District Consumer Disputes Redressal Commission ,Faridabad.

Consumer Complaint  No. 93/2023.

 Date of Institution:08.02.2023.

Date of Order: 26.02.2024.

Anand Kumar son of Shri Ram Darshan, resident of House No. 318, Gali NO.5, Sunder colony, Nangla Road, Faridabad – 121005.

                                                                   …….Complainant……..

                                                Versus

Life Insurance Corporation of India (Delhi Divn.II), Branch Code-314, branch Unit: 36, Neelam Bata Road, NIT, Faridabad – 121001 through its Branch Manager.

                                                                   …Opposite party……

Complaint under section-12 of Consumer Protection Act, 1986

Now  amended  Section 34 of Consumer protection Act 2019.

BEFORE:            Amit Arora……………..President

Mukesh Sharma…………Member.

Indira Bhadana………….Member.

PRESENT:                   Complainant in person with Shri Kanhiya Lal Advocate.

                             Sh. Aman Garg  , counsel for opposite party.

ORDER:  

                             The facts in brief of the complaint are that the complainant obtained the   policy in the name of his minor son namely Rohit Kumar under the

policy of Jeevan Kishor with profit from the opposite party vide policy No. 125495657 dated 11.01.2020 with sum assured of Rs.1,00,000/-./  Apart from the said Rohit Kumar, his another son namely Rahul (who was also minor at the time of getting the policy) was also having the another policy bearing No. 125495655 with the opposite party.  The complainant, the father of the said minor sons i.e complainant was the nominee in the aforesaid policies and the said policies were obtained through the complainant being their father and natural guardian and the complainant had been paying the premium on half yearly basis regularly from the date of taking the policy and till the date of accident of the said sons of the complainant.  On 19.07.2020, both the above sons of the complainant had met with an accident in a factory namely M/s. K.R.Rubberite Pvt. Ltd., Plot NO. 20, Sector-6, Faridabad at about 8.00 a.m. and due to which they sustained fatal injuries and died on the same day. In this regard, an FIR No. 0341 dated 19.07.2020, under Sections 286/337/304 of IPC was registered in Police Station Sector-7, Faridabad.  The post mortem of the son of the complainant namely Rohit Kumar was also conducted at B.K.Hospital Faridabad bearing PMR NO. PMR/04/MS/CH/2020 dated 19.07.2020.  The claim of his son namely Rahul was paid by the opposite party alongwith the DAB (Double Accident Benefits) while the claim of his another son namely remit was only made by the opposite party for death claim, but the Double Accident Benefits (DAB) had not been paid by the opposite.  The complainant had also paid the insurance premium for DAB on 01.04.2019.  The complainant had submitted the relevant Forms duly filled alongwith the required documents in the office of the opposite party within the stipulated period, but the claim of son of the complainant namely Rohit had not been made till now qua the DAB inspite of repeated letters, reminders and personal visits made by the complainant in the office  of the opposite party but neither any reply/response was

given by the opposite party nor made the payment of DAB.  Feeling aggrieved, the complainant made a complaint in the office of the Insurance Ombudsman, Delhi vide complaint No. DEL-L-29-2122-1678 on 11.10.2021 for getting the DAB claim amount of Rohit Kumar.  The said office of the Insurance Ombudsman, Delhi sent a letter to the complainant on 29.12.2021, vide which they asked form the complainant to submit some relevant documents within 10 days.  The complainant had also submitted the requisite documents in compliance of above said letter dated 29.12.2021. The said Insurance Ombudsman, Delhi declined the request of the complainant stating that addition of DAB would have required, submissions of relevant forms and thereafter the insurers would have conducted the necessary underwtiting scrutiny and then issued a revised policy with enhanced premium, whereas in this case, all these actions had not been done, as the policy holder had not completed the necessary procedural formalities.  In this regard, it was necessary to mention that the complainant had already deposited Rs.59/- on 01.04.2019in the office of opposite party vide receipt No. 100613 dated 01.04.2019.  The above said authority had not considered the said receipt/payments of Rs.59/- and wrongly declined the claim of the said deceased for which the opposite party had no right, title and interest to do so. The complainant sent legal notice  dated 01.12.2022 to the opposite party but all in vain. The aforesaid act of opposite party amounts to deficiency of service and hence the complaint.  The complainant has prayed for directions to the opposite party to:

a)                refund the amount of DBA of the complainant alongwith future interest at the rate of 24% p.a. from the date of incident till realization of amount.

 b)                pay Rs.2,00,000/- as compensation for causing mental agony and harassment .

c)                pay Rs.25,000/- as litigation expenses.

2.                Opposite party  put in appearance through counsel and filed written

 statement wherein Opposite party refuted claim of the complainant and submitted that policy bearing No. 125495657 was issued in favour of Mr. Rohit Kumar and policy bearing No. 125495655 was issued in favour of Mr. Rahul Kumar and both were minor at the time of taking the above policies.  It was also submitted that the complainant was made a nominee in both of the above policies.   It was submitted that at the time of taking policy bearing No. 125495657 Rohit Kumar was the minor due to which he was not eligible for accident benefit and was never charged with Double Accident Benefit (DAB) premium.  It was also pertinent to mention that in case at the time of taking policy life assured was minor then he might apply for DAB after attaining majority but to the contrary in the above case, Rohit Kumar even after attaining majority never took or applied for DAB in his policy due to which he was not eligible for DAB and hence  his claim was rejected/  however, the case of Mr. Rahul Kumar was different from that of above as on attaining majority Rahul Kumar had taken DAB in his policy, and after his death the claim was duly paid.  It was submitted that the learned Ombudsman did not find any merit in the plea of complainant and dismissed his claim.  Since, the life assured after  majority failed to obtain the DAB, his claim with Ombudsman was declined.  It was also submitted that at the time of depositing the fee of Rs.59/- LA was also required to submit DAB Form No. 3772 alongwith policy bond for securing accident benefit but he failed to do so and his DAB was not added ot the policy. Opposite party  denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.

3.                The parties led evidence in support of their respective versions.

4.                We have heard learned counsel for the parties and have gone through the record on the file.

5.                In this case the complaint was filed by the complainant against

opposite party–Life Insurance Company with the prayer to: a)  refund the amount of DBA of the complainant alongwith future interest at the rate of 24% p.a. from the date of incident till realization of amount.  b) pay Rs.2,00,000/- as compensation for causing mental agony and harassment . c) pay Rs.25,000/- as litigation expenses.

                   To establish his case the complainant  has led in his evidence,  Ex.CW-1/A – affidavit of Anand Kumar, Ex.C-1 – letter,, Ex.C-2 – nomination letter dated 01.04.2019,, Ex.C-3 – policy,, Ex.C-4 – Miscellaneous receipt, Ex.C-5 – FIR,, Ex.C-6 – post mortem examination report,, Ex.C-7 – Death certificate,Ex.C-8 to 10 – letters, Ex.C-11 – postal receipt, Ex.C-12 – miscellaneous receipt, Ex.C-13 & 14- letters, Ex.C-15 -  ombudsman letter dated 29.12.2021, Ex.C-16 & 17 – Adhaar cards. Ex.C-18 – Haryana Resident Certificate, Ex.C-19 – Order passed by the Ombusdman, Ex.C-20 – legal notice,, Ex.C-21 – postal receipt.

                   On the other hand counsel for the opposite party  strongly agitated and opposed.  As per the evidence of the opposite party Ex.RW1/A – affidavit of Shri Biju George, Manager Legal, Life Insurance Corporation of India, Divisional Office No.1, Jeevan Prakash Building, K.G.Marg, New Delhi Ex.RW-1/1(colly) – & RW1/2 – premium history of Rohit and Rahul, Ex.RW1/3 – DAB form NO. 3772 deposited by Rahul.

6.                In this case, the complaint was filed by the complainant with the prayer the claim of death of one of the minor i.e Rahul. As per Ex.C1 to  C-21.  The death claim of the two minor children has already been settled with the simple payment and one of the minor got the double benefit claim after paying the premium of  Rs.59/- as per Ex.RW1/1 colly) on dated 21.04,2023  & RW1/2  on  dated 25.05.2023.  Previously  the complainant filed the complaint  before

Insurance Ombudsman, Delhi against two claim of double benefit but the said Insurance Ombudsman, Delhi declined the request of the complainant stating that addition of DAB would have required, submissions of relevant forms and thereafter the insurers would have conducted the necessary underwtiting scrutiny and then issued a revised policy with enhanced premium, whereas in this case, all these actions had not been done, as the policy holder had not completed the necessary procedural formalities.  In this regard, it was necessary to mention that the complainant had already deposited Rs.59/- on 01.04.2019in the office of opposite party vide receipt No. 100613 dated 01.04.2019.  The above said authority had not considered the said receipt/payments of Rs.59/- and wrongly declined the claim of the said deceased for which the opposite party had no right, title and interest to do so.

7.                After going through the evidence led by the complainant as well as the opposite party, no doubt the  premium of double  benefit was given by the complainant which was wrongly received by the opposite party in different heads because of  this only the claim of one of the minor child was declined.  But as per the evidence led by the complainant, the Commission is of the opinion that a person has claimed for two minor children and in both the cares the complainant has filed the extra premium of Rs.59/- as per  Ex.RW1/1 (colly ) & Ex.RW1/2 but by mistake it was put in the different heads of the opposite party. The Commission is of the opinion that it is a mistake.  The original claim was given to the complainant already and by mistake premium of one of the minor children was put in different head. The repudiation done by the opposite party is not justified.  In the interest of justice, we dispose of this complaint with the direction to opposite party to pay 50% of the claimed amount to the complainant because it is a mistake.

 There is no deficiency.  There are no order as to costs. Compliance of this order be made within 30 days from the date of receipt of copy of order.  Copy of this order be given to the parties  concerned free of costs and file be consigned to record room.

Announced on: 26.02.2024.                                 (Amit Arora)

                                                                                  President

                     District Consumer Disputes

           Redressal  Commission, Faridabad.

                                                        (Mukesh Sharma)

                Member

          District Consumer Disputes

                                                                          Redressal Commission, Faridabad.

                                                      (Indira Bhadana)

                Member

          District Consumer Disputes

                                                                         Redressal Commission, Faridabad.