DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: NORTH-EAST
GOVT. OF NCT OF DELHI
D.C. OFFICE COMPLEX, NAND NAGRI, DELHI-93
Complaint Case No. 284/13
CORAM: Hon’ble President Sh. N.K. Goel
Hon’ble Member Sh. Nishat Ahmad Alvi
In the matter of:
Shri Laxman
S/o Suresh Kumar
R/o E-13/404 East Gokulpur
Delhi-110095 Complainant
Versus
Life Insurance Company of India
Branch-127, 7th Floor
Sachdeva Corporative Tower
D.D.A. Complex, Sector-8
Rohini, Delhi-110085
Opposite Party
Order
DATE OF INSTITUTION: 17-09-2013
DATE OF DECISION : 20-01-2015
N.K. Goel, President :-
The case of the complainant is that his father Shri Suresh had taken an Insurance Policy bearing No. 126336009 from the OP; that the father of the complainant died on 9th February 2013 in his house; that an intimation to this effect had been sent to the OP on 14-2-2013; that the status report of the policy had been obtained from the branch office of the OP according to which the policy was in force; that after receiving the claim papers from the OP on 25-2-2013 through post the complainant deposited the claim papers alongwith documents in the branch office of the OP on 12-3-2013; that he was told that he would receive the amount of the claim by means of a cheque at his house; that when he did not receive any reply he went to the branch office of the OP on 8-5-2013 where he was told that one of the forms did not bear his signature and hence his claim had been withheld; that he signed the form and was assured that the claim amount would be sent to him by means of a cheque; that when he did not receive any reply he went to the branch office of the OP on 28-8-2013 where he was told that on the date of the death of his father his father’s insurance policy had already lapsed; that he made the representations and complaints to the senior officers of the OP but in vain. Hence, pleading deficiency in service on the part of OP he has filed the present complaint for directing the OP to pay Rs. 3,00,000/- towards claim amount of the policy alongwith interest @ of 18% p.a. and Rs. 25,000/- towards compensation.
In its WS the OP has pleaded as under:-
“That the father of the complainant Suresh S/o Late Sh. Ramswroop had taken the policy bearing No. 126336009 on 19-6-2012, the total sum assured of the policy was Rs. 3,00,000/- and the premium was Rs. 827/- monthly to be paid in every year. The date of commencement of the policy and Risk was 19-6-2012, date of maturity 19-6-2048, date of last payment of premium 19-5-2048, under Table/Term/Premium paying term 149/61/36 from 12T Branch of the Opposite Party. The name of the policy was Jeevan Anand. The complainant had lastly paid the premium in August 2012 and has not making the payment of the premiums on the date fixed or for the extended period of payment of the premium including late fee as per the rules laid down by the answering opposite party and therefore the policy has been lapsed due to not paying the premium. The Father of the complainant had died on 9-2-2013 due to sudden Cardiac Arrest, Myocardial Infraction as per the certificate of Doctor filed on form No. 3784. It is submitted here that the claim of the complainant has been declined on 3-7-2013 as “CLAIM IS NOT CONSIDERABLE DUE TO LAPSE OF THE ABOVE POLICY ON THE DATE OF DEATH OF THE POLOCYHOLDER i.e. on 9-2-2013”. It is submitted here that on the written request dated 31-8-2013 of agent Rahul, the claim decline information has also been written by HOD claims in Hindi on 11-9-2013 and sent through speed post bearing No. ED 982716633IN on 12-9-2013.”
It is denied that the policy report had been obtained by the complainant in which policy was shown in force. It is prayed that the complaint be dismissed.
Complainant has filed a replication wherein he has denied that the complainant had paid the last premium in August 2012 and had not been making the payment of the premiums on the date fixed or within the extended period. He has placed reliance on clause No. 2 of the Rules & Regulations governing the policy in question which reads as under:-
“2. Payment of Premiums: A grace period of one month but not less than 30 days will be allowed for payment of yearly, half-yearly or quarterly premiums and 15 days for monthly premiums. If death occurs within this period and before the payment of the premium then due, the policy will still be valid and the sum assured paid after deduction of the said premium as also unpaid premium/s falling due before the next anniversary of the policy. If the premium is not paid before the expiry of days of grace, the policy lapses.
If the policy has not lapsed and the claim is admitted in case of death under a policy where the mode of payment of premium is other than yearly, unpaid premiums if any falling due before the next policy anniversary shall be deducted from the claim amount.”
Complainant has filed his affidavit in evidence and has relied on documents exhibit CW1/A to CW1/H. On the other hand, the affidavit of Ms. Nandita, Manager (L and HPF) of the OP insurance company has been filed and besides placing reliance on the documents filed by the complainant she has also relied on documents exhibits OP1 and OP1/2.
The only question to be decided is, whether on the date of the death of the father of the complainant, who from the documents filed on the record is proved to be the nominee of his father regarding the insurance amount, the policy in question was still in force and whether it had lapsed. The authenticity of the document dated 14-2-2013 (copy exhibit CW1/C) is not in dispute. Vide this status report the complainant had been informed that the policy in question was still in force. At the same time the complainant has also filed a copy of status report issued in August 2013. The same is exhibit CW1/D. This is in respect of the same policy but the policy is shown as “lapsed”. We have very carefully perused and compared both the documents and they are almost the same except that the status of the policy in exhibit CW1/C has been shown as “in force” while in the document exhibit CW1/D the same is shown as “lapsed”. However, from both the documents there is reason to presume that the last monthly premium in respect of the policy in question was paid in August 2012 and the next installment was due in 9/2012. Admittedly, the premium of the policy was monthly. Therefore, the deceased father of the complainant had paid the premium amount till August 2012 and thereafter he did not deposit further installments till his death which took place on 9-2-2013.
Copy of the insurance policy in question is exhibit CW1/B (exhibit OP1). Reliance has been placed on clause No. 2 of the policy. The same reads as under:-
“2. Payment of Premium: A grace period of one month but not less than 30 days will be allowed for payment of yearly, half-yearly or quarterly premiums and 15 days for monthly premiums. If death occurs within this period and before the payment of the premium then due, the policy will still be valid and the sum assured paid after deduction of the said premium as also unpaid premium/s falling due before the next anniversary of the policy. It the premium is not paid before the expiry of days of grace, the policy lapses.
If the policy has not lapsed and the claim is admitted in case of death under a policy where the mode of payment of premium is other than yearly, unpaid premiums if any falling due before the next policy anniversary shall be deducted from the claim amount.”
From a bare perusal of clause No. 2 of the policy it stands proved on the record that a grace period of 15 days is available to the insured to pay the monthly premium and if the premium is not paid before the expiry of the grace period the policy lapses. In the present case, according to the OP and as also proved from the documents the father of the complainant had paid the last premium in August 2012 and he did not pay further premiums w.e.f. September 2012 till his death. Therefore, on the date of his death the policy in question was not in force and had already expired.
It is, no doubt, true that on 14-2-13 the OP had informed the status of the policy in question as in force. However, subsequently in August 2013 the complainant had been informed that the policy in question had already lapsed. It may be because of the reckless, careless, irresponsible working of the officials of the OP that on 14-2-13 the complainant had been duly informed that the policy in question was in force. Before giving such type of informations it is the duty of the officials of the OP to check the relevant record in a responsible manner and only then to supply the information to the insured. It can be termed as an act of malafide on the part of the officials of the OP but the OP cannot be made bound by any such misstatement or wrong information given by its employees. After giving a thoughtful consideration to the matter, we do not find it to be a fit case where the doctrine of estoppel can be applied to the facts of the present case.
On the date of death of his father the complainant himself was not sure whether the policy in question had already lapsed or was still in force. That is why he had sought the information from the office of the OP but was mislead by providing wrong information.
In the special facts and circumstances of this case discussed hereinabove, we are constrained to hold that the OP did not commit any deficiency in service in repudiating the claim of the complainant. However, by giving a wrong information to the complainant on 14-2-13 thereby allowing him to file his claim before the OP and thereafter inducing and forcing the complainant to initiate legal proceedings against the OP the complainant has been made to suffer for no fault of him. By their act of misdemeanour the officials of the OP certainly committed deficiency in service. Therefore, we hold that the OP is guilty of deficiency in service so far as providing of wrong information to the complainant is concerned.
Therefore, we direct the OP to pay Rs. 25,000/- as compensation for mental pain, agony and litigation charges to the complainant within 30 days from the date of receipt of copy of this order. If the said amount is not paid within the stipulated period the same shall become payable alongwith interest @ of Rs. 8% p.a. from the date of the order till realization. The OP shall recover the said amount from the monthly salary of the officials/s at fault. Complaint stands disposed off accordingly.
Let a copy of this order be sent to each party free of cost as per regulation 21 of the Consumer Protection Regulations, 2005. Thereafter file be consigned to record room.
(Announced on 20-01-2015)
(N.K.Goel) (Nishat Ahmad Alvi)
President Member
