Punjab

Sangrur

CC/91/2015

Naseema - Complainant(s)

Versus

Tata AIA LIC Ltd. - Opp.Party(s)

Shri Sanjeev Goyal

21 Jul 2015

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                    Complaint no. 91

                                                                    Instituted on:  20.02.2015

                                                                   Decided on:    21.07.2015

 

Naseema wife of Late Akhtar Khan, resident of Bilal Colony, Thandi Sarak, Backside SDM Residence, Malerkotla, Tehsil Malerkotla, District Sangrur.  

                                                          …. Complainant.    

                                         Versus

1. TATA AIA Life  Insurance Company Limited, Registered and Corporate Office: Delphi B-Wing, 2^nd Floor, Orchard Avenue, Hiranandani Business  Park, Powai, Mumbai through its authorized signatory.
2. TATA AIA Life Insurance Company Limited, 4^th Floor, 88 Kunal Tower, The Mall Road, Ludhiana  through its Authorized Signatory.

                                                ….Opposite parties.

 

 

FOR THE COMPLAINANT:    Shri G.S.Shergill Advocate                          

 

FOR THE OPP. PARTIES  :    Shri Amit Goyal,  Advocate                    

 

 

Quorum

         

                   Sukhpal Singh Gill, President

K.C.Sharma, Member

Sarita Garg, Member

                                   

ORDER:  

 

Sukhpal Singh Gill, President

 

1.             Naseema, complainant has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that husband of the complainant obtained the services of the OPs by getting himself insured under  policy number U157570399  w.e.f. 30.06.2010 for Rs.1,40,000/- . The complainant was the nominee under the said policy.  Unfortunately on 07.07.2014, the husband of the complainant  died at Malerkotla. The complainant being the nominee immediately lodged the claim with the OPs  and submitted  all the relevant documents but the OPs only transferred an amount of Rs.13,406/-  in the account of the complainant.  On inquiry, the OPs stated that as per the policy, the fund value is payable. Thus, alleging deficiency in service on the part of OPs, the complainant has sought following reliefs:- 

i)      OPs be directed to pay a sum of Rs.1,40,000/- along with other benefits after deduction of Rs.13406/-  along with interest @18% per annum from the date of death till realization,    

ii)     OPs be directed to pay to the complainant a sum of Rs.25000/- as compensation   on account of mental agony, harassment and Rs.11000/- as litigation expenses.

2.             In reply filed by the OPs, preliminary objections on the grounds of maintainability, cause of action and jurisdiction have been taken up. On merits, it is submitted that husband of the complainant had taken plan/ policy in question from the OPs by filing proposal form on 29.06.2010.  The complainant paid five half yearly premiums i.e. total amount paid was Rs.50,000/-.  It has been stated that no premium was paid since January 2013 onwards.  The policy was lying in the lapsed state on the date of death of life assured for want of payment of regular premium.  As policy was eligible for Unit/fund value and accordingly on receiving the claim intimation from the complainant the OPs processed her claim and paid only fund/unit value, which was the complainant/ claimant was found to be entitled as per policy terms and conditions.  The OPs settled the claim and on being satisfied paid Rs.13406/-  towards fund value to the complainant/ claimant as per terms and conditions of the policy. Thus, there is no deficiency in service on the part of the OPs No.1&2.

3.             The complainant has tendered documents Ex.C-1 to Ex.C-9 and closed evidence. On the other hand, OPs have tendered documents Ex.OP-1 to Ex.OP-10 and closed evidence.

4.             In the present complaint, Akhtar Khan, husband of the complainant obtained the policy of the OPs and being the nominee of the policy the complainant became the consumer of the OPs. After the death of her husband the complainant lodged the claim with the OPs but OPs had transferred  only a sum of Rs.13406/- in the account of the complainant instead of being the claim amount of Rs.1,40,000/- .

5.             The version of the OPs is that the policy was obtained at Ludhiana and hence this Forum has no jurisdiction to entertain and decide the present complaint. Further, the OPs  have also submitted that the claim has been repudiated as the policy in question was lying in lapsed state  as the premium due on 19.01.2013  was not paid and as such only unit value  has been paid to the complainant.

6.             After hearing the arguments of the learned counsel for the parties and on perusal of the documents placed on record, we find that the main point of controversy in the present complaint is with regard to the amount of claim and that of territorial jurisdiction.

7.             Learned counsel for the OPs has vehemently argued that since no premium was  paid on 19.01.2013 by the policy holder, so the policy in question was not operated and it was in the lapsed state and only fund value was payable to the complainant and in support of this version the OPs have placed on record document Ex.OP-5. But on perusal of this document under the head discontinuance of premium within three years from inception it has been mentioned that “ The policy can be revived any time during the revival period of two years from the date of first unpaid premium subject to fulfilling  our revival conditions and by paying all the outstanding  Regular Premiums.  On revival, all outstanding charges (except mortality charge and fund management charge) will be  recovered. If the policyholder does not revive/ reinstate the Policy within revival period of two years, the policy will be terminated at end of the revival period or at 3^rd Policy Anniversary whichever is later and the Total Fund Value ceased at the end of grace period net of applicable Surrender Charges as on the date of first unpaid premium shall be payable”.  So, if the insured policyholder had not paid premium due on 19.01.2013 still the policy could have been revived within two years as per the condition mentioned above. But the insured policyholder had died on 07.07.2014  and till that date no notice was sent to the policyholder by the OPs so as to enable  him to revive  the policy in question as it was mandatory for the OPs to give notice to the insured policyholder with regard to the lapse state of the policy in question.

8.             Learned counsel for the complainant has argued that  due to this deficiency in service the insured policyholder could not revive the policy and hence the OPs are deficient in service. The version of the complainant is further fortified by the Insurance Regulatory and Development Authority (Standardization of terms and conditions of ULIP Products and treatment of lapsed policies) Regulations, 2010 in which it has been specifically mentioned that the insurance companies are bound to give notice, wherein it has been mentioned  under the head Lapsation of the Policy:-

“ 4.    Where policies lapse: the  policy holder is entitled to one of the following options:-

1. to revive the policy;
2. to continue  with the policy only to the extent of risk cover and
3. to continue with the policy with risk cover and as part of the Fund;
4. to withdraw completely from the Fund without any risk cover

5.     In order to exercise  the options available by a policy holder as mentioned in regulation 4 above, the insurance company shall take the following steps in all cases where a policy has lapsed:

a.     A notice shall be issued to such a policy holder asking him/her to exercise the said options within a period of 30 days of receipt of such notice.

b.     In case no option is exercised within 30 days, the  option at regulation 4 ( c) above, i.e. to continue in the fund with risk cover will be deemed to have been exercised and the risk charges and fund management charge will be recovered”.

 

9.             In the present complaint, we do not find any evidence of the OPs that notice was sent to the policy holder with regard to the lapsed policy and by this act of the non adhering the IRDA guidelines the Ops have deprived the insured/ policy holder from the benefit of revival of the policy in question within 24 months as per their own document Ex.OP-5. So, we find that the OPs are deficient in service.

10.           Now, with regard to the point of jurisdiction the version of the complainant is that the policy was obtained at Malerkotla from the agent of the OPs by the insured/ policyholder  since expired and the policy holder has also died at Malerkotla.  So, this Forum has got jurisdiction to entertain and decide the present complaint. In support of this version, the complainant has cited authority of Gujrat State Consumer Disputes Redressal Commission, Ahmadabad delivered in appeal number 945 of 2011 decided on 30.01.2014 in the case of Diamond Star Exports Limited Vs. M/s Siemens Limited, CLT 2014 (1) 592 in which the Hon’ble Commission has held in para 17 that policy from where purchase order was made, goods delivered  and correspondence and dispute raised, part of cause of action has arisen with the jurisdiction of that District Forum. So, in the present complaint as per the version of the complainant the policy was purchased  through the agent  of the OPs at Malerkotla  and as the insured policyholder has died at Malerkotla, so this Forum has jurisdiction to entertain and decide the present complaint.

11.           So, keeping in view of the facts mentioned above, we allow the complaint and direct the OPs to pay a sum of Rs.1,40,000/- after deducting the amount of Rs.13406/- already paid along with interest @9% per annum from the date of complaint till realization. We further order the OPs to pay a sum of Rs.5000/- on account of compensation and litigation expenses.      

12.           This order of ours shall be complied with within 30 days from the receipt of copy of the order.  Copy of the order be supplied to the parties free of charge. File be consigned to records in due course.       

Announced

                July 21, 2015

 

 

 

( Sarita Garg)       ( K.C.Sharma)       (Sukhpal Singh Gill)                                                                                                                                      

  Member                Member               President

 

 

BBS/-