Chandigarh

DF-I

CC/565/2023

MASTER NAMAN - Complainant(s)

Versus

LIFE INSURANCE CORPORATION OF INDIA THROUGH ITS BRANCH MANAGER - Opp.Party(s)

AJAY SINGH PARMAR

02 Jul 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

                                     

Consumer Complaint No.	:	CC/565/2023
Date of Institution	:	01/12/2023
Date of Decision	:	02/07/2024

 

1. Master Naman, aged about 15 years son of late Rattan Kumar son of Suresh Chand.
2. Kashish, aged about 13 years daughter of late Rattan Kumar son of Suresh Chand.
3. Sakshi, aged about 9 years daughter of late Rattan Kumar son of Suresh Chand.
4. Bishna, aged about 58 years w/o Suresh and mother of late Rattan Kumar.
5. Suresh, aged about 66 years father of late Rattan Kumar

All are residents of House No.263, New Indira Colony, Manimajra, Chandigarh.

… Complainants

V E R S U S

1. Life Insurance Corporation of India, SCO No.810 (1^st Floor) Manimajra, U.T, Chandigarh through its Branch Manager.
2. Life Insurance Corporation of India, Jeevan Prakash Building, 2^nd Floor, PB No.28, Sector 17B, Chandigarh through its Senior Division Manager.

… Opposite Parties

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER

                                                                               

ARGUED BY	:	Sh. Ajay Singh Parmar, Advocate for complainants
	:	Sh. Rajneesh Malhotra, Advocate for OPs (through VC)

 

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Master Naman and others, complainants against the aforesaid opposite parties (hereinafter referred to as the OPs).  The brief facts of the case are as under :-

1. It transpires from the allegations, as projected in the consumer complaint, that late Sh. Rattan Kumar, father of complainant Nos.1 to 3 and son of complainant Nos.4 & 5, had obtained LIC’s Jeevan Lakshya policy (Annexure C-2) in which his wife, Smt. Sangeeta was the nominee and the relevant details of the policy schedule are as under :-

Schedule
UIN	512N297V02	Policy Number	148623306
Plan & Policy Term	933-25	Premium Paying term	22
Date of commencement of Policy	28/07/2021	Date of Commencement of Risk	06/08/2021
Date of Issuance of Policy	06/08/2021	Date of Maturity	28/07/2046
Mode of payment of premium	Qly	Due date of payment of last premium for Base Policy:	28/04/2043
Due date of premium	28th	Instalment Premium for Base Policy (Rs.) :	8809.75
Basic Sum Assured (Rs.)	800000	Total Instalment Premium (Rs.) : (Taxes, if any, as applicable from time to time are charged extra)	9980.00

The premium of the subject policy was payable on quarterly basis, which was continuously paid and the last premium to the tune of ₹10,204/- was paid online on 29.4.2023 vide receipt (Annexure C-3). On having some health issues, the policyholder was admitted and treated in the Suddhi Ayurveda Panchakarma Hospital, on 10.4.2023 from where he was discharged on 25.4.2023 and was diagnosed as a case of whole abdomen, blockage, cough and weakness. Copy of discharge certificate is Annexure C-4. Thereafter the complainant, after having further complications, was admitted at Ojas Hospital on 7.5.2023 and was diagnosed with lower respiratory tract infection, sepsis, septic shock, CKD – Stage V, but, died on 8.5.2023.  Copies of death summary and death certificate are Annexure C-5 and C-6. After his demise, Sh. Rattan Kumar (hereinafter referred to as “DLA”) left behind legal heirs namely Smt. Sangeeta (wife), complainant Nos.1 to 3 (his minor children) and complainant Nos.4 & 5 (his parents). However, after a few days, on 15.5.2023 wife of the DLA Smt.Sangeeta also expired and copy of her death certificate is Annexure C-8.  In this manner, on the demise of the DLA and his wife Smt. Sangeeta, only complainants are the legal heirs of the DLA. Thereafter the parents (complainant Nos.4 & 5) of the DLA vide letter dated 5.8.2023 (Annexure C-9) requested the OPs to release the sum assured of ₹8.00 lacs to the complainants, but, nothing has been done by the OPs.  In this manner, the aforesaid act of the OPs amount to deficiency in service and unfair trade practice. OPs were requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.

2. OPs resisted the consumer complaint and filed their written version, inter alia, taking preliminary objections of maintainability, jurisdiction and mis-joinder and non-joinder of parties.  However, it is admitted that the subject policy was obtained by the DLA, but, alleged that the admission of the claim is subject to investigation required under Section 45 of the Insurance Act by the OPs and the OPs are ready and willing to release the claim under the policy, subject to claim investigation and as per the terms and conditions of the policy, to the succession holders of the subject policy.  On merits, the facts as stated in the preliminary objections have been reiterated. The cause of action set up by the complainants is denied.  The consumer complaint is sought to be contested.
3. In replication, complainants re-asserted the claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.

2. In order to prove their case, parties have tendered/proved their evidence by way of respective affidavits and supporting documents.
3. We have heard the learned counsel for the parties and also gone through the file carefully.
   1. At the very outset, it may be observed that when it is an admitted case of the parties that late Sh. Rattan Kumar i.e. the DLA had obtained the subject policy (Annexure C-2) from the OPs which commenced w.e.f. 28.7.2021 and was renewable by the DLA quarterly with maturity date of 28.7.2046 with basic sum assured of ₹8.00 lacs, as is also evident from Annexure C-2, and the DLA had died on 8.5.2023 i.e. on account of natural death, as is also evident from the death summary (Annexure C-5) and death certificate (Annexure C-6), leaving behind the complainants and his wife, Smt. Sangeeta, who also died on 15.5.2023, and after her death, complainants are the only legal heirs of the DLA, the case is reduced to a narrow compass as it is to be determined if the OPs are unjustified in not settling the complainant’s claim  even after one year of the death of the DLA and about 9 months after receiving the application from complainants No.4 & 5 for the release of the claim amount and the complainants are entitled to the reliefs prayed for in the consumer complaint, as is the case of the complainants or if the consumer complaint of the complainants is premature and the same is liable to be dismissed, as is the defence of the OPs.
   2. The consumer complaint of the complainants is resisted by the OPs on the sole ground that the claim under the subject policy is an early claim and admission of the claim is subject to claim investigation, as required under Section 45 of the Insurance Act, and the OPs are ready and willing to release the claim, subject to claim investigation and as per the terms and conditions of the subject policy.
   3. However, till date, as the OPs have not produced any document showing if the process for the investigation of the claim has been initiated by them or they have concluded the investigation and further when it has come on record that the DLA has died natural death, as is also evident from the copy of death summary (Annexure C-5) and the claim of the complainants is squarely covered under the subject policy and there is no impediment for the clearance of the claim and further when it has come on record that complainants No.1 to 3 are the minor children of the DLA whereas complainants No.4 & 5 are the parents of the DLA and all of them, being natural heirs of the DLA, are entitled for the claim, it is safe to hold that the act of the OPs in non-settlement of the claim of the complainants even after one year of the death of the DLA and 9 months after receipt of the application from complainants No.4 &5 amounts to deficiency in service and unfair trade practice on their part.
   4. In view of the aforesaid discussion, it is safe to hold that the complainants have successfully proved the cause of action set up in the consumer complaint and the present consumer complaint deserves to succeed and the OPs are liable to pay the sum assured under the subject policy alongwith interest and compensation etc.
4. In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and OPs are directed as under :-

1. to pay the sum assured of ₹8.00 lacs to the complainants alongwith interest @ 9% per annum (simple) from the date of institution of the present consumer complaint i.e. 1.12.2023 onwards.
2. to pay ₹40,000/- to the complainants as compensation for causing mental agony and harassment;
3. to pay ₹10,000/- to the complainants as costs of litigation.

5. This order be complied with by the OPs, jointly and severally, within a period of 45 days from the date of receipt of certified copy thereof, failing which the amounts mentioned at Sr.No.(i) & (ii) above shall carry penal interest @ 12% per annum (simple) from the date of expiry of said period of 45 days, instead of 9% [mentioned at Sr.No.(i)], till realisation, over and above payment of ligation expenses. It is, however, made clear that the aforesaid awarded amounts shall be apportioned amongst the complainants in equal share. The share of minor complainants No.1 to 3 be invested in the shape of FDRs in a nationalized bank, which shall be released to them only upon attaining the age of majority, and till then the FDRs be retained by the office. 
6. Pending miscellaneous application(s), if any, also stands disposed of accordingly.
7. Certified copies of this order be sent to the parties free of charge. The file be consigned.

02/07/2024 hg	[Pawanjit Singh] President
	[Surjeet Kaur] Member