BEFORE THE DISTT.CONSUMER DISPUTES REDRESSAL FORUM; FATEHABAD.

C.C.No.109/2017.

Date of Instt.: 18.05.2017.

Date of Decision:15.10.2018.

Smt. Bimla Devi wife of Jai Kumar, resident of village Kharaiti Khera, Tehsil and District Fatehabad at present resident of Nahar Colony, Fatehabad.

..Complainant.

     Versus

Life Insurance Corporation of India, Branch Office, Fatehabad through its Branch Manager.

..Respondent/OP.

Before:                Sh.Raghbir Singh, President.

                            Sh. Jasvinder Singh, Member.

Dr. Rajni Goyat, Member.

Argued by:         Sh.K.K. Jangra, Advocate for the complainant.

                            Sh. Naresh Sachdeva, Advocate for OP.

ORDER:

                              The present complaint under Section 12 of the Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Party with the averments that son of the complainant namely, Shashi Kant @ Sanjay had got himself insured with the OP vide insurance policy no. 172628308 and the same was valid from 28.12.2001 to 28.12.2021.  A  premium of Rs.1231/- was payable on half yearly basis.  The date of last payment of premium was 28.6.2021.  The complainant was nominee in respect of the abovesaid insurance policy.  It is further submitted that the life insured regularly made the payment of insurance premiums to the OP upto  the year 2014.  It is further submitted that the life assured suffered heart problem and took treatment for the same.  It is further submitted that inadvertently while taking the medicines for the heart problem the life assured consumed pesticide which was kept near the medicines of the heart problem and died on 29.7.2014.  In this regard, post mortem on the dead body of the life assured was conducted on 29.7.2014 and intimation regarding death of the life assured was given to the OP.  It is further averred that the death was unnatural/accidental as such the complainant is entitled benefits of same as well as accidental benefits.  However, the OP made a payment of only Rs. 30,700/- i.e. the amount which was paid by the life assured as premium.  The repudiation of the genuine insurance claim by the OP amounts to deficiency on their part in rendering service to the complainant.

2.                It is further submitted that the complainant had filed a similar complaint which was decided by this Forum vide order dated 10.8.2016 wherein this Forum had observed that “therefore, in view of the abovesaid Clauses 3.1 and 4 of Claim Manual, the complainant may file representation to the appropriate/higher Authorities of the opposite parties who will consider the matter for payment to the complainant and will take a decision within a period of one month from the date of filing of the representation.  Thereafter, the complainant sent a registered notice dated 9.1.2017 thereby calling upon the respondent to make payment in respect of the abovesaid insurance policy.  However, till date no payment has been made to the complainant by the OP and no reply has been furnished to the complainant regarding the abovesaid notice.  Hence, the present complaint.

3.                On being served, the OP appeared through its counsel and resisted the complaint by filing a written statement wherein various preliminary objections with regard to maintainability, locus standi, barred by limitation, cause of action and concealment of true and correct facts etc., have been raised.

4.                In reply on merits, it is submitted that regular premium was not paid by the life assured in the abovesaid policy.  The last premium was paid on 28.1.2014.  Thereafter, the insurance policy was in a lapsed condition at the time of death of the life assured i.e. on 29.7.2014.  The death of the life assured in the present case was after lapse of the grace period as such the insurance claim was not payable to the complainant.  Therefore, the present complaint is without any merits and as such the same is liable to be dismissed.

5.                The learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure C-1.  On the other hand, the learned counsel for the OP tendered in evidence affidavit of Rajendra Singh Manager as Annexure R-1 along-with documents as Annexure R-2 and Annexure R-3.

6.                We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record.   The previous complaint bearing no. 315 of 2015 filed by the complainant was disposed of by this Forum vide order dated 10.8.2016 with the observations that the life assured had died on 29.7.2014 i.e. after expiry of grace period and the policy in question was lapsed as per terms and conditions.  Since the policy was in a lapsed condition on the date of death of the life assured as such the complainant is not entitled to the sum assured as per terms and conditions of the policy.  Since the complainant is not entitled to the sum assured in a lapsed policy as such she is also not entitled any accidental death benefits.  Therefore, the insurance company is not legally liable to make payment and the claim of the complainant has been rightly rejected.  It was also further observed by this Forum that keeping in view the facts and circumstances of the case that the policy had run for a period of 13 years and the policy became lapsed for non-payment of one premium and that too for just one day and in such a like case there are provisions of ex-gratia payment as per Clause 3.1 of Claim Manual for ex-gratia claims and also provisions of relaxation in the matter for settlement of death claim under policies where premium were paid for full 2 years as per Clause 4 of the Claim Manual.  Therefore, in view of the above Clauses 3.1 and 4 of Claim Manual the complainant may file representation to the Higher Authorities of the opposite parties who will consider the matter for payment to the complainant and take a decision within a period of one month from the date of filing of the representation by the complainant.

7.                Thereafter, in view of the order dated 10.8.2016 the complainant submitted a representation to the OP and the OP after reviewing the matter vide its order dated 7.8.2018 has rejected the representation of the complainant. 

8.                Vide order dated 10.8.2016 this Forum had held that the OP is not legally liable to make payment of the insurance claim.  Therefore, the complainant was asked to file a representation before the higher authorities of OP to take decision in the matter on ex-gratia and sympathetic grounds in accordance with the provisions of Claim Manual.  It is the discretion of the competent authority to grant compensation on ex-gratia basis.  Now the representation of the complainant has been rejected by the OP.  Therefore, no further direction can be given to the OP.  The present complaint is accordingly dismissed with no order as to costs. Copy of this order be supplied to the parties free of costs. File be consigned to record room after due compliance.

ANNOUNCED IN OPEN FORUM.                                                              Dt.15.10.2018          

                                                                       (Raghbir Singh)

   President

   (Rajni Goyat)   (Jasvinder Singh)           District Consumer Disputes                      

Member        Member                        Redressal Fourm,Fatehabad