Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 91.
Instituted on : 21.02.2019
Decided on : 29.11.2024.
- Poonam Hooda age 41 years, w/o Late Sh. JitenderHooda.
- Heena d/o Sh.JitenderHooda
- Vaibhav s/o Late Sh. JitenderHooda.
All residents of 27 A New Grain Market, Rohtak-124001.
………..Complainants.
Vs.
- The Manager(Life Insurance) Star Union Dai-ichi Life Insurance Company Ltd., Branch Vaish Technical Institute, Rohtak.
- Star Union Dai-ichi Life Insurance Company Limited 11th Floor, VishwaroopI.T.Park, Plot No.34, 35 & 38 Sector 30A of IIP, Vashi, Navi Mumbai-400703.
- Star Union Dai-ichi Life Insurance Co. Ltd., Unit No.2 & 3, Ground Floor, Tower B, Signature Tower, NH-8, Gurgaon, Haryana-122001.
…….Opposite parties.
COMPLAINT U/S 35 OF CONSUMER PROTECTION ACT
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR.VIJENDER SINGH, MEMBER
Present: Sh.H.D.Shastri, Advocate for the complainants.
Sh.Rajesh Sharma, Advocate for the opposite parties.
ORDER
NAGENDER SINGH KADIAN PRESIDENT:
1. Brief facts of the case, as per the complainants are that husband of complainant no.1 and father of complainant no.2 & 3 have taken life insurance policy bearing no.00265607 in October 2010 from the opposite parties. The life assured was paying the premiums regularly on time but due to the sudden sickness, he was admitted to Medanta Hospital on 17.06.2017 because of a sudden physical trauma suffered on lower back on 17.05.2017, due to which he was bed ridden and was having acute pain. He was treated at Rohtak first but thereafter he was admitted in Medanta Hospital where acute Kidney injury and multiple Myeloma was detected which was shocking for the whole family. The life assured was struggling with acute medical problem and complainant no.1 was the only person being wife, who was taking care of him beside the responsibility of both the children who were students. As the life assured was completely unwell and bed ridden, so he could not pay the premium due in 2017 which was delayed for a month and after a month on November 12, 2017, he succumbed to the diseases and expired. The complainant no.1 immediately informed the agent of the opposite parties orally and by written letters dated 16.11.2017 and 04.12.2017 respectively and again wrote a letter dated 14.05.2018 for release of claim but to no effect. Thereafter complainant no.1 wrote a letter to the office of Insurance Ombudsman on 04.06.2018 but the amount of claim was not released to the complainants. The concerned branch of opposite parties had finally refused to pay the insured amount on 06.08.2018. The act of opposite parties amounts to deficiency in service on their part. Hence this complaint and it has been prayed that opposite parties may kindly be directed to release the life insurance policy amount to the tune of Rs.1000000/- alongwith interest @ 18% p.a. from the date of death of life assured till the date of payment and also to pay Rs.100000/- as compensation on account of mental agony and harassment to the complainant.
2. After registration of complaint, notices were issued to the opposite parties. Opposite parties in its reply has submitted that the DLI duly paid the renewal premium on 17.10.2016 and the policy was in force for the period 04.10.2016 to 04.10.2017. The subsequent renewal premium was due on 04.10.2017. The opposite party duly sent a premium payment notice dated 04.09.2017 duly reminding the DLI to pay the renewal premium on 04.10.2017. Despite the reminder notice dated 04.09.2017 the DLI failed to make the payment on 04.10.2017. The DLI also failed to pay the premium within the grace period of 30 days. . Due to non-payment of renewal premium, the aforesaid policy lapsed with effect from 04.10.2017. The DLI was duly informed vide letter dated 05.11.2017 that the policy lapsed due to non-payment of renewal premium due on dated 04.10.2017. The opposite party did not receive the premium from the DLI and hence, the Risk cover under the policy ceased. Since the policy was in lapsed status on the date of death of the insured, the opposite party as per the terms of the policy contract and as per the principles of Insurance Law, repudiated the claim of the complainant vide repudiation letter dated 17.01.2018. All the other contents of the complaint were stated to be wrong and denied and opposite parties prayed for dismissal of complaint with costs.
3. Ld. Counsel for the complainants in his evidence has tendered affidavit Ex.CW1/A, documents to Ex.C1 to Ex.C22 and thereafter failed to conclude his evidence and as such the evidence of the complainant was closed by the order dated 08.01.2020 of this Commission. Ld. counsel for the opposite parties has tendered affidavit Ex.RW1/A, document Ex.R1 to Ex.R7 and closed his evidence on dated 22.10.2020.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case, the life assured namely Sh. JitenderHooda had purchased the policy on dated 04.10.2010 and he regularly paid the premium till 2016. As per the documents and written statement filed by the respondents, the life assured paid last premium on 17.10.2016 and the policy was in force for the period 04.10.2016 to 04.10.2017. The claim of the complainant has been repudiated by the respondent officials on the ground that the policy was in ‘lapsed’ status as on date of death i.e.12.11.2017 due to non receipt of the premium within grace period.
6. We have minutely perused the documents placed on record by both the parties. As per document Ex.C2 i.e. death certificate, the life assured Sh. JitenderHooda had died on 12.11.2017 and it is also pleaded by ld. Counsel for the complainant that the DLI took follow up treatment time to time from various hospitals and was under treatment from Medanta Hospital till his death, so he could not pay the last premium.It is further contented that opposite party failed to send a letter/notice informing the complainant to pay the premium otherwise the policy would lapse. Ld. counsel for the complainant has also placed reliance upon the judgment of Hon’ble National Consumer Disputes RedressalCommission, New Delhi in Revision Petition No.1058 of 2017 titled as Life Insurance Corporation Of India Vs.PittalaPochamma @ Poschammadecided on 15 May, 2024, whereby Hon’ble National Commission has cited the observation of Hon’ble State Commission in para no.16. that: “There is a duty cast on the part of the Appellant Corporation to inform the policy holder as to the lapsed condition of the policy or else the gaps in the payment of premium, which it failed to and the only reason assigned for this is that as per letter of authorisation, there is a duty cast on the part of the life assured to make payment of premium regularly, admittedly, the Appellant failed to prove this letter. It didn't took any pains in addressing a letter and informing the employer to remit the premium. The deceased life assured was under bonafide impression that the premium amount had been settled and paid.” The Hon’ble National Commission further held that: “However, the Appellant neither addressed any letters nor informed the deceased life assured that the policy stood lapsed. In the circumstances, we hold that employer and the Appellant are equally liable to pay the benefits that were accrued under the policies.”
7. On the other hand, contention of ld. counsel for the opposite parties is that the opposite party duly sent a premium payment notice dated 04.09.2017 duly reminding the DLI to pay the renewal premium on 04.10.2017. Despite the reminder notice dated 04.09.2017 the DLI failed to make the payment on 04.10.2017. The DLI also failed to pay the premium within the grace period of 30 days. . Due to non-payment of renewal premium, the aforesaid policy lapsed with effect from 04.10.2017. The DLI was duly informed vide letter dated 05.11.2017 placed on record as Ex.R2, that the policy lapsed due to non-payment of renewal premium due on dated 04.10.2017. Since the policy was in lapsed status on the date of death of the insured, hence the claim of the complainant has been rightly repudiated vide repudiation letter dated 17.01.2018, which is placed, on record as Ex.R4. Ld. counsel for the opposite parties has also placed reliance upon the judgment of Hon’ble Supreme court in case of Life Insurance Corporation of India Vs. Mani Ram, III(2005)CPJ31(SC) has held that : “In the instant case, Condition 2 expressly provided the period during which the payment was to be made. It also in no uncertain terms stated that if premium was not paid before the expiry of grace period, the policy would lapse. In our view, the ratio in DharamVirAnand would support the Insurance Company rather than the complainant. If all the terms and conditions of the policy (contract between the parties) have to be kept in mind and given effect to, acceptance of argument on behalf of the complainant would make the last part of Condition 2 redundant, otiose and inoperative; and a Court of Law cannot construe a document in the manner suggested by the Counsel for the complainant. As the premium was due on April 28, 1996 and was not paid till May 28,1996, the policy lapsed. The Fora below hence, committed an error of law in allowing the complaint of the respondent herein and the orders are liable to be set aside."
8. In view of the aforesaid law of Apex Court, which is fully applicable on the facts and circumstances of the case, it is observed thatsince the policy was in lapsed status on the date of death of the insured, hence the claim of the complainant has been rightly repudiated by the opposite parties. However, law cited above by ld. counsel for the complainant is not fully application on the facts and circumstances of the case. Hence there is no deficiency in service on the part of opposite parties and present complaint stands dismissed with no order as to costs.
9. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
10. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
29.11.2024.
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Nagender Singh Kadian, President
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TriptiPannu, Member.
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Vijender Singh, Member.
