Delhi

North East

CC/386/2022

Sh. Ravinder Kumar Soni - Complainant(s)

Versus

M/s Shri Ram Life Insurance Co. - Opp.Party(s)

07 May 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No.386/22                                   

In the matter of:

 

	Sh. Ravinder Kumar Soni S/o Lt. Sh. Jagdish Chand Soni                                                                                                                                                                                                                                                                                                                                                                                   R/o C 22, Gokalpuri, Delhi-110094	Complainant
	Versus
	M/s Shriram Life Insurance Co. Ltd. Branch Office: Mayur Vihar, Phase 1, Delhi-110091 Regd. & Corp. Office: Plot No.31 & 32, 5th Floor, Ramky Selenium, Beside Andhara Bank Training Centre, Financial District, Gachibowli, Hyderabad-500032, Telangana State.	Opposite Party

 

DATE OF INSTITUTION:         JUDGMENT RESERVED ON:                         DATE OF ORDER  :

07.10.22 03.01.24 07.05.24

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

Adarsh Nain, Member

ORDER

 

Ms. Adarsh Nain, Member

The Complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against Opposite Party alleging deficiency in services and negligent act.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that Ms. Sushma Soni wife of Complainant is bona fide purchaser of Insurance vide policy no. NN011707056962 for 10 years providing plan named Shri Ram Life Assured Income Plan under which the assured sum was  of Rs. 2,50,000/- having maturity date 20.07.27 starting from 20.07.17 and and second policy bearing no.  NN011711104696 in favour of his wife for 10 years, Plan name Shri Ram Life Assured Income Plan for assured sum of Rs. 5,00,000/- having maturity date 22.11.27 as well as there is an additional benefit of accidental rider claim of      Rs. 5,00,000/-. It is stated that the Complainant is nominee under both the polices.  On 01.05.18 wife of Complainant expired and Complainant intimated to Opposite Party about mishap and lodged a claim against policies being nominee on 18.11.21 at Mayur Vihar Branch. On 10.01.22 Complainant received letter reference no. Claim (D) from Opposite Party head office dated 29.12.21 where the claim had been held pending by bolting unwanted necessity of “Final Judgment copy from the court of law” by the Complainant by stating that “We understand that the legal case is sub-judice and has not been adjudicated by the competent authority/court and hence we will not be in a position process the claim without complete adjudication of the case by the courts/competent authority”. The Complainant has stated that trial phase of case is a time taking process and not in the hands of Complainant and such terms had not mentioned in the agreement at the time of selling the insurance  to the Complainant. The Complainant had approached Opposite Party for releasing his claim but Opposite Party did not pay any heed to the request of Complainant. The Complainant has also sent various letters to Opposite Party but all in vain. The Complainant has also sent legal notice to Opposite Party dated 31.08.22 but neither any action has been taken by Opposite Party nor the claim of Complainant was passed. Hence, this shows deficiency in service on behalf of Opposite Party. The Complainant has prayed for the insurance amount i.e. Rs. 12,50,000/- and Rs. 2,00,000/- for financial loss and mental harassment. He has also prayed for litigation expenses.
2. None has appeared on behalf of the Opposite Party despite service of notice to contest the case. Therefore, Opposite Party was proceeded against ex-parte vide order dated 24.02.23.

Ex- Parte Evidence of the Complainant

3. The Complainant in support of his case filed his affidavit wherein he has supported the assertions made in the complaint.

Arguments & Conclusion

4. We have heard the Ld. Counsel for Complainant. We have also perused the file and the written arguments filed by the Complainant.
5. The case of the Complainant is that his wife Ms. Sushma Soni was a bona fide purchaser of two Insurance policies providing plan namely Shri Ram Life Assured Income Plan under which the assured sum was  of Rs. 2,50,000/- and Rs. 5,00,000/- and  the Complainant is nominee under both the polices.  It is the case of the Complainant is that the his wife who was the life assured under both the policies expired and the Opposite Party did not process the claim and kept the same pending on the ground that “Final Judgment copy from the court of law” is required while the Complainant submits that trial is a time taking process and not in the hands of Complainant and such terms had not mentioned in the agreement at the time of selling the insurance to the Complainant. The Complainant has prayed for the death sum assured under both the polices which is Rs. 2,50,000/- and Rs. 5,00,000/- as well as Rs. 5,00,000/- under the accidental benefit rider and the compensation.
6. The Opposite Party has not contested the case as has been proceeded ex parte.
7. On perusal of the copy of subject policies relied upon by the Complainant, it is evident that the wife of the Complainant (since deceased) was life assured under the above-noted polices issued by the Opposite Party insurance company and the Complainant (husband of life assured) was nominee under both the policies. It is also evident that the death sum assured under the policies was Rs. 2,50,000/- and Rs.5,00,000/- respectively.
8. The grievance of the Complainant is that Opposite Party company had kept the claim pending without any valid reason. The Opposite Party had asked for the final judgement in trial matter related to the death of the life assured while as per the Complainant, the same will take time and no such terms were mentioned in the agreement at the time of issuance of the policies.
9. The perusal of the material on record including the criminal record related to the death of the life assured clearly shows that the wife of the Complainant died due to gunshot injury and an FIR was also lodged to this effect under Section 307 of IPC. Perusal of the terms and conditions of the subject polices relied upon by the Complainant do not mention anywhere any exclusion or condition qualifying the factum of death. the policies’ terms simply has provision for the death sum insured in case of the death of life assured and in the present matter, the factum of death is well established from the material on record. It is also clear from the letter dated 29.12.21 issued by the Opposite Party that the Complainant’s claim was not processed as final judgement copy was required. The Opposite Party has not questioned the validity of the policies on the date of death. The Opposite Party has also acknowledged the claim filed by the Complainant for payment of death sum insured.
10. Neither death of life assured is disputed nor the validity of the policies were in question, hence, the Complainant being nominee is very much entitled for the payment of death sum insured under both the policies and Opposite Party has been deficient in services by not releasing the valid claim of the Complainant.
11.  The Complainant has also prayed for an additional benefit of accidental rider claim of  Rs. 5,00,000/-. The copy of policy confirms that the premium was paid for the said benefit. However, it is evident from the material on record that the death of the wife of the Complainant (Life assured) was not accidental as it is the case of the Complainant himself that she died of gun shot injury and FIR was also registered and trial is going on. Hence, in our view, the death of the life assured was homicidal and not accidental. Not only this, vide letter 18.01.2022, Complainant himself had asked from the Opposite Party company for the basic death sum insured only. Therefore, in view of above, the Complainant’s prayer for additional benefit of accidental rider claim of Rs. 5,00,000/- stands disallowed.
12.  In view of above discussion and the unrebutted, uncontroverted testimony of the Complainant regarding the deficiency of services on the part of Opposite Party, we are of the considered view that the Opposite Party has been deficient in services by holding back a valid claim of the Complainant and not processing the same in time.
13. Thus, we allow the present complaint partly and direct the Opposite Party i.e. M/s Shriram Life Insurance Co. Ltd to pay to the Complainant Basic death sum insured under the subject policies which is Rs. 2,50,000/- and Rs. 5,00,000/- respectively with interest @ 9% per annum from the date of institution of the complaint. The Opposite Party is also directed to pay Rs. 25,000/- towards compensation and litigation cost along with interest @ 9 % per annum from the date of this order till its recovery.
14. Order announced on 07.05.24.

Copy of this order be given to the parties free of cost

File be consigned to Record Room.

 

(Anil Kumar Bamba)	(Adarsh Nain)	(Surinder Kumar Sharma)
(Member)	(Member)	(President)