New Complaint No.234 of 2023.
Date of Institution:26.10.2023.
Old Complaint No:298 of 2018.
Date of Institution: 13.07.2018.
Date of order:11.01.2024.
Narinder Kaur widow of Ravinder Singh Son of Sh. Roor Singh, resident of Village Kot Jograj, Post Office Kala Bala, Tehsil and District Gurdaspur being the nominee of late S. Ravinder Singh as per Insurance Police bearing No. 473550074 having Aadhaar Card No. 7070 4771 3322. …........Complainant.
VERSUS
1. Life Insurance Corporation of India, Branch Office Qadian, Tehsil Batala District Gurdaspur, through its Branch Manager.
2. Life Insurance Corporation of India, Main Office Mehta Market G.T. Road, Gurdaspur, through its Chief Manager.
….Opposite parties.
Complaint Under section 12 of the Consumer Protection Act.
Present: For the Complainant: Sh.Munishwar Nagpal, Advocate.
For the Opposite Parties: Sh.A.K. Joshi, Advocate.
Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Narinder Kaur, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act (here-in-after referred to as 'Act') against LIC of India Etc. (here-in-after referred to as 'opposite parties).
2. Briefly stated, the case of the complainant is that the complainant is the nominee of late S. Ravinder Singh Son of S. Roor Singh resident of Village Kot Jograj Post Office Kala Bala, Tehsil and District Gurdaspur, who is well conversant with the facts of the complaint and is competent to pursue and depose. The complainant being the nominee is the consumer of the opposite parties. It is pleaded that the husband of the complainant/nominee was the holder of three Life Insurance Policies "Jeewan Anand (with profits) (with accident benefits)" bearing No. 473550074 for Rs.10,00,000/- (Rupees Ten Lacs), Policy No. 473038029 for Rs.1,00,000/-(Rupees One Lac), bearing Policy No. 473387976 for Rs.1,00,000/- (Rupees One Lac). It is further pleaded that husband of the complainant paid regularly the half yearly premium of all the above mentioned policies as per the table. It is further pleaded that husband of the complainant/nominee of late S. Ravinder Singh Son of S. Roor Singh met with an accident on 07.12.2016 near Village Chaudharpur, Near Main Highway Bypass and received multiple grievous injuries and due to those injuries the right leg of her husband was amputated at Amandeep Hospital, Amritsar, but unfortunately during his treatment her husband succumbed to the injuries on 16.12.2016. It is further pleaded that complainant/nominee immediately informed the opposite parties regarding the death of her husband in an accident and filed claim for the above mentioned policies for insured amount, with profits and accident benefits. It is further pleaded that the opposite parties made the payment of the insured amount and accident benefit of third policy bearing No. 473387976 vide NEFT – 000081940126 / LIC of India Divisional Office Amritsar on 02.05.2017 and again NEFT – 000103141582 / LIC of India Divisional Office Amritsar on 03.11.2017 for the principle amount of Rs.96,840/- and Rs.1,00,000/- of accident benefit and as such made the total payment alongwith accidental benefits of policy No. 473387976 as per their terms and conditions. It is further pleaded that above mentioned policies are in the record of the opposite parties. It is further pleaded that the opposite party No. 2 also made the payment of principle amount of Rs.82,355/- on 16.06.2017 through NEFT No. 000086869488 / LIC of India Divisional Office Amritsar against policy No. 473038029 on 02.05.2017 after deducting of Rs.17,645/- from the insured amount. Similarly the opposite party No. 1 also made payment of Rs.9,75,925/- through NEFT – 000073659254 / LIC of India Divisional Office Amritsar on 20.02.2017 after deducting of Rs.24,075/- from the insured amount, but the opposite parties did not make the payment of profits and accident benefits of both the above mentioned policies. It is pertinent to mention here that the opposite parties never gave any detail of accounts of payments to the complainant/nominee. It is further pleaded that non giving the details of account is unfair trade practice on the part of the opposite parties. It is further pleaded that to the utter surprise of the complainant, the complainant (nominee) received a registered AD letter dated 17.03.2018 repudiating the genuine claim of accident benefits to the complainant with regard to policy numbers 473550074 and 473038029 on the terms of the policies vide condition 10.2 b (iv) which was never disclosed to the husband of the complainant at the time of insuring and issuing him the above mentioned policies. It is further pleaded that as such the complainant/nominee is not bound by the above mentioned term and condition which is hidden by the opposite parties. It is pertinent to mention here that both the above mentioned original policies are with the opposite parties. It is further pleaded that not paying the profits and accidental claim against the above mentioned policies to the complainant (nominee) is unfair trade practice and deficiency in service on the part of the opposite parties. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.
On this backdrop of facts, the complainant has alleged deficiency and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite parties to pay benefits of accident against policy numbers 473038029 and 473550074 amounting to Rs.11,00,000/- and amount of Rs.17,645/-, Rs.24,075 and Rs.3,160/-in total Rs.44,880/- deducted from the insured amount of the three policies while making the payment. The opposite parties may also be burdened with Rs.1,00,000/- for harassment, mental agony and Rs.70,000/- as litigation expenses alongwith interest @ 18% from the date of death i.e. 16.12.2016 till its realization in the interest of justice. Any other relief this Hon'ble Commission may deem fit may pass in favour of the complainant/nominee.
3. Upon notice, the opposite parties appeared through counsel and contested the complaint and filing their written reply by taking the preliminary objections that the life assured Sh. Ravinder Singh purchased Life Insurance policies from LIC of India bearing No. 473550074 for a Sum Assured Rs.10,00,000/-, Table Term 149-45-16 with Date of Commencement 24.07.2012 from Branch Office Batala-II and Policy No. 473038029 for a Sum Assured Rs.1,00,000/-, Table Term 149-48-15 with Date of Commencement 25.03.2010 from Branch Office Gurdaspur and Policy No. 473387976 for a Sum Assured Rs.1,00,000/-, Table Term 149-45-16 with Date of Commencement 28.06.2012 from Branch Office Gurdaspur. As per the policy records, nominee under all the policies is Smt. Narinder Kaur wife of the deceased Life Assured. It is pleaded that a death claim was filed with the opposite parties Life Insurance Corporation of India by the nominee Smt. Narinder Kaur. The date of death of deceased life assured as per the death certificate is 16.12.2016 and on the date of death all the policies were in force. It is further pleaded that the basic death claim under all the policies have already been paid by the opposite parties corporation, but the double accident benefit claim has been rejected as the deceased life assured died while committing breach of law. It is further pleaded that after the perusal of General Dairy Report No. 011, dated 17.12.2016, P.S. Sekhwan, Police District Batala, it clears that on 07.12.2016, deceased life assured met with an accident when he was driving his motor cycle as his motor cycle collided with a car while he was crossing the road through an unauthorized passage. It is further pleaded that the policy bearing No. 473038029 fvg. Sh. Ravinder Singh (DLA) having Basic Sum Assured Rs.1,00,000/- and DAB Sum Assured Rs.1,00,000/-, policy bearing No. 473387976 fvg. Sh. Ravinder Singh Deceased Life Assured having Basic Sum Assured Rs.1,00,000/- and DAB Sum Assured Rs.1,00,000/- and policy bearing No. 473550074 fvg. Sh. Ravinder Singh Deceased Life Assured having Basic Sum Assured Rs.10,00,000/- and DAB Sum Assured Rs.3,00,000/- subject to admissibility of DAB claim. It is further pleaded that Deceased Life Assured had committed breach of law and as per policy conditions 10.2.b (iv), the additional sum under the policy is not payable if the death is caused while the life assured dies as a result of committing any breach of law. It is further pleaded that keeping all the facts, the corporation rejected the double accident benefits claim under the terms and conditions of the above said policy. It is further pleaded that the claim petition is not maintainable and is liable to be dismissed on this ground only. It is further pleaded that inadvertently the opposite parties LIC of India has paid double accident benefit claim under Policy No. 473387976 on 03.11.2017 to the complainant, which was not payable under the terms and conditions of the policy as mentioned above. It is further pleaded that opposite parties corporation has requested the complainant vide its registered letter dated 27.07.2018 and registered reminder dated 16.08.2018 to deposit the amount of Rs.1,00,000/- (One Lakh) at the Gurdaspur branch, but till the date, the complainant neither deposited the same, nor replied the said latter, hence, the opposite parties corporation has reserved his rights to initiate the legal proceedings against the complainant for the recovery of above said amount under the provisions of law.
On merits, the opposite parties have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite parties. In the end, the opposite parties prayed for dismissal of complaint with costs.
4. Learned counsel for the complainant has tendered into evidence affidavit of Narinder Kaur, (Complainant) as Ex.CW-1/A alongwith other documents as Ex.C-1 to Ex.C-6.
5. Learned counsel for the opposite parties has tendered into evidence affidavit of Sh. Sukhwinder Singh, (Administrative Officer, LIC of India, Batala) as Ex.OPW-1/A alongwith other documents as Ex.OP-1,2/1 to Ex.OP-1,2/8 alongwith reply.
6. Rejoinder not filed by the complainant.
7. Written arguments filed by the opposite parties but not filed by the complainant.
8. Counsel for the complainant has argued that husband of the complainant had purchased three policies from the opposite parties namely Jeewan Anand with profits and with accidental benefits for Rs.10,00,000/-, Rs.1,00,000/- and also for Rs.1,00,000/-. It is further argued that husband of the complainant met with an accident on 07.12.2016 and later on succumbed to the injuries on 16.12.2016 and the claim was lodged with the opposite parties but the opposite parties made payment of insured amount and accidental benefit of 3rd policy No.473387976 and in this way made the entire in respect of policy No.473387976 referred above. It is further argued that opposite party No.2 made payment of principal amount of Rs.82,355/- on 16.06.2017 after deducting Rs.17,645/-. Similarly, opposite party No.1 also made payment of Rs.9,75,925/- through NEFT on 20.02.2017 from the insured amount but the opposite parties did not make payment of profits and accidental benefit of both the policies referred above. Even the opposite parties failed to give any detail regarding the payments made. It is further argued that on 17.03.2018 the opposite parties repudiated the claim of the complainant with regard to policies No.473550074 and 473038029 by relying upon the policies condition No. 10.2 b (iv). However, the husband of the complainant was never disclosed about the said terms and conditions by the opposite parties. Failure to pay the accidental benefit to the complainant being nominee and deduction of amount from the insured amount amounts to deficiency in service on the part of the opposite parties.
9. On the other hand counsel for the opposite parties has argued that the husband of the complainant purchased policy No.473550074 for sum assured of Rs.10,00,000/- and other two policies for sum assured of Rs.1,00,000/- each. It is further argued by the counsel for the opposite parties that the basic death claim under all the policies have been paid to the complainant but the double accident benefit claim has been rejected by the opposite parties as the deceased died while committing breach of law. It is further argued by the counsel for the opposite parties that bare perusal of GDR No.11 shows that husband of the complainant was crossing the road through unauthorized passage and collided with a car and accordingly additional sum under the policy is not payable. It is further argued that inadvertently opposite parties had paid double accidental benefit under the policy No.473387976 to the complainant on 03.11.2017. However, the said claim was not payable and the opposite parties have demanded back said amount from the complainant and opposite parties reserve their right to recover the said amount from the complainant. Counsel for the opposite parties has also relied upon case law 2018 (1) CPJ Page 603 and has prayed for dismissal of the complaint.
10. We have heard the Ld. counsels for the parties and gone through the record.
11. To prove her case complainant has placed on record her affidavit Ex.CW-1/A, copies of policies Ex.C1 and Ex.C2, copy of GDR No.11 Ex.C3, copy of death certificate Ex.C4, copy of statement of account Ex.C5 and copy of repudiation letter Ex.C6 whereas opposite parties have placed on record affidavit of Sukhwinder Singh Admn. Officer Ex.OPW-1/A, copies of policies Ex.OP-1,2/1, Ex.OP-1,2/2 and Ex.OP-1,2/3, copy of copy of GDR No.11 Ex.OP-1,2/4, copy of letter dated 17.03.2018 Ex.OP-5, copy of death certificate Ex.OP-1,2/6, copy of letter dated 27.07.2018 Ex.OP-1,2/7 and copy of letter dated 16.08.2018 Ex.OP-1,2/8.
12. It is admitted fact that husband of the complainant purchased three policies namely Jeewan Anand from the opposite parties with profits and with accidental benefits. It is further admitted fact that policy No.473550074 was for Rs.10,00,000/-, policy No.473038029 was for Rs.1,00,000/- and policy No.473387976 was also for Rs.1,00,000/-. It is further admitted fact that in case of death of life assured the complainant was entitled to receive double benefit under the policies. It is further admitted fact that the husband of the complainant met with accident on 07.12.2016 and succumbed to the injuries on 16.1.22016. It is further admitted fact that opposite parties have made payment of basic sum assured under all the three policies to the complainant. It is further admitted fact that opposite parties have paid double accidental benefit under policy No.473387976 to the complainant on 01.11.2017 and had declined the payment to double accidental benefit under the other two policies. The only question for adjudication before this Commission is whether the repudiation of the claim for payment of double accident benefit in respect two policies is justified by the opposite parties by relying upon the terms and conditions of the policies.
13. The opposite parties have declined benefit of double accident benefit to the complainant under the other two policies by relying upon the facts mentioned in GDR No.11 Ex.C3 and by relying upon the condition No.10.2 b (iv) as per which the accidental benefit is not payable on account of death of life assured while committing breach of law. Perusal of file shows that rather it is admitted fact that opposite parties have paid double accidental benefit to the complainant under the policy No.473387976 and have failed to pay the same benefit to the complainant under the two other policies for which the complainant was entitled to receive the same benefit. Although, the opposite parties have taken the plea that the amount of double benefit was paid inadvertently and the opposite parties have demanded recovery vide letters Ex.OP-1,2/7 and Ex.Op-1,2/8 but the perusal of file shows that present complaint has been filed on 13.07.2018 and the said letters have been issued on 27.07.2018 and 16.08.2018 which shows that opposite parties realised their mistake after instition of the complaint before this Commission and immediately issued above referred letters to hide their own misdeeds. Moreover, although, the opposite parties have taken plea that the opposite parties have also demanded back double accident benefit paid under policy No.473387976 from the complainant but perusal of file shows that said payment was made on 03.11.2017 and letters for recovery of the said amount were issued on 27.07.2018 and 16.08.2018 and so far the opposite parties have not initiated any recovery proceedings against the complainant meaning thereby that it is proved on record that the opposite parties admit to have made the payment rightly to the complainant and failure to initiate any proceedings for recovery further proves that the amount is not recoverable by the opposite parties. We are of the view that payment was made to the complainant under policy No.473387976 on 03.11.2017 and limitation to recover the said amount expired on 04.11.2020 and even if we are exclude the period which has been exempted by the Hon'ble Supreme Court of India for filing of suit w.e.f. 15.03.2020 to the year 2022 in that case also the limitation period to initiate proceedings for recovery of amount from the complainant has expired, which shows that the opposite parties have only tried to escape from their liability and has taken false excuses to deny the benefit of double accident benefit to the complainant under the other two policies.
14. As far as the plea non-payment of double benefit on the basis of exclusion clause No.10.2 b (iv) is concerned we are of the view that it has not come on record that the said terms and conditions were ever read over and explained to the husband of the complainant while issuing the policies. Moreover, bare perusal of policy document Ex.OP-1,2/1 to Ex.OP-1,2/3 shows that the said terms and conditions are written in very small alphabet and cannot be read by any prudent person normally and we are of the view that the insured person is not expected to use magnifing glass to read the the same.
15. We have relied upon judgment of Hon’ble State Consumer Disputes Redressal Commission Punjab Chandigarh in First Appeal No.1095 of 2022 in case titled as Care Health Insurance Limited etc. Vs. Guriqbal Singh wherein in para No.20 it is held as under:-
"Therefore, it is clear that the Ops had neither disclosed all the terms and conditions/exclusion clauses of the policy to the Complainant at the time of purchase of the same. The Complainant was made aware about any such Clauses which were a basis of repudiation of the claim of medical treatment of his son in above said terms. The District Commission had also gave its finding in para No.9 of its order on the similar lines that Ops have not put forth any document in evidence and/or in support of the delivery/receipt of the terms and conditions of the said policy to the Complainant".
16. We are further of the view that if we go through GDR No.11 Ex.C3 in that case also it is not proved on record that the deceased was violating any law as we are of the view that if the accident took place due to negligence of the husband of the complainant in that case the police authorities must had registered FIR under relevant sections of IPC agasint the husband of the complainant and there was no requirement to the record GDR No.11 Ex.C3. Moreover, the said breach of law by the husband of the complainant is not proved on record by the opposite parties by placing affidavit of any police official or eye witness. As such by relying upon facts, evidence and documents and case law referred above we are of the view that repudiation of the claim by the opposite parties regarding payment of double accidental benefit to the complainant under policy No.473550074 for Rs.10,00,000/- and policy No.473038029 for Rs.1,00,000/- amounts to deficiency in service.
17. Accordingly, present complaint is partly allowed and opposite parties are directed to pay the double accidental benefit claim to the complainant under the policy No.473550074 for Rs.10,00,000/- and policy No.473038029 for Rs.1,00,000/- alongwith interest @ 9% P.A. from the date of filing of the complaint till realization within 30 days from the date of receipt of copy of this order.
18. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
19. Copy of the order be communicated to the parties free of charges. File be consigned.
(Lalit Mohan Dogra)
President.
Announced: (B.S.Matharu)
Jan. 11, 2024 Member.
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