Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 170.
Instituted on : 09.07.2013.
Decided on : 03.08.2015.
Ram Kishan Jain(Husband and nominee of deceased Smt. Maya Jain) R/o H.No.858/23, D.L.F. Colony, Rohtak.
………..Complainant.
Vs.
Life Insurance Corporation of India through its Divisional Manager Opposite All India Radio Station, Subhash Road, Rohtak.
……….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.JOGINDER KUMAR JAKHAR, PRESIDENT.
MS. KOMAL KHANNA, MEMBER.
Present: Sh.Deepak Jain, Advocate for the complainant.
Sh.S.P.Gulati, Advocate for the opposite party.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that complainant is husband and nominee of Late Smt. Maya Jain who was appointed and granted Life Insurance Agency by the Chandigarh based office of opposite party vide their letter dated 24.03.1988 under agency code no.4353176 and Smt. Maya Jain had expired on 07.02.2012. It is averred that vide letter dated 06.11.1992 it was confirmed by the Karnal based office of opposite party company that late Smt. Maya Jain was eligible for insurance under Group Insurance Policy and on 02.12.1992 the original documents were submitted at the office of opposite party company. It is averred that since the date of insurance of Late Smt. Maya Jain the opposite party had been regularly deducting insurance premium towards Group Insurance Scheme from the commission being paid to late Smt. Maya Jain and at that time less amount was deducted thereafter as per auditor advise of the opposite party’s company the additional amount was also deducted from the account of late Smt. Maya Jain. It is averred that after the death of Late Smt. Maya Jain the complainant filed a claim with the opposite party and requested to pay Rs.500000/- as insured amount but despite his continuous correspondence and repeated requests, no satisfactory reply was ever given by the opposite party. The complainant filed the complaint with the ombudsman but the same was dismissed on the ground that late Smt. Maya Jain was not eligible to be covered under the scheme since she was of more than 65 years. It is averred that the opposite party sent a cheque amounting to Rs.6300/- dated 05.06.2013 but the same was returned by the complainant to the opposite party. It is averred that there is great deficiency in service on the part of opposite party and as such it is prayed that the opposite party may kindly be directed to pay the insurance amount of Rs.500000/- alongwith interest, compensation and litigation expenses.
2. On notice opposite party appeared and filed its written reply submitting therein that there was no scheme of Group Insurance of Agents in the year 1992 and the Group Insurance Scheme of agents came in force from 01.09.2007 vide Circular Ref.Mktg/ZD/16/2007-2008 dated 16.8.2007 for agents of less than 65 years of age. Since Maya Jain agent date of birth is 17.05.1940, so as on 01.09.2007 she was 67 years of age and as per rules she was not eligible for Group Insurance Scheme of Agents. The group Insurance Scheme/policy which has been mentioned as the year 1992 does not exist. It is averred that the deduction was made upto Aug 2011(Sept 2007 to Aug 2011). The sum of Rs.1200/- yearly were deducted w.e.f. September 2007 to August 2010 and Rs.1500/- were deducted in August 2011 i.e. total Rs.6300/- were wrongly deducted. As the agent Maya Jain was not eligible for Group Insurance Scheme, so the amount of Rs.6300/- were refunded to Nominee R.K.Jain but he refused to take the amount. It is averred that there is no deficiency in service on the part of opposite party and dismissal of complaint has been sought.
3. Both the parties led evidence in support of their case.
4. Complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C13 and has closed his evidence. On the other hand ld. Counsel for the opposite party has tendered affidavit Ex.R1, documents Ex.R2 to Ex.R3 and has closed his evidence.
5. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
6. In the present case it is not disputed that as per letter Ex.C1 dated 06.11.1992, issued by the opposite party to deceased Smt. Maya Jain, she was eligible for insurance under Group Insurance policy. It is also not disputed that as per the reply and affidavit filed by the opposite party, opposite party has deducted the premium amount from the account of Smt. Maya Jain upto the year 2011(August 2011). After the death of Smt. Maya Jain on 07.02.2012, the complainant being the nominee of the policy, had filed the insurance claim with the opposite party but the opposite party had not paid the insurance claim and vide its letter Ex.C7 dated 06.06.2013 had made a refund of Rs.6300/- for the period from 08/2007 to 08/2011 on the ground that as the agent Smt. Maya Jain agent code 04353176 was not eligible for Group Insurance Cover as per Circular Ref.Mktg/ZD/16/2007-2008 dated 16.08.2007. Complainant has also filed a complaint before the Insurance Ombudsman but the same was dismissed vide order dated 06.06.2013 on the ground that Smt. Maya Jain was not eligible to be covered under Group Insurance Scheme as at the time of inception of the scheme she was of more than 65 years of age. To prove its contention opposite party has placed on record copy of letter Ex.R3 dated 16.08.2007 whereby it is submitted that the scheme is introduced for the agents of the Corporation who are aged less than 65 years with effect from 1st September 2007.
7. After going through the file and hearing the parties it is observed that the contention of the opposite party is that as on 01.09.2007 Smt. Maya Jain was of 67 years and as per rules she was not eligible for Group Insurance Scheme of agents. But on the other hand, opposite party continued to deduct the premium from Smt. Maya Devi w.e.f. 01.09.2007 to 08/2011 i.e. for continuous 4 years and it was only after her death that the opposite party at the time of giving claim amount has submitted that the premium amount was wrongly deducted. It is also on record that as per letter Ex.C1 Smt. Maya Jain was eligible for the Group Insurance Scheme since the year 1992 and she was regularly paying the premium. It is also on record that Smt. Maya Jain had died on 07.02.2012 and after her death the opposite party vide its letter Ex.C2 had informed that an amount of Rs.1200/- for commission cycle 8/2011 and Rs.300/- for 18.11.11 were deducted. It is also not disputed that as per claim form Ex.C3 issued by the opposite party, the name of the scheme is Group Insurance Scheme for confirmed, Policy No. is 693223 and the sum insured was Rs.500000/- and as per letter Ex.C4 the claim form of the husband of the deceased Smt. Maya Jain was sent to Head office by the opposite party. But the opposite party instead of giving the insurance claim to the complainant had sent a letter Ex.C7 dated 06.06.2013 alongwith cheque no.470655 dated 5.6.13 on the ground that Smt. Maya Devi was not eligible under the scheme. In this regard we have placed reliance upon the law relied upon by ld. Counsel for the complainant cited in 2015(2)CLT 276 titled as Superintendent of Post Offices & Anrs. Vs. Navin Kumar Singh whereby Hon’ble National Commission, New Delhi has held that: “Policy issued and premium also accepted-At no point of time postal Authorities had either rejected the proof of age or had asked for an additional proof of her age-Insured expired-OP rejected claim on the ground that the proof of age furnished by her was not a valid standard age proof-Having kept quiet for all these months, the OP was estopped for raking up the issue of age after the death of the insured-such a conduct on the part of the postal authorities is responsible and deserves to be outrightly rejected”, as per 2014(1)CLT218 titled as ICICI Lombard General Insurance Vs. Jasbir Singh, Hon’ble Rajasthan High Court has held that: “Having once entered into an agreement with the card holder with certain benefit and facilities the appellants suo moto could not have withdrawn the facility already given in arbitrary manner-The additional cards had been issued only after the customer being satisfied with the scheme of insurance cover and obtained the additional cards-The whole action on the face of it appears to be unjustified arbitrary and nothing but unfair trade practice”. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case it is observed that in the present case also, the premium was accepted by the opposite party for the continuous four years without any objection and only after the death of life assured had taken the plea of non-eligibility of agent for the scheme which is illegal, arbitrary and against the natural justice. As such the complaint is entitled for the insurance claim.
8. In view of the aforesaid discussion and findings it is directed that opposite party shall pay the insurance claim of Rs.500000/-(Rupees five lac only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 09.07.2013 till its actual realization, other benefits under the policy, if any and shall also pay an amount of Rs.2500/-(Rupees two thousand five hundred only) as litigation expenses to the complainant maximum within one month from the date of decision. Complaint is allowed accordingly.
9. Copy of this order be supplied to both the parties free of costs.
10. File be consigned to the record room after due compliance.
Announced in open court:
03.08.2015.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
