Punjab

Fatehgarh Sahib

CC/38/2015

Bant Singh S/O Ram Chand (2 )Varinder Singh S/O Bant Singh (3) Gurmukh Singh S/O Bant Singh - Complainant(s)

Versus

L.I.Co. of India - Opp.Party(s)

Sh.MPS Batra

29 Jan 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

Consumer Complaint  No. 38 of 2015

                                           Date of institution : 15.04.2015       

                                           Date of decision    : 29.01.2016

1. Bant Singh son of Ram Chand,
2. Varinder Singh son of Bant Singh
3. Gurmukh Singh son of Bant Singh, All residents of village Nalini, Tehsil and District Fatehgarh Sahib.

……..Complainants

Versus

1. LIC of India, Nabha Branch Office, Cinema Road Blii/781, Nabha, District Patiala.
2. Lachmi Chand, Senior Business Associate(Dev. Officer), Br.  LIC opposite Bank of India, Nabha Road, Amloh, Tehsil and District Fatehgarh Sahib.

…..Opposite Parties

Complaint Under Sections 11 to  14 of the Consumer Protection Act.                                             

Quorum

Sh. Ajit Pal Singh Rajput, President             

Smt. Veena Chahal, Member                         

Sh. Amar Bhushan Aggarwal, Member

Present :  Sh.M.P.S.Batra, Adv. counsel for the complainants.                   

                Sh.M.L.Singhi, Adv.Cl. for OP No.1.                                   

               Sh. P.C.Joshi, Adv.Cl. for OP No.2.

ORDER

 

By Ajit Pal Singh Rajput, President.

                          Complainants, Bant Singh son of Ram Chand, Varinder Singh son of Bant Singh and Gurmukh Singh son of Bant Singh, all residents of village Nalini, Tehsil and District Fatehgarh Sahib, have filed this complaint against the Opposite Parties (hereinafter referred to as the OPs) under Sections 11 to  14 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.           OP No.2, who is agent of OP No.1, approached the complainants and suggested to purchase policies, which cover accident and ailment benefits along with life insurance. The complainants agreed to purchase policies and paid Rs.3218/-, Rs.2981/- and Rs.3305/- as premiums for the policies and the OPs issued policies bearing No.164705209, 162873963 and 164698245 to the complainants. The complainants also paid all the premiums to the OPs i.e. Rs. 23,000/-, Rs.63000/- and Rs.25000/- for the said policies respectively. Complainant No.2, namely; Varinder Singh was injured in an accident in 2014 and OPs were informed regarding the same. The complainants demanded cashless treatment as assured by OPs at the time of issuing the policies but OP No.2 refused to provide any medical help by the company. On the treatment of complainant No.2 Rs. 1,00,000/- were incurred by the complainants and being disappointed with the OPs the complainants requested the OPs to refund the premiums paid by them for the said policies. But the OPs only refunded Rs.9127/-, Rs.20554/- and Rs.11,056/- for the said policies. The complainants so many times visited the office of OPs and requested to refund the actual premiums paid by the complainants, but till date they do not refund the actual premiums to the complainants, which amounts to unfair trade practice, malpractice and deficiency in service on the part of the OPs. Hence, this complaint for giving directions to the OPs to pay the premium amounts paid by the complainant alongwith interest and further to pay Rs. 20,000/- as compensation for mental agony and unnecessary harassment suffered by the complainants and Rs.20,000/- as damages and unnecessary litigation expenses

3. The complaint is contested by the OPs. In reply to the complaint, OP No.1 raised certain preliminary objections, inter alia, that the present complaint is not maintainable; the complainants have not come to the court with clean hands; the complaint is bad for mis-joinder and non-joinder of necessary parties; the complainants have no cause of action to file the present complaint and the complaint is time barred. As regards to the facts of the complaint, OP No.1 stated that the complainants were never told by OP No.2 that the policy covers the accident and ailment alongwith the insurance. The complainants were well aware about the terms and conditions of the policies and they offered for the same with their sweet will and filled up the proposal form and given the declaration of its correctness. It is further stated that the policy issued in the name of complainant No.2 is money back policy and there is no provision of cash free treatment as per its terms and conditions. No amount for alleged purpose was payable by the OPs. The policies in question were not health plan, where medical reimbursement is made for medical expenses.The medical benefits are not covered under the policies in question. The request of policy holders for surrender of policies was accepted and amount of Rs.9,127/-, Rs.20,554/- and Rs.11,056/- were refunded under policies No.164705209, 162873963 and 164698245 respectively as per the terms and conditions of the policies. In addition to the above said amount an amount of Rs.15,000/- has been paid to the life assured towards the survivor benefits under policy No.162873963 on 03.06.2010. Hence, there is no deficiency in service on the part of the OPs. After denying the other averments made in the complaint, it prayed for dismissal of the complaint.

4.              In reply to the complaint OP No.2 raised certain preliminary objections, inter alia, that the present complaint is not maintainable in the present form as well as under law; the complainants have concealed the true and material facts from this Forum; the complainants are stopped by their own act and conduct to file the present complaint; the complaint is false, frivolous and vexatious and this Forum has got no jurisdiction to try and decide the present complaint. As regards to the facts of the complaint, he stated that he neither approached the complainants nor he ever sold any policy of LIC to any customer. He is posted as Development Officer in the office of L.I.C. at Nabha and the sale of policy is within the exclusive powers of agents of the L.I.C. He never received any premium from the complainants and the said premium might be paid by the complainants in the office of L.I.C. at their own and he has no concern or connection with the same. There is no deficiency in service on his part. After denying the other averments made in the complaint, he prayed for dismissal of the complaint.

5.              In order to prove his case, the complainants tendered in evidence affidavit of complainant No.1 Ex. C-1, affidavit of complainant No.2 Ex. C-2,  attested copy of policies Ex. C-3 and Ex. C-4, legal notice Ex. C-5, original receipts Ex. C-6 to Ex. C-9 and closed the evidence. In rebuttal OP No.1 tendered in evidence affidavit of Hem Lata, Manager(Legal) as Ex. OP1/1 and closed the evidence. OP No.2 tendered in evidence his affidavit Ex. OP2/2, certificate dated 28.09.2015 as Ex. OP2/1 and closed the evidence.

6.              The ld. counsel for the complainants has submitted that the main controversy involved in the present case is that OP No.1 repudiated the claim of the complainant, despite the fact that the complainant was having a valid insurance policy i.e Ex.C-3 and Ex.  C-4 issued by OP No.1. He also submitted that complainant No.2 had met with an accident in the year 2014 and he got himself treated for the same. Thereafter complainant No.2 had demanded cashless treatment from OP No.1 but the same was rejected. He stated that at the time of taking the insurance policy OP No.2 had assured the complainants, that in case of any injury due to accident, the complainants shall be entitled to cash free treatment. The ld. counsel pleaded that after refusal to pay for the treatment expenses by OP No.1, complainants requested the OPs to refund the premiums paid by the complainants and  OP No.1 did not refund the actual premiums paid by the complainants. The ld. counsel argued that from the act and conduct of the OPs it is ample clear that the OPs had committed deficiency of service by rejecting the claim of the complainant and by not refunding the actual premium paid by the complainants to the OPs, hence he prayed that the complaint be accepted and complainants be compensated for the act and conduct of the OPs.

7.              On the other hand, the ld. counsel for OP No.1 has stated that the polices i.e Ex.C-3 and Ex.C-4 are actually money back life insurance policies. The insurer is not covered for medical treatment/reimbursement of medical bills and the same is very clearly mentioned in the terms and conditions of the said policies. He submitted that complainants had requested for surrender value of the policies. OP No.1 accepted their request and paid them the requisite amounts, the complainants were entitled to, as per the surrender value. The ld. counsel further submitted that the present complaint be dismissed with special cost, as no deficiency of service had been committed by OP No.1 and the OPs had been dragged in unnecessary litigation.

8.              The ld. counsel on behalf of OP No.2 has submitted that the complainants had been depositing the premiums in the branch office. The OP was only receiving the same on behalf of OP No.1.The ld. counsel further submitted that OP No.1 had authorized OP No.2 for collecting the premiums and the same is evident from Ex.OP2/1.The ld. counsel pleaded that it is very much evident from the policies, that policies were money back policies with profits and life insurance, there was no question that OP No.2 informed the complainants that it covers medical treatment also. The ld. counsel argued that the present complaint be dismissed qua OP No.2, as he only acted on behalf of OP No.1.

9.              After hearing the Ld. Counsel for the parties and going through the pleadings, evidence produced by the parties and the oral arguments as well as the written submissions and we have gone through the contents of the polices i.e Ex.C3 and Ex.C4, and the relevant part is reproduced as below:-

“Death before date of maturity == Sum assured + vested bonus

Surviving 5 years from commencement == 20% of Sum Assured

Surviving 10 years from commencement== 20% of Sum Assured

Surviving 15 years from commencement == 20% of Sum Assured

Surviving on date of maturity == 40% of sum + vested bonus”,

it is established that the said polices were money back life insurance policies, which covers death due to accident. In our opinion the said polices were not medical claim policies and complainant No.2 was not entitled to any cashless treatment. It becomes ample clear from the statement of the manager of OP No.1 i.e Ex.OP1/1, wherein it has been stated that the request of the complainant for reimbursement of the medical expenses could not be accepted, as the policies issued by OP No.1 were life insurance policy with profit. It is also an admitted fact that the complainants requested for the refund of the premiums and OP No.1 paid the surrender value, to which the complainants were entitled. It is also established from the authorization letter i.e Ex.OP1/1 issued by OP No.1 in favour of OP No.2 that OP No.2 was only authorized to receive the premiums on behalf of OP No.1. It has come to our notice that as per terms and conditions of the policy the accident benefit means “ if the Accident Benefit is opted for, at any time when this Policy is in force for the full Sum Assured or reduced sum assured in case of partial surrender of the policy, the Life Assured, before the expiry of the policy term or before the policy anniversary on which the age nearer birthday of the Life Assured is 70 years, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation.”

10.            Accordingly, in view of the aforesaid discussion, we find that the policies issued by OP No.1 only covered death due to accident and that the same were not medical insurance. The complainants were only entitled to receive the surrender value and the same had been duly paid by OP No.1. The Hon’ble National commission has held in case titled Life Insurance Corporation Vs Siba Prasad Dash(Dr) & Ors(2008)CPJ156(NC) that              “ Consumer Forum cannot direct the refund of Policy, as the risk stood covered for the period for with premium had been paid”. Thus, we do not find any merits in the submissions made by the ld.counsel for the complainants, hence the present complaint is hereby dismissed being denuded of any merit.

11.            The arguments on the complaint were heard on 22.01.2016 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated29.01.2016

            (A.P.S.Rajput)                     

              President

 

(Veena Chahal)          

   Member

      (A.B.Aggarwal)        

     Member