Chandigarh

DF-I

CC/46/2022

Jyotsana Sharma - Complainant(s)

Versus

PNB Metlife India Insurance Co. Ltd. - Opp.Party(s)

Rakesh K. Sharma

02 Apr 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

                                     

Consumer Complaint No.	:	CC/46/2022
Date of Institution	:	06/01/2022
Date of Decision	:	02/04/2024

 

1.     Jyotsana Sharma, aged 34 years, W/o Late Sh. Gaurav Sharma:

2.     Master Shivansh Sharma, aged 9 years, s/o Late Sh. Gaurav Sharma, through his mother-natural guardian and next friend Jyotsana Sharma:

        Both complainants R/o H.No.933, Sector 9, Panchkula, Haryana.

… Complainants

V E R S U S

1.     PNB Metlife India Insurance Company Ltd., office at SCO No. 68-69, Third Floor, Sector 17-B, Chandigarh.

2.     Kamal Sachdeva, Branch Manager, PNB Metlife India Insurance Company Ltd., office at SCO No.68-69, Third Floor, Sector 17-B, Chandigarh.

3.     PNB Metlife India Insurance Company Ltd., Registered office at Unit No.701,702,703, 7^th floor, West Wing, Raneja Towers, 26/27 M.G. Road, Bangalore.

… Opposite Parties

 

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

 

                                                                               

ARGUED BY	:	Sh. Rakesh K. Sharma, Advocate for complainants
	:	Sh. Rajesh Sabharwal, Advocate for OPs 1 & 3
	:	OP-3 ex-parte.

 

Per Pawanjit Singh, President

1. The present consumer complaint has been filed by Smt.Jyotsana Sharma and her minor son Master Shivansh Sharma, complainants against the aforesaid opposite parties (hereinafter referred to as the OPs).  The brief facts of the case are as under :-

1. It transpires from the allegations as projected in the consumer complaint that on 30.6.2020, husband of complainant No.1 and father of complainant No.2 namely Gaurav Sharma had obtained a policy namely “PNB MetLife Mera Term Plan” (hereinafter referred to as “subject policy”) from the OPs on payment of premium of ₹1,894/- with following details :-

Product/Plan	PNB MetLife Mera Term Plan
Policy Number	23352405
Date of Issue	30.06.2020
Date of Commencement of Risk	29.06.2020
Policy Holder/Life Assured	Mr. Gaurav Sharma
Sum Assured	Rs.1,00,00,000/-
Policy Term	45 Years
Premium Payment Term	45 Years
Annualized Premium Amount	Rs.22,707.84/-
Modal Premium	Rs.1892.32/- (inclusive of tax)
Premium Frequency	Monthly
Name of Nominee	Mr.Shivansh Sharma (Son)

 

As per policy terms & conditions, grace period for the purpose of paying the premium was 15 days from the due date of monthly installment of premium.  The life assured continued paying monthly premium on due dates and the monthly premium which was payable on 29.3.2021 was paid by him on 31.3.2021 vide receipt (Annexure C-3) i.e. within the grace period of 15 days as provided under clause 13 and 3.3 of the subject policy. Thereafter, husband of the complainant fell ill during the second wave of COVID-19 pandemic i.e. in the middle of April 2021 and when his RT-PCR test was conducted, he was diagnosed with COVID-19 virus. Thereafter he was home quarantined w.e.f. 21.4.2021 and was put under supervision of doctor at Sector 8, Government Dispensary, Panchkula. Due to non-availability of ventilator in the hospital he was shifted to different hospitals, in order to provide ventilator facility as he was facing difficulty in breathing. Unfortunately, on 28.4.2021 the life assured, Sh. Gaurav Sharma expired at 7:00 p.m. and after his demise complainants lodged claim with OPs on 20.5.2021, but, the same was repudiated vide letter dated 30.6.2021 (Annexure C-6) on the ground that policy stands lapsed since 29.3.2021 for non-payment of renewal premium. However, as the Deceased Life Assured (hereinafter referred to as “DLA”) had already deposited the premium amount on 31.3.2021 i.e. within 15 days grace period, OPs have wrongly repudiated the claim.  In this manner, the aforesaid act of the OPs amounts to deficiency in service and unfair trade practice. OPs were requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.

2. OPs 1 & 3 resisted the consumer complaint and filed their written version, inter alia, taking preliminary objections of maintainability, concealment of facts, cause of action and also that the complainants tried to mislead the Commission by distorting the facts of the complaint.  However, it is admitted that the subject policy was obtained by the DLA from the OPs.  It is further alleged that the DLA has paid the last monthly premium on 28.2.2021, but, the premium which was due on 29.3.2021 could not be paid by the DLA even within the grace period, as a result of which the policy lapsed and the claim of the complainant was rightly repudiated.  The death of the DLA due to COVID-19 has not been denied.  Even the lapse notice dated 8.4.2022 (Annexure R-5) was issued by the OPs to the DLA and vide letter dated 30.6.2021 (Annexure R-6) OPs informed the complainants that the company is unable to accept any liability.  In this manner, as the subject policy had already lapsed, complainants are not entitled for the policy benefits.   On merits, the facts as stated in the preliminary objections have been reiterated. The cause of action set up by the complainants is denied.  The consumer complaint is sought to be contested.
3. OP-2 did not turn up before this Commission, despite proper service, hence it was proceeded against ex-parte vide order dated 10.2.2023.
4. In rejoinder, complainant re-asserted the claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.

2. In order to prove their case, contesting parties have tendered/proved their evidence by way of respective affidavits and supporting documents.
3. We have heard the learned counsel for the contesting parties and also gone through the file carefully, including written arguments.
   1. At the very outset, it may be observed that when it is an admitted case of the parties that the DLA had obtained the subject policy (Annexure C-1 & C-2) on 30.6.2020 with date of commencement of risk from 29.6.2020, sum assured of ₹1.00 crore, monthly premium of ₹1,892.32 and premium payment term of 45 years and the DLA had died on 28.4.2021, as is also evident from the copy of death summary (Annexure C-4) and the claim lodged by the complainants was repudiated by the OPs vide letter 30.6.2021 (Annexure C-6) stating that the policy stood lapsed since 29.3.2021 due to non-payment of renewal premium, the case is reduced to a narrow compass as it is to be determined if the OPs are unjustified in repudiating the claim as the premium due on 29.3.2021 was paid within the grace period and the complainants are entitled to the reliefs prayed for in the consumer complaint, as is the case of the complainants, or if the OPs are justified in repudiating the claim as the policy stood lapsed on account of non-payment of monthly premium which was payable on 29.3.2021 and the same even could not be paid by the DLA within the grace period, and the consumer complaint of the complainant, being false and frivolous, is liable to be dismissed as is the defence of the OPs.
   2. In the backdrop of the foregoing admitted and disputed facts on record, one thing is clear that the entire case of the parties is revolving around the documentary evidence placed on record by them and the same is required to be scanned carefully to determine the real controversy between the parties.
   3. Perusal of subject policy (Annexure C-2) clearly indicates that the DLA has opted for the aforesaid policy on payment of monthly premium and he had paid the last premium on 28.2.2021, which has also been admitted by the contesting OPs. The entire controversy between the parties is revolving around the issue if the DLA had paid the premium amount to the OPs, which was payable on 29.3.2021, within the grace period or not.
   4. Annexure C-2 is copy of terms & conditions of the subject policy, which clearly indicates that clause 13 thereof provides for grace period of 15 days from the regular/limited premium due date if the regular/ limited premium is payable monthly. The said clause is reproduced below for ready reference :-

“PART B

DEFINITIONS APPLICABLE TO YOUR POLICY.

        xxx                   xxx                   xxx

13.   Grace Period means a period of 15 days from the Regular/Limited Premium due date if the Regular/Limited Premium is payable monthly and 30 days for all other frequencies for payment of Regular/Limited Premium. The Policy shall continue to be in In-force Status with the insurance cover without any interruption as per terms of the Policy during the Grace Period.”

 

5. From the receipt (Annexure C-3) as it stands proved on record that the DLA has deposited the premium amount, which was due on 29.3.2021 with grace period on 31.3.2021 and though the said receipt has been disputed by the contesting OPs, without proving that the same has not been issued by them or if the same is forged document, it is safe to hold that the DLA had deposited the due premium amount on 31.3.2021 i.e. within the grace period and the next due date, as mentioned in the receipt (Annexure C-3) was 29.4.2021. As it is an admitted fact that the DLA had died on 28.4.2021, it is clear that the subject policy was subsisting at the time when the DLA had died. Since the contesting OPs have repudiated the claim of the complainants simply on the ground that the subject policy had lapsed and otherwise it stands proved on record that the same was valid and was subsisting at the time of death of the DLA, it is safe to hold that the OPs have wrongly repudiated the genuine claim of the complainants and the present consumer complaint deserves to succeed.

4. In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and the OPs are directed as under :-

1. to pay the sum assured of ₹1.00 crore to the complainants (less deduction, if any, as per terms & conditions of policy) alongwith interest @ 9% per annum from the date of repudiation i.e. 30.6.2021 onwards.
2. to pay ₹25,000/- to the complainants as compensation for causing mental agony and harassment;
3. to pay ₹10,000/- to the complainants as costs of litigation.

5. This order be complied with by the OPs within forty five days from the date of receipt of its certified copy, failing which, the payable amounts, mentioned at Sr.No.(i) & (ii) above, shall carry interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.  It is, however, made clear that the aforesaid awarded amount shall be apportioned amongst the complainants in equal share i.e. in the ratio of 50:50 each.
6. Pending miscellaneous application(s), if any, also stands disposed of accordingly.
7. Certified copies of this order be sent to the parties free of charge. The file be consigned.

02/04/2024 hg	Sd/- [Pawanjit Singh] President
	Sd/- [Surjeet Kaur] Member
	Sd/- [Suresh Kumar Sardana] Member