BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, FATEHABAD.
Complaint no.190/2018.
Date of instt.13.07.2018.
Date of Decision: 24.12.2019
Dharam Pal son of Sh. Seokaran, resident of MT-58, Hisar Road Bhattu Kalan, Tehsil Bhattu Kalan, District Fatehabad.
..Complainant.
Versus
- PNB Metlife India Insurance Company Limited, Unit No. 701, 702, 703, 7th Floor, West Wing, Raneja Towers, 26/27 M, Bangalore.
- Punjab National Bank, Fatehabad Branch through its Manager.
..Respondents/OPs.
Complaint under Section 12 of Consumer Protection Act, 1986.
Before: Sh.Raghbir Singh, President.
Sh. Jasvinder Singh, Member.
Argued by: Sh. Ravinder, Advocate for the complainant.
Sh. Vinod Godara, Advocate for the OP no. 1.
Sh. Sita Ram Beniwal, Advocate for the OP no. 2.
ORDER
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Ops with the averments that Smt. Dhapa Devi wife of the complainant during her lifetime had obtained a life insurance policy bearing no.21883537 dated 7.6.2016 from the OPs for an insured sum of Rs.4,50,000/-. The complainant being husband of the life assured was nominated as nominee in the abovesaid policy and at the time of issuance of the policy a premium of Rs.45,074/- was paid by the life assured.
2. It is further submitted that at the time of getting the insurance policy the doctors on the penal of the OPs had examined the health condition of the life assured and after satisfaction of the same the said policy was issued by the OPs.
3. It is further submitted that unfortunately on 16.6.2017 Smt. Dhapa Devi life assured died at her home due to heart failure. Before her death the life assured was very fit and she was not suffering from any disease or illness. Intimation regarding death of life assured was given by the complainant to the OPs and requested for settlement of the insurance claim but the Ops demanded certain documents for issuance of the insurance policy. In response to the same the complainant supplied all the documents relating to death of the life assured but the OPs prolonged the matter on one pretext or the other and ultimately declined the insurance claim vide letter dated 8.3.2018 on the ground that the policy had already lapsed on 26.5.2017 due to non-payment of the renewal premium.
4. It is further submitted that the aforesaid reason for declining the death claim by the OPs is totally wrong and illegal as the life assured was not suffering from any disease and she never remained admitted in any hospital before taking the insurance policy. Repudiating the insurance claim of the complainant by the OPs is totally illegal and amounts to deficiency on their part in rendering service to the complainant. The Ops are under legal obligation to release the insured sum of Rs.4,50,000/- alongwith interest at the rate of 18% and compensation for harassment and mental agony. The complainant has further prayed that the present complaint may be allowed and the OPs may kindly be directed for making a payment of Rs.4,50,000/- to the complainant alongwith interest at the rate of 18% and other benefits. Hence, the present complaint.
5. On being served, the OP No. 1 appeared through its counsel and resisted the complaint by filing a written statement wherein various preliminary objections with regard to maintainability, jurisdiction, concealment of true and correct facts and cause of action etc., have been raised.
6. In reply on merits, it is submitted that the renewal premium under the said policy was due on 26.5.2017. However, the complainant failed to pay the premium on the due date and resultantly the policy in question had lapsed with effect from 26.5.2017. Therefore, on the date of death of the life assured the policy had already lapsed and as such no benefit is payable under the said policy. Therefore, the insurance claim of the complainant has been repudiated by the OPs on the ground that when the life assured had died on 16.6.2017 the insurance policy in question was in existence. The decision of the OPs in repudiating the insurance claim of the complainant is perfectly in accordance with the terms and conditions of the insurance policy and sustainable in the eyes of law. The present complaint is without any merits and as such the same is liable to be dismissed.
7. The OP no. 2 has also resisted the complaint by filing a written statement wherein various preliminary objections with regard to maintainability, cause of action and jurisdiction etc., have been raised.
8. In reply on merits, it is submitted that the OP no. 2 is not carrying the business of life insurance. The complainant had only deposited Rs.45,074/- in the bank of the OP and except this the OP no. 2 has no concern or any connection of any kind in the insurance policy issued by OP no. 1. It is further submitted that since the insurance policy was issued by OP no. 1 and as such the present complaint for receiving insurance claim is not maintainable against OP no. 2. The complaint is without any merits and as such the same is liable to be dismissed against Op no. 2.
9. The learned counsel for the complainant tendered in evidence affidavit of complainant as Annexure CW-1/A alongwith documents as Annexure C-1 to Annexure C-8. On the other hand, the learned counsel for OP No. 1 tendered in evidence affidavit of Rajeev Sharma, Senior Manager- Legal as Annexure R-1 alongwith documents as Annexure R-2 to Annexure R-4. The learned counsel for OP no. 2 tendered in evidence affidavit of Sanjay Kumar Branch Manager as Annexure R-1.
10. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the documents placed on record. In the present case, it is not disputed that the insurance policy in question for an amount of Rs.4,50,000/- was obtained by late Smt. Dhapa Devi wife of the complainant. It is also not disputed that the complainant was nominated as nominee in the abovesaid policy and the date of inception of the policy was 26.5.2016. It is also not disputed that at the time of obtaining the abovesaid policy the life assured had deposited an amount of annual premium of Rs.45,074/- with the OPs. It is also not in dispute that next date of making payment of the premium was 26.5.2017. It is also not in dispute that the life assured had died on 16.6.2017 and the same is also evident from the death certificate placed on record as Annexure C-7. The insurance claim of the complainant in the present case was repudiated by the OPs vide letter dated 8.3.2018 placed on record as Annexure C-8. A perusal of the letter dated 8.3.2018 (Annexure C-8) reveals that the insurance claim of the complainant has been declined by the OPs on the ground that the policy in question had already lapsed on 26.5.2017 as the renewal premium was not paid by the life assured and the life assured had expired after the lapse of the insurance policy in question. No other ground has been taken by the OPs for repudiation of the insurance claim of the complainant in the present case.
11. After considering the arguments advanced by learned counsel for the parties and having examined the documents placed on record, we are of the considered opinion that repudiation of the insurance claim of the complainant in the present case is not in accordance with the terms and conditions of the insurance policy issued to the life assured. From perusal of the Part B i.e. “Definitions” application in the present policy, it is evident that the grace period for making payment of the premium is 30 days and the policy shall continue to be in force with the insurance cover during the grace period. From perusal of the Part C item no. 4.3 regarding grace period, it is evident that the regular premium if not received in full by due date may be paid in full during the grace period and upon the insured’s death during the grace period the death benefit shall be payable in full.
12. In the present case, the due date for making payment of the premium was 26.5.2017 and including the grace period the due date for making the payment of premium was 26.6.2017 and whereas the life assured died on 16.6.2017. Meaning thereby the life assured had died before the expiry of the grace period i.e. on 26.6.2017. Therefore, in view of the terms and conditions of the insurance policy as discussed above, the complainant is entitled for receiving the insurance claim.
13. Therefore, in view of aforesaid discussion, we are of the considered opinion that the complainant has been able to prove deficiency on the part of OPs in rendering service to him. The present complaint is accordingly allowed and the OPs are directed for making a payment of Rs.4,50,000/- to the complainant as insurance claim alongwith interest at the rate of 8% from the date of filing of the present complaint till realization. The Ops are further directed for making payment of Rs.5,000/- as compensation and litigation charges to the complainant. This order be complied with within a period of 45 days, otherwise the amount shall carry an interest at the rate of 8% per annum for the default period. Copy of this order be supplied to the parties free of costs. File be consigned to record room after due compliance.
Announced in open Forum:
Dt.24.12.2019.
(Jasvinder Singh) (Raghbir Singh)
Member President DCDRF, Fatehabad.
