Haryana

Karnal

64/2012

Mohinder Kaur Wd/o Rish Pal - Complainant(s)

Versus

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

Sh. Dinesh Chauhan

26 Nov 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.               

                                                          Complaint No. 064 of 2012

                                                          Date of instt.: 30.01.2012

                                                          Date of decision: 30.11.2015

 

Smt.Mohinder Kaur widow of Shri Rish  Pal son of Shri  Bakshish Singh resident of V & P.O.Biana Dera tehsil Indri district Karnal.

                                                                  ……..Complainant.

                   Vs.

 

1.Life Insurance Corporation of India, Unit-II, 05, Sant Nagar, Hansi Road, Karnal through Senior Branch Manager.

 

 

2.Life Insurance Corporation of India, Divisional Office, 489, Model Town, Karnal through its Senior Divisional Manager.

                                                                  …..Opposite Parties.

 

                     Complaint u/s 12 of the Consumer

                     Protection Act.

 

 

 

Before          Sh.K.C.Sharma……….President.

                   Smt. Shashi Sharma……….Member.

                   Sh.Anil Sharma …………Member.

 

Present:-       Sh.Dinesh Chauhan Advocate for the complainant.

                   Sh.Satpal Singh Advocate for the Ops.

 

                   This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the   averments that her husband namely Rish Pal (since deceased) obtained insurance policy from the Opposite Parties ( in short OPs) vide insurance policy No. 175263713 in the year 2006, for an assured sum of Rs.one lakh. As per the said policy, in case of untimely death of the policy holder in a motor vehicle accident, a further sum of Rs.one lakh would be given to his nominee/legal heir. Her husband died in a motor vehicular accident on  21.10.2010 Being nominee she applied for claim and accidental benefits to the Ops and also submitted the original policy alongwith other relevant and necessary documents as required for adjudication  of the claim, vide file No. Claim/17B/175263713. However, the Ops made payment of sum assured i.e. Rs.one lakh only and the accidental benefit of Rs.one lakh was not paid. The claim regarding accidental benefits was denied vide letter dated 23.9.2011 but no satisfactory reason was given. Ultimately, she got served legal notice  dated 11.11.2011 upon the OPs for reconsidering her claim regarding accidental benefits, but the same also did not  yield any result. In this way, there was deficiency in services on the part of Ops, which caused her mental harassment apart from financial loss.

 

2.                Notice of the complaint was given to the OPs who put into appearance and filed written statement disputing the claim of the complainant. Objections have been raised that complaint is not maintainable; that complainant has no loucs standi to file the present complaint; that complainant is estopped from filing the present complaint by her own acts and conduct; that complainant has suppressed the true and material facts from this Forum and that the present complaint is an abuse of the process  of  law.

 

                   On merits, it has been admitted that Rishipal , the husband of the complainant had obtained insurance policy for an assured sum of Rs.one lakh in the year 2006.  It has been submitted that nominee would have become entitled for accidental benefits only if the deceased had deposited all the due premiums as per terms and conditions of the insurance policy. The deceased was to pay half yearly premium installments of Rs.2475/-. The deceased  did not deposit the premium, which  fell due in the month of June, 2010. As the deceased life assured died on 21.10.2010. the policy fell in Auto  cover period at the time of his death. Therefore, as per condition  “Non Forfeiture Regulations”  of the policy bond the basic claim  of Rs.one lakh after deducting the premium amount and interest was paid  and as per condition no.4 accidental benefits were not payable during the Auto  cover period.  The claim of the complainant for accidental benefits was  rightly repudiated and the complainant was informed vide letter dated 23.9.2011.  In this way, there was no deficiency in services on the part of the OP. The other allegations made in the complaint have been  specifically denied.

                    

3.                In evidence of the complainant, her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C17 have been tendered.

 

4.                On the other hand, in evidence of the Ops, affidavit of Sh.Balihar Singh Manager Legal, Ex.O1 and documents Ex.O2 to Ex.O4 have been tendered.

 

5.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

 

6.                The parties are not at dispute that Rish Pal, deceased life assured obtained insurance policy for the sum assured of Rs.one lakh from the OP. The said policy was to commence w.e.f. 28.12.2006 and the first installment of premium of Rs.2475/- was deposited on 15.1.2007.  The installment premium of Rs.2475/- was payable half yearly. According to the case of the complainant, the deceased was  paying the installments regularly, but Ops have alleged that installment  payable in June, 2010 was not paid  and for that reason the policy was under Auto cover period at the time of death of the deceased on 21.10.2010. It is also admitted that  that Ops have paid the sum assured of Rs.one lakh after deducting the premium amount and interest, to the complainant. The dispute is with regard to the payment of accidental benefits. Thus, the material question which arises for consideration is whether deceased had paid all the premium installments regularly before his death or the premium installment payable in June, 2010 was not paid.

 

7.                The Learned counsel for the complainant contended that it is quite evident from renewal payment receipt, the copy of which is Ex.C13, that deceased life assured had deposited Rs.2557.70P on 18.5.2010 as the amount of premium. The said amount was accepted by the  Ops and thus the  policy stood renewed. The Ops neither brought to the notice of the deceased life assured nor to the complainant that any premium was payable in June, 2010 after the renewal of the policy on 18.5.2010.  The letter of the Ops, the copy of which is Ex.C16, also indicates that initially the Ops wanted to consider the claim of the complainant regarding benefits and asked her to send the copy of the police inquest report, but lateron her claim for accidental benefits was repudiated arbitrarily.

 

8.                Admittedly, installment was payable half yearly. The policy commenced w.e.f. 28.12.2006 and the first premium installment was paid on 15.1.2007. Thus, the deceased life assured was to pay premium installments in the months of January and June every year. There is no dispute regarding the fact that deceased life assured deposited Rs.2575/- as premium installment on 18.5.2010 and his policy was renewed. Neither it has been pleaded nor there is any material evidence from which inference may be drawn that amount of  Rs.2557-70  was deposited by the deceased life assured on 18.5.2010 with regard to the premium installment which was  to  fall due in June, 2010 .The receipt Ex.C13 shows that policy was renewed after depositing the amount of Rs.2575.70.This fact indicates that the policy was already in lapsed condition  as the previous premium which  fell due in December, 2006/January, 2007, was not deposited and then the policy was got renewed after depositing Rs.2575.70 on 18.5.2010. The premium installment payable in June, 2010 was not paid by the deceased life  assured and  this fact is quite evident from status report of the   policy, the copy of which is Ex.O3. Thus, it is emphatically clear that premium installment, which became due in June, 2010 was not deposited by the deceased life assured before this death. The deceased life assured had died on 21.10.2010. Therefore, the policy was under Auto cover period at the time of his death.  As per condition no.4 of the policy, regarding “Non Forfeiture Regulations”, the accidental benefit rider will cease to apply if the policy is in lapsed condition and during auto cover period, the accidental benefit rider shall not be available. Therefore, as per the said condition of the insurance policy, the claiment was not entitled to accidental benefits as policy was under auto cover period at the time of death of the deceased  life assured. Resultantly, the  order of repudiation of the claim of the complainant regarding accidental benefits by the Ops cannot be termed as illegal or unjustified in any manner.

 

9.                As a sequel to the foregoing discussion, we do not find any merit in the present complaint and the same is therefore, dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:30.11.2015                                                                         

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

(Anil Sharma) (Smt.Shashi Sharma)    

       Member.     Member.

 

 

Present:-       Sh.Dinesh Chauhan Advocate for the complainant.

                   Sh.Satpal Singh Advocate for the Ops

 

                   Arguments heard. For orders, the case is adjourned to 30.11.2015.

Announced
dated:26.11.2015                                                                         

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

(Anil Sharma) (Smt.Shashi Sharma)    

       Member.     Member.

 

Present:-       Sh.Dinesh Chauhan Advocate for the complainant.

                   Sh.Satpal Singh Advocate for the Ops

 

                   Vide our separate order of the even date, the present complaint has been dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:30.11.2015                                                                         

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

(Anil Sharma) (Smt.Shashi Sharma)    

       Member.     Member