DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

U.T. CHANDIGARH

Bhupinder Singh, aged 53 years, s/o Sh. Mehma Singh r/o House No.71, Village Buterla, UT, Chandigarh.

                                      ---Complainant.

Versus

Life Insurance Corporation of India, Unit-I Branch (163), Jeevan Deep Building, Sector 17-B, Chandigarh through Branch Manager.

---Opposite Party

BEFORE:  SHRI LAKSHMAN SHARMA                 PRESIDENT

                   SMT. MADHU MUTNEJA                       MEMBER

                   SHRI JASWINDER SINGH SIDHU       MEMBER

Argued by: None for the complainant

                        Sh. Pawan Kumar Longia, Adv. for the OP

PER LAKSHMAN SHARMA, PRESIDENT

1.                           Sh. Bhupinder Singh, has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the Act only) praying for the following relief :-

“(i)     Pay Rs.1,54,000/- to the complainant immediately.

(ii)            Pay Rs.50,000/- for mental harassment and torture.

(iii)         Pay Rs.30,000/- for financial loss on account of delay in kidney transplant and expenses on diagnosis.

(iv)           Pay Rs.11,000/- as costs of the complaint.

(v)              Pay any other amount to which the complainant is found entitled.”

2.                           In brief, the case of the complainant is that on 28.11.2000 he purchased LIC Asha Deep Policy from the opposite party for a sum assured of Rs.1,00,000/-.   The premium for the said policy was Rs.3,233/- which was payable half yearly.  He paid the premiums regularly upto 28.11.2011.  According to the complainant, he was told that it was a medical insurance policy and if during its term he suffered from any serious problem, like heart attack, cancer, kidney failure and paralysis, the opposite party was to pay him the sum assured of Rs.1,00,000/- plus accrued bonus immediately to meet the medical expenses.

                   According to the complainant, he developed some problem in his kidney.  He was put on dialysis at Ivy Hospital, Mohali.  He was advised for kidney transplantation. It has been averred that he submitted his claim with the opposite party on 13.10.2011 alongwith all the relevant documents.  It has further been averred that since 13.10.2011 he made several requests for release of the policy amount, but the opposite party did not settle the claim, which amounts to deficiency in service.

                   Hence this complaint has been filed claiming the reliefs mentioned above.

3.                           The opposite party in its written statement admitted that the policy in question was issued to the complainant.  However, it has been denied that the sum assured of Rs.1,00,000/- plus accrued bonuses was payable immediately to meet the medical expenses. According to the opposite party, as per the policy bond, 50% of the sum assured was payable immediately and the balance 50% sum assured alongwith bonus was payable on maturity of the policy or on death prior to the date of maturity.  Thereafter, 10% of sum assured was payable on each policy anniversary upto date of maturity or death prior to that date. 

                   According to the opposite party, the claim of the complainant was duly considered as per the terms and conditions of the policy and an amount of 50% of the sum assured i.e. Rs.50,000/- was released to the complainant vide cheque dated 22.3.2012 which was duly encashed by him on 31.3.2012.  It has further been averred that an amount of 10% of the sum assured i.e. Rs.10,000/- due on the policy anniversary i.e. 28.11.2011 was also paid to the complainant vide cheque dated 27.4.2012.  It has further been averred that the premiums were waived immediately from the policy anniversary falling due after the date of eligibility of the claim.   

                   According to opposite party, there is no deficiency in service on its part and the complaint deserves dismissal.

4.                           On 22.8.2012, when the case was fixed for arguments, none appeared for the complainant.  Therefore, we proceeded to dispose of this complaint on merits under Rule 4 (8) of the Chandigarh Consumer Protection Rules, 1987 read with Section 13(2) of the Act (as amended upto date) even in the absence of the complainant. 

5.                           We have heard the learned counsel for the opposite party and have gone through the documents on record.

6.                           The case of the complainant is that he was entitled to a sum of Rs.1,00,000/- plus accrued bonus immediately after the operation to meet out the medical expenses but the opposite party has failed to pay the same, which amounts to deficiency in service.

7.                           On the other hand, it was vehemently argued by the ld. Counsel for the opposite party that as per the terms and conditions of the policy, the complainant was entitled to 50% of the sum assured alongwith accrued bonus.  It has been asserted by the ld. Counsel for the opposite party that a sum of Rs.50,000/- was released to the complainant vide cheque dated 22.3.2012, which was duly encashed by him on 31.3.2012. A further amount of Rs.10,000/- was also paid to the complainant vide cheque dated 27.4.2012. The opposite party has placed on record a copy of the policy.  Under the heading ‘Quantum of payment of sickness benefit claim’ it has been mentioned as under :-

“(1)    Immediate payment of 50% of the sum assured.

(2)              Waiver of subsequent premiums falling on or after the policy anniversary immediately after the date of eligibility on which conditions of ailments are fulfilled.  However, unpaid premiums alongwith unpaid premiums till the next anniversary upto eligible date will be recovered from the benefit claim amount.

(3)              Payment of an amount equal to 10% of the sum assured, every year commencing from the policy anniversary falling on or after date of eligibility  and ending with the policy anniversary preceding the date of maturity or the date of death of the life assured, whichever is earlier.

(4)              Payment of balance 50% of the sum assured and vested bonus on the date of maturity or on death of the life assured, which ever is earlier.  The bonus will be calculated on the full sum assured even though 50% of the sum assured would have been paid earlier.”

From the bare perusal of the above said terms and conditions of the policy, it is apparent that the complainant was entitled to immediate payment of the 50% of the sum assured alongwith payment of an amount equal to 10% of the sum assured.  Both the aforementioned amounts have been duly paid as pleaded by the opposite party.  This fact has not been denied by the complainant by filing any counter affidavit.  Thus, it is clear that the plea of the complainant to the effect that he was entitled to a sum of Rs.1,00,000/- immediately to meet out the medical expenses is not based on the terms and conditions  of the policy reproduced above.

8.                           As the opposite party has already paid a sum of Rs.50,000/- plus Rs.10,000/- in accordance with the terms and conditions of the policy, so we are of the opinion that there is no deficiency in service on its part.   The complaint is accordingly dismissed with no order as to costs.

9.                           Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

23.08.2012.

Sd/-

(LAKSHMAN SHARMA)

PRESIDENT

Sd/-

 (MADHU MUTNEJA)

MEMBER

Sd/-

(JASWINDER SINGH SIDHU)

MEMBER