Complainant Ravi Kumar Saini through the present complaint filed under Section 12 of the Consumer Protection Act, 1986 (for short, ‘the Act’) has prayed that the necessary directions may kindly be issued to the opposite parties to pay a sum of Rs.2,00,000/- alongwith interest on account of double accident benefit. Opposite parties be further directed to pay Rs.50,000/- on account of harassment, mental agony and pain and any other relief which he may be found entitled to in the given circumstances.
2. The case of the complainant in brief is that he had got Money Back policy No.473386047 on 28.05.2012 for his son Raul Saini from opposite party no.1 and its maturity was on 28.5.2032 and quarterly installments of premiums were regularly paid to the opposite parties. During the subsistence of the policy, his son died in road accident on 28.10.2015 and he being beneficiary of the policy is consumer of the opposite parties. He has further pleaded that during the subsistence of the policy, his son named Rahul Saini died on 24.10.2015 in road accident in Amritsar District and in this regard an FIR No.100 dated 25.10.2015 under section 304-A, 279, 427 IPC, Police Station Kathu Nangal was registered against the owner/driver of offending vehicle namely Harjinder Singh son of Gurnam Singh, resident of village Graikot District Gurdaspur. Thereafter he lodged insurance claim with opposite party no.1 as per the terms and conditions of the abovesaid policy, but opposite party no.1 settled his claim to the tune of Rs.2,24,900/- i.e. Rs.2.00 lacs as sum assured and the remaining amount of Rs.24,900/- as bonus and interest vide letter dated 25.05.2016. As per the terms and conditions of the policy, the opposite parties were also liable to pay double accident benefits to him, which they have failed to pay to him. He has next pleaded that it was also the duty of opposite parties who are providing services to its different consumers to intimate to him regarding double accident benefits at the time of life assured's attaining majority and for completing requisite formalities for the same. The opposite parties are under legal obligations to safeguard the interest of its consumers. He visited the office of the opposite parties time and again for the payment of double accident benefit amount, but all in vain. Thus, there is deficiency ins service on the part of the opposite parties. Hence this complaint.
3. Notice of the complaint was served upon the opposite parties who appeared through their counsel and filed their joint written reply taking the preliminary objections that the present complaint is not maintainable; the complainant has not come to the Forum with clean hands and has concealed the true and material facts from this Ld.Forum and the complainant has no cause of action to file the present complaint. On merits, it was admitted that opposite party has paid a sum of Rs.2,24,900/-. Actually, Rahul Saini was minor at the time of getting the policy and his date of birth is 8.6.1996 and he became major on 8.6.2014 but he had not submitted any documents for getting the Double Accidental Benefit which were necessary. According to the terms and conditions of the policy minor is not entitled to get DAB, he can get the benefit of DAB only after becoming major and after submitting necessary documents and fulfilling other formalities, but in this case nothing was done by the policy holder to get the DAB, so the complainant is not entitled to get DAB. All other averments made in the complaint have been denied and lastly the complaint has been prayed to be dismissed with costs.
- Counsel for the complainant tendered into evidence affidavit of complainant Ex.C1 along with other documents Ex.C2 to Ex.C9 and closed the evidence.
- Sh.Mohinder Pal Kalotra, Administrative Officer of opposite parties
tendered into evidence his own affidavit Ex.OP-1 along with other documents Ex.OP-2 to Ex.OP-4 and closed the evidence.
6. We analytically observe with the judicial precision (that the majesty of constitutional justice bestows upon the Indian Courts) and find that the OP insurers have arbitrarily repudiated (vide Ex.C3) the complainant’s DAB (Double Accident Benefit) Claim collateral to his settled insurance death-claim for Rs 02.00 Lac under the related policy for the reason that the DLA (Deceased Life Assured) had been minor (hence not eligible to opt for DAB) at the time of purchase of the insurance policy and further he did not opt for it (DAB) during his life-time, upon/after attaining majority hence the present dispute culminating into the present consumer complaint.
7. We find that the complainant on 28.05.2012 had admittedly purchased one Money Back Life Policy with an Assured Sum of Rs.2.0 Lac from the OP insurers for his minor son Rahul Saini who however breathed his last in a Road Side Accident on 24.10.2015. At the time of purchase, the Policy though eligible for the DAB (Double Accident Benefit) was not activated for the same on account of minority of the DLA (Deceased Life Assured) who was supposed to opt for inclusion of the DAB clause in his Policy upon/after attaining majority. We further find that the insured somehow could not opt for inclusion of the DAB clause in his policy upon/after having attained majority on 08.06.2014 but had unfortunately died in a road-accident on 24.10.2015 and thus the nominee-father (the present complainant) was refused the double accident benefit at the time of settlement of the DLA’s death-claim by the OP insurers, on 25.05.2016. The learned counsel for the complainant has vehemently argued (as also pleaded in the complaint) that the opposite party insurers, at no point of time, had informed that the insured and/or nominee were supposed to intimate the DAB option to the insurers upon the insured’s majority to become eligible for the same and further it has been the professional duty/ liability of the OP insurers to have sought the vital DAB option from the insured upon his attaining majority on 08.06.2014. Here, the OP insurers have failed in their professional duty to have themselves sought the DAB option from the minor insured upon his having attained majority and that amounts to deficiency in service on their part and that rakes them up to an adverse statutory award under the applicable Consumer Protection Act, 1986.
8. The OP insurers have admittedly deposed in their accompanying affidavit (Ex.OP1) to written reply that the complainant has been deprived of the DAB (double accident benefit) since the DLA during his life time had not opted for the same after having attained majority on 08.06.2014. It also proves that the instant DAB depravity-loss to the claimant/complainant could have been avoided had the OP insurers acted in a consumer friendly fashion by seeking the DAB option from the DLA during his life-time upon/after having become major on 08.06.2014 and before his accidental death on 24.10.2015. The OP insurers have also produced supposedly supporting evidentiary documents (Ex.OP2 to Ex.OP4) but even these do not absolve them of their professional responsibility cum liability. The complainant, on the other hand, has successfully and satisfactorily proved his contented complaints vide his duly deposed affidavit Ex.C1 and the supporting documents exhibited here as: Ex.C2 to Ex.C9.
9. We find further that the purchase and validity of the related policy have been duly admitted along with the factum of receipt of its premium and resultant enforceability in law. Somehow, the OP insurers have failed to produce any cogent evidence absolving them of their professional ethics to ‘consumer care’ and that addresses its DAB refusal/deprivation at the final stage of settlement as arbitrary, unfair and visibly for collateral considerations. The OP insurers have based their above repudiation decision solely on conjunctions and presumptions and the same are not admissible in judicial adjudicatory.
10. In the light of the all above, we are of the considered opinion that the OP insurers have indeed bruised the consumer rights of the present complainant by employing ‘unfair trade practice’ amounting to ‘deficiency in service’ and that lines them up to an adverse statutory award under the applicable Consumer Protection Act’ 1986. We, therefore, partly allow the present complaint and thus ORDER the OP insurers to pay the impugned ‘insurance claim’ for the full insured amount of the related Policy including the DAB clause as per its governing ‘terms’ (to its full benefits) strictly in accordance with the IRDA guidelines on ‘settlement of claims’ favoring the complainant besides to pay him an amount of Rs.10,000/- as cost and compensation within 30 days of receipt of the copy of the present orders otherwise the aggregate award amount shall attract interest @ 9% PA from the date of the orders till actual payment.
11. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Naveen Puri)
President
Announced: (Jagdeep Kaur)
June,04 2018 Member
*MK*
