Delhi

North East

CC/1/2019

Smt. Pushpa - Complainant(s)

Versus

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

06 Sep 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 01/19

 

In the matter of:

 

1.         2.     3.     4.	Smt. Pushpa W/o Late Sh. Ravi Kumar For herself and on behalf of other Legal heirs of Late. Sh. Ravi Kumar   Master Ayush Kumar (Minor through his mother i.e. Smt. Pushpa)   Baby Anshika (Minor through her mother i.e. Smt. Pushpa)   Baby Engel (Minor through her mother i.e. Smt. Pushpa)	Complainant
	Versus
1.	Life Insurance Corporation of India Through its Administrative Officer (Claims) At 15/1, Grand Trunk Road, Block-E, Jeevan Sarita, Dilshad Garden, Delhi-110095		Opposite Party

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                          DATE OF ORDER :

03.01.2019 13.07.2022 06.09.2022

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

 

ORDER

Anil Kumar Bamba, Member

 

The Complainant has filed the present complaint under Section 12 of the Consumer protection Act, 1986.

Case of the Complainant

1. The facts of the case are that the husband of the Complainant met with an accident and died on 04.02.18 during his treatment. On 13.12.16 the husband of the Complainant purchased an insurance policy bearing no.118187688 w.e.f 14.12.16 and paid a premium of Rs.48,471/- against the said policy with an assured amount of Rs.9,95,000/-. The Complainant stated that unfortunately the premium of the said policy became due on 01.02.18 and asked his relative for help and he paid the due premium with late fee. The Complainant stated that she is the nominee in the said policy in question. The Complainant had lodged the claim with Opposite Party including benefits of death and accident claim. The Opposite Party approved the payment of basic sum assured in the policy in question of Rs.10,78,580/- on 16.07.18 through NEFT. The Complainant stated that the accidental benefits are also covered in the said policy but the Opposite Party did not pay it to the Complainant. The Complainant stated that she is informed by Opposite Party that the accidental claim was not released due to late payment of the premium. The premium was paid on 02.02.18 and the husband of the Complainant died on 04.02.18 due to which the accidental claim is payable. The Complainant submitted that she had moved an appeal to the Zonal Manager, LIC on 02.08.18 but Zonal Office Claims Dispute Redressal Committee refuse to entertain the matter vide letter dated 12.09.18. The Complainant stated that the premium was paid to Opposite Party with late fee and policy was continued the same thus the deceased was fully covered under the policy. The Complainant made various phone calls to Opposite Party she get no response. Hence, this shows deficiency on the part of Opposite Party.  It is prayed by complainant that opposite party is directed to release the death claim of the deceased husband of the complainant awarding appropriate claim to the complainant under the said policy. She is also prayed for  Rs. 1,00,000/- on account of mental agony and Rs. 22,000/- on account of litigation expenses.

     Case of Opposite Party

2. The Opposite Party contested the case and filed written statement to the complaint of the Complainant. It is stated by the Opposite Party that the present complaint is liable to be dismissed as the policy in question was already lapsed since the premium for December 2017 was not paid in time and the same was paid on 02.02.18 at about 12:12 p.m. through 11-P Branch of LIC i.e. after the accident of the insured/deceased which was occurred at about 06:15 a.m. on 02.02.18 as per FIR and such no Double Accident Benefit amount was payable as per Circular Ref;-CO/PD/73 dated 14.08.15 i.e. LIC’s linked Accidental Death Benefit Rider is opted for and if the Life assured is involved in an accident, which is defined as “a sudden, unforseen and involuntary event caused by external, visible and violent means” leading to death and such incident shall occur within 180 days from the date of accident then Accident Benefit Sum Assured shall be payable. However, the policy shall have to be inforce at the time of accident irrespective of whether or not it is in force at the time of death and death benefit had already been paid on 13.07.18, hence the present complaint is liable to be dismissed.
3.  Further, It is submitted that since the premium was not paid in time and such the policy was lapsed since the premium was paid even after 30 days grace period the premium was due on December 2017 which was not deposited in time. The same was also not deposited in days of grace of 30 days. However, death benefit of Rs.10,78,580/- had already been paid on 13.07.18. As the policy was not inforce at time of accident due to non payment of premium in time accident benefit is not payable and as such the present complaint is liable to be dismissed.

 

 

Rejoinder to the Written Statement of Opposite Party

4. The Complainant filed rejoinder to the written statement of Opposite Party wherein it is specifically denied that the complaint is liable to be dismissed as the policy in question was already lapsed or that he premium for December, 2017 was not paid in time or that the same was paid on 02.02.18 after the accident or that such no double accident benefit amount was payable as per any alleged circular etc. It is submitted that on 13.12.16, the deceased husband of the Complainant, during his lifetime, had purchased a Policy bearing no. 118187688, and the date for commencement of risk was from 14.12.16. The deceased husband of the complainant had paid premium of sum of Rs. 4,8471/- against the said policy, vide which, the basic sum assured was Rs. 9,95,000/- and the accidental assured cover was for Rs. 9,95,000/- respectively. Unfortunately, the further premium of the said policy became due and the deceased husband of the Complainant on 01.02.18 had informed one of his relative to pay the premium of the said policy and the relative of the deceased husband of the Complainant had paid the premium of sum of Rs. 50,346.16 including the late fee of                 Rs. 767.30, CGST- 553.93 & SGST- 553.93 on 02.02.18 at about 12.12 hours. He was totally unaware about the accident of the deceased Ravi Kumar, which took place in the morning and the death of the deceased at 01:30 p.m. 04.02.18. The Complainant and her family members were in severe shock and trauma as they have lost their beloved family member and an earning hand also.
5. It is further submitted that the Complainant is the nominee in the aforesaid life insurance policy of the deceased Ravi Kumar and she had lodged her claim with the respondent to get the policy benefits including death and accident claim, and had submitted all the requisite documents and completed other formalities also. But, the competent authority of the divisional office of the respondent/OP has approved the payment of basic sum assured in the said policy and the Complainant received only the payment of Rs. 10,78,580/- on 16.07.18 through NEFT. In addition to the said paid amount, since accidental benefits is also covered in the above policy, the Complainant, was expecting the sum of accidental benefit, but it was not paid to the Complainant. When the Complainant contacted the concerned branch, she was informed that the competent authority has not released the accidental claim benefit due to late payment of policy premium. The premium was paid on 02.02.18 and the husband of the Complainant died on 04.02.18, while the death accidental benefit is payable since the husband of the Complainant was the lone bread winner of the family and the LIC is famed with people welfare organization, thus, the Complainant had also moved an appeal to the Zonal Manager, LIC of India, On 02.08.18, but the Zonal Office Claims Dispute Redressal Committee also refused to entertain he matter vide letter dated 12.09.18

Evidence of the Complainant

6. The Complainant in support of her complaint filed her affidavit wherein she has supported the assertions made in the complaint.

Evidence of the Opposite Party

7. The Opposite Party in support of its case has filed the affidavit of Shri Ajay Tyagi, Manager, L & HPF, LIC, Kasturba Gandhi Marg, LIC Building, New Delhi. In his affidavit, he has supported the case of the Opposite Party as mentioned in the written statement.

Arguments and Conclusion

8. We have heard the Ld. Counsels for the Parties and have perused the file. The case of the Complainant is that the her husband purchased an insurance policy bearing no.118187688 on 13.12.16 w.e.f 14.12.16 and paid a premium of Rs.48,471/- against the said policy with an assured amount of Rs.9,95,000/-. The Complainant stated that unfortunately the premium of the said policy became due on 01.02.18 and asked his relative for help and he paid the due premium with late fee. The Complainant stated that she is the nominee in the said policy in question. The Complainant had lodged the claim with Opposite Party including benefits of death and accident claim. The Opposite Party approved the payment of basic sum assured in the policy in question of Rs.10,78,580/- on 16.07.18 through NEFT. The Complainant stated that the accidental benefits are also covered in the said policy but the Opposite Party did not pay it to the Complainant. The Complainant stated that she is informed by Opposite Party that the accidental claim was not released due to late payment of the premium. The premium was paid on 02.02.18 and the husband of the Complainant died on 04.02.18 due to which the accidental claim is payable.
9. On the other hand, the case of the Opposite Party is that the present complaint is liable to be dismissed as the policy in question was already lapsed since the premium for December 2017 was not paid in time and the same was paid on 02.02.18 at about 12:12 p.m. through 11-P Branch of LIC i.e. after the accident of the insured/deceased which was occurred at about 06:15 a.m. on 02.02.18 as per FIR.
10. It is further submitted that since premium due for 13.12.17 was paid by policy holder on 02.02.18 at 12:12 p.m. after the occurrence of accident on 02.02.18 at 6:15 a.m., Accident benefit is not payable as per circular ref CO/PD/73 dated 14.08.15. the policy was not inforce at the time of occurrence of accident. However death benefit of Rs.10,78,580/- had already been paid on 13.07.18. As the policy was not inforce at time of accident due to non payment of premium in time accident benefit is not payable.
11. It is clear from the facts of the case that the premium of the policy was paid after the grace period i.e. 31.01.18 by which premium to be paid. The premium was paid on 02.02.18 at about 12:12 p.m. after the accident of insured/deceased which was occurred at about 6:15 a.m. on 02.02.18.
12. In view of the above discussion, the complaint is dismissed accordingly.
13. Order announced on 06.09.2022.

         Copy of this order be given to the parties free of cost.

File be consigned to Record Room.

 

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma) President