Haryana

Karnal

CC/302/2020

Nirmal Devi - Complainant(s)

Versus

Max Life Insurance Company Limited - Opp.Party(s)

Vipindeep Singh

20 Jun 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 302 of 2020

                                                        Date of instt.20.08.2020

                                                        Date of Decision:20.06.2022

 

Nirmal Devi widow of Shri Ram Pal, resident of village Rasina, Tehsil Pundri, District Kaithal.

                                               …….Complainant.

                                              Versus

 

1.     Max Life Insurance Company Limited through its Manager/Managing Director, Sector 90A, Udyog Vihar, Sector 18 Gurugram, Haryana-122015, India.

 

2.     Max Life Insurance Company Limited through its Manager/Managing Director, 419 Bhai Mohan Singh Nagar, Rail Majra, Tehsil Balachaur, District Nawanshahar, Punjab-144533.

 

3.     Max Life Insurance Company Limited, through its Branch Manager, 2^nd floor, SCO 135, city Commercial Centre, Sector-12, Karnal-132001 (near Pathak Hospital.

 

4.     Axis Bank Limited, through its Manager, Loan Centre4, 1^st floor, SCO 221, Paramjit Tower Sector-12, Karnal-132001.

 

                                                                  …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary….Member

 

 Argued by:  Shri Vipindeep Singh, counsel for complainant.

                    Shri Atul Mittal, counsel for OPs no.1 to 3.

                     Shri Deepak Saini, counsel for the OP no.4.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that husband of complainant got insured himself, vide insurance policy no.522616499 from the OPs through OP no.4 and the policy holder had been paying annual premium of policy to the OPs. OPs no.12 to 4 are working for the OP no.1. As per the policy the premium amount is Rs.24,949/- and the premium payment mode is annual. The total insured amount is Rs.10,00,000/-and in case of accidental death the guaranteed death sum assured is Rs.15,00,000/-. The period of insurance is 26.11.2018 to 26.11.2038. The husband of complainant was hale and healthy at the time of inception of the insurance policy. On 14.01.2020 the husband of complainant has expired. On 03.02.2020 after the death of her husband, complainant being nominee lodged the death claim with the OP no.3. Thereafter, on 11.02.2020 complainant got an intimation of claim request acknowledgement and required documents to the OP no.1 and complainant submitted all the documents, but on 17.02.2020 the OP no.1 rejected the claim of the complainant on the ground that the policy was in lapse mode on the date of death of insured person. The ground for rejection of the claim is totally vague, false and self created. The husband of complainant had been paying regularly premium of the policy to the OPs. On 09.1.2020 the husband of complainant gave full amount of the premium of the policy through cheque bearing no.960938 dated 09.01.2020 to the OP no.3. It is further averred that still the current status of insurance policy is upto dated and the policy had never been lapsed and as per the status of the policy the next premium due date of insurance policy is 26.11.2020. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice OPs no.1 to 3 appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that husband of complainant namely Ram Pal had approached the OPs and chosen the Max Life Premium Return Protection Plan and for the purchase of the policy of insurance, the complainant signed the proposal form on 26.11.2018 on the basis of which the policy of insurance was issued on 30.11.2018 subject to verification of the information supplied by the complainant in the proposal form. It is further pleaded that life assured died on 14.01.2020. Thereafter, complainant lodged the death claim with the OPs.  OPs wrote a letter dated 11.02.2020 for demanding some documents relating to the insured for processing the claim. Vide letter dated 17.02.2020, the complainant was informed that the renewal premium for the abovesaid policy was due for payment on 26.11.2019. Since the renewal premium was not paid, the policy lapsed on expiry of the grace period w.e.f.26.12.2019. The excess premium received on 24.01.2020 post the date of death was refunded to the consumer. Infact the policy of insurance purchased by the life assured was in lapse mode o the date of death of late Mr. Ram Pal on 14.01.2020. Hence, due to lapsation of the policy on the date of death of Ram Pal, the death claim lodged by the complainant was repudiated and the letter dated 17.02.2020 was issued to the complainant. It is further pleaded that due to non-payment of 2^nd premium in time, the policy was in lapse mode. However, the showing status about 3^rd premium does not conferred any right in favour of complainant to process the claim, when 2^nd premium is not paid by the life assured in time. At the time of death of life assured the policy in question was on lapse mode. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             OP no.4 appeared and filed its separate written version and followed the same lines of written version filed by OPs no.1 to 3 and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, affidavit of Pardeep Kumar son of complainant Ex.CW2/A, copy of payment acknowledgment Ex.C1, copy of death certificate Ex.C2, copy of death claim application form Ex.C3, copy of premium paid certificate Ex.C4, intimation of claim Ex.C5, copy of repudiation letter dated 17.02.2020 Ex.C6, copy of policy issue letter Ex.C7, copy of policy summary detail Ex.C8, copy of bank statement Ex.C9, copy of insurance policy Ex.C10 and closed the evidence on 18.08.2021 by suffering separate statement.

6.             On the other hand, learned counsel for the OPs no.1 to 3 has tendered into evidence affidavit of Prashant Singh Deputy Manager-Legal Ex.RW1/A, copy of proposal form Ex.R1, copy of insurance policy Ex.R2, copy of renewal premium intimation letter Ex.R3, copy of policy lapse intimation dated 26.12.2019 Ex.R4, copy of policy lapse intimation dated 14.01.2020 Ex.R5, copy of repudiation letter dated 17.02.2020 Ex.R6 and closed the evidence on 03.03.2022 by suffering separate statement.

7.             OP no.3 has tendered into evidence affidavit of Vikas Goyal Branch Manager Ex.RW4/A, copy of repudiation letter dated 17.02.2020 Ex.RW4/B and closed the evidence on 03.03.2022 by suffering separate statement.

8.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

9.             Learned counsel for complainant, while reiterating the contents of complaint, has vehemently argued that husband of complainant namely Ram Pal (since deceased) got insured himself, with the OPs through OP no.4. The total insured amount is Rs.10,00,000/-and in case of accidental death the guaranteed death sum assured is Rs.15,00,000/-. The period of insurance is 26.11.2018 to 26.11.2038. On 14.01.2020 the husband of complainant has expired. On 03.02.2020 after the death of her husband, complainant being nominee lodged the death claim with the OP no.3, but on 17.02.2020 the OP no.1 rejected the claim of the complainant on the ground that the policy was in lapse mode on the date of death of insured person. The ground for rejection of the claim is totally vague, false and self created. The husband of complainant had been paying regularly premium of the policy to the OPs and prayed for allowing the complaint.

10.           Per contra, learned counsel for OPs no.1 to 3, while reiterating the averments made in the written version, has vehemently argued due to non-payment of 2^nd premium in time, the policy was in lapse mode, when 2^nd premium is not paid by the life assured in time. At the time of death of life assured the policy in question was on lapse mode. Therefore, the claim of the complainant has rightly been repudiated, vide letter dated 17.02.2020 and prayed for dismissal of the complaint.

11.           Learned counsel for OP no.4 argued the same lines which argued by the learned counsel for OPs no.1 to 3. Hence, prayed for dismissal of the complaint.

12.           Admittedly, the deceased life assured got insured himself from the OPs no.1 to 3. It is also admitted that the policy in question was lapsed due to non-payment of premium.  It is also admitted that deceased life assured passed away on 14.01.2020. The claim of the complainant has been repudiated by the OPs, vide letter Ex.C6/Ex.R6/Ex.RW4/B dated 17.02.2020 on the grounds which reproduced as under:-

“The renewal premium for the above policy was due for payment on 26.11.2019. Since the renewal premium was not paid, the policy lapsed on expiry of the grace period w.e.f. 26.12.2019. The excess premium received dated 24.01.2020 post the date of death has been refunded in your bank account.

As the above mentioned,  policy was in lapse mode on the date of death of late Mr. Rampal i.e. 14.01.2020, we regret out inability to admit the death claim against the captioned policy”.

13.           The claim of the complainant has been repudiated by the OP due to non-payment of 2^nd premium in time and the policy in question was in lapsed mode, on the date of death of life assured.

14.           The onus to prove her case lies upon the complainant but complainant has miserably failed to prove her case by leading any cogent and convincing evidence. Complainant has miserably failed to prove on record, that at the time of death of life assured, the policy in question was in force condition.

15.           As per version of the complainant, on 09.01.2020 a cheque of Rs.24,949/- was issued in favour of the OPs for renewal of the policy in question.  The premium amount got transferred in the account of the OPs on 27.01.2020, at that time Ram Pal was no more as he died on 14.01.2020. It is evident from bank account statement Ex.C9 of the deceased life assured, on 09.01.2020 there was no sufficient balance remained in the said account and only Rs.16,853/-remained in the said account and if the cheque in question presented by the OPs though the same was going to be dishonoured due to insufficient fund. The cause of death of life assured has also not been disclosed by the complainant in her complaint. For only maintaining the sufficient amount, an amount of Rs.12,000/- was transferred in the account of deceased life assured (Ram Pal) on 13.01.2020 and on the very next day, Ram Pal passed away. It appears that the complainant had transferred the said amount only in order to grab the claim amount, knowing very well that Ram Pal was not in healthy state and there was no sufficient amount in his account  to clear the cheque issued on 09.01.2020. In view of the above, on the date of death, the policy in question was not in force, hence complainant is not entitled for any relief as claimed by her.

 16.          Thus, as a sequel to abovesaid discussion, we do not find any merits in the complaint and same deserves to be dismissed and  same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated:20.06.2022

                                                                       

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member