Jammu and Kashmir

Jammu

CC/616/2017

RAJ KUMARI - Complainant(s)

Versus

PNB METLIFE INSURANCE - Opp.Party(s)

SANDEEP SINGH

05 Mar 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,JAMMU

(Constituted under J&K Consumer Protection Act,1987)

                                                          .

 Case File  No               409/DFJ           

 Date of  Institution     18-01-2017

 Date of Decision         30-01-2018

 

Mrs.Raj Kumari,

W/O Late Sh.Ginsi Ram,

R/O Chak Mango  Rakwal,

Tehsil & Distt.Samba.

                                                                                                                                Complainant

                    V/S

PNB Metlite India Insurance Co.Ltd.

4^th Floor GMC 29 Rail Head Complex,

Jammu.

PNB Metlite India Insurance Co.Ltd.

Hotel TRG Building Bahu Plaza,Jammu.

                                                                                                                                Opposite parties

CORAM

                  Khalil Choudhary              (Distt.& Sessions Judge)  President

                  Ms.Vijay Angral                                                               Member

                  Mr.Ghulam Sarwar Chauhan                                      Member

 

In the matter of Complaint under section 10 of J&K Consumer

                              Protection Act 1987.

 

S.Sandeep Singh,Advocate for complainant, present.

Mr.Shafiq Ahmed Wani,Advocate for Ops,present.

 

 

                                                                       ORDER

                      Facts relevant for the disposal of complaint on hand are that husband of complainant after completing all the formalities obtained policy on yearly basis premium of Rs.24,000/-under policy No.20779755 for a total amount of Rs.1.25 lac  and the said yearly payment was being deposited by the husband of complainant from time to time, however in February,2014 there was some delay in depositing the amount, as such, her husband was asked to deposit the amount alongwith interest and get the policy regularized. Further contention of complainant is that in pursuance of that her husband deposited an amount of Rs.24,860/-,copy of receipt of amount is annexed with the complaint, but after the deposit of amount, husband of complainant died on,13-06-2015 ,copy of death certificate is annexed with the complaint. Complainant further submitted that after the death of her husband, she lodged a claim with OP for payment of insurance policy of an amount of Rs.1.25 lac,but to the utter surprise of complainant she received a communication from OP that the policy bearing No. 20779755 has been elapsed on,18-03-2015.Allegation of complainant is that her husband had deposited the amount of Rs.24,860/-through cheque on,27-03-2015 and had regularized the policy and the OP had issued the receipt of the same to her husband and after the receipt of said premium amount alongwith interest , it does not lied in the mouth of Ops to say that the policy has been elapsed from 18-03-2014 due to non payment of renewal premium, hence this act of Ops amounts to un-fair trade practice, besides deficiency in service,therefore,complainant prays for refund of Rs.6.25 lac and in addition also prays for sum of Rs.1,50,000/- under different heads.

                    On the other hand,OPs filed written version and while resisting the complaint, went onto submit that the deceased husband of complainant Late Ginsi Ram after duly understanding the terms and features of our product Met Suvidha Non Participating voluntarily filled and signed and submitted a proposal form on 17-03-2012.Upon receipt of the duly filled up proposal form alongwith the initial premium, the OP evaluated and processed the Proposal Form on the basis of information furnished by deceased Life Insured and issue the policy bearing No. 20779775 with Risk commencement date of 18-03-2013 for a sum assured of Rs.1,25,000/-.The complainant was made the nominee under the said policy. The Ops further submitted that as per the terms and conditions of the policy contract, if the regular premiums were not received by the Company on the due date or within the grace period, then the policy shall lapse and no benefit shall be paid under the said policy. It is submitted that the policy was issued with effective date of coverage as 18-03-2012 and the renewal premium falls due on,18^th March every year. The Ops received the death claim intimation on 26-08-2015 from the complainant, thereby intimating the OP that the DLI expired on,13-06-2015 which was acknowledged by the Ops vide letter dated 28-08-2015 .The Ops further submitted that upon evaluating the claim of complainant, it was revealed that the policy was in lapsed status at the time of death of DLI.It is once again submitted that the DLI failed to make the renewal premium due on,18-03-2014 and even within grace period of 30 days and as a result the policy lapsed with effect from 18-03-2014.Lastly it is prayed that complaint maybe dismissed with costs.

                 Complainant adduced evidence by way of duly sworn her own evidence affidavit and affidavit  of Ankur Kumar.Complainant has placed on record copy of communication ,copy of death certificate ,copy of acknowledgement slip, copy of receipt, copy of communication dated 25-07-2015 issued by Ops to complainant and copy of notice.

                   On the other hand,Ops have adduced evidence by way of duly sworn evidence affidavit of Rajeev Sharma Manager Legal of PNB Metlife India Insurance Company Ltd.Ops have placed on record copy of application form, copy of policy, copy of claim intimation form, copy of receipt for policy delivered, copy of application for death claim, copy of physical statement Form B,copy of welcome letter and copy of letter dated 21-09-2015 issued by Ops to complainant.

              We have perused case file and heard L/C s for the parties at length.

                  Briefly stated facts of the case are that the husband of complainant obtained policy on the basis  of yearly premium of Rs.24,000/-under policy No.20779755 for a sum of Rs.1.25 lac  and premium was deposited by the husband of complainant from time to time, however in February,2014 there was some delay in depositing the amount, as such, her husband was asked to deposit the amount alongwith interest and get the policy regularized. Further contention of complainant is that in pursuance of that her husband deposited an amount of Rs.24,860/-,copy of receipt of amount is annexed with the complaint, but after the deposit of amount, husband of complainant died on,13-06-2015 ,copy of death certificate is annexed with the complaint. Complainant further submitted that after the death of her husband, she lodged a claim with OP for payment of insurance policy of an amount of Rs.1.25 lac,but the same was not reimbursed to her, despite repeated requests.

                    On the other hand,defence of OPs that as per the terms and conditions of the policy contract, if the regular premiums were not received by the Company on the due date or within the grace period, then the policy shall lapse and no benefit shall be paid under the said policy. It is submitted that the policy was issued with effective date of coverage as 18-03-2012 and the renewal premium falls due on,18^th March every year. The Ops received the death claim intimation on 26-08-2015 from the complainant, thereby intimating the OP that the DLI expired on,13-06-2015 which was acknowledged by the Ops vide letter dated 28-08-2015 .The Ops further submitted that upon evaluating the claim of complainant, it was revealed that the policy was in lapsed status at the time of death of DLI.It is once again submitted that the DLI failed to make the renewal premium due on,18-03-2014 and even within grace period of 30 days and as a result the policy lapsed with effect from 18-03-2014.

                    Short point which requires consideration is as to whether or not, there is deficiency in service on the part of Ops in not settling the claim of complainant.

                     In order to prove her contention, complainant adduced evidence in the shape of her own duly sworn affidavit and also filed evidence affidavit of Ankur Kumar. The deposition of complainant is verbatim reproduction of averments of complaint,therefore,need not to be reiterated again,.However,witness of complainant namely,Ankur Kumar,who deposed that  yearly payment was being deposited by the uncle of the deponent Sh.Ginsi Ram from time to time,however,in February,2014 there was some delay in depositing the amount, as such, the deponent uncle deceased Ginsi Ram was asked to deposit the amount alongwith interest and get the policy regularized. The deponent further deposed that in pursuance of that the late Sh.Ginsi Ram had deposited the amount of Rs.24,860/-.That after the deposit of the amount the uncle of the deponent died on,13-06-2015.

       

                          The claim of complainant is also strengthen by the receipt issued by PNB Metlife OPs, wherein it is clearly mentioned that an amount of Rs.24,860/-has been received by Ops on,27-02-2015.Once the husband of complainant had deposited an amount of Rs.24,860/- and the OPs have issued the receipt of the same and regularized the policy, it does not lie in the mouth of Ops to say that the policy had  been elapsed from 18-03-2014 due to non payment of renewal premium. Once the premium amount alongwith interest had been received by OPs on,27-02-2015,therefore,it is the bounded duty of the Ops to indemnify the complainant, under the terms of policy                                   

                   On the other hand,OPs have also filed evidence affidavit of Rajeev Sharma Manager Legal of PNB Metlife India Insurance Company Ltd. Again the testimony of witness of OPs is corroborative of version of OPs,therefore,same need no repetition.

                     Otherwise also legally speaking it is settled law that the parties are always bound and governed by the terms and conditions of contract and whenever contract is entered into there is proposal made by one party in its unequivocal and unambiguous terms conveyed to the otherside and acted by otherside with the same response and in its understanding and knowledge leaving no scope of any future suspicion and incredibility in mind to come in the way of the said contract afterwards.

                         Further also to make it more clear, as for as the terms of the policy are concerned reliance can be had to judgment in case titled Indraprastha Gas Ltd.V/S New India Assurance Co.Ltd.& Ors. reported in 1(2015)CPJ 279(NC)wherein the relevant para it is laid down

      The court has to give material meaning to the document. It is not open to the court to make any addition to or subtraction from the terms and conditions contained in Insurance Policy.

               It is however observed that the Insurance Company should not repudiate the claim of the policy holders on technical grounds as by repudiating the genuine insurance claims on such grounds looses the confidence of the policy holders on the Insurance Companies and it also gives rise to unnecessary litigation which in our opinion the Insurance Company should try to avoid the same.

                   Therefore, in view of the foregoing reasons the complaint filed by the complainant for redressal of her grievance is allowed and Ops are directed to pay to the complainant the insured amount of Rs.1.25 lacs alongwith interest @ 7 per annum w.e.f.13-06-2015(i.e. from the date of death of insured),till its realization. The complainant is also entitled to compensation of Rs.10,000/-for causing unnecessary harassment and mental agony and litigation charges of Rs.10,000/-.The OPs shall comply the order within one month from the date of receipt of this order. Copy of this order be provided to both the parties as per requirement of the Act. On deposit of the amount in this Forum, the same shall be paid to the complainant through payees account cheque.The complaint is accordingly disposed of and file be consigned to records after its due compilation.

Order per President                                              Khalil Choudhary

                                                                         (Distt.& Sessions Judge)

Announced                                                              President

30-01-2018                                                   District Consumer Forum

Agreed by                                                                Jammu.

 

Ms.Vijay Angral          

Member        

 

Mr.Ghulam Sarwar Chauhan,

Member