Haryana

Fatehabad

CC/494/2019

Lal Chand - Complainant(s)

Versus

Life Insurance Company - Opp.Party(s)

Amit Kumar Soni

01 Sep 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM; FATEHABAD.

                              Sh. Rajbir Singh, President.                                                 Smt.Harisha Mehta and Sh.K.S.Nirania, Members

 

                                                          Complaint case No.494 of 2019.                                                       Date of Instt.: 24.12.2019.                                                                 Date of Decision: 01.09.2023.

Lal Chand son of Ram Chander r/o village Banawali Tehsil Bhattu & District Fatehabad.

                                                                             ..Complainant.                                   Versus

1. The Manager, Life Insurance Corporation, Corporate Office: Yogakshema Building, Jeevan Bima Marg, P.O. Box No.19953 Mumbai-400021.

2.Branch Manager, Life Insurance Corporation, District Fatehabad.

 

                                                                   ..Opposite Parties.

 

          Complaint U/S 12 of the CP Act,1986              

Present:                  Sh. Amit Soni, Advocate for complainant.                                                   Sh. N.K.Sachdeva, Advocate for Ops.                 

ORDER

Sh.Rajbir Singh, President

                              Briefly stated the facts of the present complaint are that complainant took a single premium LIC Policy No.178603556 on 08.05.2010 with policy term year upto 08.05.2018 with extended life cover upto 08.05.2020 for a sum of Rs.3 lac with accidental benefits of Rs.3,75,000/-; that Minakshi daughter of the complainant has been nominated as nominee in the said policy; that the complainant met with a road side accident on 09.04.2015 wherein he sustained injuries on his body and due to this he is not even able to walk and to do routine work; that the complainant requested the Ops vide application dated 07.05.2019 besides completing all other formalities for releasing the accidental benefits claim but to no avail. The act and conduct of the Ops clearly amounts to deficiency in service on their part. In evidence, the complainant has tendered affidavit Annexure CW1/A and documents Annexure C1 to Annexure C3.

2.                On notice, OPs appeared and resisted the claim of the complainant by filing joint reply taking several preliminary objections such as maintainability, locus standi, concealment of material facts and cause of action etc. It has been further submitted that the maturity claim to the tune of Rs.4,13,815/- has already been paid to the complainant on dated 08.08.2019; the extended life cover for two years was also provided to the complainant in the said policy; that the life assured is still alive and maturity claim has already been paid to him, therefore, the accidental death benefit is not payable as per the terms and conditions of the policy; that the claim on account of accidental death benefit is only provided in case of death of life insured in road side accident but in the present case the life assured is alive, therefore, no claim on account of accidental death benefit is admissible; that there is no deficiency in service and unfair trade practice on the part of Ops. Other contentions made in the complaint have been controverted and prayer for dismissal of the complaint has been made. In evidence, the Ops have tendered affidavit of Smt.Sunita Mata, Manager (Legal) as Ex.RW1/A alongwith documents Annexure R1 to Annexure R3.

4.                          We have heard learned counsels for the parties and perused the case file minutely.

5.                          Undisputedly, the complainant had obtained insurance policy commencing from 08.05.2010 to 08.05.2018 with extended life cover upto 08.05.2020 from Ops (Annexure C1) and the fact regarding providing of accidental claim benefit facility of life insured in road side accident in the said policy is also not disputed. The conditions and privileges of the policy are as under:

                   i) Premium Allocation charges as per condition 5 (A)

                   ii)Mortality charge: as per Condition 5 (B)(i)                                   iii)Accident Benefit charge: as per condition 5 (B) (ii)                     iv)Policy Administration charge: as per condition 5 (B) (iii)                  v)Miscellaneous charge: As per Condition 5 (B) (iv)                         vi)Service Tax charge : As per condition 5 (B) (V)

 

 

The said policy was issued in the name of Lal Chand i.e. complainant and the fact regarding making the payment of maturity amount to the tune of Rs.4,13,815/- is also established. It is strange that on one hand the complainant is filing the present complaint alleging therein that he is unable to walk and do other routine work and further treatment is pending and on the other hand the complainant is claiming accidental benefit charges without leading any evidence that the policy in question was for providing benefit on account of disability by the policy holder. Since the complainant has not led any evidence to show that the present policy covers the disability of the life insured, therefore, we have no hitch to reach at the conclusion that the relief allegedly prayed for by the complainant through the present complaint is not admissible as per law keeping in view the above said terms and conditions of the insurance policy in question (Annexure R1). The relevant portion depicted in condition No.2 qua Eligibility condition for accident benefit as mentioned in Annexure R3,  is as under:

………………… Kindly, note that disability benefit i.e.PDB/EPDB is not included in the above accident benefit. If the age at entry of life assured is less than 18 years, then accident benefit rider can be opted for from the policy anniversary coinciding with or immediately following the completion of 18 or more years of age. On accidental death of policy holder during the term of policy or policy anniversary on which age nearer birthday of L.A. is 70 years, whichever is earlier, a sum equal to accident benefit sum assured will become payable, provided policy is in force or treated in force under auto cover of 2 years.

 

The complainant has even failed to produce on the case file his disability certificate on the case file to strengthen his pleas taken in the complaint.

6.                          In view of the above mentioned reasons/discussions, we do not find any merits in this complaint, as the complainant has not been able to prove any deficiency in service and unfair trade practice on the part of Ops, therefore, the present complaint is hereby dismissed.  In the given facts and circumstances of this case, parties are left to bear their own costs. Copy of this order be supplied to the parties concerned, free of cost, as per rules, and thereafter, the case file be consigned to record room, as per rules, after necessary compliance. This order be also uploaded forthwith on website of this Commission, as per rules, for perusal of parties herein.

          

Announced in open Commission.                                                            Dated: 01.09.2023

 

                                                                                                        

          (K.S.Nirania)                 (Harisha Mehta)                 (Rajbir Singh)                        Member                                 Member                              President