DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC.No.167of 27.07.2009<br /> Decided on: 11.11.2009<br /> <br /> Shashi Bala Goyal wife of Late Sh. Ramesh Goyal, aged about 37 years, resident of # 13062, St. No. 8, Namdev Nagar, Bathinda.<br /> …….Complainant.<br /> Versus<br /> <br /> 1. Life Insurance Corporation of India, through its Branch Manager, Jeevan Jyoti Building, Bibi Wala Road, Bathinda.<br /> 2. Harbhagwan Singh, LIC Agent C/o Branch Manager, LIC Jeevan Jyoti Building, Bibi Wala Road, Bathinda.<br /> ……..Opposite parties.<br /> <br /> Complaint under Section12 of the Consumer Protection Act, 1986.<br /> <br /> Present:<br /> For the Complainant : Sh. R.K. Gupta, counsel for the complainant.<br /> For the Opposite parties : Sh. Inderjit Singh, counsel for opposite party <br /> No.1.<br /> Sh. Bansi Lal, counsel for opposite party No.2.<br /> <br /> QUORUM<br /> <br /> Sh. George, President.<br /> Dr. Phulinder Preet, Member.<br /> Sh. Amarjeet Paul, Member.<br /> <br /> ORDER<br /> <br /> GEORGER, PRESIDENT:-<br /> <br /> 1. Briefly stated, complainant’s case is that she got her son namely Rishi Goyal (born on 9th Dec., 1997) insured with opposite party No.1, through opposite party No.2 being agent of opposite party No.1 for a sum of Rs. 50,000/-, and paid the premium of Rs. 10,000/- on 12.04.2008. She was issued Policy No. 30075983 dated 30.04.2008. She was assured at the time, when she filled up the Proposal Form, and paid the premium by opposite party No.2, who is authorized agent of opposite party No.1, that in case of any mishappening, she is likely to get full amount of insurance, and she was told that insurance cover started from the day, when premium was paid. Unfortunately, Rishi Goyal her son, suddenly died on 06.04.2009 at Bathinda, due to heart failure. She approached opposite party No.1 for payment of the insurance amount in respect of Insurance Policy of Rishi Goyal her son. She supplied all the required documents alongwith Claim Form. She received a letter dated 08.07.2009 from opposite party No.1, wherein she has been asked to file a fresh claim, and also intimated her that only a sum of Rs. 6979.20 is payable to her instead of Rs. 50,000/-. She approached opposite party No.1 time and again, but she was told by opposite party No.1 that she will be paid only an amount of Rs. 6979.20 instead of Rs. 50,000/-. However, lastly, she has been told by opposite party No.1 that the age of child was less than 12 years at the time of insurance, so the claim is repudiated, and settled at Rs. 6979.20. She pleaded that opposite party No.1 played unfair trade practice, and she was not bound by any hidden conditions laid down in the Policy, which does not find mention in proposal form, which in fact, were not shown and got singed, at the time of Insurance. She has claimed that opposite party No.1 be directed to release insurance claim of Rs. 50,000/- alongwith compensation to the tune of Rs. 20,000/- alongwith cost of litigation expenses. <br /> 2. Opposite parties contested the allegations of the complainant raising legal objections that complaint is not maintainable, as the complainant has not disclosed true and material facts, regarding the health of her child. As the child, died within two years of the Policy as per Section 45 of the Insurance Act, claim is not payable. Complainant was informed to submit Form No. 3801 vide letter dated 12.06.2009, but she failed to supply the required documents, due to which, the claim of the complainant has not been finalized, and present compliant is premature. Moreover, vide the aforesaid letter, dated 12.06.2009, complainant was conveyed that a net amount of Rs. 6979.20 paise is liable to be paid to the complainant, as per terms and conditions of the LIC’s Profit Plus (Plan No.188) of the Policy, the Policy has been issued on 12.04.2008, and risk of the life assured was to commence w.e.f. 12.04.2010 as per clause (b) (ii) of the Policy. It has been held that in case of death of the life assured aged less than 12 years before the commencement of risk, only fund value of the unit held in the Policy Holder’s shall become payable, and therefore, complainant was conveyed vide letter dated 12.06.2009 that she is only entitled to an amount of Rs. 6979.20 paise; complaint is not maintainable; this Forum has no jurisdiction to entertain the complaint; complainant has no locus-standi or cause of action; complainant is estopped by her own act and conduct to file the present complaint; there is neither deficiency in service nor unfair trade practice on the part of opposite parties, and complaint is liable to be dismissed.<br /> 3. On merits also, opposite parties while denying the facts on merit, reiterated the facts pleaded by the opposite parties in reply as has been referred to here in above. <br /> 4. Complainant in order to prove her allegations, filed his own affidavit dt. 01.10.09 Ex.C-1 and affidavit of Sh. Zia Lal dt. 01.10.09 Ex.C-10 and also brought on record, copy of claimant’s statement Ex.C-2; photo copy of Medical Attendance Certificate Ex.C-3; copy of death certificate of Rishi Goyal Ex.C-4; copy of policy Ex.C-5; copy of endorsement Ex.C-6; copy of premium receipt Ex.C-7; copy of letter dt. 12.06.09 Ex.C-8; copy of Performa of Form No. 3801 Ex.C-9 and Performa of Profit Plus Plan Form Ex.C-11.<br /> 5. To controvert the evidence of the complainant, opposite parties filed affidavits of Sh. Harbhagwan Singh dt. 07.10.09 Ex.R-1 and Sh. P.K. Saxena, Manager Legal dt. 12.10.09 Ex.R-6, and also brought on record, copies of policy Ex.R-2 to Ex.R-3; copy of letter dt. 12.06.09 Ex.R-4 and copy of death certificate of Rishi Goyal Ex.R-5.<br /> 6. We have heard the learned counsel for both the parties and perused the entire record of the case carefully.<br /> 7. It is an admitted fact that complainant got insured her son namely Rishi Goyal, who was born on 09.12.1997 with opposite party No.1 through opposite party No.2, who is an authorized agent of opposite party No.1 for Rs. 50,000/-, and opposite party No.1 received first premium of Rs. 10,000/- on 12.04.2008. It has been urged by counsel on behalf of the complainant that complainant has not signed the Insurance Policy Ex.R-2, she has only singed the Proposal Form for insurance, and in Proposal Form of the insurance, for which she paid premium of Rs. 10,000/- on 12.04.2008, there was no such condition, that the Policy will covering the risk, commencing from same later date, nor there was any such condition that as per clause (b) (ii) of the policy, whereby it has been laid down by the Insurance Company that in case of death of the life assured aged less than 12 years before the commencement of risk, only fund value of the unit held in the Policy Holder’s shall become payable. The learned counsel has strongly urged that any condition, which has been incorporated in the policy, at a later stage, was not admittedly, the part of the Proposal Form, signed by the complainant, and the same is not binding on her. The learned counsel has also urged that opposite parties have brought on record the Original Proposal Form of insurance, which was singed by the complainant. <br /> 8. We have considered the rival contentions of learned counsel for both the parties, and record of the case carefully.<br /> 9. It is an admitted fact that opposite party No.1, is in possession of the Original Proposal Form of Insurance, which in fact, is filled up by the complainant, and she singed the same, and paid the premium of Rs. 10,000/- for Insurance of her son. It is an admitted fact that Insurance is a contract between the parties. Both the parties are bound by the terms and conditions, agreed at the time of entering into contract of Rs. 10,000/- on 12.04.2008, and therefore, there is no reason, that after receiving the premium of such a big amount, the Insurance Co. will postpone the date of risk covered to 12.04.2010. If this would have been the terms in the proposal form, complainant is bound by such terms. But opposite parties have failed to brought on the record Proposal Form, and no reason has been given by opposite parties, as to why the Proposal Form has been with held. <br /> 10. We are of the considered view that insurance cover Ex.R-2 prepared by the Insurance Co. is one sided, and complainant is not a party or not signatory to the same, and as such, even opposite parties have laid down a clause (b) (ii) in the Policy, whereby in case of death of the life assured aged less than 12 years before the commencement of risk, only fund value of the unit held in the Policy Holder’s, shall become payable. This condition, if, it would have been mentioned in Proposal Form, definitely the complainant would have been bound by the terms and conditions, but since Proposal Form is not brought on the record by opposite party No.1, and terms and conditions Ex.R-2 are not signed by the complainant, complainant is not bound by the terms and conditions mentioned in Ex.R-2. After receiving the premium on 12.04.2008 and also introducing a clause (b) (ii) in Insurance Policy, opposite parties appear to be indulging in unfair trade practice, creating unwarranted extension clause, which amounts to deficiency in service and unfair trade practice. Contractual terms are binding on the parties. A person, who signed a document containing contractual terms, is normally bound by them, even though, he had not read them or was ignorant of their precise legal effect. Similar view has been taken by Hon’ble National Consumer Disputes Redressal Commission, New Delhi, in case titled M/s. Desk to Desk Courier & Cargo Vs. Kerala State Electronics Development Corpn. Ltd., 2004 (2) CLT 117. In the present case, since Proposal Form is not brought on the record by opposite party No.1, and terms and conditions, Ex.R-2, are not signed by the complainant, complainant is not bound by the terms and conditions mentioned in Ex.R-2.<br /> 11. We accordingly, accept the complaint, and opposite party No.1 shall be liable to pay the full amount of the Insurance i.e. Rs. 50,000/- to the complainant alongwith litigation expenses to the tune of Rs. 2,000/-. <br /> 12. The compliance of this order be made within 45 days from the date of receipt of copy of this order.<br /> 13. The copy of this order be sent to the parties concerned free of cost and file be indexed and consigned.<br /> <br /> Pronounced (GEORGE)<br /> 11.11.2009 PRESIDENT<br /> <br /> <br /> (DR. PHULINDER PREET)<br /> MEMBER<br /> <br /> <br /> (AMARJEET PAUL)<br /> MEMBER<br /> <br />