Haryana

StateCommission

A/624/2019

KAVITA - Complainant(s)

Versus

TATA AIA LIFE INSURANCE COMPANY LTD. - Opp.Party(s)

PRADEEP SINGH SHEORAN

30 Sep 2024

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA, PANCHKULA

 

First Appeal No.624 of 2019

                   Date of Institution:10.07.2019

Date of Decision:30.09.2024

 

Kavita W/o Late Sh.Pawan Kumar S/o Sh.Ombir Singh, R/o Near Boys School Village Kaimari, Tehsil and Distt. Hisar.

 

..…Appellant

Versus

 

 

1.      The Branch Manager, Tata AIA Life Insurance Company Ltd., Plot No.23-25, 1-2^nd Floor, Red Square Market, Hisar, Haryana.

 

2.      The Managing Director, Tata AIA Life Insurance Company Ltd., Registered and Corporate Office Delphi-B, Wind, 2^nd Floor, Orchard Avenue, Hiranandani Business Park, Powai, Mumbai 40007.

 

..…Respondents

 

CORAM:   Hon’ble Mr. Justice T.P.S Mann, President.

                   Mr.S.P.Sood, Judicial Member

 

Present:-    Shri  Vikas Kumar, proxy counsel for Shri Pradeep Kumar Sheoran, counsel for the appellant.

                   Shri S.C.Thatai,  counsel for the respondents.

 

O R D E R

T.P.S. MANN J.

 

          Delay of 58 days in filing of the appeal is condoned for the reasons stated in the application for condonation of delay. 

2.      Complainant-Appellant-Kavita, has filed the instant appeal under Section 15 of the Consumer Protection Act, 1986 for challenging the order dated 01.04.2019 passed by learned District Consumer Disputes Redressal Forum, Ambala(In short “District Consumer Commission”) whereby complaint filed by complainant-Kavitawas dismissed.

3.      The brief facts of the case as set out in the complaint are that the complainant’s husband Sh.Pawan Kumar was insured with the opposite parties (In short “OPs”) vide Policy No.U133469518, dated 26.02.2016 with a sum assured of Rs.2,00,000/-. The complainant’s husband paid the premium and OPs issued the policy. Complainant’s husband was making the payment of the installments/premium regularly. Complainant’s husband died on 15.01.2018. Being a nominee, complainant informed the OPs and fulfilled all the requisite formalities as desired by the OPs and demanded the insured amount of policy on account of death of her husband. She requested the OPs to pay the insured amount, but, OPs did not settle the claim of the complainant till date.Thus there was deficiency in service on the part of the OPs. The complainant prayed that OPs be directed to make theinsured amount of Rs.2,00,000/- alongwith interest @ 18% per annum from the date of death of husband of the complainant till realization. In addition, the complainant also prayed for compensation of Rs.1,00,000/- and Rs.11,000/- as litigation expenses.

4.      Notice being issued, OPs appeared and filed written statement.  Preliminary objections about maintainability of complaint, locus standi, concealment of true and material facts, jurisdiction etc. were raised and requested to dismiss the complaint.  It was further submitted that complainant had intentionally concealed the true facts while filing the present complaint.  It was submitted that complainant’s husband had submitted proposal form dated 24.02.2016  at the Hisar Branch of the answering OPs for the purchase of “Tata AIA Life Maha Life Gold” Plan.  The husband of the complainant had paid an advance initial premium of Rs.29,652/- by cash on 24.02.2016 and accordingly the policy in question was issued bearing No.C133469518 having commencement date of 26.02.2016, basic sum assured of Rs.2,00,000/- and annual premium of Rs.28,612/- (plus applicable taxes). On 29.02.2016, the policy was delivered by speed post to the insured. The renewal premium payment in the policy in question was due on 26.02.2017, which insured failed to pay nor the renewal premium even paid in the grace period. Hence, the policy in question was moved to ‘Reduced Paid-up’ status vide letter dated 12.04.2017.   As per the terms of the policy contract, the life assured Pawan Kumar was bound to make payment of installment premium amount on regular annual basis but in the present case, the life assured after making payment of 1^st installment premium i.e. 26.02.2016, has stopped making payment of further installment premium, which stood due on 26.02.2017 and the respondents company wrote various letters requiring the life assured to make payment of the installment premium amount, but the life assured till the time of his death did not make payment of further installment premium amount and resultant to the same, the policy in question ran under lapsation on the date of death of the life assured so occurred on dated 15.01.2018.  So as per the terms and conditions of the policy contact, the demand of the complainant seeking entitlement of sum assured value of Rs.2,00,000/- even otherwise was not acceptable as per the terms and conditions of the policy contract. The complainant never ever approached the OPs nor has submitted death claim form. The OPs have denied all other allegations made in the complaint. There was no deficiency in service on the part of the OPs and the OPs prayed for dismissal of the complaint.

5.      After hearing both the parties, learned District Consumer Commissiondismissed the complaint vide impugned order dated 01.04.2019.

6.      Feeling aggrieved therefrom, complainant-appellant has preferred this appealseeking setting aside of the impugned order.

7.      We have heard learned counsel for the appellant as well as learned counsel for the respondents. With their kind assistance the entire record of appeal wasthoroughly perused andexamined.

8.      Learned counsel for the complainant-appellant vehemently argued thathusband of the complainant was making the payment of the installment of insurance premium regularly to the OPs and his policy was intact even at the time of death of the husband of the appellant which occurred on 15.01.2018. Further argued that she informed the OPs and fulfilled all the requisite formalities as desired by the OPs, but, the OPs did not settle the genuine claim of the complainant. The complainant-appellant was entitled for the insured amount as prayed for.

9.      On the contrary, learned counsel for the OPs-respondents vehemently argued that husband of the complainant had paid an advance initial premium of Rs.29,652/- by way of cash on 24.02.2016 and accordingly the policy in question was issued by the insurance company bearing policy No.C133469518 having commencement date of 26.02.2016, basic sum assured of Rs.2,00,000/- and annual premium of Rs.28,612/- (plus applicable taxes). The policy was delivered by speed post to the insured on 29.02.2016.  Further argued that renewal premium payment in the policy in question was due on 26.02.2017, which insured-Pawan Kumar failed to pay the renewal premium even in the grace period. Hence, the policy in question was moved to ‘Reduced Paid-up’ status vide their letter dated 12.04.2017.  Counsel further argued that insured died on 15.01.2018 and at the time of his death, the insurance policy had already lapsed and according to the terms and conditions of the policy, the complainant was not entitled for receiving any insurance claim. Learned District Consumer Commission has rightly dismissed the complaint of the complainant and prayed for dismissal of the appeal. 

10.    It is admitted that complainant’s husband was insured with theOPs vide policy dated 26.02.2016 with a sum assured of Rs.2,00,000/-.  It is also admitted that next due date of installment/premium was 26.02.2017. It is also admitted that insured died on 15.01.2018. It is also admitted that at the time of obtaining the policy, the insured was 21 years old. It is also admitted that as per policy, the policy term was 64 years and premium payment term (yrs) was 15 years.   The plea of the complainant was that insured-Pawan Kumar paid the installments/premium regularly to the OPs and policy was intact even at the time of death of her husband and hence, she be entitled for the insured amount.   The plea of the OPs was that after the death of the insured, the complainant did not submit the claim before the insurance company and due to non-payment of premium, the policy was in lapsed condition. It means that the policy was not cancelled by the insurance company.  Perusal of the terms and conditions of the insurance company shows that the complainant was entitled as per  “Reduced Paid Up Policy”.  Clause Reduced Paid Up Policy is relevant  and reproduced below:-

“If the full premium for atleast the first policy year has been paid, and subsequent premiums remain unpaid, the policy will be converted into a Reduced Paid Up Policy by default.  Once the policy becomes reduced paid up, the policy shall not be entitled to any further non guaranteed cash dividends.

In case of reduced paid up policies, the benefit shall be payable as under:-

a.      Death Benefit: On death of the life insured during the policy term, sum assured on death x (No of premiums paid/ (No of premiums payable, during the entire policy term) shall be payable.

This total amount will be subject to a minimum of 105% of Total premiums paid, as on the date of death.”

          As per clause Reduced Paid Up Policy, the complainant is entitled for the claim benefit under the above said category. As per insurance policy i.e. “Tata AIA Life Insurance MahaLife Gold”, the policy term was upto 64 years and since the life assured had died during the policy term, the complainant was entitled for the amount according to clause “Reduced Paid Up Policy”. The learned District Consumer Commission has wrongly dismissed the complaint of the complainant.

11.    Accordingly, this appeal is accepted, the impugned order dated  01.04.2019is set aside and liberty is granted to the complainant to submit the claim form alongwith death certificate of her husband and other requisite  documents to the insurance company within 60 days from date of passing of order and insurance company is directed to settle the claim within 30 days from the date of submitting the claim form by the complainant. The OPs are also directed to settle the claim according to clause “Reduced Paid Up Policy”.

12.  

13.    A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act,1986/2019. The judgment be uploaded forthwith on the website of the Commission for  perusal of the parties.

14.    File be consigned to record room.

 

30^thSeptember, 2024          S.P.Sood                                                      T.P. S. Mann

                                                Judicial Member                                         President

 

S.K

(Pvt. Secy.)