Punjab

Sangrur

CC/1016/2015

Gurdial Kaur - Complainant(s)

Versus

PNB Met Life Ins.Co. Ltd. - Opp.Party(s)

Shri G. S. Shergill

01 Jul 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

                                                Complaint No.  1016

                                                Instituted on:    08.09.2015

                                                Decided on:       01.07.2016

 

1.Gurdial Kaur aged 70 years, wife of late Shri Hari Singh.

2.Harpreet Singh son of Hari Singh,

3.Harjeet Singh son of Hari Singh, resident of VPO Kular Khurd, Tehsil and District Sangrur (Punjab)

                                                        …Complainants

                                Versus

1.     PNB Metlife India Insurance Company Limited (formerly known as Met Life Insurance Co. Ltd.) Platinum Tower, 4^th Floor Sohna Road, Sector -47, Gurgaon -122 002 through its authorised signatory.

2.     PNB Metlife India Insurance Company Limited (formerly known as Met Life Insurance Co. Ltd.) Brigade Seshamahal, 5, Vani Vilas Road, Basavanagudi, Bangalore-560 004 through its MD.

3.     PNB Metlife India Insurance Company Limited (formerly known as Met Life Insurance Co. Ltd.) Punjab National Bank, Gaushalla Road, Sangrur through its Branch Manager.

4.     Puneet Duggal, authorised agent of PNB Metlife India Insurance Company Limited (formerly known as Met Life Insurance Co. Ltd.) Punjab National Bank, Gaushalla Road, Sangrur.

                                                        ..Opposite parties

 

For the complainant  :       Shri G.S.Shergill, Adv.

For OP No.1 to3       :       Shri G.P.Sharma, Adv.

For OP No.4             :       Exparte.

 

Quorum:   Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President

 

1.             Smt. Gurdial Kaur is the wife of Hari Singh, whereas Harpreet Singh and Harjeet Singh are sons of Hari Singh, complainants (referred to as complainant in short) have preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that agent of the Ops approached the deceased/insured Shri Hari Singh (referred to as DLA in short) and as such, he purchased the policy and paid the first premium of Rs.40,000/- through cheque and thereafter the OPs number 1 and 2 issued policy bearing number 20405966 namely “Met Smart Life” for the period of 31 years having annual premium of Rs.40,000/- per annum under which the DLA was insured for Rs.8,00,000/- and the complainant was the nominee under the policy. It is further averred that thereafter the DLA paid the premium of Rs.40,000/- each for the year 2011, 2012, 2013 and 2014  and by this way, the complainant paid premium of Rs.2,00,000/- to the Ops.

 

2.             It is further averred that on 23.10.2014, the DLA alongwith the complainant number 2 were returning to his village on scooter, but unfortunately he was hit by a vehicle, as a result of which the DLA died an accident side injuries, of which FIR number 99 dated 24.10.2014 was lodged at PS Sadar Sangrur and the post-mortem was also conducted in Civil Hospital, Sangrur.   It is further averred that thereafter the complainant number 2 lodged the claim with the Ops and submitted the required documents and the Ops assured that the claim would be paid within 15 days, but nothing was done like this.  Thereafter the complainant sent email to the Girevance Cell of the Ops and in reply to that the Ops stated that the claim is not payable as the policy was foreclosed on 26.9.2014 due to the surrender value below the annualized premium. It is further mentioned in the email that an amount of Rs.76,908.80 towards policy foreclosure amount was despatched on 31.10.2014, which was undelivered and returned back. It is stated that the policy was foreclosed on 26.9.2014 and insured died on 23.10.2014, therefore the claim is not payable.  It has been stated that though the fact that the DLA paid all the premiums in time  and there is no fault on the part of the DLA in payment of premium. The last premium was received by OP number 4 on 26.9.2014. Lastly, the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.8,00,000/- along with interest @ 18% per annum from the date of death of the DLA and further claimed compensation and litigation expenses.

 

3.             In reply filed by OPs number 1 and 2, preliminary objections are taken up on the grounds that the complaint is false, malicious, incorrect and with malafide intention, that the complaint is vague, baseless one, that the complaint filed by the complainant does not fall within the definition of the consumer dispute, that the DLA took the policy after understanding the terms and conditions of the product and as such the policy was issued to the complainant and that there is no deficiency in service on the part of the Ops and as such the complaint is not maintainable before the Forum.  On merits, it is stated that after receipt of the duly filled up and signed proposal form along with the initial premium amount, the policy in question was issued.  It is stated that the complainant is not entitled to get the full claim as claimed.

 

4.             Record shows that the OP number 4 did not appear despite service, as such OP number 4 was proceeded exparte on 10.11.2015.

 

5.             The learned counsel for the complainant has produced Ex.C-1 to Ex.C-9 copies of emails, Ex.C-10 to Ex.C-17 copies of premium receipts, Ex.C-18 copy of FIR dated 21.10.2014, Ex.C-19 copy of PMR and Ex.C-20 copy of accounts statement and Ex.C-21 affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 to 3 has produced Ex.OP1 to 3/1 affidavit along with annexure OP-1, Ex.OP-2 and closed evidence.

 

6.             We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

7.             It is an admitted fact that the DLA during his life time obtained an insurance policy bearing number 20405966 from the Ops in the year 2010 by paying the requisite premium of Rs.40,000/- per year which was paid regularly uptill the year 2014, as the DLA died on 23.10.2014 in an accidental death while he was coming to his village on scooter, of which DDR number 99 dated 24.10.2014 was also recorded at PS Sadar Sangrur, a copy of which on record is Ex.C-18, wherein it has been clearly stated that the DLA Hari Singh died an accidental death while his scooter met with an accident with the vehicle bearing number HR99TB(T)5391.  Ex.C-19 is the copy of post-mortem report showing the accidental death of the DLA in an road side accident.  As such, it is not in dispute that the DLA died an accidental death. But, the grievance of the complainant is that the Ops did not pay the claim to the complainant on flimsy grounds and withheld the same illegally.   On the other hand, the OPs have admitted that the DLA was insured for Rs.8,00,000/- with them as it is evident from the copy of premium receipt, which is on record as Ex.C-10. But, it is stated that the complainant is not entitled to get the claim amount of Rs.8,00,000/- from the OPs.  We have further perused the copy of email dated 17.2.2015 sent by the Ops to the complainant, wherein it is stated that the complainant is entitled to get only an amount of Rs.76908.80 towards the policy foreclosure amount and the cheque for the said amount was sent to the complainant which was received back undelivered, as the policy of the DLA was foreclosed as on 26.9.2014 due to the surrender value falling below the annualized premium as per the policy terms and conditions.  Further the Ops have not produced any documentary evidence on record to show that they ever sent a cheque for Rs.76908.80 to the complainant.

 

8.             We have very carefully perused the complaint file along with the documents, but failed to go with the contention of the OPs that the complainant is entitled to get only an amount of Rs.76908.80, whereas the DLA was insured for Rs.8,00,000/-  as is evident from the insurance policy as mentioned above.  The Ops have mentioned that the policy was foreclosed on 26.9.2014 due to the surrender value falling below the annualized premium, but no such information was given by the Ops to the DLA during his life time on 26.9.2014 and the OPs only stated this fact after the death of the DLA which occurred on 23.10.2014 in an accident and the Ops only intimated the complainant that the claim is not payable as the surrender value falling below the annualized premium.  The OPs only offered refund of Rs.76,908.80 on 31.10.2014 after receiving the intimation of the death of the DLA, which took place on 23.10.2014.  It is clear that the Ops after thought tried to not to pay the actual claim of Rs.8,00,000/- rather opted to pay only Rs.76,908.80 to the complainants taking a false plea of surrender value below the annualized premium.   We may further mention that the Ops have not taken any clear stand in the written reply to clarify why they have withheld the rightful claim of the complainants. In the circumstances of the case, we find it to be a clear cut case of deficiency in service and unfair trade practice on the part of the OPs by not paying the insurance claim of Rs.8,00,000/- to the complainants.

 

9.             The insurance companies are in the habit to take these type of projections to save themselves from paying the insurance claim. The insurance companies are only interested in earning the premiums and find ways and means to decline claims. The above said view was taken by the Hon’ble Justice Ranjit Singh of Punjab and Haryana High Court in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others 2008(3) R.C.R. 9 (Civil) 111.

 

 

10.           In view of our above discussion, we allow the complaint and direct the OPs number 1 to 3 to pay to the complainants an amount of Rs.8,00,000/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 08.09.2015 till realisation in full. Ops are further directed to pay to the complainant an amount of Rs.20,000/- on account of compensation for mental tension, agony and harassment and Rs.11,000/- on account of litigation expenses.

 

11.           This order of ours be complied with within a period of thirty days of its communication. A  copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                July 1, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

                                                              (K.C.Sharma)

                                                                   Member

 

                                                                (Sarita Garg)

                                                                    Member