BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 170 of 2015
Date of Institution : 30.9.2015
Date of Decision : 30.1.2017.
Murti Devi aged about 55 years wife of late Shri Subhash Chander son of Shri Pirthi Singh, resident of village Assa Khera, Tehsil Dabwali, District Sirsa.
….Complainant.
Versus
1. Tata AIA Life Insurance Company Ltd., B-Wing, 9th Floor, 1- Think Techno Campus, Behind TCS, Pokhran Road No.2 close to Eastern Express Highway, Thane (West)-400607 through its Managing Director.
2. The Insurance Ombudsman, office of Insurance Ombudsman S.C.O. No.101, 102 & 103, 2nd Floor Batra Building Sector 17-D, Chandigarh-160017.
2-A. Tata AIG Life Insurance Company Ltd., Bhatinda through its Manager.
3. Tata AIG Life Insurance Company Ltd., Bala Ji Tower, Sangwan Chowk, Sirsa, through its Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.LOHIA. ……………………..PRESIDENT.
SHRI RANBIR SIGH PANGHAL……..MEMBER.
Present: Sh. G.S. Chahal, Advocate for the complainant.
Sh. M.K. Singla, Advocate for the opposite parties No.1, 2A and 3.
Presence of op no.2 was dispensed with VOD 22.9.2016.
ORDER
In brief, the complainant’s case is that her husband namely Subhash Chander had taken policy No.U-15306168 for sum assured of Rs.5,00,000/- through agent Dalip Singh from the office of opposite parties at Bhatinda on 20.10.2010 and paid a sum of Rs.14,087/- as first installment of the premium and the mode of next premium was semi annual. The husband of the complainant had been depositing the installments of the premium regularly. Unfortunately, there was some break in depositing the installments and on 1.7.2014, her husband had deposited a sum of Rs.50,000/- for renewal and revival of his policy. All the necessary documents were supplied to the concerned employee at that time and said employee had assured that the policy would be revived and intimation in this regard would be sent on mail. The husband of complainant contacted the agent and asked him to supply the receipt and intimation of revival of the policy upon which he stated that as and when policy would be revived, the receipt would be supplied. Ultimately, the receipt was received and the amount of premium was shown to be deposited on 14.7.2014 instead of 1.7.2014. It was assured that in future the receipt of the deposit of the premium would be handed over to them at the spot. The husband of complainant expired on 17.7.2014 due to heart attack and thereafter the complainant applied for claim under the policy. The claim of complainant has been rejected by ops on 4.5.2015 against law and facts and without application of mind and thus rejection of claim be quashed. The complainant is resident of village Assa Khera, Tehsil Dabwali, Distt. Sirsa and the amount of Rs.50,000/- was paid to the ops at their branch office at Sirsa on 1.7.2014 and the receipt dated 14.7.2014 was also issued by the branch office at Sirsa. The complainant is legally entitled to receive the amount of Rs.five lacs alongwith interest and other benefits. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement. It has been submitted that upon being approached by one Subhash Chander and as per the information supplied by him, the ops had issued the policy for a sum assured of Rs.5,00,000/- on 23.9.2010. At the time of proposal form and as per the information supplied by life assured, he represented that he was free from all sort of disease and the ops considering the information true had issued the policy. As per further terms and conditions of the policy bond, he had to adhere to the premium payment schedule and under the policy, the life assured had to make payment of Rs.14087/- towards semi annual mode. But the life assured had not adhered to the same since beginning and resultantly the policy in question runs under lapse mode for want of installment of premium amount which stands due since 23.9.2012. Many times reminder has been sent to the life assured requiring him to deposit the due amount and to enter into major revival form but the life assured had not deposited the major revival form and on account of same, the policy could not be revived and was under lapsed condition on the date of death of the husband of complainant. The second premium due on 23.3.2011 was deposited by the insured on 18.4.2011. Thereafter, the third premium due on 23.9.2011 was deposited on 15.11.2011. The fourth semi annual premium that was due on 23.3.2012 was paid on 28.5.2012. The fifth semi annual premium which was due on 23.9.2012 was never paid. Thereafter, the premiums due on 23.3.2013, 23.9.2013 and 23.3.2014 were never paid. It is pertinent to mention here that a lump sum amount of Rs.50,000/- was received by answering ops on 14.7.2014. As the amount of Rs.50,000/- was not accompanied with the health certificate as per the requirement of the answering ops, the policy could not be revived. Prior to deposit of said lump sum amount of Rs.50,000/- deceased insured never made inquiry about the outstanding premium, hence, it clearly seems that the said amount of Rs.50,000/- was deposited in a hurry. It is vehemently denied that the deceased husband of complainant himself came to their branch at Sirsa to deposit the premium on 1.7.2014. It has been further submitted that husband of complainant died on 17.7.2014. However, it is vehemently denied that he died due to heart attack. The complainant in her own version at the time of filing of claim has specifically mentioned that they did not take him to any doctor prior to his death on 17.7.2014. Without any doctor’s report it cannot be sustained that husband of complainant died due to heart attack. Rather, the true facts are that husband of complainant was suffering from cancer and was under treatment from Acharya Tulsi Regional Cancer treatment and Research Center, Bikaner. Apart from the same on the date of death of life assured no concluded contract came into existence and deposition of an amount of Rs.50,000/- was under pipeline and even mere deposition of an amount towards renewal premium does not mean that the policy has been enforced from the date of deposition of premium in the absence of compliance of required formalities. On the date of death of life assured, the policy was not in force. Even otherwise as per the representation made by the complainant with the ops, her husband at the time of deposition of an amount of Rs.50,000/- was hale and hearty and was not suffering from any sort of disease and her husband had also submitted certificate of good health but after receipt of death claim, the ops had investigated the matter and found that husband of complainant much prior to his death was suffering from throat cancer and the life assured deliberately had concealed this fact. So even otherwise the complainant is not at all entitled to receive any single penny in respect of the policy in question and an admissible amount of Rs.49,049/- has already been disbursed to the complainant towards full and final settlement of all her claims. With these averments, dismissal of complaint has been prayed for.
3. The complainant has tendered her affidavit Ex.PW1/A, policy data Ex.C1, letter dated 27.1.2015 Ex.C2, copy of receipt of amount of Rs.50,000/- Ex.C3, copy of application Ex.C4, letter dated 4.5.2015 Ex.C5, letter dated 31.3.2015 Ex.C6, claim notification Ex.C7, initial premium deposit receipt Ex.C8, receipt dated 15.11.2011 Ex.C9, receipt dated 18.4.2011 Ex.C10, copy of application dated 24.6.2015 Ex.C11 and again receipt dated 15.11.2011 Ex.C12. On the other hand, ops tendered affidavit of Sh. Harsimran Singh, Assistant Manager Legal Ex.RW1/A, copy of proposal form Ex.R1, policy data Ex.R2, intimation letter dated 7.5.2012 Ex.R3, premium payment notice Ex.R4, intimation letter dated 6.11.2012 Ex.R5, copy of receipt dated 20.9.2010 Ex.R6, copy of claim form Ex.R7, copy of letter dated 27.1.2015 Ex.R8, copy of investigation report Ex.R9 and patient summary Ex.R10 with follow up detail and copy of death certificate Ex.R11 and extract of register Ex.R12.
4. We have heard learned counsel for the parties and have gone through the case file carefully.
5. There is no dispute that the husband of the complainant namely Subhash Chander obtained a life insurance policy from the opposite parties on 20.9.2010 (not 20.10.2010 as alleged by complainant) for sum assured of Rs.5,00,000/- which fact is evident from receipts of premium and policy documents placed on file. The husband of the complainant died on 17.7.2014 and death claim submitted by the complainant has been denied by the ops. It is mentioned in the letter of the ops dated 27.1.2015 Ex.C2 that annual premium due on 23.9.2012 was not received by them, therefore, the said policy lapsed. As the policy remained lapsed on the date of death, there is no liability for death claim in the said policy and their liability shall be limited to Rs.49409.33/- i.e. refund of the proceeds of discontinued policy fund and claim payout of Rs.49,490.33/- has been credited in the account of complainant on 24.1.2015 being full and final settlement of her claim under the policy. The case of the complainant is that unfortunately there was some break in depositing the installments and on 1.7.2014 her husband had deposited a sum of Rs.50,000/- for renewal and revival of the policy and all the necessary documents were supplied to the concerned employee of the ops at that time and it was assured that policy would be revived and receipt of the above said amount was given to them on 14.7.2014. Whereas it is the case of the ops that life assured during his life time had not adhered to the premium payment schedule as mentioned above. The firth semi annual premium which was due on 23.9.2012 was not paid and thereafter premiums due on 23.3.2013, 23.9.2013 and 23.3.2014 were not paid. The amount of Rs.50,000/- was received by them on 14.7.2014 and as it was not accompanied with the health certificate as per the requirement of answering ops, the policy could not be revived. Although, the complainant claims in her complaint and in the application dated 24.6.2015 that all the requisite documents including health certificate were submitted to the ops but the complainant has not even produced the copy of health certificate on the file. First of all, the policy in question was in lapsed condition as premiums due on 23.9.2012, 23.3.2013, 23.9.2013 and 23.3.2014 were not paid and for revival of policy, only a lump sum amount of Rs.50,000/- was paid in the month of July, 2014 but the policy could not be revived in absence of health certificate of life assured and even the complainant has not placed on file copy of health certificate which lends support to the case of the ops that at that time the deceased life assured was suffering from the disease of cancer and chances of his survival were very less and due to that reason the above said amount of Rs.50,000/- was deposited in hurry without knowing the actual amount of due premiums. The life assured died on 17.7.2014 and as the revival/ renewal of the policy is a fresh contract, therefore, the insured has to furnish correct information at the time of revival of the policy also. The opposite parties in order to prove that deceased life assured was suffering from throat cancer from last one year i.e. in the year 2014 have produced on file investigation report Ex.R9 and documents procured by the Investigator i.e. patient summary of Subhash from Acharya Tulsi Regional Cancer Treatment & Research Centre, Bikaner Ex.R10 which reveals that patient Subhash was taken to that hospital on 11.6.2014 for the problem of neck and was admitted there upto 1.7.2014 and his treatment was done there but the said material information was withheld from the ops. The complainant has not been able to submit any credible evidence to rebut the facts in the documents/ records produced from above said hospital and has not been able to prove that said documents/ records do not pertain to her husband. The ops have already credited an amount of Rs.49,409.33/- being full and final settlement of claim of complainant and complainant is not entitled to death claim of her husband due to reasons as discussed above.
6. Thus, as a sequel to our above discussion, we find no merit in the present complaint and same is hereby dismissed with no order as to costs. Copy of this order be given to the parties as per rules. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated: 30.1.2017. Member. District Consumer Disputes
Redressal Forum, Sirsa.
