Punjab

Sangrur

CC/330/2016

Sukhpal Kaur - Complainant(s)

Versus

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

Shri Gurinder Pal Sharma

30 Nov 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

                                                       

                                                Complaint No.  330

                                                Instituted on:    22.03.2016

                                                Decided on:       30.11.2016

 

 

Sukhpal Kaur wife of Late Gurpreet Singh, resident of village Ghoranab, Tehsil Lehra, District Sangrur.

                                                        …Complainant

                                Versus

1.             Life Insurance Corporation of India, Railway Road, Sangrur through its Branch Manager.

2.             Life Insurance Corporation of India, Jiwan Parkash Building, Sector 17-B, Chandigarh through its Regional Manager.

3.             Indian Reserve Battalion No.2, Ladda Kothi, Sangrur through Commandant.

4.             Indian Reserve Battalion No.1, Bahadargarh, Patiala through Commandant.

5.             S.P. Excise and Taxation Department, Patiala.

                                                        …Opposite parties

 

For the complainant  :               Shri Gurinder Pal Sharma, Adv.

For OP No.1&2         :               Shri Amit Goyal, Adv.

For OP No.3             :               Shri Kuldeep Josh, Inspector.

For OP No.4             :               Shri Simarjit Singh.

For OP No.5             :               Shri Raj Singh, Constable.

 

Quorum:   Sukhpal Singh Gill, President

                Sarita Garg, Member

      

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Sukhpal Kaur complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that her husband, namely, Gurpreet Singh (referred to as DLA in short) obtained the services of the OP number 1 and 2 by getting insurance policy bearing number 164591283 for Rs.3,00,000/-, which commenced on 12.3.2012. It is further averred that under the policy the premium payable was Rs.1225/- under salary saving scheme i.e. the premium was to be paid by the employer of the DLA i.e. OPs number 3 and 4.  The complainant is the nominee under the policy. It has been further averred that the above said policy was having accidental benefit in addition to the basic sum assured under the policy i.e. a sum equal to the basic sum was payable in case of accidental death.  Further case of the complainant is that the DLA was working as constable in Punjab police and his last posting was at police station Civil Lines Patiala in Excise and Taxation Department, whereas he was employed under Indian Reserve Battalion No.2. Ladda Kothi at first and later on was transferred to Indian Reserve Battalion No.1 Bahadurgarh.  The case of the complainant is that unfortunately the DLA died on 19.3.2015 in an accidental death due to injury suffered on head after falling from stairs, of which DDR number 26 dated 20.3.2015 was recorded at PS Civil Lines, Patiala.  Post mortem of the DLA was also conducted at Rajindera Hospital, Patiala.  Further case of the complainant is that thereafter the complainant lodged the claim with the OPs number 1 and 2 and also submitted the documents required for settlement of the claim, but the OPs failed to settle the claim. Thus, alleging deficiency in service on the part of the OPs number 1 and 2, the complainant has prayed that they  the OPs directed to pay Rs.3,00,000/- on account of insurance claim along with Rs.3,00,000/- claim on account of accidental benefit  with interest @ 9% per annum  from the date of death of the deceased till realisation and further claimed compensation and litigation expenses.

 

2.             In reply filed by the OPs number 1 and 2, preliminary objections are taken up on the grounds that the complaint is not maintainable, that the complainant has no cause of action and locus standi to file the present complaint and that the complainant has not come to the Forum with clean hands. On merits, it is admitted that the DLA was insured for Rs.3,00,000/- under the policy bearing number 164591283 under the salary saving scheme with the OPs with the date of commencement as  12/3/2012 and it is also admitted that the complainant is the nominee under the policy. However it is denied that the complainant was paying the premium regularly. 

 

3.             Further case of the OPs that the complainant obtained the policy under salary saving scheme through his employer and monthly premiums were to be deducted by the employer of the DLA from his salary and the same were to be deposited with the Ops. However, the employer of the DLA did not pay the premiums for the month of 5/2012, 7/2013 to 4/2014 i.e. a total of 11 premiums were not deposited by the employer of the DLA and as such the policy in question was in lapsed condition. However, it is admitted that the claim was lodged with the OPs under the policy in question along with other three policies.   Further case of the OPs is that the Ops written several letters to the complainant having dated 28.4.2015, 4.5.2015, 28.5.2015, 3.6.2015, 6.7.2015, 17.7.2015 and 18.9.2015 seeking clarification regarding deduction of gap premiums by the employer of the assured, but the complainant failed to give any reply. As such, it is stated that there is no deficiency in service at all in not paying the claim and lastly prayed for dismissal of the complaint.

 

4.             In reply filed by OP number 3, it is stated that the complaint is not maintainable against the OP number 3.  Further it is stated that the LIC has informed the complainant vide letter number 172/claims dated 24.9.2015 that her case for Rs.3,89,214/- has already been processed against policy number 164552453 and further vide letter number 172/claims dated 24.9.2015 that her case for Rs.1,89,080/- has already been processed against policy number 164581809. The other allegations levelled in the complaint have been denied.

 

5.             In reply filed by OP number 4, it is stated that the DLA was transferred to the Excise and Taxation Department, Patiala on deputation and was relieved on 11.4.2013 to report to SP, Excise and Taxation Patiala. The DLA remained posted in the IRB from 9.4.2013 to 11.4.2013 just for 2 days and no pay of DLA was drawn and no deduction of LIC instalment was made from his pay by the 1^st IRB Patiala.  Further it is stated that the OP number 4 has been unnecessarily dragged as a party by the complainant.  It is stated that no pay was drawn by OP number 4 and as such, it is stated that nothing was to be done by OP number 4.

 

6.             In reply filed by OP number 5, it is stated that office of Superintendent of Police, Excise and Taxation Patiala has been unnecessarily dragged.  It is stated that the last pay certificate paid up 31.8.2013 received by this office from DETC Jalandhar had not mentioned the LIC policy number, as such, this office was not able to deduct the amount of LIC policy without its number.  In the month of May, 2014 the DLA requested to deduct the amount of LIC policies i.e. Rs.4950/- per month from his salary and after that the same was started to deduct. It is stated further that the DLA expired on 19.3.2015 and was posted in the Excise and Taxation department at the time of death. It is further stated that the remaining allegations are not relating to OP number 5. Lastly, prayed for dismissal of the complaint with special costs.

 

7.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of death certificate, Ex.C-3 copy of DDR, Ex.C-4 copy of voter card of complainant, Ex.C-5 copy of identity card of DLA, Ex.C-6 copy of PMR, Ex.C-7 copy of claim form, Ex.C-8 copy of application form, Ex.C-9 copy of cancelled cheque, Ex.C-10 copy of claimant statement, Ex.C-11 copy of policy, Ex.C-12 copy of status report of policy, Ex.C-13 to Ex.C-15 copies of status report of policies, Ex.C-16 copy of policy detail and closed evidence.  On the other hand, the learned counsel for OPs number 1 and 2 has produced Ex.OP1&2/1 copy of insurance policy, Ex.OP1&2/2 copy of letter, Ex.OP1&2/3 copy of drawn statement in respect of Ct. Gurpreet Singh, Ex.OP1&2/4 copy of application dated 28.11.2015, Ex.OP1&2/5 to Ex.OP1&2/10 copies of status report, Ex.OP1&2/11 copy of letter, Ex.OP1&2/12 to Ex.OP1&2/13 copies of status report, Ex.Op1&2/14 copy of letter, Ex.Op1&2/15 copy of application, Ex.Op1&2/16 copy of claimant statement dated 25.4.2015, Ex.Op1&2/17 copy of report under section 174, Ex.OP1&2/18 copy of post mortem report, Ex.Op1&2/19 copy of insurance policy, Ex.Op1&2/20 and Ex.Op1&2/21 copies of other insurance policies and Ex.OP1&2/22 affidavit and closed evidence.

 

8.             We have carefully perused the complaint, version of the opposite parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

9.             It is an admitted fact between the parties that the DLA was insured for Rs.3,00,000/- with the OPs number 1 and 2 under policy number 164591283 under the salary saving scheme and the premium of Rs.1225/- was being paid to the Ops number 1 and 2 through the Ops number 3 and 4 after deduction from the salary of the DLA.  It is further an admitted fact that the DLA died on 19.03.2015, as is evident from the copy of death certificate, which is on record as Ex.C-2, whereas Ex.C-3 is the copy of report submitted by the police of Civil Lines Police Station, Patiala.

 

10.           In the present case, the claim of the complainant is on account of death of the DLA to the tune of Rs.3,00,000/- plus Rs.3,00,000/- on account of benefit due to accidental death of the DLA, which has been repudiated by the OPs number 1 and 2 saying that at the time of death of the DLA, the premiums for the months of 5/2012, 7/2013 to 4/2014 i.e. total of 11 premiums were not paid to the Ops by the Ops number 3 and 4 and, as such, the policy in question was in lapsed condition, which fact is also admitted by the Ops number 3 and 4.  It is contended further by the learned counsel for the Ops number 1 and 2 that the claim has rightly been repudiated as the policy was in the lapsed condition.  On the other hand, the learned counsel for the OP number 5 has stated that as per the last pay certificate paid upto 31.8.2013 received by OP number 5 from the office of DETC Jalandhar, no policy number was mentioned in the last pay certificate, as such, the OP number 5 did not deduct any amount.  Further in the month of May, 2014, the DLA had requested to deduct the amount of Rs.4950/- per month from his salary and thereafter the same was started to deduct.    Now, the question which arises for determination before us is whether the claim is payable to the complainant or not.

 

11.           It is an admitted fact on record that the policy of the DLA was under salary saving scheme and the premium was being paid to the OPs number 1 and 2 by the OPs.  It is an admitted fact on record that the OP number 5 did not pay the premium  for the month from 7/2013 to 4/2014 and of 5/2012, and as such, the OPs number 1 and 2 have repudiated the claim saying that the policy was in lapsed condition.  But, the fact remains that the DLA had given in writing as well this fact was mentioned in the last pay certificate that the amount on account of LIC policy premium was Rs.4950/-, but the same was not deducted by Op number 5 on the ground that there was no mention of the policy number.  It is the Op number 5 who had to deduct the premium thereafter only on saying the DLA.  If the premium was not deducted by the OP number 5, the employer of the DLA, there is nothing on record produced by the Ops number 1 and 2 that they ever wrote any letter/intimation to the complainant or to the OP number 5 stating non receipt of the premium of the policy in question in respect of the complainant.  There is no explanation from the side of the Ops number 1 and 2 that why they did not do so.  Further there is nothing on record that why the OP number 5 after receiving the last pay certificate of the DLA did not wrote any letter to know about the policy number of the DLA, more so when there is mention of LIC premium in the column of deductions. After carefully perusing the whole case file, we feel that the fact remains that the DLA died during the subsistence of the insurance policy meaning thereby the policy was not in lapsed condition.  The learned counsel for the complainant has contended vehemently that even if the employer of the DLA did not pay the premium to the LIC then in that case also, the Ops number 1 and 2 are liable to pay the death claim to the nominee. To support such a contention, the learned counsel for the complainant has cited LIC of India and others versus Krishna Devi and others 2013(1) CLT 22 (NC), wherein it has been held that the claim cannot be rejected on the ground that the insurance policy stood lapsed for non deduction and non remittance of premium of policy to the concerned office of the LIC from the salary of the husband of the complainant by PSEB.  It is further held that authority of PSEB is as an agent of the petitioners to collect the premium on its behalf through deduction from salary and then to remit to the LIC. The contention of the petitioner as regard liability of the PSEB repelled and held that the LIC would be liable to pay out on the policy in question even if the premium had not been paid due to default of the employer i.e. PSEB. It clearly shows that the claim is payable by the LIC of India.  The learned counsel for the complainant has further cited Life Insurance Corporation of India and others versus Ram Sakhi and others 2015(1) CPR 263 (NC), wherein it is stated that in a similar case of salary saving scheme, repudiation of death claim on ground that premium for two months had not been received from employer on time and policy had lapsed. The question of lapse of a policy arises only when the premium remains unpaid for six months and intimation regarding this was required to be sent, in another prescribed form to the concerned employee.  The intimation under both provisions was neither sent to the employer nor to the employee, which is a clear lapse on the part of the insurance company, which is a clear contravention of terms and conditions of the policy issued under salary saving scheme and further it was held that the repudiation in these circumstances is not justified.  Similarly, in LIC of India versus Gousabi 2009(1) CPJ 266 (NC), it has been held that under the salary saving scheme, if the policy lapses due to non payment of the insurance premium as the premium was to be deducted by the employer from the salary. As such, it is not for the employee to intimate the LIC about non remittance of the premium and it is the duty of the employer to inform the LIC that the premium from the salary of the deceased was not being deducted and remitted as he had proceeded on leave and only thereafter the LIC could have asked the deceased to pay the premium. The deceased kept ignorant about non-deduction of the premium from salary, not responsible for consequences of non payment of premium and the LIC was held liable to pay sum assured to the wife of the deceased.   The same is the position in the present case and we are of the considered opinion that the claim is payable to the complainant by the Ops number 1 and 2.

 

12.           Another contention of the OPs that the claim is not payable as the policy was not in force for the period of three years after deducting the unpaid months is also not tenable.  It is on the record that the policy in question was taken by the DLA on 12.3.2012 and the DLA died on 19.3.2015 after a period of more than three years. There is nothing on the record nor in the terms and conditions that the OPs will count such period after deducting the unpaid months.   As such, we feel that the Ops are not justified in denying the claim of the complainant on this ground.            

 

13.           Now, coming to the point that who is the nominee in the present case and who is entitled to get the claim from the OPs number 1 and 2. In the present case, admittedly the complainant Sukhpal Kaur is the nominee and as such, we are of the considered opinion that she is entitled to get the claim on account of death of the DLA.

 

14.           In the present case, the DLA admittedly died an accidental death on 19.3.2015 after falling from the stairs and as such suffered head injury, as is evident from the copy of post-mortem report, a copy of which on record is Ex.C-6.  In the circumstances, since the DLA died an accidental death, as such, we are of the considered opinion that the complainant is entitled to get the amount in view of accidental benefit also.

 

15.           Further it is worth mentioning here that the complainant had to file the present complaint only due to the act of the OP number 5. Had the OP number 5 paid the premium to the OPs number 1 and 2 in time, then there was no question of filing of the present complaint by the complainant.  As such, we are of the considered opinion that the complainant is entitled to get the compensation and litigation expenses from the OP number 5.

 

16.           In view of our above discussion, we allow the complaint and direct the Ops number 1 and 2 to pay to the complainant an amount of Rs.6,00,000/- on account of death of the DLA (Rs.3,00,000/- death benefit sum assured plus Rs.3,00,000/- on account of accidental death) along with interest @ 9% per annum from the date of filing of the present complaint i.e. 02.05.2016 till realisation.  Further the OP number 5 is also directed to pay to the complainant an amount of Rs.25,000/- on account of compensation for mental tension, agony and harassment and Rs.10,000/- on account of litigation expenses. 

 

17.           This order of ours be complied with within a period of thirty days of its communication. A copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                November 30, 2016.

 

                                                (Sukhpal Singh Gill)

                                                     President

                               

 

                                       

                                                  (Sarita Garg)

                                                         Member