District Consumer Disputes Redressal Forum, Near F.C.I. Godowns, Muradpura Tarn Taran (Punjab)
Consumer complaint No : 18 of 2016
Date of Institution : 11.2.2016
Date of Decision : 16.8.2016
Darshan Kaur w/o Sukhdev Singh s/o Gurmukh Singh resident of V.P.O. Kang, Tehsil Khadur Sahib District Tarn Taran.
…Complainant
Versus
- Life Insurance Corporation of India, Branch Office Phillor at : Old G.T. Road, near Bus Stand, Phillor, Tehsil Phillor District Jalandhar through is Branch Manager/ Authorised Officer.
- Life Insurance Corporation of India, Branch Office, Tarn Taran: Sarhali Road, Tarn Taran District Tarn Taran through its Branch Manager/ Authorised Officer.
…Opposite Parties
Complaint Under Section 11, 12 and 13 of the Consumer Protection Act, 1986.
Quorum: Sh. A.K.Mehta, President.
Smt.Jaswinder Kaur, Member
For complainant Sh.M.P.Arora, Advocate
For Opposite Parties Sh. M. S. Bhatia, Advocate
A.K. Mehta, President
1 Ms. Darshan Kaur filed the present complaint under Section 11, 12 and 13 of the Consumer Protection Act (herein-after called as ‘the Act’) against Life Insurance Corporation of India etc. (Opposite Parties) on the allegations of deficiency in service with prayer to direct the Opposite Parties to pay Rs.1.5 lacs as total minimum death benefit under policy and Rs. 20,000/- as compensation and Rs. 10,000/- as costs of litigation.
2 The case of the complainant in brief is that complainant is wife of Sukhdev Singh and opposite parties are dealing in life insurance policies and has deputed number of agents to procure business; that on the persuasion and offers presented by agent of opposite parties, Sukhdev Singh obtained Life Insurance Policy of the Opposite Parties and filed proposal form dated 28.9.2011 with date of commencement of policy as 28.8.2011 and paid premium of Rs. 6,378/- and installments were to be paid annually and sum assured at maturity of the policy as Rs. 1,50,000/- and date of maturity of policy was 28.8.2016 and Darshan Kaur was appointed as nominee of the Life Assured Sukhdev Singh (deceased); that Sukhdev Singh paid all the installments of the policy on time as per schedule till his death and unluckily Life Assured Sukhdev Singh died on 7.10.2013; that complainant gave required information to opposite parties regarding death of Life Assured Sukhdev Singh and for receiving death benefits of policy in question bearing No. 133496993; that all the requisite documents including death certificate and other information were provided to the official of the opposite parties but opposite parties kept mum for many months since the date of death of Sukhdev Singh and then complainant sent written request to the opposite parties for satisfying claim and after some days, complainant was called in the office of opposite parties at Phillor by official of the corporation and officials demanded certain verficiations on the printed performa issued by the corporation from the employer of the deceased and Doctor who gave treatment to Sukhdev Singh; that the complainant collected the demanded information from the employer of the deceased and from the concerned doctor and sent the same to opposite parities through registered post but opposite parties again called the complainant and her son in its office at Phillor and returned back all the documents and asked the complainant that there is need of some kind of more verifications and complainant is to submit the required verifications once again; that complainant again collected every demanded information from the employer of the deceased and concerned doctor and sent the same to corporation through registered post but the corporation officials again called the complainant and her son in its office at Phillor and returned back all the documents in a arbitrary manner and told the complainant that claim cannot be settled at that time due to certain medical reasons of the Life Assured Sukhdev Singh (deceased) but the complainant told the officials of the opposite parties that the Life Assured Sukhdev Singh (deceased) was not suffering from any kind of disease at the time of issuance of policy but officials of the corporation did not pay any heed towards the request of the complainant; that thereafter complainant requested the corporation to give reasons in writing for not satisfying her claim and officials of corporation told that no final decision has been taken by higher officials and they will call the complainant again when the need arises; that Life Assured Sukhdev Singh was not suffering from any kind of disease at the time of issuance of policy nor life assured had suppressed any kind of medical disease nor there exists any medical record history from which it can be said that the Life Assured Sukhdev Singh (deceased) was suffering from any kind of pre policy disease; that the corporation in a very un-business like manner has kept pending the claim of the complainant for a long time and till date has neither repudiated nor gave any valid reason for not deciding the claim of the complainant and as such, it amounts to higher degree of deficiency in service on the part of the opposite parties who have orally repudiated the claim of the complainant on the basis of oral medical reasons as alleged by the corporation; that at the time of issuance of the policy, all necessary information related to the Life Assured Sukhdev Singh and his family were taken by the officials of the opposite parties and they also collected the information and relevant documents and verified the facts regarding health of the deceased through medical examination and personal investigation conducted by them and as such correct information was given to the official of the corporation and now in order to grab the sum assured on the death of Life Assured Sukhdev Singh, the opposite parties are not deciding the claim of the complainant on baseless grounds in an arbitrary manner whereas the complainant after the death of her husband Sukhdev Singh is running from pillar to post for seeking justice and as such it amounts to deficiency in service on the part of the opposite parties and complainant has suffered loss of death benefits under the policy and the conduct of the opposite parties also caused mental and physical harassment and agony to the complainant. Hence complaint was filed.
3 After formal admission of the complaint, notice was sent to Opposite Parties-LIC and opposite parties appeared through counsel and filed written reply contesting the complaint on the preliminary objections that complaint is not maintainable being pre mature as the death claim of Life Assured Sukhdev Singh has neither been rejected nor decided by Opposite Parties and claimant was asked by LIC to fulfill the requirement regarding claim form but she took back her papers and has not submitted the same again for consideration of death claim; that the complainant is estopped by his act and conduct to file the present complaint as there is no deficiency in service on the part of the opposite parties and complainant has not submitted the claim papers after complying necessary requirements; that the complaint is liable to be dismissed being time barred as Life Assured Sukhdev Singh died on 7.10.2013 whereas present complaint is filed after 2 years of the cause of action; that complainant has not sued the opposite parties through Zonal Manager Life Insurance Corporation of India as required under Regulation 41 of the Life Insurance Corporation of India Regulation 1959; that the complainant has no cause of action to file the complaint as claim has neither been rejected nor the same is pending with the opposite parties. On merits, it was admitted that opposite parties corporation is dealing in life insurance business and have appointed agents but it was asserted that the agents of Life Insurance Corporation are to assist policy holder and to give post sales services but it is not duty of the agent to fulfill the requirement which are required from the claimant for settlement of claim. It was asserted that the benefits as well as terms and conditions of the policy are explained in the policy documents and if the policy holder is not satisfied with the terms and conditions then he has the option to get the policy cancelled during cooling off period. It was admitted that DLA purchased the policy in dispute with commencement date 28.8.2011 and with sum assured as Rs. 1,50,000/- and complainant is nominee in the said policy. It was also admitted that installments of the policy were paid regularly and DLA died on 7.10.2013. It was asserted that claimant had submitted incomplete papers while lodging the claim and she was asked to complete requirements for settlement of claim but she took back all papers relating to the claim and never approached the servicing branch at Phillor; that the opposite parties had not indulged in any kind of deficiency in service and opposite parties have never denied for consideration of the claim of the complainant and Life Insurance Corporation is still ready to settle the claim on receipt of all the requirements as per rules and procedure of Life Insurance Corporation of India; that opposite parties have never denied for settlement of claim as per rules of Life Insurance Corporation until the required documents are submitted by the claimants and Life Insurance Corporation is still ready to consider the same and as such there is no deficiency in service on the part of Life Insurance Corporation in not settling the claim. All other allegations mentioned in the complaint were denied with prayer to dismiss the complaint with costs or in the alternative, the complainant be instructed to file the claim with all requirements for settlement of claim by the opposite parties.
4 Sufficient opportunities were granted to the parties to lead evidence in order to prove their respective case. The complainant produced her affidavit Ex. C-1, affidavit of Sarabjit Singh Ex.C2 alongwith documents i.e. Renewal Premium receipts Ex. C-3 to C-7, Certificate of employer Ex. C-8, Application addressed to Branch Manager LIC Phillor Ex. C-9, Certificate of Identity and Burial or Cremation Ex. C-10, Medical Attendant’ s certificate Ex. C-11, Form No. 3816 Ex. C-12, Form No. 3801 Ex. C-13, Death Certificate of Sukhdev Singh Ex. C-14, Policy Ex. C-15, Registered cover Ex. C-16, Postal Receipt Ex. C-17, Application dated 16.5.2015 addressed to Branch Manager Ex. C-18, Postal receipt Ex. C-19, Claim’s settlement Ex. C-20, Form No. 3801 Ex. C-21, Medical attendant’s Certificate Ex. C-22, Form Ex. C-23, Insurance policy Ex. C-24, Certificate of Identity and Burial or Cremation Ex. C-25, Postal Receipt Ex. C-26, Application dated 22.1.2015 Ex. C.-27, Postal receipt Ex. C-28, Application dated 28.6.2015 Ex. C-29 and closed evidence and thereafter ld. counsel for Opposite Parties tendered affidavit of Yoginder Singh Sisodia Ex. OPs 1, 2/1 alongwith documents i.e. Self attested copy of Proposal Form Ex. OPs. 1,2/2, Self attested copy of Policy Bond Ex. OPs. 1, 2/3, Self attested copy of e-mail dated 9.3.2016 Ex. OPs 1, 2/4 and closed evidence.
5 We have heard the ld. counsel for the parties and also gone through the evidence and documents produced by parties.
6 Ld. counsel for the complainant contended that complainant is wife of Sukhdev Singh (deceased) who on the persuasion of agent of the opposite parties- LIC purchased one life insurance policy which was to commence from 28.8.2011 and premium of Rs. 6,378/- was to be paid annually and sum assured was Rs. 1.5 Lacs and policy was to mature on 28.8.2026. He contended that Sukhdev Singh paid all the due installments but unfortunately died on 7.10.2013 at his village. He contended that immediate intimation was given to the opposite parties regarding the death of Sukhdev Singh and documents including death certificate of Sukhdev Singh was submitted to the opposite parties but opposite parties did not settle the claim and then called the complainant in its office. He contended that complainant alongwith her son went to office of LIC where officials of Opposite Parties - LIC asked for certain verification on the printed forms from the employer as well as from the doctor and accordingly complainant obtained the said information as per requirement of opposite parties and sent the same to opposite parties through registered cover but even then the claim was not settled and complainant was again called in the office of Opposite Party- LIC and again returned all documents to the complainant on the ground that some more verification is to be filed from the employer as well as doctor. He contended that complainant again collected the required information from the employer and doctor and submitted the same to Opposite Parties- LIC through registered Post but again claim was not settled, rather the complainant was again called in the office and all documents were returned to complainant in arbitrary manner on the ground that claim could not be settled at that time due to certain medical reasons of the deceased but nothing in writing was given to the complainant nor any written objections were delivered to the complainant and documents were returned orally which amounts to refusal to settle the claim by the opposite party insurance company and it amounts to deficiency in service on the part of the Opposite Parties- LIC which caused harassment and mental agony to the complainant who is widow of Sukhdev Singh and she has no other source of income and as such Opposite Parties- LIC should be burdened with compensation and litigation expenses and complaint is required to be allowed.
7 The Ld. counsel for the Opposite Parties- LIC admitted that policy in question was purchased by Sukhdev Singh (deceased) which was to be effective w.e.f. 28.8.2011. Ld. counsel for the Opposite Parties- LIC admitted that Sukhdev Singh died on 7.10.2013 and claim was filed by the complainant who is widow and nominee of deceased Sukhdev Singh but complainant had not filed the complete claim papers and as such she was asked to file the complete papers on printed forms but again the papers filed by the complainant were not complete and she was again asked to complete the papers but complainant took back all the claim documents and thereafter never submitted the same for settlement of claim and as such there is no deficiency in service on the part of Opposite Parties- LIC as Opposite Parties- LIC could not settle the claim for want of required documents and verification. He contended that complaint is also pre mature as Opposite Parties- LIC have neither settled the claim of the complainant nor rejected the same and as such, complaint is liable to be dismissed being pre mature.
8 The issuance of policy in dispute to Sukhdev Singh is admitted fact in this case. The various salient feature of the policy like premium, payment of premium on scheduled dates and the death of Life Assured Sukhdev Singh on 7.10.2013 is also admitted facts between the parties. It is also admitted case of the parties that after the death of Sukhdev Singh, claim papers were submitted to Opposite Parties- LIC for settlement. The contention of the Opposite Parties- LIC is that complainant has not submitted the complete documents alongwith claim form and complainant was repeatedly asked to submit the complete documents with claim forms but instead of filing the documents, complainant took back the claim papers and never submitted the same for settlement whereas the contention of the complainant is that the complainant completed requirements of Opposite Parties- LIC two times and sent the required documents taken from employer as well as from doctors on the printed forms as per requirement of Opposite Parties- LIC twice in settlement of the claim but Opposite Parties- LIC arbitrarily did not settle the claim rather returned all the documents to the complainant with oral objection that claim cannot be settled due to medical reason.
9 It is admitted fact between the parties that complainant filed the claim and as per contention of the complainant, she fulfilled the requirement of Opposite Parties- LIC twice and sent the complete papers to the Opposite Parties- LIC through registered cover, but even then Opposite Parties- LIC has not settled the claim of the complainant nor repudiated the same and kept the same pending on one or the other pretext. It is also case of the Opposite Parties- LIC that the claim of the complainant was not settled as complainant did not fulfill the requirement of Opposite Parties- LIC inspite of repeated requests. However, Opposite Parties- LIC has not produced any document on the file to show that any objection was raised in the claim case and was intimated or sent to the complainant for complying the requirement. On the contrary, complainant has proved 29 documents on the file including certificate of employer as well as certificate or verification from the doctor and complainant has proved application Ex. C-9 vide which she intimated the death of Sukhdev Singh and prayed for settlement of death claim. She also proved application dated 16.5.2015, 22.1.2015, and 28.6.2015 requesting the Opposite Parties- LIC for early settlement of her claim case. Complainant has also proved postal receipt dated 31.1.2015 Ex. C-16, C-17 dated 19.5.2015, Ex. C-19 dated 2 .11.2015, C-28 dated 11.9.2015 to show that after completing the requirement, she sent the papers to Opposite Parties- LIC through registered cover but Opposite Parties- LIC has proved only 3 documents on the file i.e. Proposal Form, Policy bond and attested copy of e-mail which was sent by the manager claim L.I.C to Branch Manager of concerned LIC Branch regarding claim case. As such no documents have been filed by the Opposite Parties- LIC to show that it ever raised any objection in the claim case of the complainant and conveyed the same to the complainant for completing the requirements. It rather gives credence to the contention of the complainant that complainant was summoned by the LIC even repeatedly and orally handed over the documents with oral direction to complainant to complete the requirement which has not come on the file. It shows the causal approach and arbitrariness on the part of Opposite Party- LIC for the settlement of the claim case of the complainant and show that the Opposite Parties- LIC postponed the claim case of the complainant on one or the other pretext without any justification. Otherwise also Sukhdev Singh husband of the complainant died on 7.10.2013 and claim case of the complainant was not settled by the opposite party LIC for more than two years and complainant had to file the complaint on 11.2.2016 i.e. after about 2½ years from the death of Sukhdev Singh. This conduct of the opposite parties must have caused harassment and mental agony to the complainant and she requires to be compensated on this ground otherwise it is admitted case that opposite party returned all the documents to the complainant with oral objection that the claim cannot be settled due to certain medical reasons. Otherwise the Opposite Parties- LIC is required to raise the objection in writing and to deliver the same to the complainant under proper receipt, but no such step was taken by the Opposite Parties- LIC which shows that the Opposite Parties- LIC delayed the settlement of claim of the complainant arbitrarily and it amounts to deficiency in service on the part of the Opposite Parties- LIC. Otherwise, it is admitted case that Opposite Parties- LIC have returned all documents to the complainant and without documents, Opposite Parties- LIC cannot settle the claim case of the complainant. It is also the contention of the Opposite Parties- LIC that complaint is not maintainable being pre mature as Opposite Parties- LIC has not settled the claim of the complainant nor repudiated the same. It is also contended by Opposite Parties- LIC that the complaint is time barred as it has been filed after 2 years from the date of death of Sukhdev Singh i.e. 7.10.2013. However, the Forum does not agree with the Ld. counsel for Opposite Parties- LIC. In case titled ICICI Lombard General Insurance Co. Ltd. Vs Principal Sh. J.P. Pardiwala Arts Commerce College & Others 2014(1) Consumer Law Today page 161, the claim case was filed with the opposite party-insurance company but the insurance company never repudiated the claim. The accident of the insured occurred on 4.6.2003 but complaint was filed on 18.3.2010 and plea was taken by the opposite party-insurance company that complaint is beyond limitation. However this plea of the opposite party- Insurance company was rejected and it was observed by the Hon’ble Gujrat State Consumer Disputes Redressal Commission Ahmadabad that as the case remained undecided, the cause of action will continue till the insurance company settles or rejects the claim and as the claim was kept pending by the insurance company and claim remained undecided, the cause of action will continue till insurance company pass or reject the claim and it is continuous cause of action and complaint was held within limitation. In the case in hand also, it is admitted case of the Opposite Parties- LIC that claim case of the complainant has not been allowed or repudiated by Opposite Parties- LIC and as such in view of law laid down in case titled ICICI Lombard General Insurance Co. Ltd. Vs Principal Sh. J.P. Pardiwala Arts Commerce College & Others (Supra) the cause of action will continue till insurance company pass or reject the claim of the complainant and as such it is continuous cause of action and complaint is within limitation.
10 Therefore in the light of above discussion, the complaint is disposed off with the observation that complainant to file the documents as per requirement of LIC or otherwise within 20 days from the date of receipt of copy of order and thereafter Opposite Parties- LIC to settle the claim of the complainant within one month thereafter and if Opposite Parties- LIC failed to settle the claim of the complainant within said period of one month, then the claim of the complainant shall be deemed to have been allowed in toto by Opposite Parties- LIC. Opposite Parties- LIC is also burdened with Rs. 10,000/- as compensation on account of harassment and mental agony caused due to delay in settlement of the claim case of the complainant. The complainant can obtain the original documents from the Forum on application under proper receipt and identification and subject to filing of certified copies for filing the same to Opposite Parties- LIC. In view of peculiar circumstances of the case, the parties are left to bear their own costs. The Opposite Parties- LIC to comply the payment of compensation to the complainant within one month from the date of receipt of copy of order. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.
Pronounced in Open Forum
Dated 16.8.2016.
