Haryana

Kurukshetra

CC/296/2019

Mam Kaur - Complainant(s)

Versus

PNB Metlife - Opp.Party(s)

Raj Kumar

24 Oct 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KURUKSHETRA

                            Complaint No. 296 of 2019

                                   Date of institution: 24.07.2019

                                 Date of decision: 24.10.2024

 

Mam Kaur widow of Shri Surjeet Singh, resident of Village Isharheri P.O. Kharindwa, District Kurukshetra.

 

                                                                        …Complainant.

Versus

 

1.     The Manager, PNB Metlife Insurance Company Office at SCO No.223, Sector-12, Near Secretariat, Karnal.

2.     PNB Metlife Insurance Company, Brigade Seshamahal 5, Vani Vilas Road, Basavangudi, Banglore-560004 through its  authorized person.

3.     Punjab National Bank, Babain, District Kurukshetra through  its Branch Manager.

                                                            …Opposite parties.

 

CORAM:    Dr. Neelima Shangla, President.

    Neelam, Member.

    Ramesh Kumar, Member.

 

Present:   Shri Raj Kumar Saini, Advocate for the   complainant.

                Shri Harpal Malhotra, Advocate for the Ops No.1    & 2.

                Shri Shekhar Kapoor, Advocate for the OP No.3.

 

• :

                This is a complaint under Section 12 of the Consumer Protection Act.           

2.             Briefly stated, the case of the complainant that the husband of complainant namely Shri Surjeet Singh son of Rachna Ram had obtained an Insurance policy namely Met Smart Platinum Unit Linked Plan No.21243959 on 14.1.2014 from PNB, Babain, District Kurukshetra for a period of 10 years.  The premium of the said policy is Rs.30,000/- per year and the complainant regularly paid Rs.30,000/- per annum in the above mentioned policy and in this policy, the basic sum insured of Rs.2,10,000/- plus other benefits.  The complainant further averred that her husband had died on 20.03.2019 due to heart attack.  The complainant further averred that being nominee, she approached to the OPs for release of death claim as well s entire benefits of the said policy, but OPOs have not entertained the claim request of the complainant.  Thereafter, the complainant sent the application along with all documents in the office of the OP No.1, but no step was taken by the OPs.  Thereafter, a legal notice upon he OPs No. 1 & 2 on 15.05.2019, but it also did not yield any fruitful result. Thereafter, the OP No.1 again took the death certificate along with policy bond and other relevant documents from the complainant after that on 26.06.2019, the OPs released the claim amount only to the complainant which was transferred in the account of the complainant.  However, the Ops failed to release the entire benefits like as fund value, fund assets or other benefits to complainant.  Hence, this complaint.

3.            On notice, learned counsel for the OPs No. 1 & 2 and filed their joint written version raising preliminary objections with regard to maintainability; cause of action; locus standi; jurisdiction and concealment of true and material facts. On merits, complaint was contested and vehemently denied the allegations of the complaint as made out in the complaint and prayed for dismissal of the complaint.

4.             On Notice, OP No.3 appeared and filed their written version raising preliminary objections with regard to maintainability; cause of action; locus standi; jurisdiction and concealment of true and material facts controverted all the material assertion and contended specifically by pleading inter alia that he has no role to play in the present complaint because the OP No.3 has not received a single penny from the complainant and it is the Insurance Company which is liable to comply with the terms and conditions of the policy of insurance, if any.  There is no negligence on the part of the OP as he is not an Insurance company rather is a bank which transfers the payments only.  Hence bank cannot be held responsible for the alleged compensation.

5.             The learned counsel for complainant has tendered into evidence affidavit of complainant Ex. CW1/A and documents EX. C1 to Ex. C4 and closed the evidence on 25.10.2021 by suffering separate statement.

6.             The learned counsel for the OP No.1 & 2 has tendered into evidence affidavit Ex. RW1/A and documents EX.R-1 to Ex.R-3 on 05.04.2022 by suffering separate statement, while learned counsel for the OP No.3 tendered affidavit Ex. RW2/A and documents as Ex. R-4 and R-5 on 26.07.2022.

7.            We have heard the learned counsel for the parties at length and have gone through the record available on the file carefully.

8.            Sh.Raj Kumar Saini, counsel for the complainant has argued that the husband of complainant namely Shri Surjeet Singh son of Rachna Ram had obtained an Insurance policy namely Met Smart Platinum Unit Linked Plan No.21243959 on 14.1.2014 from PNB, Babain, District Kurukshetra for a period of 10 years.  The premium of the said policy is Rs.30,000/- per year and the complainant regularly paid Rs.30,000/- per annum in the above mentioned policy and in this policy, the basic sum insured of Rs.2,10,000/- plus other benefits.  Ld. Counsel for the complainant further argued that her husband had died on 20.03.2019 due to heart attack.  Ld. Counsel for the complainant further argued that being nominee, she approached to the OPs for release of death claim as well as entire benefits of the said policy, but OPs have not entertained the claim request of the complainant.  Thereafter, the complainant sent the application along with all documents in the office of the OP No.1, but no step was taken by the OPs.  Thereafter, a legal notice upon the OPs No.1 & 2 on 15.05.2019, but it also did not yield any fruitful result. Thereafter, the OP No.1 again took the death certificate along with policy bond and other relevant documents from the complainant after that on 26.06.2019, the OPs released the claim amount only to the complainant which was transferred in the account of the complainant.  However, the Ops failed to release the entire benefits like as fund value, fund assets or other benefits to complainant. 

9.            Sh.Harpal Madhan, counsel for opposite parties No.1 & 2 has argued that as per Ex.R-3 Rs.2,10,000/- have been paid to the complainant.  Now, complainant is demanding benefit fund value and another benefit as per the relevant rules and conditions mentioning in Ex.C-3, if the insurer dies before the attaining age of 60 during the policy term and while the policy is in force, then we will pay or the nominee the highest of:

a)    The regular premium Fund Value as on the relevant date, or

b)    The basic sum assured, less any and all the partial withdrawals made from the base premium unit account in the 24 months immediately preceding the insured’s death, of

c)    105% of the total Regular Premiums received under the policy.  2.1.2 if the insured dies after attaining age 60 during the Policy Term and while the policy is in force then we will pay you or the nominee the highest of:

a)    The Regular Premium Fund value as on the relevant date, or

b)    The base sum assured less the higher of

       (i)     all partial withdrawals made from the regular Premium Unit Account in the 24 months immediately preceding the insured’s death, or

       (ii)    All partial withdrawals from the Regular Premium Unit Account after the insured having attained the age of 60; or

(c)           105% of the total Regular Premiums received under the policy. 

If death happens during the grace period or the subsequent notice period before discontinuance of the policy in case of non-payment of premiums under the Base Policy, then the overdue charges, if any, comprising Mortality charges and Policy Administration charges will be deducted from the death benefit.

10.          Ld. Counsel for opposite parties No.1 & 2 has argued that as per Clause 2.1.2 of the Policy Contract, upon the death of the DLI, nominee was entitled to receive the highest of:

       (i)     The regular premium fund value as on the relevant date; or

       (ii)    The Base Sum Assured; or

       (iii)   105% of the total Regular Premiums received under the                      policy.   

 

Ld. Counsel for opposite parties No.1 & 2 has further argued that since the sum assured was the highest under Clause 2.1.2, the opposite party rightly paid the sum assured amount of Rs.2,10,000/- in favour of the complainant.  The Hon’ble Supreme Court in the case of Vikram Greentech India Ltd versus New India Assurance Co. Ltd. reported in (2009) 5 SCC 599 has observed that:

                “An insurance contract is a species of commercial         transactions and must be construed like any other contract to its own terms and by itself.  In a contract of insurance, there is requirement of uberrima fides i.e. good faith on the part of the insured.  Except that, in other respects, there is no difference between a contract of insurance and any other contract.  The four essentials of a contract of insurance are, (i) the definition of the risk, (II) the duration of the risk, (iii) the premium and (iv) the amount of insurance.  Since upon issuance of insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the insurance policy, its terms have to be strictly construed to determine the extent of liability of the insurer. The endeavour of the court must always be to interpret the words in which the contract is expressed by the parties. The court while construing the terms of policy is not expected to venture into extra liberalism that may result in re-writing the contract or substituting the terms which were not intended by the parties.  The insured cannot claim anything more than wheat is covered by the insurance policy”.  

11.           Hence, as per relevant rules Clause 2.1.2 of policy contract upon the death of insured the amount of Rs.2,10,000/- is rightly paid by the opposite parties to the complainant.  Since the sum assured was the highest under Clause 2.1.2, the opposite party rightly paid the sum assured amount of Rs.2,10,000/- in favour of the complainant. 

        12.           In view of our foregoing discussion, there is no merit in the complaint moved by the complainant. Hence, the complaint is dismissed with order as to costs.  A copy of this order be sent to the parties free of cost. File be consigned to the record room after due compliance.   

Announced in open 24.10.2024

                                                       (Dr. Neelima Shangla)            

                                                               President,

                                                               DCDRC, Kurukshetra.

 

(Neelam)                (Ramesh Kumar)

Member                   Member