Samitri, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act, 1986 (here-in-after referred to as 'Act') against the LIC & others (here-in-after referred to as 'opposite parties).

2.       Briefly stated, the case of the complainant is that the husband of the complainant namely Gopal Masih was serving in Punjab Police and died due to heart attack on 26.11.2017 and at the time of death he was posted at Qadian. It is alleged that during his lifetime, Gopal Masih took one Policy having No.472250851 i.e. Jeevan Lakshya Policy, Table No. 833 from the opposite party no.1. It is further alleged that the payment of the premium was to be deducted from the salary directly. The life Insurance Co. issued letter and as per letter, the opp. party no.2 used to deduct the amount from the salary of Gopal Masih and to pay it directly to the LIC/opposite party no.1. The first premium of the policy was paid on 28 September, 2015. In the policy, the premium is to be paid every month. It is further alleged that even the last premium has been deducted on 28 December, 2017 through the department and the policy is in existence on the date of death i.e. 26.11.2017. It is further alleged that after the death of Gopal Masih, she being nominee applied for getting the claim under the policy to get the sum assured and other benefits and she duly submitted all the original documents i.e. the original policy, death certificate, Bhatia Hospital's medical record etc. It is further alleged that the benefits covered under the policy are i.e. Rs.1,00,000/- Insured amount, 10% of amount to be paid every year till maturity i.e. 28th Sept. 2029, which comes to Rs.10,000/- per month and full maturity amount with bonus at the time of maturity. It is further alleged that the opposite party no.1 failed to make the payment inspite of the repeated requests. The claim has orally been repudiated by the opposite party no.1 i.e. LIC on the ground that no premium has been received for the three months i.e. the premium due on 28 November 2015, 28 December, 2015 and January, 2016.The claim has wrongly been repudiated and the matter of fact is that as already stated, it is the duty of S.S.P Office Batala to make the payment every month. It is further alleged that there is no lapse on the part of the deceased and no letter has ever been sent to the deceased by the L1C regarding the fact that there is any gap of three months of premium. Even the policy has never been cancelled and the LIC duly received the premium for the further months and the policy is in existence at the time of date of death. If the policy is in existence at the time of date of death of the insured, then the insurance co. has no right to repudiate the claim. Due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental harassment and inconvenience. So, there is a clear cut deficiency on the part of the opposite parties.

          On this backdrop of facts, the complainant has alleged deficiency in service and unfair trade practice on the part of the opposite parties and prayed that the opposite parties may be directed to pay the amount of Rs.1,00,000/ - i.e. the sum assured and further to give all the benefits under the policy i.e. Rs.10,000/- every year till its maturity i.e. 28 September, 2029 and further at the time of maturity full maturity amount with bonus may also be given. The opposite parties further directed to pay the compensation of Rs.50,000/- for harassment, deficiency in services and litigation expenses in the interest of justice.

3.       Upon notice opposite party No.1 appeared through their counsel and filed written reply by taking preliminary objection that Sh.Gopal Masih S/o Yakoob Masih purchased a Policy Bearing No. 472250851 for a Sum Assured of Rs.1,00,000/- under table & terms 833-17-14 with the monthly mode of premium with the date of Commencement 28.09.2015 from the Branch Office: Gurdaspur. It is pleaded that the deceased life assured has reportedly died on 26.11.2017 due to Heart Attack. The policy has lapsed on the date of death as the death of the deceased life assured has taken place even after the expiry of the one month grace period. As such, no claim is payable as the policy is not in force as on the date of death. As per the record of replying respondent, there are four gaps of depositing the premium of policy in question, as the premium is due in November, 2016, January, 2017 February, 2017 and March. 2017 and due to these four gaps, the policy has lapsed. It is further pleaded that the claim is still not repudiated and is under process in wait of any document from the complainant to prove the payment of above said gap period to replying respondent by deduction from the salary of the deceased life assured, but till the date, the complainant has not submitted any document regarding the said payment of premium. It is further pleaded that the replying respondent is still ready to consider the claim of the complainant, if the complainant submits any authenticated document of deduction of the premium from the salary of the deceased life assured by his department and payment to the replying respondent. Therefore, the complaint is liable to be dismissed on this score only and the complaint filed by complainant against the replying respondent is hopelessly and PRE-MATURE and the complaint is as such prima-facie liable to be dismissed and the complainant should have approached the office of “Insurance Ombudsman”, Chandigarh for redressal of his grievance, if any. It is further pleaded that the conditions and privileges of the policy contract printed on the back of the policy bond under the heading ‘FORFEITURE IN CREATION EVENTS’ and the complainant is estopped to file the instant complaint as there is no deficiency in service on the part of the opposite parties as defined in section (i) (g) of the Consumer Protection Act, 1986. It is further pleaded that the complaint of the complainant is bad for mis-joinder or non-joinder for all the necessary parties. All the Class-I legal heirs of the decreased are the necessary parties.

          On merits, the opposite party no.1 have reiterated their stand as taken in legal objections and denied all the averments of the complaint. In the end, the opposite party no.1 prayed for dismissal of complaint with cost.

4.       Upon notice opposite party no.2 appeared through Govt. Pleader and filed written reply, stating therein that nothing is payable by the answering respondent to the complainant as against the Policy No.472250851 a sum of Rs.686/- were deducted from salary of deceased employee Gopal Masih No.3220/BTL and were sent to the Treasury accordingly. It is pleaded that the letter dated of 27.2.2019 of Accountant office of SSP Batala is enclosed herewith. So claim of the petitioner against the L.I.C is to be considered/payable by the respondent no.1, so present petition against answering respondent is not maintainable. In the end, the opposite party no.2 prayed that petition/ application against answering respondent no.2 may please be dismissed accordingly in the interest of justice.

5.       Learned counsel for the complainant has filed document as Ex.C1.

6.       Learned counsel for the opposite party no.1 has filed affidavit of Virsa Singh, Manager (Legal), LIC, Divisional Office, Amritsar as Ex.OP-1/1 alongwith other documents as Ex.OP-1/2 to Ex.OP-1/4.

7.       Opposite party no.2 has filed written reply through Govt. Pleader ADA Hardeep Kumar and other document as Ex.OP-2/1.

8.       Rejoinder filed by the complainant.

9.       Written arguments on behalf of opposite party no.2 filed but not filed by the complainant and opposite party no.1.

10.     Counsel for the complainant has argued that husband of the complainant was employed with Punjab Police and died on 26.11.2017 and during his life time he has taken policy of insurance No.472250851 i.e. Jeevan Lakshya Policy, Table No.833 from the opposite party No.1. Last premium was deducted from the salary of the deceased on 28.12.2017 as the premium installments were being deducted from the salary of the deceased. Further, after the death of deceased Gopal Masih the claim was lodged with the opposite party No.1 but the claim has not been settled by the opposite party No.1 inspite of lapse of considerable time.

11.     Counsel for the complainant has relied upon case laws of 2008(2) C.P.J. 213 : 2009(1) C.P.C 430 : 2008(52) R.C.R.(Civil) 110 of Hon'ble Punjab State Consumer Disputes Redressal Commission in which it has held that "Consumer Protection Act, 1986 Section 2(1)(g) Insurance - Claim - Repudiation of - policy lapsed - Contention is that premium was not deposited from March, 2001 to November 2001 - Acceptance of Premium from December 2001 till February 2004, without raising any objection - when no objection was raised at proper time, Insurance Company is stopped to raise objection at this stage, after death of insured - Insurer is liable to pay amount under policy".

          2020(4) PLR 15 : 2021(2) CivilLJ 150 of Hon'ble Punjab and Harayana High Court in which it has held that "LIC should have informed with regard to non payment/non remittance of premium by its employer, thus, enabling him to pay the requisite premium particularly in the circumstances that as per the policy, there was a provision for revival of discontinued policies when the premium is not paid within the days of grace and the policy lapses - Deceased never received any intimation from LIC with regard to non payment of premium for the month of October, 1982 or the policy having got lapsed for non payment of premium, there was no occasion with him to approach the LIC authorities for revival of the policy particularly in the circumstances that he unfortunately died - Entitled to recover the amount minus the amount of premium of Rs.215.20 with interest @ 6% per annum from the date the same became due till calculation of outstanding liability".

          2007(2) C.P.J. 317 : 2007(2) CLT 605 : 2006(47) R.C.R. (Civil) 287 of Hon'ble Punjab State Consumer Disputes Redressal Commission in which it has held that "Salary Saving Scheme - Employer acts as agent of insurer - Failure of employer to remit premium amount to insurer after deducting same from salary of deceased - Claim repudiated on the ground that policy had lapsed - Complaint allowed by District Forum - Appeal against - Insurer not absolved of its liabililty to pay insured amount, for acts/omissions of its agent - Appeal dismissed".

12.     On the other hand counsel for the opposite party No.1 has argued that deceased Gopal Masih had taken the policy of insurance through his department and died on 26.11.2017 due to heart attack. However, the said policy had lapsed on the date of death, as the death of the deceased life assured took place after expiry of one month of grace period. It is further argued that the premium for the months of November, 2016, January, 2017, February, 2017 and March, 2017 had not been paid by the deceased. However, the claim is still pending with the opposite party No.1 and complainant was requested to give details of deposit the premiums for the period of gap as mentioned above and as such the complaint is premature.

13.     Ld. public prosecutor has argued on behalf of opposite party No.2 that complaint as such is not maintainable against opposite party No.2 and is liable to be dismissed.

14.     We have heard the Ld. counsels for the parties and gone through the record. It is admitted fact that Gopal Masih was employed with opposite party No.2 and during his life time had obtained a policy of insurance No.472250851 i.e. Jeevan Lakshya Policy, Table No.833 from opposite party No.1. It further admitted fact that the installments of premiums were being deducted from the salary of the deceased and last premium was deducted on 28.12.2017 by the department i.e. opposite party No.2. It is further admitted fact that life assured died on 26.11.2017. It is further admitted fact that the complainant being widow and nominee of the deceased had lodged claim with the opposite party No.1 which has not been settled by opposite party No.1 till date. Counsel for the opposite party No.1 has argued that policy of insurance had elapsed on account of non deposit of premiums of four months i.e. November, 2016, January, 2017, February, 2017 and March, 2017 but the opposite party No.1 has not placed on record any proof regarding payment of above referred four months and as such complaint is pre-mature and is liable to be dismissed. However, perusal of record shows that the installments of premiums were being deducted from the salary of the deceased and if there was gap of four months in that case there is no fault on the part of the life assured, as the premiums could not be deposited due to negligence or lapse on the part of opposite party No.2 and last premium deducted from the salary of deceased is on 28.12.2017 and since the deceased expired on 26.11.2017, as such by accepting the premium on 28.12.2017 the opposite party No.1 cannot claim that the policy of insurance has elapsed or that complaint is liable to be dismissed.

15.     We are of the view that if there is non deposit of four installments, the same had occurred due to negligence on the part of opposite party No.2 and complainant cannot be allowed to suffer for the negligence of opposite party No.2. Opposite party No.1 had also not issued any notice to the department i.e. opposite party No.2 of life assured or to the life assured to this effect that premiums of above mentioned four months is due. Even, opposite party No.1 has not issued any letter to this effect that the policy of insurance has elapsed due to non deposit of premiums. Accordingly, we are of the view that non settlement of the claim for such a long time by opposite party No.1 on frivolous grounds amounts to deficiency in service. Accordingly, after going through record and case law referred above the present complaint is partly allowed with the following directions;-

          i)       Opposite party No.1 is directed to pay sum assured of Rs.1,00,000/- after deducting three months unpaid premiums i.e. Rs.1986/- to the complainant being nominee alongwith    interest @ 9% P.A. from the date of filing of the complaint   till its realization.

          ii)      Opposite party No.1 is further directed to pay all the other benefits payable under the policy.

          iii)     Opposite party No.1 is directed to pay Rs.5,000/- as   compensation for mental tension and cost of litigation.

          iv)     Order be complied with within 30days of the receipt of the copy of the order.

16.      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.

17.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room. 

                                (Lalit Mohan Dogra)

                                                                        President   

Announced:                                          (B.S.Matharu)

Aug. 10, 2023                                               Member

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