District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.147/2019.
Date of Institution: 19.03.2019.
Date of Order: 02.09.2022.
Mubin son of Shri Matru, 2. Ashrafi wife of Shri Mubin, 3. Fairman wife of Fakru @ Fakruddin, 4. Sebez minor son, 5. Sakib Khan minor son, 6. Mohammad, 7. mOhd. Jed minor son, 8. Laeba, 9. Misroz minor daughters of Fakru @ Fakruddinm minors through their mother namely Smt. Fairman as a natural guardian and next friend of minors, all resident of village Malokhra, tehsil Hathin, Distt. Palwal.
…….Complainant……..
Versus
1. Shree Ram Life Insurance Company Limited through its Manager office at A-7/1, 2nd floor, Samadhan Chamber, near Canara Bank, Neelam Bata Road, AC Nagar, New Industrial Town, Faridabad Distt. Faridabad Haryana – 121001.
2. Shree Ram Life Insurance Company Limited, through its Divisional Manager, S-173, School Blcok, Block S1, Nanakpura, Shakarpur, Delhi – 110 0092.
3. Shree Ram Life Insurance Company limited, Plot NO 31 & 32, 5th & 6th floor, Ramky Selenium, Beside Andhara Bank, Training centre, Financial Distt. Gachowali, Hyderabad – 500 032.
4. India Infoline Finance Limited,12A -10, 13th floor,
Service be effected at: IIFL Tower, NO. 143, M.G.R road, (Near Life Line Hospital) Perunguide Chennai.
Branch office at: B-4/5, App. Studio, Ist floor, Sector-63, Noida, Uttar Pradesh
…Opposite parties……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
PRESENT: Sh. K.K.Gupta, counsel for the complainant.
Sh. Sanjeev Bansal, counsel for opposite parties Nos.1 to 3.
Opposite party No.4 ex-parte vide order dad 28.0.2020.
ORDER:
The facts in brief of the complaint are that the son of the complainant Nos.1 & 2, husband of the complainant Nos. 4 to 9 namely Fakruddin @ Fakru (since deceased) purchased a Shri Ram Life Group Life Protector Plan SP (Product UIN: 128N044V01) vide certificate No. 033000019729493, loan ID NO. 1000109426 baring member policy No. MN161012019729493, cover commence dated 30.09.2016 cover termination date 30.09.2016 cover amount Rs.13,00,000/- on 30.09.2016 from the office of opposite parties Nos.1 to 3 and the date of commencement of risk was from 30.09.2016.. In that policy deceased paid premium amount of Rs.8,227/- excluding service tax and the opposite parties Nos.1 to 3 extended life insurance cover to deceased Fakruddin @ Fakru in the mater policy No. GN011504000330, it was pertinent to mention here that the said policy as purchased by the deceased was a group insurance cover designated for the loan borrowers of India Info Line Finance Limited i.e opposite party No.4. As per this policy the opposite parties Nos.1 to 3 protected the life of deceased through this group life insurance policy and as per the conditions of the policy the opposite party Nos.1 to 3 were liable to pay the cover amount in the unfortunate event of death of insured member during the tenure commenced from 30.09.2016 till termination i.e. 30.09.2020.. The insured namely Fakruddin @ Fakru died on dated 18.04.2017 near Bajrang Hotel due to pain in chest and the police of P.S.Sayala, Tehsil Sayal, Distt. Surrender Nagar Gujarat got recorded a DD NO. 254 dated 18.4.2017 and the concerned doctor declare him died due to chest pain and as per record the death was natural and instantaneous and he concerned police proceed the matter as per the case of natural death. The complainants came to know that being master policy holder, the opposite partyNo.4 duly intimated the death of deceased Fakruddin @ Fakru and opposite party Nos.1 to 3 proceed the same and ultimately vide letter dated 20.09.2018 repudiated the claim of deceased by way of holding “that the exact cause of death was not mentioned, so we were repudiating the claim on receipt of FIR and post-mortem with exact cause of death be can reopen and decided accordingly”. Moreover the opposite parties Nos.1 to 3 made basis for the above said observation about the question No.1 wherein the answerer were negative, however the deceased not suffered from any ailment as mentioned in question No.1 and he rightly answered the same in negative, moreover the natural process of probe and concerned medical officer qua a natural death was taken place at the distant area from the residence of the deceased and the documents as obtained by the complainant from there clearly shows that the deceased died due to his natural death without any ailment or previous disease. The complainants several times visited in the office of the opposite parties and demanded the amount of Rs.13,00,000/- from the opposite parties but the opposite parties made one lea or the other and did not pay the insurance policy amount to the complainant. The aforesaid act of opposite parties amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite parties to pay an amount of Rs. 13,00,000/- alongwith interest @ 24% p.a. from the date of death of insured, till its realization
2. Opposite parties Nos.1 to 3 put in appearance through counsel and filed written statement wherein Opposite parties Nos.1 to 3 refuted claim of the complainant and submitted that one Mr. Fakhruddin had joined into the group insurance policy through India Infoline Finance Ltd., who was the Master Policy holder with shriram Life Insurance Company under the plan “Shriram Life Group Life Protector Plan SP”, against the loan ID No. 1000109426 under the Master policy No. GN011504000330 vide Member Policy No. MN161012019729493 for a cover amount of Rs.13,00,000/- starting from 30.09.2016 to 30.09.2020, wherein the life cover reduced each month as per the risk cover schedule. It was submitted that based on the disclosure of health made by the deceased life assured late Mr. Fakhruddin in Declaration of Good Health (DGH) Form given at the time of joining the Group Insurance, this opposite parties Nos.1 to 3 Insurance company issued a policy bearing Member policy No. MN161012019729493. It was submitted that the master policy holder i.e India Infoline Fiancée Ltd/opposite party No.4 herein intimated the death of the deceased life assured to the opposite parties Nos.1 to 3 insurance company on 31.5.2017 stating that the life assured died on 18.4.2017. It was submitted that for processing the death claim, the insurance company as to ascertain the actual cause of death of the life assured so as to rule out if there was any suspicion in the death of the life assured. On perusing the death claim intimation, the death of the deceased Fakhruddin was confirmed by a Death Certificate, however nowhere it reflected/revealed the cause of death. Hence, the claim of the policy was repudiated on 20.09.2018 with an option to re-open the claim on submission of the documents and decide accordingly. Opposite parties Nos. 1 to 3 denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. Registered notice sent to opposite party No.4 on 28.01.2020 and received back either served or unserved. Case called several times since morning. But none appeared on behalf of opposite party No.4. More than one month had elapsed. Therefore, opposite party No.4 was proceeded against ex-parte vide order dated 28.02.2020.
4. The parties led evidence in support of their respective versions.
5. We have heard learned counsel for the parties and have gone through the record on the file.
6. In this case the complaint was filed by the complainant against opposite parties–Shri Ram Life Insurance with the prayer to pay
an amount of Rs. 13,00,000/- alongwith interest @ 24% p.a. from the date of death of insured, till its realization
To establish his case the complainant has led in his evidence, Ex.CW1/A – affidavit of Mubin, certificate dated 22.01.2019, Receipt regarding dead body dated 22.01.2019,, death certificate,, letter dated 20.09.2018, repudiation letter dated 20.09.2018
On the other hand counsel for the opposite parties strongly agitated
and opposed. As per the evidence of the opposite parties, Ex.R/1 A – affidavit of E.Sridhar, S/o E.J. Lingam, General Manager with opposite party , Ex.R-1 –
certificate of insurance schedule,Ex.R-2 – Declaration of Good Health (DGH) Form, Ex.R-3 – Claim form for Shriram group term Life Insurance Plan (UIN 128042Vo1), Ex.R-4 – death certificate,, Ex.R-5 - repudiation letter dated 20.09.2018, Ex.R-7 – Dismissed as withdraw order dated 19.09.2018 passed by Shri Prateek Jain, ACJ (SD), Palwal,
7. It is evident from Annexure -1, Shri Fakhruddin had joined into the group insurance policy through India Infoline Finance Ltd., who was the Master
Policy holder with shriram Life Insurance Company under the plan “Shriram Life Group Life Protector Plan SP”, against the loan ID No. 1000109426 under the Master policy No. GN011504000330 vide Member Policy No. MN161012019729493 for a cover amount of Rs.13,00,000/- starting from 30.09.2016 to 30.09.2020, wherein the life cover reduced each month as per the risk cover schedule. Based on the disclosure of health made by the deceased life assured late Mr. Fakhruddin in Declaration of Good Health (DGH) Form given at the time of joining the Group Insurance, this opposite parties Nos.1 to 3 Insurance company issued a policy bearing Member policy No. MN161012019729493 vide Annx.2 It is evident form Annx.-3 that the master policy holder i.e India Infoline Fiancée Ltd/opposite party No.4 herein intimated the death of the deceased life assured to the opposite parties Nos.1 to 3 insurance company on 31.5.2017 stating that the life assured died on 18.4.2017. It is evident from repudiation letter vide Ex.R5 that “on receipt of the death intimation of deceased member of assured, our company has conducted its detailed enquiry into the claim to know the veracity. Basing on the investigation report and medical records exact cause of death is not mentioned, so we are repudiating the claim. On receipt of the FIR and post-motrem with exact cause of death we can re-open and decide accordingly.
8. After going through the evidence led by the parties, the Commission is of the opinion that opposite parties has not repudiated the claim of the complainant. Opposite parties closed their claim after demanding the certain documents vide Ex.R5. Opposite parties objected that he has already filed a case in Civil Court.
9. As per order dated 19.09.2018 passed by ACJ(SD), Palwal, (vide Ex.R-7) the complaint was dismissed as withdrawn with liberty to file fresh one subject to law of limitation. The complainant is also ready to submit the demanded documents as required by the opposite party vide Ex.R5. Keeping in view of the above, the Commission is of the opinion that the complaint is allowed.
10. Opposite parties are directed to process the claim of the complainant , subject to submission of documents required by the opposite parties within 30 days of receipt of the copy of order and pay the due amount to the complainant along with interest @ 6% p.a. from the date of filing of complaint till its realization. The opposite parties are also directed to pay Rs.2200/- as compensation on account of mental tension, agony and harassment alongwith Rs.2200/- as litigation expenses to the complainant. Copy of this order be given to the parties concerned free of costs and file be consigned to record room.
Announced on: 02.09.2022 (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
