Haryana

Ambala

CC/53/2020

Gurmeet Kaur - Complainant(s)

Versus

Max Life Insurance Co Ltd - Opp.Party(s)

Akash Garg

22 Mar 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

 

                                                                      Complaint case no. :   53 of 2020.

                                                          Date of Institution :   18.02.2020.

                                                          Date of decision     :   22.03.2022.

 

Gurmeet Kaur age about 35 years widow of Shri Amritpal, Resident of House No.78/153 Barola, Ambala District Ambala, Haryana-133004.

          ……. Complainant.

 

                                                Versus

 

1.       Max Life Insurance Company Limited, Plot No.90-A, Sector 18, Gurgaon           (Gurugram) 122015, Haryana through its Authorized Signatory.

2.       Max Life Insurance Company Limited, Branch Office at 1^st Floor, Cross       Road, Niclolson Road, Punjabi Mohalla Ambala Cantt. 133001 through        its Authorized Signatory.

3.       Axis Bank Limited Dinarpur (441088) Tehsil Saha, District Ambala   through its authorized signatory.

 

                                                                                  ….…. Opposite Parties.

         

Before:        Ms. Neena Sandhu, President.

                   Ms. Ruby Sharma, Member,

Sh. Vinod Kumar Sharma, Member.           

                            

Present:       Shri Akash Garg, Advocate, counsel for the complainant.

                   Shri Sandeep Kashyap, Advocate, counsel for the OPs No.1 & 2.

                   Shri Rahul Vig, Advocate, counsel for the OP No.3.

 

Order:        Smt. Neena Sandhu, President.

Complainant has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’), praying for issuance of following directions to them:-

1. To pay the death benefits as per policy i.e.  Rs.7,29,289/- alongwith interest @ 12% per annum from the date of death of the life assured till its realization.
2. To pay Rs.50,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.
3. To pay Rs.15,000/-, as litigation expenses.
4. To pay the aforesaid amount alongwith interest @ 12% per annum, till its realisation
382.  

Any other relief which this Hon’ble Commission may deem fit.

 

2.                Brief facts of the case are that the husband of the complainant was working as motor mechanic. In order to enlarge its business, the OP No.3 on behalf of OPs No.1 and 2 introduced insurance schemes to her husband. In the month of November 2015, husband of the complainant obtained a Max Life Monthly Income Advantage Plan from the OP No.1 & 2 through OP No.3 vide policy No.108446071. The husband of the complainant paid premium amount and other charges of Rs.51,750.05 as per the demand of the OPs and in lieu of that OPs issued an insurance premium receipt dated 17.11.2015 to the husband of the complainant. As per said policy, the insurance company is legally bound to pay Rs.7,29,289/-, as death benefits, on the death of the insured person. The deceased husband of the complainant paid next premium amount and other charges of Rs.50,000/- and in lieu of that the OPs issued a insurance premium receipt dated 13.11.2016. In the month of December 2016, the husband of the complainant was suffering from Jaundice (Kala Pilia) and he took treatment from various hospitals but his health was going down day by day and lastly he died in PGI Chandigarh, on 19.01.2019. Due to bad health, the husband of the complainant could not pay the next premium, on the due date. OPs did not issue any notice to the husband of the complainant for the payment of the premium. Complainant was not aware about the said policy of her husband and came to know about the same after his death, when she found the policy documents. Thereafter, complainant being nominee lodged the claim with the OPs, to get the death benefits, as per the terms and conditions of the policy. Vide letter dated 22.04.2019, OPs demanded certain documents, which were duly provided to them. OPs vide letter dated 29.04.2019, informed the complainant that the renewal premium for the said policy was not paid and the policy lapsed on expiry of the grace period. The OPs not only refused to pay the death benefits but had also refused to refund the amount paid by the husband of the complainant to them. Husband of the complainant could not pay the renewal premium, due to his decease but the OPs intentionally did not issue any notice to him regarding the payment of the renewal premium and lapsed the policy illegally. By not paying the death benefits, OPs have committed deficiency in service. Hence, the present complaint.

3.                Upon notice, OPs No.1 and 2 appeared through its counsel and filed written version raised preliminary objections with regard to maintainability, jurisdiction, cause of action, estoppel and not come with clean hands and suppressed the material facts etc. On merits, it is stated that Shri Amritpal Singh, husband of the complainant had purchased a ‘Max Life Monthly Income Advantage Plan-12 Pay’. Shri Amritpal Singh had submitted his duly signed proposal form on 09.11.2015. On receipt of the proposal form dated 09.11.2015 and 1^st premium amount from L.A., the answering OPs issued the insurance policy bearing No.108446071 dated 17.11.2015. The L.A had paid only two premium under the policy. The premium under the policy of insurance was due on 09.11.2017 but the answering OPs did not receive the premium. The policy was on direct debit mode accordingly the account number was hit on 29.11.2017, 14.12.2017, 15.01.2018, 14.02.2018, 14.03.2018, 24.03.2018, 28.03.2018 and 13.04.2018 respectively, but could not get the amount due to insufficient funds. Due to non-payment of the premium, the policy got lapsed and intimation was given to the LA vide letter dated 10.12.2017, 14.12.2017, 14.02.2018, 13.03.2018, 23.03.2018 and 13.04.2018. The life assured expired on 19.01.2019 and the answering OPs received the death claim intimation from the complainant on 11.04.2019, alongwith the death claim intimation form-A, Death certificate and other documents. The death claim intimation was acknowledged vide letter dated 22.04.2019. The claim lodged by the complainant was not admissible because on the date of the death of life assured i.e. on 19.01.2019, the insurance policy was lying in the lapse mode and as per condition No.7.1 of the insurance policy which is reproduced as under:-

“7.1   If you discontinue the payment of premium before paying premium for the first 3 policy years, then the policy will lapse on the expiry of the grace period and no benefits under the policy will be payable.

          Claim was not payable and complainant was duly informed about the same vide letter dated 29.04.2019. Rest of the averments of the complainant were denied by the answering OPs and prayed for dismissal of the present complaint with costs.

4.                Upon notice, OP No.3 appeared through its counsel and filed written version raised preliminary objections with regard to maintainability, locus standi and mis-joinder of necessary parties etc. On merits, it is stated that the answering OP is merely a bank, working as per the Banking Regulations Act, 1949. Bank is not doing the business of insurance, it works as  facilitator/referral agent and the insurance policy was issued by the insurance company. Under Section 230 of the Indian Contract Act, which reads as under:-

230. In the absence of any contract to that effect, an agent cannot personally enforce contracts entered into by him on behalf of his principal, nor is he personally bound by them.

Such a contract shall be presumed to exist in the following cases :-

(a) where the contract is made by an agent for sale or purchase of goods for a merchant resident abroad

(b) where the agent does not disclose the name of his principal;

(c) where the principal, though disclosed, cannot be sued.

          Perusal of the above provisions indicate that none of the circumstances envisaged therein have been pleaded as existing in the instant case in any of the paras of the complaint. There is no privity of contract between the complainant and the Bank to claim insurance from the bank and the answering OP is not bound by the terms and conditions of the policy. Rest of the averments of the complainant were denied by the answering OP and prayed for dismissal of the present complaint with costs.

5.                Learned counsel for the complainant tendered affidavit of complainant as Annexure CA alongwith documents as Annexure C-1 to C-11 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OPs No.1 and 2 tendered affidavit of Shri Prashant Singh, working as Deputy Manager-Legal, duly constituted Attorney of OP company, M/s Max Life Insurance Company Limited office at Max Life Insurance Company Limited, 11^th Floor, DLF Square, Jacaranda Marg, DLF City Phase 2, Gurugram-122002, Haryana as Annexure RX alongwith documents Annexure R1/1 to R1/10 and closed the evidence on behalf of OPs No.1 and 2. Learned counsel for the OP No.3 tendered affidavit of Shri Saurabh Anand Branch Manager Axis Bank Dinarpur as Annexure OP3/A and closed the evidence on behalf of OP No.3.

 

6.                We have heard the learned counsel for the parties and carefully gone through the case file.

7.                 Learned counsel for the complainant submitted that the deceased husband of the complainant (hereinafter referred to as ‘DLA’), during his lifetime paid two instalments of premium at the due date but due to his bad health he could not pay the next premium on the due date. However, OPs intentionally did not issue any notice to the DLA regarding payment of the renewal premium and lapsed the policy illegally.

8.                On the contrary, the learned counsel for the OPs No.1 and 2 have submitted that the complainant had paid only two installments of the premium and did not pay the 3^rd instalment of the premium which was due on 09.11.2017. DLA died on 19.01.2019 and after his death, complainant lodged the claim with the insurance company but the same is not payable because on the date of death of the life assured i.e 19.01.2019, due to non-payment of the renewal premium within the grace period, the insurance policy was lying in a lapse mode and as per term No.7.1, complainant cannot get any benefit under the policy.

9.                The learned counsel for the OP No.3 has submitted that the OP No.3 has acted as a facilitator/referral agent and the policy in question was issued by the insurance company. There is no privity of contract between the complainant and the Bank. The answering OP has no role to play as such, the complaint filed against it may be dismissed with costs.

10.              Admittedly, the DLA had taken an insurance policy in question  from the OPs No.1 and 2, through OP No.3. The plea of the OPs No.1 and 2 is that the DLA had paid only two installments of the premium. Many reminders were sent to the DLA during his lifetime inspite of that he did not pay the third premium within the grace period and due to non-payment of the renewal premium within the grace period, the insurance policy was lying in a lapse mode and as per term No.7.1, complainant cannot get any benefit under the policy.  It may be stated here that parties are bound by the terms and conditions of the policy in question. Terms and Conditions of the policy are annexed alongwith  Annexure C-1, in condition No.7, lapsation of policy which is as under:-

           “7.1  If you discontinue the payment of premium before paying premium for the first 3 policy years, then the policy will lapse on the expiry of the grace period and no benefits under the policy will be payable.

As per the said condition no amount is payable to the complainant because the DLA paid premium only for two years and did not pay the premium for the 3^rd year, within the grace period and the policy was lying in a lapsed condition. In this view of the matter, we do not find any merits in the complaint filed by the complainant, consequently we dismiss the same being devoid of merits. The parties are left to bear their own costs. Certified copy of the order be sent to the parties concerned as per rules.  File be annexed and consigned to the record room.

Announced on: 22.03.2022.

 

 

          (Vinod Kumar Sharma)        (Ruby Sharma)          (Neena Sandhu)

              Member                             Member                   President
Present:       Shri Akash Garg, Advocate, counsel for the complainant.

                   Shri Sandeep Kashyap, Advocate, counsel for the OPs No.1 & 2.

                   Shri Rahul Vig, Advocate, counsel for the OP No.3.

 

Vide our separate detailed order of even date, the present complaint has been dismissed. File be consigned to Record Room, after due compliance.

Announced on :22.03.2022.

 

 

 

 

(Vinod Kumar Sharma)            (Ruby Sharma)               (Neena Sandhu)

            Member                            Member                         President