Chandigarh

DF-II

CC/1005/2019

Jaswinder Singh - Complainant(s)

Versus

Life Insurance Corporation of India - Opp.Party(s)

Devinder Kumar Adv.

29 Sep 2022

ORDER

 

 DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II,

U.T. CHANDIGARH

 

Consumer Complaint  No	:	1005 of 2019
Date  of  Institution	:	03.10.2019
Date   of   Decision	:	29.09.2022

 

 

 

Jaswinder Singh son of Sh.Raman Singh aged about 55 years r/o H.No.1113, Sector 43-B, Chandigarh.

…Complainant

Versus

Life Insurance Corporation of India, Career Agent Branch, SCO No.1110-1111, Sector 22-B, Chandigarh through its Branch Manager.

….Opposite Party

 

 BEFORE: SMT.PRITI MALHOTRA        PRESIDING MEMBER 

                    SH.B.M.SHARMA              MEMBER

                               

For Complainant : Sh.Devinder Kumar, Adv. for the complainant

For OP          : Sh.Rajeev Sharma, Advocate for the OP.

 

PER PRITI MALHOTRA, PRESIDING MEMBER

1.          Concisely put, the complainant who is the nominee under the insurance policy in question has filed the present complaint stating that his wife who was insured under the insurance policy No.160897572 regularly paid the premium for the period from 1997 till 2018.  The deceased/insured met with an accident on 17.03.2018 and sustained multiple injuries and since the expenses to be incurred in the hospital were beyond his reach and as such on the advice of the doctors, he took his wife to the home  and got installed the survival system at his premises from 17.03.2018 till her death i.e. 28.10.2018 and during this period different surgeries were performed  and the insured taken to various hospitals but finally, she succumbed to her injuries on 28.10.2018.   After performing all the rites and bhog ceremony, he checked all the documents and insurance policies and came to know that the complainant’s wife took the insurance policy from the OP and the premium was due in September, 2018 which was expired.     Due to the aforesaid reasons, he could not deposit the due installment of Rs.183/- for the third quarter with the OP, which was to be deposited on 28.09.2018 even during the grace period of 30 days.  Subsequently, he lodged the claim with the OP in January, 2019 with requisite documents   and on 24.04.2019, he received message regarding receipt of Rs.15,555/- from the Bank and as such he immediately approached the OP for remaining payment but the OP assured him that the remaining payment was to be paid shortly. Subsequently, the claim was repudiated vide letter dated 04.06.2019 on account of late deposit of quarterly installment. However, the complainant had paid the third premium of his wife (deceased insured) on 28.11.2018 along with interest and penalty. Alleging that the aforesaid acts of omission and commission on the part of the OPs amount to deficiency in service and unfair trade practice, the complainant has filed the instant complaint.   
2.     In its written statement, the OP while admitting the factual matrix of the case has stated that the policy in question belongs to the complainant himself not belongs to his wife and the complainant’s wife obtained the policy No.160897590 with date of commencement as 28.09.1997  under plan 111/26/26 under quarterly mode of premium of Rs.183/- and sum assured is Rs.50000/- and the complainant was nominee under the said policy. It has been further stated that till June, 2018 premium was paid regularly but premium for the period of September, 2018 was not paid and the same was paid on 28.11.2018 after the death of the LA (i.e. 28.10.2018).  It has been further stated that the OP has already paid the basic sum assured to the tune of Rs.55087/- to the complainant as per the terms and conditions of the insurance policy. However, the complainant had claimed the “double accidental death claim” of Rs.1.00 lakhs for which he was not entitled as double accidental death claim is not payable as per the condition No.8-B of the policy  which reads as under:-

    “To pay an additional sum equal to the death benefit under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 120 days of its occurrence solely, directly and independently of all other causes result in the death of life assured”.

         Since the wife the complainant had died on 17.03.2018 i.e. after more than 120 days from the date of accident (i.e. 17.03.2018) and as such the OP had rightly released the claim of Rs.55087/- to the complainant and no due is standing towards the OP. Denying other allegations, the OP has prayed for dismissal of the complaint.

3.     Rejoinder has also been filed by the complainants controverting the assertions made by OP.
4.     Parties led evidence in support of their contentions.
5.     We have heard the ld.Counsel for the parties and have perused the entire record. 
6.     After going through the documentary evidence on record and the rival submissions of the parties, we are of the considered opinion that the facts on record clearly reveals that the OP-LIC of India has rightly released the claim of Rs.55,087/- towards the sum assured to the complainant as per the terms and conditions of the insurance policy.  Whereas the claim with regard to the accidental death has been rightly declined by the OP-LIC because the same is not payable to the complainant as per Condition No.8-B of the terms and conditions of the insurance policy reproduced above in the written version as the death of the LA took place on 28.10.2018 i.e. after 120 days from the date of the accident (i.e. 17.03.2018). 
7.     Taking into consideration the facts and circumstances of the case, we are of the considered view that the OP has committed the deficiency in service by not releasing the claim with regard to the sum assured of the policy in question to the complainant in one go, as per the assessment made by the OP itself, reproduced in para 9 of the preliminary objections of the written statement on merits. Pertinently, the OP had initially released the amount of Rs.15,555/- to the complainant on 22.04.2019 towards claim and thereafter released the remaining claim of Rs.39,532/- on 30.11.2019 only that too after institution of the present complaint. Therefore, the complainant is certainly entitled to compensation on account of mental agony and physical harassment suffered by him at the hands of the OP as the complainant has to approach this Commission by way of filing the instant complaint.
8.     In view of the foregoing discussion, we dispose of the complaint with a direction to the OP to pay a sum of Rs.7,000/- to the LRs of the insured deceased –Smt.Surinder Kaur on account of composite compensation for mental agony and physical harassment. This order be complied with by the OP, within 45 days from the date of receipt of its certified copy, failing which the awarded amount shall carry interest @9% per annum from the date of this order till its actual payment.
9.     Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced 29/09/2022
	Sd/- (PRITI MALHOTRA) PRESIDING MEMBER
	Sd/-
	(B.M.SHARMA) MEMBER