Jasbir Kaur, complainant has filed the present complaint U/s 12 of the Consumer Protection Act, 1986 against the Life Insurance Company, seeking necessary directions to the opposite party to release the DBA amount to the complainant alongwith Rs.50,000/- for harassment and mental agony to her and pay Rs. 10,000/- towards litigations charges in the interest of justice.
2. That the case of the complainant in brief is that the complainant’s husband Tarlok Singh purchased Insurance Policy No.473388210 from LIC Gurdaspur on dated 21.08.2012. He was a truck driver and died in a road accident at District Pali of Rajasthan. It is alleged that she has received an amount of Rs.1,30,000/- from LIC on account of life cover but LIC authorities are not releasing the DBA amount which is used to be given to nominee of a person who dies in an accident. It is further alleged that she met with officials of LIC regarding release of DBA against policy no.473388210 but there is a clear- cut deficiency in service on part of LIC. Further, she again met with staff of LIC Division- Amritsar during 1st week of November, 2018 Regarding DBA but LIC authorities have denied the claim. That the complainant is too much physical and mental harassment due to their act and conduct. Thus, there is clear cut deficiency in service on the part of the opposite parties. Hence, this complaint.
3. Upon notice of the complaint being issued to the opposite parties who appeared through their counsel and filed their written reply taking the preliminary objections that Tarlok Singh purchased an insurance policy bearing no.473388210 for a sum assured of Rs.1,25,000/- with mode of payment half yearly on dated 21.08.2012 from Branch Gurdaspur and the nominee under the policy is Smt.Jasbir Kaur. It has been pleaded that policy has resulted into death claim on 14.11.2014. Death claim filed by the complainant on 21.07.2016. On which basic death claim was paid for an amount of Rs.1,30,877/-. Later on the complainant submitted papers of double accident benefit claim with an affidavit submitted by the complainant that her husband was a truck driver for the last 20-25 years, while as per the proposal form the proponent filled his occupation as Agriculturist in the proposal form. It has been further pleaded that if the proposer would had been mentioned his correct occupation, clause 85 would be imposed which states that if the death of the proponent occurred due to accident while he is engaged in his hazardous occupation ,double accident benefit is not payable. Hence, the double accident is not payable under the policy. The claim of the complainant is not maintainable and liable to be dismissed. It has been pleaded that the complainant approached this Hon’ble Court without exhausting the other remedies available under the law of redressal of his complaint and there is no deficiency in service on the part of the replying respondent and the claim of double accident benefit under the policy in question is not payable under the terms and conditions of the policy. All other averments made in the complaint have been Denied. Lastly, prayed for dismissal of complaint with cost.
4. Ld. counsel for the complainant has tendered into evidence affidavit of complainant (Ex.CW1/A) alongwith other documents (Ex.C-1to Ex. C-3).
5. Ld. counsel for the opposite parties has tendered into evidence affidavit of Virsa Singh Manager (Legal),(Ex.OP-1/A) alongwith other documents (Ex.OP-1 to Ex.OP-6).
6. Rejoinder not filed by the complainant.
7. Written arguments not filed by the parties.
8. We have heard the learned counsels for the parties and gone through the record.
9. To prove his case complainant has placed a record copy of affidavit of the complainant copy of letter addressed to opposite party. On the other hand opposite party has placed on record affidavit of Virsa Singh Manager legal (Ex.OP-1) and copy of policy of insurance (Ex.OP-1) copy of letter (Ex.OP-3) copy of claim form (Ex.OP-6), the policy of insurance and death of the insured is admitted. The only question involved before this commission is regarding payment of DBA benefit. It is further admitted fact that opposite party has already paid Rs.1,30,000 to the complainant and dispute is only regarding of entitlement DBA. The only plea to deny the DBA claim taken by the opposite parties that in all the documents submitted by the deceased, he disclosed himself to be agriculturist, however now the complaints are claiming that the deceased was a truck driver by profession and since the deceased was engaged in hazardous job and as such for such hazardous jobs extra premium was required to be paid. We have gone through the policy of insurance placed on file (Ex.OP-1) where in no such definition of hazardous jobs has been mentioned, more over this commission is of the view that truck driving cannot be consider to be a hazardous job. This Commission is also of the view that hazardous jobs can be considered as working in mines, dams and driving of JCB in hilly areas but in the present case the deceased was only the truck driver which is a normal job. As far as the contentions of the counsel for the opposite parties regarding wrong mentioning of occupation in proposal form is concerned. The complainant has fully proved on record that the deceased was a truck driver by producing driving license Ex.C4. As such the opposite parties cannot deny the DBA benefit in the policy by taking excuse of exclusion clause No.85. Moreover, it is not proved on record that said exclusion clause is explained, read over and supplied to the insured. Accordingly, this commission is of the view that complainants are entitled to receive DBA benefit. In similar case decided by the Hon'ble Supreme Court of India reported in 2022 CPJ 17 (SC) it has been held as under:- (iii) Insurance - Duty of Disclosure, Good Faith and Notice - Principles governing disclosure, good faith and notice are founded on common law principle of fairness - High standard of good faith disclosure and due compliance of notice is required on part of insurer, keeping in view unique nature of insurance contract - Act of good faith on part of insurer starts from time of its intention to execute contract - Disclosure should be norm and what constitutes material fact requires liberal interpretation - Foremost duty of insurer to give effect to due disclosure and notice in its true letter and spirit - When exclusion clause is introduced making contract unenforceable on date on which it is executed, much to knowledge of insurer, non-disclosure and failure to furnish copy of said contract by following procedure required by statute, would make said clause redundant and non-existent. (Paras 14, 15) (iv) Insurance Regulatory and Development Authority (Protection of Policy Holder's interests, Regulation, 2002 - Contract Act, 1872 - Sections 2(i), 10, 17, 18, 19 - Insurance - Exclusion clause - Doctrine of blue pencil - Applicability- There is onerous responsibility on part of insurer while dealing with exclusion clause - Insurer is statutorily mandated as per Clause 3(ii) of Regulation to effect that insurer and his agent are duty bound to provide all material information in respect of policy to insured to enable him to decide on best cover that would be in his interest - Clause 4 enjoins duty upon insurer to furnish copy of proposal form within thirty days of acceptance, free of charge - Any non-compliance, obviously would lead to irresistible conclusion that offending clause, be it exclusion clause, cannot be pressed into service by insurer against insured as he may not be in knowhow of same - In such situation, doctrine of "blue pencil" which strikes off offending clause being void ab initio, has to be pressed into service - When Court of law is satisfied that fraud, or misrepresentation resulted in execution of contract through suppression of existence of mutually destructive clause facilitating window for insurer to escape from liability while drawing benefit from consumer, resultant relief will have to be granted. (Paras 21, 22, 27). Accordingly, present complaint is partly allowed and the opposite party No.1 is directed to pay the DBA benefit under the policy of insurance along with interest at the rate of 9% from the date of filling of the present complaint till realization of the amount. The opposite party No.1 is also directed to pay compensation of Rs.3000/- on account of mental tension and harassment suffered by the complainants. Entire exercise will be completed within 30 days from the date of receipt of copy of this order.
10. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
11. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room.
(Lalit Mohan Dogra)
President.
Announced: (B.S.Matharu)
July 20, 2023 Member
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