as such, they file the present complaint through their mother and natural guardian complainant No. 2 Rajbir Kaur who has no adverse interest against the minors. Feeling dissatisfied by the act and conduct of the opposite parties, the complainants perforce has filed this complaint against the opposite party
3 After formal admission of the complaint, notice was issued to Opposite Party and opposite party appeared through counsel and filed written version contesting the complaint by taking preliminary objection that the present complaint is not maintainable. On merits, it was pleaded that assured Rajbir Singh was a minor at the time of issuance of policy on 28.3.2005. As per proposal form his date of birth was 10.1.1988. As per terms and condition and scheme of the policy the minor is not entitled to the double accidental benefits i.e. DAB. Moreover, it has been specifically mentioned on the policy bond that the accidental benefits are not acceptable on the policy of the life assured Rajbir Singh. As per rules, after attaining the age of majority the assured has to apply for double accident benefits and has to pay extra premium. But in this case, after attaining majority the life assured Rajbir Singh has not opted double accident benefits and has not paid any extra premium, therefore, the complainants are not entitled to accidental benefit. It is entirely the wish of the life assured whether he wants to get the extra benefit upon payment of extra premium or not as life assured Rajbir Singh did not opt to get extra benefit, respondent is not liable to pay double accident benefit. Infact, the basic claim to the tune of Rs. 1,36,795/- was already paid on 27.4.2016 and all the other allegations in the complaint have been denied by the opposite parties and prayer was made for dismissal of the complaint with costs.
4 To prove the case of complainant, Ld. counsel for the complainants has tendered in evidence affidavit of complainant Dalbir Kaur Ex. C-1 alongwith documents Ex. C-2 to Ex. C-10 and closed the evidence. On the other hands, Ld. counsel for the Opposite Party tendered in evidence affidavit of Ajaypal Singh Dhillon Assistant Administrative officer Ex. OP/1, documents Ex.OP/2, OP/3, affidavit of Rajinder Kumar Manager Legal Divisional Office, Amritsar Ex. OP/4 and closed the evidence.
5 We have heard the Ld. Counsel for the complainants and opposite parties and have gone through the evidence and documents placed on the file by the parties.
6 The case of the complainants is that Rajbir Singh son of Hardip Singh took a life insurance policy bearing No. 471547531 on 28.3.2005 from the opposite party which is Ex. C-2 on the file. Rajbir Singh was working with Bureaus Facilities Services Private Limited as security supervisor and died in road accident on 27.12.2015 and DDR No. 11 dated 28.12.2015 was registered at Police Station Verowal under Section 174 Cr.P.C and other required formalities were done by the police. Post Mortem was also conducted of the body of the deceased Rajbir Singh at Civil Hospital Tarn Taran. As per insurance policy in question, in case of accidental death of the insurer then the claim will be double of the sum insured plus vested bonus. In the present insurance policy, the sum assured is Rs. 1,00,000/- as such the claim in the present case will be sum assured Rs. 1,00,000/- plus accidental claim Rs. 1,00,000/- plus vested bonus as Rajbir Singh died in road accident. The complainants submitted the claim form alongwith the original policy, death certificate of deceased Rajbir Singh, DDR No. 11 dated 28.12.2015, Post Mortem Report and other required documents with the opposite party. The opposite party made payment of Rs. 1,36,795/- through bank on 27.4.2016 as insurance claim of the deceased, but the present case due to accidental death of the insurer, the claim is to be double of the sum assured plus vested bonus. The complainants requested the opposite party to admit accidental claim of the deceased and to make payment of remaining amount but opposite party refused and declined their requests. On the other hands, the case of the opposite party is that assured Rajbir Singh was a minor at the time of issuance of policy on 28.3.2005. As per proposal form his date of birth was 10.1.1988. As per terms and condition and scheme of the policy the minor is not entitled to the double accidental benefits i.e. DAB. It has been specifically mentioned on the policy bond Ex. C-2 that the accidental benefits are not acceptable on the policy of the life assured Rajbir Singh. As per rules, after attaining the age of majority the assured has to apply for double accident benefits and has to pay extra premium. But in this case, after attaining majority the life assured Rajbir Singh has not opted double accident benefits and has not paid any extra premium, therefore, the complainants are not entitled to accidental benefit. It is entirely the wish of the life assured whether he wanted to get the extra benefit upon payment of extra premium or not as life assured Rajbir Singh did not opt to get extra benefit, respondent is not liable to pay double accident benefit. The basic claim to the tune of Rs. 1,36,795/- was already paid on 27.4.2016.
7 The complainants have failed to produce on record any request letter for applying the double accident benefits after attaining the age of majority and has also not placed on record any payment of extra premium. However, the document i.e. Ex. C-2 placed on record by the complainants itself shows that ‘Accident Benefit is not applicable to this policy’. As such, the complainants are not entitled to the accidental benefit in this case. So opposite party has validly not given the accidental benefit to the complainants. As regards conveyance of terms and conditions of the policy to the complainant, it has been held by the Hon'ble State Commission in case Tarun Bansal & Anr Vs. Reliance General Insurance Company Ltd. & Ors II(2007) CPJ 295 that the terms and conditions are part of the policy. The complainant cannot be allowed to blow hot and cold in the same breath by saying that he is lodging claim under the same policy and yet says that the exclusion clause i.e. terms and conditions of the same policy would not be applicable as having not been conveyed . The Hon'ble State Commission has relied upon the ruling of the five judge bench of the Apex Court in General Assurance Society Ltd. Vs. Chandmull Jain and Anr. AIR 1966 Supreme Court 1644. It has been further held by the Hon'ble Apex Court in case M/s Suraj Mal Ram Niwas Oil Mills (P) Ltd Vs. United India Insurance Co.Ltd & Anr that in a contract of insurance the rights and obligations are governed by the terms of the contract. Term of contract of insurance have to be strictly construed. No exception can be made on the ground of equity- in construing the terms of a contract of insurance, the words used therein must be given paramount importance and it is not open for the court to add, delete or substitute any word. In this case also contract of insurance between the parties is based on terms and conditions of the policy and must be followed in letter and spirit. Opposite party has rightly not given the accidental benefit in this case to the complainants as per terms and conditions of the policy which was the base of the contract of insurance between the parties.
8 In view of the above discussion, the complaint is without merit and the same is hereby dismissed with no order as to costs. Copies of the orders be supplied to the parties as per rules. File is ordered to be consigned to the record room.
Announced in Open Forum
09.10.2019
(Charanjit Singh)
President
(Jaswinder Kaur)
Member
