BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JALANDHAR
Complaint No.456 of 2017
Date of Instt. 29.11.2017
Date of Decision: 27.04.2021
Harjinder Kaur aged about 46 w/o late Harjit Singh, R/o House No.665-A, Guru Nanak Pura (East), Post Office Chogiti, Jalandhar-1444009.
..........Complainant
Versus
1. Life Insurance Corporation of India (LIC), Branch Office, Unit No.4, Ground Floor, Jeevan Prakash, Model Town Road, Jalandhar through its Branch Manager.
2. Life Insurance Corporation of India, Divisional Office, Jeevan Prakash, Model Town Road, Jalandhar through its Senior Divisional Manager.
3. Manager (Claims) Life Insurance Corporation of India, Divisional Office, Jeevan Parkash, Model Town Road, Jalandhar 144001.
4. Manager (CRM) Life Insurance Corporation of India, Divisional Office, Jeevan Parkash, Model Town Road, Jalandhar-144001.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Kuljit Singh (President)
Smt. Jyotsna (Member)
Present: Smt. Haleen Kaur, Advocate Counsel for complainant.
Sh. Bhupesh Vaid, Advocate Counsel for OPs.
Order
Kuljit Singh (President)
1. The instant complaint has been filed by the complainant, against OPs on the averments that her husband (since deceased) whilst alive was insured with OPs bearing policy no. 1322443150 for Rs.50,000/- sum assured under LIC’s Money Plus Table No. 180 for term 10 years through authorized agent of OP No.1 under the supervisory and administrative control of OP No.2. Due to misfortune her husband died on 11.05.2018 due to sudden heart attack. The complainant gave written intimation of death of DLA vide letter dated 15.07.2011 to OPs being nominee. The complainant submitted prescribed claim form A, Death Certificate, Original Policy Bond, Form No. 3801 duly completed signed, witnessed and attested by notary and complied with all requirements. The complainant contacted OPs to know the final outcome of her case but OPs maintained silence. No reason whatsoever was put forth by OP No.4 and OP No.1 regarding action taken and efforts made to trace out alleged missing claim papers and documents and action taken against delinquent officials responsible for getting the claim papers missed. The complainant got legal notice dated 10.02.2017 served upon OP No.1, but all in vain. The OPs have completely ignored and violated the IRDA. No to settle and pay the claim to the complainant and delay on that account per se is sufficient to saddle with the charge of deficiency in service, negligence and unfair trade practice. Due to above said act and conduct of OPs, the complainant has filed the present complaint and prayed that OPs be directed to pay Rs.50,000/- with interest @ 12% per annum from the date of claim till its actual payment besides Rs.25,000/- shall be recovered from delinquent officer and Rs.10,000/- as costs of litigation.
2. Upon notice, OPs appeared and filed written reply and contested the complaint of the complainant by raising preliminary objections that complaint is not maintainable. The complainant is ex facie misconceived and vexatious. The complainant has not fall under the definition of consumer under the CP Act. On merits, it was averred that as per branch record of OPs intimation of death claim has been submitted and letter was issued to complainant being time barred claim. There is no negligence on the part of OPs as complainant has not submitted the requirement till date for further consideration of claim. The claim paper received on 15.09.2011 and date of death is 15.11.2008 and death intimation received after three years so claim is barred by limitation since nothing is payable as per claim manual. Rest of the averments of the complainant was denied by OPs and they prayed for dismissal of the complaint.
3. The glance of evidence is required for settlement of the case. The complainant has tendered in evidence her affidavit as Ex.C-A on the record in support of her case. Ex.C-B additional affidavit of complainant. Ex.C-1 is copy of legal notice dated 07.03.2017. Ex.C-2 is copy of repudiation letter. Ex.C-3 is copy of legal notice dated 10.02.2017. Ex.C-4 is copy of copy of format. Ex.C-5 is copy of aadhar card of the complainant. Ex.C-6 is copy of letter dated 16.08.2017. Ex.C-7 is copy of letter dated 26.08.2016 addressed to complainant by OPs. Ex.C-8 is copy of letter addressed to OPs by complainant. Ex.C-9 is copy of letter dated 16.02.2017. Ex.C-10 is copy of letter addressed to complainant by OPs. Ex.C-11 is copy of office note. Ex.C-12 is copy of letter dated 24.03.2017. Ex.C-13 is copy of office note. Ex.C-14 is copy of status report of policy. Ex.C-15 is copy of policy. Ex.C-16 is copy of death certificate of Harjit Singh.
4. To refute this evidence of the complainant, OPs tendered in evidence affidavit of Parvathy Krishnan M (Caims) LIC as Ex.OW-1/A on the record. This witness stated that the husband of the complainant expired on 11.05.2008 and claim submitted by the complainant on 15.09.2011, which is time barred. The complainant was asked to submit the claim regarding the earlier death claim of Harjit Singh but no response was given to OPs. Ex.O-1 is copy of policy containing with terms and conditions thereof. Ex.O-3 is copy of letter addressed to complainant by OPs. Ex.O-4 is copy of terms and conditions of death claim.
5. It is an established fact that the deceased Harjit Sigh insured with OPs vide policy bearing no.1322443150 for Rs.50,000/- sum assured under LICs Money Plus Table no. 180 for term 10 years through OP no.1 under the supervisory control of OP no.2. This fact is admitted by OPs that insured Harjit Singh expired on 11.05.2008, this fact is clear from perusal of copy of death certificate Ex.C-16 on the record. This certificate prepared by Local Registrar Birth & Death, Municipal Corporation, Jalandhar. The complainant has filed the present complaint being nominee on behalf of her husband (since deceased). The OPs repudiated the claim of the complainant on the ground that claim paper received on 15.09.2011 and date of death is 15.11.2008 and intimation received after three years so claim is barred by limitation.
6. The OPs written letter to complainant Ex.C-2 that claim paper received on 15.09.2011 and date of death is 11.05.2008 and death intimation was given to OPs after three years so claim is barred by limitation. OPs written letter to complainant vide Ex.C-6 placed on the record that claim papers not traceable in the concerned branch hence cannot be provided. Further, OPs written letter dated 26.08.2016 to complainant regarding status of policy is ‘foreclosed’ and death claim paper are received or lying pending in this regard. The complainant has submitted the claim papers with OPs on 15.09.2011, this fact is clear from letter Ex.C-8 placed on the record. The version of OPs that complainant submitted the claim form with them on 15.09.2011 is correct as per Ex.C-8, this document of complainant herself. Further OPs written letter Ex.C-9 dated 16.02.2017 to complainant that ‘kindly let us know when and where the claim papers were submitted by you with them. The case is time barred and foreclosed in status. The OPs further addressed letter to complainant that claim paper received on 15.09.2011 and date of death is 11.05.2008 and death intimation received after three years so claim is barred. From perusal of letter Ex.C-11 it is clear that OPs received legal notice on 10.03.2017 for settlement of an early and time barred death under the above policy. Earlier to this a letter from complainant received on 20.08.2016 and 16.02.2017. OPs stated that no claim papers were pending with them. As per contents the claim paper were received on 15.09.2011 but the insured expired on 11.05.2008. This letter was signed by HGA (Claims) and HOD (Claims) placed on the record.
7. Ex.O-4 is terms and conditions of the death claim. The terms and conditions of the policy binding upon both the parties and no one wriggle out from the same. As per Clause no.1 All the policies where death of the life assured takes place within 3 years from the date of policy i.e. date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later is classified as Death Claims arising within three years from the date of policy. The complainant not followed this above term, the insured Harjit Singh husband of the complainant expired on 11.05.2008 and complainant being nominee submitted the claim paper with OPs on 15.09.2011 and death intimation received after three years from the date of death of life assured. The gap of three years from the death of the life assured is not tenable as per terms and conditions of the policy. The complainant kept mum for at least three years after the death of her husband Harjit Singh. The terms and conditions are strictly binding upon both the parties and no one wriggle out from the same. As per Ex.O-4 “all the polices where claim of the life assured takes place within 3 years from the date of policy i.e. date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later is classified as death claims arising within three years from the date of policy as defined above. It has been decided to conduct claims investigation in all cases where death of the life assured takes place within three years from the date of policy as defined above, irrespective of the claim of death, plan of insurance, sum assured etc.
DEATH CLAIM WHERE CLAIM INVESTIGATION IS NOT WARRANTED
All policies where death of the assured takes place after three years from the date of policy i.e. date of issuance of policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later is classified as death claims arising after three years from the date of policy is defined above and in such cases claim investigation is not required.
8. In the light of our above discussion and from perusal of the terms and conditions of the policy, we find no deficiency or negligence attributed on the part of OPs. The complainant has not followed the terms and conditions of the policy, however, the terms and conditions binding upon both the parties and no one wriggle out from the same. The husband of the complainant expired on 11.05.2008 and information of his death has been received by OPs on 15.09.2011 which is time barred case and complainant was also asked to submit the claim regarding the earlier death claim of Harjit Singh vide letter Ex.O-3, but no response was given by complainant to OPs. This lapse attributed on the part of the complainant and not on the part of OPs. The complainant herself admitted in document Ex.C-8 that all the documents submitted by her with OPs on 15.09.2011 but the husband of the complainant (Harjit Singh) expired on 11.05.2008. The complainant kept mum for at least three years after the death of the life assured. As per terms and conditions of the policy, the OPs are not liable to pay the claim.
9. In view of totality of the facts and circumstances of the case, we find no force in the submission of the complainant and we hereby dismissed the complaint of the complainant. Parties are left to bear their own costs. This complaint could not be decided within stipulated time due to rush of work and spread of Covid-19.
10. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room after due compliance.
Announced in open Commission
27th of April 2021
Kuljit Singh
(President)
Jyotsna
(Member)
