BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.402 of 2014

Date of Instt. 17.11.2014

Date of Decision :10.07.2015

1. Nancy Bawa Wd/o Late Sh.Iqbal;

2. Sujal Bawa minor (aged about 9 years) son of Late Sh.Iqbal;

3. Paras Bawa minor (aged about 4 years) son of Late Sh.Iqbal;

Complainants No.2 & 3 through complainant No.1 their mother being the natural guardian/next friend.

4. Kulwant Kaur wife of Vijay Bawa;

All resident of 130, New City Gopal Nagar, Jalandhar-144002.

..........Complainants Versus

1. M/s DLF Pramerica Life Insurance Company Ltd, 4th Floor Building No.98, Cyber City, DLF City, Phase-III, Gurgaon-122002.

2. M/s DLF Pramerica Life Insurance Company Ltd, 2nd Floor, Eminent Mall Unit Nos.S.F.-3,4, Property No.261, Lajpal Nagar, Guru Nanak Mission Chowk, Jalandhar-144001, Punjab.

.........Opposite parties

Complaint Under Section 12 of the Consumer Protection Act.

Before: S. Jaspal Singh Bhatia (President)

Ms. Jyotsna Thatai (Member)

Sh.Parminder Sharma (Member)

Present: Sh.Vijay Prabhakar Adv., counsel for complainant.

Sh.HS Kohli Adv., counsel for opposite parties.

Order

J.S.Bhatia (President)

1. The complainant have filed the present complaint under section 12 of the Consumer Protection Act, against the opposite parties on the averments that Mr.Iqbal i.e the husband of the complainant No.1 Nancy Bawa (nominee) was a customer of the opposite parties. During his life time he had life insurance policy No.000085748 from opposite party No.2 for 30 years. The sum insured was Rs.25,00,000/- and the policy commenced on 22.9.2011 which was to mature on 21.09.2041. Iqbal was having another life insurance policy cover note No.000045224. The sum insured was Rs.8,40,000/- and the policy commenced on 15.12.2010, which was to mature on 14.12.2025. Nancy i.e the complainant No.1 was declared as nominee in both policies. Iqbal during his life time was regularly paying the premium to the insurance company. But all of a sudden on 12.9.2012 Iqbal i.e husband of the complainant collapsed due to heart-attack. He suddenly felt pain in his chest, he was taken to Sacred Hospital, Jalandhar but he could not survive and he died due to heart attack. Both the policies were in effect at the time of death of the assured. The matter was reported to police. As no one was at fault in death so no case was got registered against anyone. After the funeral and last rites of the insured, the complainant No.1 being the nominee of the insured lodged the insurance claim before the opposite party i.e the insurance company regarding both the polices. Complainant No.1 was shocked and surprised as and when she received the letter dated 21.5.2013 vide which the claim qua to the insurance policy No.00085748 has been repudiated by alleging that the deceased has committed suicide within one year from the date of commencement of the policy and the policy has become null and void in terms of the policy contract without any sufficient reasons. However, it is made clear that the assured Iqbal has died due to heart-attack and he has not committed suicide. The opposite party No.1 vide its letter dated 21.5.2013 in respect of the claim submitted by the complainant qua to the above mentioned insurance policy No.000045224 instead of paying an amount to Rs.8,40,000/- has only paid an amount of Rs.48,425.95/- towards the full and final settlement by alleging that the policy went into discontinuation as the premium was not deposited within due date. The complainant left with no option except to file the complaint before the State Consumer Commission as the claim was more than Rs.20,00,000/-. It is worth to mention that the said complaint was partly allowed by the Hon'ble State Consumer Commission qua the policy No.000085748 which was amounting to Rs.25,00,000/- vide its order/judgment dated 4.9.2014. In the para No.7 of the said order the Hon'ble Commission has made it clear. "we will confine our discussion and decision to the first policy bearing No.000085748. In respect of the second policy No.00004524 the complainants shall have their independent remedy to file suit/complaint before the appropriate court/forum". On such like averment, the complainants have prayed for directing the opposite party insurance company to pay them Rs.8,40,000/- on account of the insurance claim. They have also claimed compensation and litigation expenses.

2. Upon notice, opposite parties appeared and filed their written reply, inter-alia, pleading that the life assured/policy holder Iqbal (herein referred to as Deceased Policy Holder or DLI) after completely understanding the terms and conditions of the insurance product "DLF Pramerica Wealth + Premier Plan" had voluntarily applied for an insurance policy vide proposal form bearing No.AF000226901 dated and signed 22.11.2010 wherein the complainant No.1 i.e wife of DLA was proposed as nominee. In the proposal form, the DLI had given all relevant details and information in the prescribed form, for a coverage sum assured amounting to Rs.8,40,000/- for which the premium amounting to Rs.21,000/- was proposed to be paid quarterly for the period of five years. Based on the information and declaration contained in application and further believing the same to be true and also upon receipt of the duly filled form alongwith the initial premium opposite party has issued the policy bearing No.000045224 with the commencement dated 15.12.2010. Thereafter policy document alongwith the schedule and the terms and conditions thereto and a welcome letter were sent to the deceased policy holder which were duly delivered to the address of the deceased policy holder. Thereafter, on 23.10.2012, the opposite party received death claim intimation of DLI from the complainant, whereby opposite party was given to understand that the DLI expired suddenly on 12.9.2012 due to heart-attack and further claim for sum assured. Upon receipt of the claim intimation, the opposite party vide its letter dated 29.10.2012 requested the complainant to provide the necessary documents in order to process the claim at the earliest, but the complainant did not give any response. It is submitted that thereafter the opposite party continuously sent reminders to the complainant to furnish necessary documents vide letter dated 3.1.2013, 4.2.2013, 4.3.2013 but the complainant did not pay any heed to it for the best reasons known to her. The said policy went into discontinuation fund on 30.11.2011, as the premium was not deposited on due dates. As per clause 3(e) of the terms of the policy, when the policy moves to discontinuance fund and death occurs, the company is only liable to pay fund value alongwith interest till the date of death of policy holder to the nominee. Hence, the opposite party has rightly declined the claim of the complainant under the said policy. It is further submitted that as per the policy terms and conditions, the opposite party has paid the fund value of Rs.48,425.95/- by cheque No.039399 dated 21.5.2013 drawn on HDFC bank to the complainant and the said cheque has been encashed on 16.7.2013. It is submitted that the said policy was already in discontinued mode at the time of death of DLI, hence the opposite party is not liable to pay claim under the said policy as per the policy terms and conditions. It is submitted that the same was also communicated to the complainant vide letter dated 21.5.2013. They denied other material averments of the complainant.

3. In support of his complaint, learned counsel for the complainant has tendered into evidence affidavit Ex.CA alongwith copies of documents Ex.C1 to Ex.C10 and closed evidence.

4. On the other hand, learned counsel for the opposite parties has tendered affidavit Ex.OPW-1/A alongwith documents Ex.OP1 to Ex.OP6 and closed evidence.

5. We have carefully gone through the record and also heard the learned counsels for the parties.

6. The dispute involved in the present complaint is regarding cover note/policy No.000045224 under which the sum assured was Rs.8,40,000/-. Under the policy, the premium was payable quarterly to the extent of Rs.21,000/- for a period of five years. It is not disputed that the deceased life assured had paid only one premium of Rs.21,000/- after taking policy and thereafter did not pay any other premium. At the time of arguments, this fact not disputed by learned counsel for the complainants. The complainants have also not produced receipts regarding payments of subsequent premiums. So due to non payment of premiums the policy went into discontinued mode. Counsel for the complainant contended that as per condition No.3(d) of the policy terms and conditions, the insurance company was required to send notice to the policy holder to give option to continue the policy by paying due regular premium or terminate the policy without any risk cover continuing. He further contended that no such notice was sent to the deceased and as such discontinuation of the policy is against the terms and conditions of the policy. On the other hand, it has been contended by learned counsel for the opposite parties that admittedly the deceased life assured paid only one premium after the policy and had not paid subsequent quarterly premiums and as such the complainants are not entitled to the claim amount, whether any notice was given to the deceased life assured or not. He further contended that complainant No.1 has received the fund value of Rs.48,425.95/- towards the full and final settlement of the claim under the policy in question and as such after accepting the payment in full and final settlement of the claim, they are not entitled to claim any other amount. We have carefully considered the contentions advanced by both the parties. In para 8 of the complaint, the complainants have themselves pleaded that opposite party No.1 vide letter dated 21.5.2013 in respect of the amount of Rs.8,40,000/- has only paid an amount of Rs.48,425.95/- towards the full and final settlement by alleging that the policy went into discontinuation as the premium was not deposited within due date. So according to the own version of the complainants, the above said amount was given by the insurance company towards the full and final settlement of the claim. The above said amount was sent through cheque and was got encashed on 16.7.2013. The fact that the above said amount was sent to the complainant No.1 towards full and final settlement of claim is also evident from the letter dated 21.5.2013 Ex.C6 produced by the complainants. In this letter it is mentioned as under;-

"Please find enclosed cheque with number 039399 dated 21.5.2013 for amount Rs.48,425.95(Rupees Forty Eight Thousand Four Hundred Twenty Five & Ninety Five Paisa Only) as fund value refund towards the full and final settlement for policy No.000045224.

Upon banking of above cheque, the company would be discharged from its liability towards the above policy".

7. From this letter it is also evident that above said amount was sent through cheque as full and final settlement of the claim under the policy in question which was accepted by complainant No.1 as the cheque was got encashed by her. Once the complainant No.1 has accepted the amount towards full and final settlement of the claim, the relationship of consumer and service provider between the parties comes to end. In support of this view reference may be made to Amit Chawla and anothers Vs. Parsvnath Developers Ltd, II(2015) CPJ 473 (NC). Moreover, at the time of death of the deceased life assured, the policy was in discontinued mode as admittedly the deceased life assured has not paid the premiums regularly. So without paying the premiums under the policy, the complainants are not entitled to the claim amount as due to non payment of premiums, the policy was not subsisting at the time of death of the deceased life assured.

8. In view of above discussion, we hold that there is no merit in the present complaint and same is hereby dismissed with no order as to cost. Copies of the order be sent to the parties free of costs under rules. File be consigned to the record room.

Dated Parminder Sharma Jyotsna Thatai Jaspal Singh Bhatia

10.07.2015 Member Member President