Jammu and Kashmir

Jammu

CC/63/2017

NEELAM GUPTA - Complainant(s)

Versus

MET LIFE - Opp.Party(s)

ANIL GUPTA

21 Jul 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,JAMMU

         (Constituted under J&K Consumer Protection Act,1987)

 

  Case File  No.                473/DFJ           

 Date of  Institution       09-03-2017

 Date of Decision           17-07-2018

 

Smt.Neelam Gupta,

W/O Late Radha Raman Gupta,

R/O H.No.197 Sector-1,Dogra Nagar,

Near Lower Roop Nagar,Jammu.

                                                                                                                                                                Complainant

                          V/S

1.The Incharge/Branch Manager,

Met Life Insurance,Gupta Towers Hotel

TRG Top  Floor,Bahu Plaza,Jammu

Behind Vishal Mega Mart.

2.The Head Insurance Regulatory and

Development Authority of India Head Office,

3^rd Floor Parisrama Bhavan Basheer Bagh

Hyderabad-500004 Telegana State.

3.Branch Manager J&K Bank,SMGS Hospital,

Jammu.

                                                                                                                                                                Opposite parties

     CORAM

                  Khalil Choudhary             (Distt.& Sessions Judge)      President

                  Ms.Vijay Angral                                                            Member

                  Mr.Ghulam Sarwar Chauhan                                       Member

 

In the matter of: Complaint under section 10 of J&K Consumer

                              Protection Act 1987.

 

Mr. Anil Gupta,Advocate for complainant, present.

Mr.Shafiq Ahmed Wani,Advocate for OP1,present.

Mr.Ajay K.Gandotra,Advocate for OP3,present.

    

                                                       ORDER

 

                    Facts germane to the complaint on hand are that; late husband of complainant,namely,Sh.Radha Raman Gupta had obtained Met Loan & Life Suraksha-Certificate of Insurance from OP1 for covering the risk with respect to loan liability of Rs.2,80,000/-of Jammu & Kashmir Bank Ltd.Branch SMGS Hospital Jammu(OP3)on the basis of his pension account and the mode of payment was one time premium and the amount of premium was Rs.8,570/-on,28-09-2015. Complainant further submitted that her husband died on,20-02-2016 and incharge of J&K Bank has been asking her to repay the loan liability despite the fact that the same was insured/covered by the Suraksha Cover-certificate of insurance issued by OP1,who are under contractual and legal obligation to indemnify(copy of death certificate is annexed).Allegation of complainant is that initially in the month of May,2016 she approached OP1 for redressal of her grievance by performing their part of contract/promise, but they did not do the needful, which constrained her to issue legal notice through counsel which has not been replied by OPs.That after waiting for 2/3 months complainant again approached OP1 to know the fate of her claim, but nothing was done by OPs and this act of Ops constitutes deficiency in service. Hence the present complaint. In the final analysis, complainant prays for indemnification of loan liability of Rs.2,80,000/-alongwith interest accrued to OP3 bank in terms of receipt of one time premium from her husband and in addition also prays for compensation to the tune of Rs.1.50,000/-including litigation charges.

       On the other hand,OP1 filed written version and resisted the complaint on the ground that the instant complaint is not maintainable before this Forum for the reason that complainant is not a Consumer within the meaning of J&K Consumer Protection Act,1987.It is submitted that no policy of insurance was ever issued in favour of deceased husband of complainant and hence, complainant does not qualify to become a Consumer within the meaning of the Act. It is submitted that the OP was in receipt of a duly filled and signed Proposal Form from Mr.Radha Raman (hereinafter referred to as the Deceased)wherein he deceased expressed his willingness to obtain a Met Loan & Life Suraksha Policy of OP.That upon evaluation of the proposal form submitted by the Decease, the OP issued a letter dated 15-10-2015 calling upon the deceased to furnish the following medical documents:

1. Medical Examination Report
2. Electrocardiogram
3. Fasting Blood Sugar
4. Urine Routine Analysis
5. Lipid Profile

(Copy of letter dated 15-10-2015 is annexed as Annexure-OP1)That the deceased failed to fulfill the medical requirements as raised by the OP vide letter dated 15-10-2015.That, since the deceased failed to fulfill the medical requirements, the policy could not be issued in favour of the deceased. The OP duly refunded the premium amount of Rs.8570/-in the deceased’s account ending with 7042 through NEFT on,08-06-2016

                 On the other hand,OP2 filed objections  and  admitted that Late Radha Raman Gupta took a life insurance policy “Met Loan & Life Suraksha Certificate of Insurance “from M/S Met Life Insurance Company Ltd.and paid Rs.8,570/-as one time premium through his bank account with OP3,on,28-09-2015 for a sum assured of Rs.2,80,000/-covering his loan liability with Jammu & Kashmir Bank Ltdl,Branch SMGS Hospital,Jammu.Late Radha Raman Gupta died on,20-02-2016 and complainant preferred the death claim under the said policy to repay loan liability. Complainant approached OP1 in the month of May,2016 and also sent a legal notice on,28-06-2016.At the outset, it is submitted that the complaint is between the complainant and OPs 1&3 relating to settlement of Death Claim under the policy and for issuing of the Policy Bond.Further,it is submitted that the onus is on the OPs 1&3 to resolve the grievance and OP2 plays a facilitative e role in resolution of grievances, as it discharges regulatory and supervisory functions. The Op2 lays down broad policy and does not adjudicate upon dispute between individual policy holder and the Insurance Company. The complainant can approach Ombudsman in case he is not satisfied by the resolution of his grievance by the Insurance Company or if he doesn’t receive any communication from the Insurance Company within 30 days of intimation. Apart from that the complainant can sue the Insurance Company for any deficiency of service or breach of terms and conditions of contract entered between complainant and Insurance Company, as such no further role of OP2 arises in the matter. It is submitted that OP2 has put in place a system called Integrated Grievance Management System(IGMS),whereby any policy holder can register a complaint which will be flagged to the insurance  company for quick resolution. If complaint is addressed to OP2,it is registered and the documents captured are forwarded to insurance company for resolution. The insurance company is required to examine the complaint and attend to it within two weeks by responding to the complainant The action taken on the complaint has to be updated by the insurance company in the Integrated Grievance Management System (IGMS).The status of the complainant and the description of action taken can be checked by the complainant from the IGMS or by calling up OP2 Grievance Call Centre by using the token number assigned to the complaint. In case the complainant does not come back within eight weeks of the insurance company attending to the complaint and recording the action taken, the complaint will be closed by the insurance company. In case the company does not respond even after 15 days or if the complainant is not satisfied with the action taken, he can again escalate the complaint to OP2.It will then taken up the complaint with the company for its resolution and responding to the complainant. In case of dissatisfaction with the resolution of the insurance company, the complainant may approach the Insurance Ombudsman or any other for appropriate legal authority.

               At the same time,OP3 filed objections and submitted that Mr.Radha Raman Gupta S/O Sh.Hans Raj Gupta was granted Personal Consumer Loan (Term Loan)of a sum of Rs.2.80 lacs on,10-08-2015,which he secured by virtue of Met Loan Assurance Policy through PNB Metlife by paying a premium of Rs.8750.00 and the amount of premium was debited by his saving account No.7042 on,28-09-2015.However,after the death of borrower, his loan account No.1203265300002170 was under stress and the family of the deceased borrower was approached to liquidate the loan amount and they refused on the ground that the loan was secured by Insurance Company. In this regard, the matter was taken up with PNB Metlife for setting the account and copy of letter dated 01-10-2015 was received wherefrom it was brought to the notice of the replying OP that owing to Mr.Radha Raman Gupta having not submitted the additional documents which were requisitioned from him by PNB Metlife India Insurance Company Ltd.vide its communication dated Ist October,2015,policy was not decisioned in the system and as a result whereof, the amount of premium was reversed/credited into account No.7042 of Mr.Radha Raman Gupta on,10-06-2016 through NEFT(Annexure R-1 and R-2).Perusal of same would reveal that there was no contract of insurance between the husband of complainant and the replying OP and it was not at all in any manner related with or instrumental in the decisions of the OPs No.1&2 having even not intimated the replying OP before crediting the amount of premium into the account of Sh.Radha Raman Gupta through NEFT.It is submitted that owing to the default being committed towards the payment of loan which was availed by Radha Raman Gupta having expired on,20-02-2016,requests were made to his wife, the complainant for regularizing the account or liquidating the entire outstanding amount, but she declined to adhere to the requests made on the premise that the said loan was covered under the certificate of insurance which was issued by PNB Metlife India Insurance Company Ltd.Undeniably a contract of insurance existed between complainant the wife of Radha Raman Gupta and OP1 having received the premium on,28-09-2015 which was received without completion of the requirements and if it is so, then as to how the policy was issued and having been issued it was not required to have been cancelled unless fullest opportunity of hearing would have been afforded to the policy holder. The communication seeking submission of additional documents (Annexure R-1)is dated Ist October,2015 and whereas Radha Raman Gupta has expired on,20-02-2016 and the date of reversal of amount of premium into the account of deceased is 10-06-2016and that too by way of NEFT,itself shows that if at all there could be element of deficiency of service or that of unfair trade practice. It is however,reiterated that the legal heirs of deceased Radha Raman Gupta as being the complainant is under legal obligation to pay the amount outstanding alongwith the interest accrued thereupon as against the facility which was availed by her husband by executing security documents agreeing to repay the same to OP3.The complainant as her successor having succeeded to his estate is liable to discharge his liability as well irrespective of dispute she has raised with OPs 1and 2.

              Complainant adduced evidence by way of duly sworn evidence affidavit and affidavits of Anil Mehra and Beant Gupta,respectively.Complainant has placed on record copy of bank statement alongwith service record, copy of death certificate, copy of legal notice and copy of RTI application.

          On the other hand,OP1 adduced evidence by way of duly sworn evidence affidavit of Rajeev Sharma Senior Manager Legal duly constituted Attorney of PNB MetLife India Insurance Co.Ltd.Unit No.701,702 & 703 7^th Floor West Wing,Raheja Towers.

                  We have perused case file and heard L/Cs for the parties at length.

                 Briefly stated case of complainant is that her husband,namely,Sh.Radha Raman Gupta had obtained Met Loan & Life Suraksha-Certificate of Insurance from OP1 for covering the risk with respect to loan liability of Rs.2,80,000/-of OP3 on the basis of his pension account and the mode of payment was one time premium and the amount of premium was Rs.8,570/-on,28-09-2015. Complainant further submitted that her husband died on,20-02-2016 and incharge of J&K Bank has been asking her to repay the loan liability despite the fact that the same was insured/covered by the Suraksha Cover-certificate of insurance issued by OP1,who are under contractual and legal obligation to indemnify. Allegation of complainant is that initially in the month of May,2016 she approached OP1 for redressal of her grievance by performing their part of contract/promise, but nothing was done by OPs and this act of Ops constitutes deficiency in service.

        On the other hand, stand of OP1 is that since the deceased failed to fulfill medical requirements, the policy could not be issued in favour of deceased and the OP duly refunded the premium amount of Rs.8570/-in the deceased’s account No.7042 through NFT on,08-06-2016.The OP1 further submitted that since the said policy was never issued in favour of deceased, complainant is not entitled to claim any relief from the OP.

                        Before heading further, it is to be noted that since parties have lead evidence in the shape of evidence affidavits, which are much or less reproduction of contents of their respective pleadings, therefore, we do not feel it necessary to represent the same again and if need arises, same would be referred hereinafter at appropriate stage.

               On the other hand, according to Ops, complaint is not maintainable because it involves disputed questions of fact and law which cannot be gone into while exercising the jurisdiction under Consumer Protection Act. According to OP1,the deceased had failed to fulfill medical requirements, so the Policy could not be issued in favour of Deceased. Further stand of OP1 is that OP1 had refunded the premium amount of Rs.8570/-in the Deceased’s account ending with 7042 through NEFT on,08-06-2016, as such question of malpractice, unfair trade practice and defective service provided by Ops does not arise at all.

                         Apart from this legal discussion otherwise also while seeing to the text and form of the grievance as aired in this complaint, it involves complicated question of law and fact which certainly would require an exhaustive and detailed inquest in the case rather to deal with these grievance in a summary prescribed manner under the Act. The Act is a social legislation meant strictly to deal with the cases of consumer in a summary prescribed manner so to render timely and effective remedial course of justice in a time frame manner rather to hold detailed and roving enquiry by this Forum.

                         To lend support in the case reliance can be placed on the judgment of  National Consumer Disputes Redressal Commission,New Delhi in case titled Niwas Spinning Mills Ltd.and others V/S Canbank Mutual Fund and another reported in 2002(1)CLT 113,wherein it has been held as:

       “Consumer Protection Act,1986 ,Section 12-Complex issue of law and fact-Complaint filed claiming damages worth Rs.4.68 crores with interest @ 18%-Held that the complaint raises various complex issues both of law and facts-There are numerous documents which have to be proved to sustain the claim made in the complaint-Such type of complaint requires tremendous amount of time for recording evidence and hearing arguments-The Commission has to decide a complaint within a set time schedule and exercises summary jurisdiction .the complaint is not fit to be entertained-Complaint dismissed and complainant left to seek his remedy before appropriate Forum.”

                          In view of these settled legal position and all what has been stated here to fore this forum is of the considered view that there appears no legal force and substance in the argument and also in the grounds as stated in the complaints by the complainant to seek redressal of the grievance, accordingly the present complaint being devoid of legal force merits dismissal.

In the back drop of both these facts and circumstances, this Forum is of the considered view that there is no force in the complaint and the same is dismissed with a liberty to approach appropriate Forum, if she so advised. Copy of this order be provided to the parties free of costs. Copy of this order be placed in all the files to keep the record straight. Files after its due compilation be consigned to records.

Order per President                                              Khalil Choudhary

                                                                         (Distt.& Sessions Judge)

Announced                                                              President

 17-07-2018                                                   District Consumer Forum

Agreed by                                                                Jammu.

 

Ms.Vijay Angral          

Member        

 

Mr.Ghulam Sarwar Chauhan,

Member