Haryana

Kurukshetra

55/2018

Preeti - Complainant(s)

Versus

Max Life Ins - Opp.Party(s)

Roshan lal

21 Dec 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KURUKSHETRA.

                                                     Complaint Case No.55 of 2018.

                                                     Date of institution: 12.03.2018.

                                                     Date of decision:21.12.2018.

Preeti aged 30 years, daughter of Usha Rani, resident of Village House No.1739, Sector-7, U.E. Kurukshetra.

                                                                        …Complainant.

                        Versus

1. Max Life Insurance Company Ltd. Branch Office, near ICICI Bank, Sector-17, Kurukshetra, through its Branch Manager.
2. Max Life Insurance Company Ltd. Operation Centre, Plot No.90A, Sector-18, Udhyog Vihar, Gurgaon-122015 through its Manager/Director.

….Respondents.

Before:      Smt. Neelam Kashyap, President.

                Ms. Neelam, Member.

                Sh. Sunil Mohan Trikha, Member.

       

Present:     Sh. Roshan Lal Sharma, Advocate, for the complainant.   

                Sh. Rajesh Kaushik, Advocate for the OPs.

               

ORDER

                This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Preeti against Max Life Insurance Company, the opposite parties.

2.            Brief facts of the present complaint are that the mother of complainant namely Smt. Usha Rani got obtained life insurance policy bearing No.779636778 from the Ops.  The mother of complainant paid the three consecutive premium and as such, paid the total amount of Rs.75,000/- with the Ops.  The mother of complainant fell ill and died in the month of October, 2016.  It is further alleged that the complainant being nominee of her mother lodged the claim with the Ops and submitted all the necessary documents and the Ops issued the cheque bearing No.931463 dt. 01.02.2016 amounting to Rs.25,661.49 paise in the name of deceased Usha Rani.  The complainant requested the Ops to pay the cheque of entire deposited amount and to issue the same in her name but the Ops issued the cheque again and again in the name of deceased Smt. Usha Rani.  So, it is a clear cut case of deficiency in service on the part of Ops and prayed for acceptance of complaint with the direction to Ops to pay a sum of Rs.75,000/- alongwith interest @ 18% p.a. and further to pay Rs.1,00,000/- as compensation for harassment and mental agony as-well-as Rs.11,000/- as litigation charges.   

3.            Upon notice, the OPs appeared before this Forum and contested the complaint by filing their reply raising preliminary objections with regard to locus-standi; maintainability; cause of action; estoppel; jurisdiction; time-barred; that the complainant has concealed the true and material facts from this Forum; The true facts are that the policy of insurance was issued in favour of Smt. Usha Rani on 01.03.2010.  The annual due premium on 28.02.2013 was not paid by the insured and before this, the intimation regarding renewal premium was sent to the complainant on 29.01.2013 but inspite of this, the insured did not pay the premium under the policy and accordingly, vide letter dt. 31.01.2016, the policy in question was terminated as the total value at that time was Rs.25,630.59 paise.  There is no deficiency in service on the part of Op.  On merits, it is stated that the termination letter was sent alongwith the cheuqe of Rs.25,661.49 paise in the name of Smt. Usha Rani because the fund value become less than one Annual Target Premium.  The other objections raised in the preliminary objections are reiterated and so, prayed for dismissal of complaint.

4.             The complainant tendered into evidence affidavit, Ex.CW1/A and documents Ex.C1 to Ex.C8 and thereafter, closed the evidence.

5.           On the other hand, the Ops tendered into evidence affidavit, Ex.RW1/A and documents Ex.R1 to Ex.R4 and thereafter, closed the evidence.

6.             We have heard the learned Counsel for both the parties and perused the record carefully.

7.             Learned counsel for the complainant contended that the mother of complainant namely Usha Rani had taken the life insurance policy from the Op.  The next point contended by the counsel of complainant that the complainant was the nominee in that policy i.e. mentioned in the policy Ex.R1.  The insured person has taken the policy in question on 26.02.2010.  She had deposited three installments upto February, 2012.  After that she fell ill and got bed ridden.  Due to that she could not pay the installment to the Op.  The mother of complainant was died on 17.10.2016.  After the death of insured person, the complainant has applied for claim to return the amount which was deposited by the insured person i.e. Rs.75,000/- but the Ops have sent the cheque of Rs.26,696.84 paise on 06.04.2017, Ex.C3, Rs.26,779.01 paise on 27.07.2017, Ex.C4 and Rs.26,868.21 paise on 20.11.2017, Ex.C5 and moreover, they have sent the cheques in the name of deceased Smt. Usha Rani and all the cheques were returned by the complainant to the Ops with the request to send total premium amount and in the name of complainant, so, it is great negligence on the part of Ops to give the cheques in the name of deceased person.  The next point raised by the counsel of complainant that the policy of mother of complainant was terminated on 31.01.2016 i.e. Ex.R3.  The counsel of complainant further contended that as per policy, Ex.R1 para No.13 in which clearly mentioned the grace period and revival of lapse policy and para No.14 regarding the termination of policy.  The policy of her mother was wrongly terminated by the Ops.  At the time of arguments, the counsel of complainant placed on record death certificate, Mark-A and treatment record of insured person, Mark-B.

8.             On the other hand, the counsel of Ops placed on record copy of proposal form of insured person, Mark-RA.  He admitted that three installments were deposited by the insured person upto February, 2012 but the policy of insured person was terminated on 31.01.2016 i.e. Ex.R4 due to non-payment of installment by the insured person.  The counsel of Ops argued that the insurance company has sent cheques to the complainant i.e. Ex.C2 to Ex.C5 but that were not taken by the complainant. 

                During the course of arguments of counsel of Ops, the counsel of complainant again contended that the cheque given by the Ops was of only amounting to Rs.26,696.84 paise on 06.04.2017, Ex.C3, Rs.26,779.01 paise on 27.07.2017, Ex.C4 and Rs.26,868.21 paise on 20.11.2017, Ex.C5.  The premium was deposited by the insured person amounting to Rs.75,000/-, so, there is gross negligence and deficiency in service on the part of Ops.  The counsel of Ops also contended that if the insured person was suffering from any disease, the document was not given by the deceased or her nominee (complainant).  So, she was not liable for rider of the policy and hence, he prayed for dismissal of complaint. 

9.             We have seen the record.  As per para No.13 of policy, Ex.R1, it is mentioned as under:-

        “13. GRACE PERIOD AND REVIVAL OF LAPSED POLICY:

        13.1 A grace period of Thirty (30) days from the due date shall be allowed for payment of contractual Premium.  The Policy can be revived at the Company’s sole discretion, within a period of Thirty Six (36) months from the date of lapse”.

In the present case, the last installment was deposited by the insured person in the month of February, 2012.  The next installment was due in February, 2013.  The grace period of 30 days from due date shall be allowed for payment of contractual premium.  The policy can be revived at the Company’s sole discretion, within a period of Thirty Six (36) months from the date of lapse.  Meaning thereby, upto March, 2016, the policy can be revived according to policy but the Ops terminated the policy of insured person on 31.01.2016 i.e. wrong and illegal.  Moreover, as per policy, Ex.R1, at page No.3, it is mentioned that in case of dread disease, sum assured of Rs.1,25,000/-.  As per document submitted by the counsel of complainant, the insured person fell ill and also on bed ridden as per document Mark-B as the insured person was suffering from cancer.  The insured person was on bed, so, she could not give the installment of Ops.  It is also mentioned in the policy that in case, the policy-holder became suffer from dread disease, the Ops shall be liable to pay Rs.25,0,000/- +Rs.1,25,000/-.   But the Ops have not paid the said amount to the complainant.  Hence, in the facts and circumstances of the case, we are of the considered view that there is deficiency in service on the part of Ops.

10.            Thus, as a sequel of above discussion, we allow the complaint and direct the Ops to pay Rs.2,50,000/-+Rs.1,25,000/- and total Rs.3,75,000/- to the complainant and further to pay Rs.20,000/- as lump sum compensation on account of harassment, mental agony including litigation charges in the interest of justice.  Let the order be complied with within 30 days from the date of preparation of copy of this order, failing which, the complainant shall be entitled interest @ 9% p.a. from the date of order till its realization.  Both the Ops are jointly and severally liable.  A copy of said order be supplied to the parties free of cost.  File be consigned to record-room after due compliance.     

Announced in open court:

Dt.: 21.12.2018.  

                                                                        (Neelam Kashyap)

                                                                        President.

 

(Sunil Mohan Trikha),           (Neelam)       

Member                             Member.