BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Consumer Complaint no. 139 of 2020
Date of Institution : 02.07.2020
Date of Decision : 08.10.2024
Sudesh Rani wife of Shri Chander Shekhar, resident of Rajasthan Tyres Resoling Near GTM Hisar Road Sirsa now deceased through her legal heirs
- Manthan Arora son of Shri Sudesh Rani, wife of Shri Chander Shekar, R/o Rajasthan Tyres opposite Pritam Palace Hisar Road, Sirsa.
- Priyanshina daughter of Shri Sudesh Rani wife of Shri Saurab Grover, R/o House No. D-2808, Ashok Vihar, Phirni Road, Fazilka.
……Complainant.
Versus.
1. The Manager (Claims) Life Insurance Corporation of India, Divisional Office, 3, 4, 45, SCO Sector 1, Rohtak.
2. The Branch Manager Life Insurance Corporation of India, Sirsa.
…….Opposite Parties.
Complaint under Section 35 of the Consumer Protection Act, 2019.
Before: SH. PADAM SINGH THAKUR……. PRESIDENT
MRS.SUKHDEEP KAUR……………MEMBER.
SH. OM PARKASH TUTEJA………MEMBER
Present: Sh. A.K. Beniwal, Advocate for the complainant.
Sh. S.K. Puri, Advocate for opposite parties.
ORDER
Initially the complainant Smt. Sudesh Rani filed the present complaint under Section 12 of the Consumer Protection Act, 1986 (after amendment u/s 35 of the Consumer Protection Act, 2019) against the opposite parties (hereinafter referred as Ops) and now after her death her above said legal heirs have been impleaded on her behalf.
2. In brief, the case of complainant is that in the month of July, 2004 the husband of complainant namely Chander Shekhar had purchased a life insurance policy bearing No. 174162065 from op no.2 at Sirsa. As per terms and conditions of the policy, total 28 half yearly installments of Rs.6283/- each were to be deposited by him with op no.2 and sum assured was Rs.2,00,000/- and husband of complainant had appointed the complainant to be his nominee being his wife. That after purchase of said policy, the husband of complainant kept on making the payment of the installments to op no.2 time to time without any delay up to July, 2015 against proper receipts but on account of some financial crises, he could not deposit the installments for the months of January and July, 2016 with the op no.2 but in the month of September, 2016 the husband of complainant contacted the op no.2 and showed his willingness to continue the policy. It was asked by op no.2 to him that on account of non deposition of the installment amounts, the said policy has already been lapsed and as per terms and conditions of the policy in order to continue the same, the complainant has to deposit three installments i.e. two due installments and one installment in advance with op no.2 alongwith a penalty amount of Rs.1038/-. It is further averred that further it was asked to the husband of complainant that his medical tests will also be conducted before continuing the policy and he agreed to the same and ultimately on 15.09.2016 he deposited a total sum of Rs.19,887/- (Rs.6283 X 3 = Rs.18,849/- + Rs.1038/- = Rs.19,887/-) with op no.2 against proper receipt and as per instructions of op no.2, all the required medical tests were conducted and after being satisfied, the policy was continued and thereafter every installment has been deposited by him without any delay. That thereafter in the month of August, 2017 husband of complainant had got paralysis attack and he was taken to various hospitals i.e. PGI, Fortis, All India Hospital, Dabwali road, Sirsa, Life Line Hospital, Jindal Hospital etc. and costly life saving drugs were given to him and further got provided the best treatment to him but inspite of the best treatment given to him, he was in Coma and was still under treatment. It is further averred that complainant made representations to ops no.1 and 2 regarding health of her husband and requested to indemnify her claim under the said policy but no response whatsoever was received by her and ultimately the op no.1 vide letter dated 15.03.2018 wrongly and illegally repudiated the claim of complainant, hence complainant got served a legal notice to the ops on 08.08.2018. It is further averred that as no response was received from ops, therefore, a complaint was filed before this Forum (now Commission) but unfortunately during the pendency of that complaint on account of complainant being financially unsound and on account of no financial assistance from ops, the husband of complainant died on 11.01.2019 and thus complainant had withdrawn the aforesaid complaint on 30.01.2019. It is further averred that after withdrawal of the complaint, the complainant had also lodged her claim under the aforesaid policy with the ops but ops while not properly considering the claim of complainant had paid only Rs.2,47,581/- whereas apart from this amount, Rs.2,00,000/- were also to be paid by ops to the complainant being sum assured as per terms and conditions of the policy but ops have not paid the same to the complainant without assigning any reason despite their several requests and despite legal notice dated 07.03.2020. The ops have given a vague reply dated 12.03.2020 to the complainant vide which claim of complainant has wrongly been repudiated by ops stating therein that nothing is payable to the complainant as her claim falls under the category of early claim because her husband died within a period of three years of the revival of the policy and as such repudiation of her claim is totally wrong, arbitrary and unlawful and the act and conduct of ops amounts to gross negligence, deficiency in service, unfair trade practice on account of which complainant has suffered unnecessary harassment. Hence, this complaint.
3. On notice, ops appeared and filed written statement taking preliminary objections regarding maintainability, locus standi, non joinder of necessary parties, suppression of true and material facts, estoppal and that claim of complainant has since been fully and finally settled and paid up to the complainant, so there was no lack of service on the part of answering ops towards the complainant, so present complaint does not lie before this Commission and same cannot proceed any further. On merits, it is submitted that policy issued to Shri Chander Shekhar had lapsed from January, 2019 due to non payment of the premium amount due on 28.01.2019. On an earlier occasion, the aforesaid policy of LA Chander Shekhar had lapsed due to non payment of the premium amount from 7/2015 to 7/2016. However, the LA had got revived the same on 15.09.2016 by depositing the premium amount from 7/2015 to 7/2016 and declaration of good health and thereafter, the premium was paid up to 7/2018 and the policy lapsed again due to non payment of premium due on 28.01.2019 onwards. It is further submitted that complainant had lodged the claim for critical illness of the life assured, however, the benefit was not applicable before the expiry of one year from the date of FPR/ revival, therefore, the critical illness rider was regretted by the ops as per terms and conditions of the policy vide letter dated 15.3.2018. The death claim lodged by complainant was considered by the competent authority and same was repudiated by the competent authority after treating the revival date 15.9.2016 as null and void as the deceased life assured had not disclosed the material information regarding his illness with malafide intention in the DGH form at the time of revival on 15.05.2016. The paid-up value of Rs.2,47,581/- was paid to the nominee on 11.06.2019 towards the death claim as full and final payment as per terms and conditions of the policy. The complainant is not entitled to any other sum as claimed by her in this complaint. It is further submitted that it is a well settled principle of law that contract of insurance between insurer and insured is made in utmost good faith and suppression of any material information at the time of submission of proposal/ renewal of insurance would justify the repudiation of claim by insurer. The deceased life assured has made deliberate misstatements and withheld material information from them regarding his health at the time of effecting of insurance, hence in terms of policy contract and the declaration contained in the forms of proposal for insurance, the claim was repudiated and accordingly the ops are not liable for any payment under the above policy and all moneys that have been paid stands forfeited to the ops/ LIC. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint made.
4. The LRs of deceased Sudesh now complainants have tendered documents Ex.C1 to Ex.C24.
5. On the other hand, ops have tendered affidavit of Sh. Rajender Gajraj, Branch Manager as Ex.R1 and documents Ex.R2 to Ex.R4.
6. We have heard learned counsel for the parties and have gone through the case file.
7. Admittedly in the month of July, 2004 the father of Manthan Arora and Priyanshiana (now complainants) namely Shri Chander Shekhar now deceased had purchased life insurance policy from ops and paid premium amounts of Rs.6283/- each in half yearly installments to the ops from July, 2004 to July, 2018 and during this period when the policy in question had lapsed due to non payment of premium amount from July, 2015 to July, 2016, the deceased life assured had got revived the same on 15.09.2016 by depositing premium amount from 7/2015 to 7/2016 i.e. by depositing total sum of Rs.19,887/- i.e. two due installment and one installment in advance of the amount of Rs.6283/- each with penalty amount of Rs.1038/- as is evident from receipts placed on file by complainants as Ex.C5 to Ex.C23 and said fact is also not disputed even by ops. The ops have failed to prove on record that life assured had made deliberate misstatement and withheld material information regarding his health at the time of issuance of policy in question or at the revival of the policy in question. The life assured had suffered problem of paralysis in the month of August, 2017 only and ops have failed to prove on record that life assured was suffering from any pre existing disease at the time of issuance of policy in question or at the time of revival of the policy in question and had concealed any health condition from them. So, the ops have taken almost wrong and baseless plea in this regard. The life assured had made last payment of installment towards policy in question in the month of July, 2018 and next installment was due on 28.01.2019 but he died on 11.01.2019 meaning thereby that policy was not in lapsed condition on the date of death of life assured Shri Chander Shekhar. The mother of complainants Smt. Sudesh Rani had already filed a complaint against the ops seeking benefit under critical illness when her husband life assured suffered paralysis disease which was repudiated by ops vide letter dated 15.03.2018 Ex.R4 but after the death of life assured she had got withdrawn the complaint on 30.01.2019 and present complaint has been filed earlier by Smt. Sudesh (now deceased) seeking death claim of her husband which after death of complainant Sudesh is being proceeded by her sons (now complainants). The above said both grounds taken by ops i.e. concealment about health condition by life assured at the time of revival of policy and that policy has been lapsed on 28.01.2019 are immaterial because ops have failed to prove on record that life assured was suffering from any disease on the date of revival of policy and policy was not in lapsed condition on the date of death of life assured i.e. on 11.01.2019. So, the complainants are entitled to sum insured amount of Rs.2,00,000/- from ops due to death of their father and ops cannot deny the same on the ground that paid up value has already been paid because the paid up value was paid by ops only on the basis of premium and not as a death claim.
8. In view of our above discussion, we allow the present complaint and direct the opposite parties to make payment of death claim i.e. sum assured amount of Rs.2,00,000/- to the present complainants/ LRs of deceased due to death of their father Shri Chander Shekhar life assured within a period of 45 days from the date of receipt of copy of this order, failing which complainants will be entitled to receive the said claim amount of Rs.2,00,000/- from ops alongwith interest at the rate of @6% per annum from the date of this order till actual realization. We also direct the ops to further pay a sum of Rs.10,000/- as composite compensation for harassment and litigation expenses to the complainants within above said stipulated period. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced. Member Member President,
Dated: 08.10.2024. District Consumer Disputes
Redressal Commission, Sirsa.