BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHABAD.
Complaint Case No.: 104 of 2016.
Date of Institution: 31.03.2016
Date of order: 31.01.2017.
Raghubir Sharma s/o Sh.Harmesh Sharma resident of VPO Dharsul Kalan, Tehsil Tohana District Fatehabad.
….. Complainant.
Versus
- The Dharsul Khurd Primary Agriculture Co-operative Society Ltd; Dharsul Khurd Tehsil Tohana District Fatehabad through its Manager/CEO.
- The Fatehabad Central Cooperative Bank Ltd.Branch Office Dharsul, Tehsil Tohana, District Fatehabad, through it Branch Manager.
- The Fatehabad Central Cooperative Bank Limited Fatehabad,through its Branch Manager/CEO.
- Bajaj Allianz Life Insurance Company Limited, Regd.& Head Office-GE Plaza, Airport Road, Yerawada, Pune 411006, through its Managing Director.
….Opposite parties.
Complaint U/s 12 of the Consumer Protection Act
BEFORE: Sh. Raghbir Singh, President.
Smt. Ansuya Bishnoi, Member.
Present: Shri Sandeep Kumar Goyal, Advocate for the complainant.
Shri Suraj Kiran, Advocate for the OP Nos.1 to 3.
Shri M.K.Dharnia, Advocate for the OP No.4.
ORDER:
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties (hereinafter to be referred as OPs).
2. Briefly stated the facts of the present complaint are that OP Nos. 1 to 4 had obtained one Group Insurance Policy known as Sarv Shakti Suraksha Policy for its members/account holders from OP No.4. It has been further averred that as per scheme each member was insured for a sum of Rs.2,50,000/- and in the event of death of the member an amount of Rs.2,50,000/- alongwith the account value of the member would be payable. Sh.Babu Ram, Grandfather of the complainant was member of above said insurance cover having membership No.5500536455 and he died on 03.08.2014. The grandmother of the complainant namely Dhanwanti Devi who was nominee in that policy was also died on 23.05.2014.
3. It has been further averred that during his life time insured Babu Ram had executed a Will dated 24.12.2013 in favour of the complainant qua his moveable and immoveable properties, therefore, after the death of said Babu Ram the complainant is entitled for the benefits under the said policy. The employee of OP No.1 namely Satbir Singh used to collect premium from the members including grandfather of the complainant annually and regarding this receipts/acknowledgments have been issued sometimes.
4. It has been further averred that grandfather of the complainant had paid all the regular premiums with the OPs through said Satbir Singh and a receipt dated 26.02.2014 for premium of Rs.10,000/- for the year 2014-15 was also issued by the OPs. After the death of insured Babu Ram on 03.08.2014, the complainant had submitted claim form alongwith all relevant documents to the Op No.4 through OP Nos.1 to 3 but he felt surprise when the OP No.4 had deposited Rs.26712/- only in his account through NEFT despite the fact that the entitlement of the complainant is Rs.2,50,000/- being sum assured.
5. It has been further submitted that the complainant requested the OPs to make the payment of full claim amount and also sent written request dated 16.12.2015 but to no avail. The act and conduct of the OPs clearly amounts to deficiency in service and unfair trade practice
on their part. In evidence, the complainant has tendered his affidavit Ex.C1 and documents Ex.C2 to Ex.C10.
6. On notice OPs appeared and contested the complaint of the complainant by filing separate replies. OP Nos. 1 to 3 in their joint reply have taken many preliminary objections such as cause of action, maintainability, concealment of material facts from this Forum and jurisdiction etc. It has been further submitted that the amount of insurance was paid to the OP No.4 through his authorized agent Hanuman Parshad (Senior Self Executive). There is no deficiency in service on their part as the letter dated 16.12.2015 received from the complainant was sent to the OP No.4 through OP No.3. It has been further submitted that the amount paid by Babu Ram had already been sent to OP No.4. Lastly, prayer for dismissal of the complaint has been made.
7. OP No.4 in its separate reply has taken many preliminary objections such as maintainability, estoppal, cause of action, suppression of material facts from this Forum and complainant does not fall within the ambit of consumer etc. It has been further submitted that Satbir Singh was not authorized to collect the premium amount from the members and the policy holders have deposited only three premium amount i.e. on 18.12.2010, 05.11.2012 and 31.07.2013, therefore, the policy in question bearing No.0208521440 was lapsed and the agreement between the policy holder and the OP No.4 had come to an end. It has been further submitted that claim of the complainant was duly considered and the same was repudiated as per law and the paid up value of the policy in question has already been released in favour of the complainant. There is no deficiency in service on the part of OP No.4 and by controverting the other averments made in the complaint, prayer for dismissal of the complaint has been made. In evidence, the OPs have tendered affidavit of Sh.Surinder Wadhwa, Branch Manager as Ex.RW1/A, affidavit of Lilu Ram, Branch Manager as Ex.RW1, documents Ex.R1, Ex.R2, Ex.RA to Ex.RJ.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. This fact is not disputed that the grandfather of the complainant namely Babu Ram being member of OP Nos. 1 to 3 was insured with OP No.4. It is also not disputed that the payment of the said insurance was made to Op No.4 through OP Nos.1 to 3. It is also established that insured Babu Ram had died on 03.08.2014 (Ex. C4) and nominee Dhanwanti Devi had also died on 23.05.2014 (Ex.C3). Execution of Will dated 23.12.2013 (Ex.C2) by the insured Babu Ram in favour of the complainant is also not disputed. The sole ground of the Op No.4/insurance company as mentioned in repudiation letter Ex.R2 is that The death claim procedure has been completed, the premium due on 13.12.2013 was not paid within grace period of 30 days. Hence, the policy was in lapse condition as on date of death i.e. on 03.08.2014. As a result claim has been approved for refund of Fund value as per policy conditions.
6. Perusal of the Ex.C6 reveals that the Fatehabad Central Co-op Bank Limited is the master policy holder bearing No.0162511596 and said policy was commenced from 09.03.2010. Further perusal of this document reveals that insured Babu Ram was having membership number 5500536455 and he had obtained insurance policy for sum assured to the tune of Rs.2,50,000/- being individual member commenced from 13.12.2010. The Cover Condition No.4 (a) of the certificate of insurance is as under :
“On death of an individual member: On death of an individual member, the death benefit equal to the amount of sum assured for which the individual member was assured plus the account value of the individual member as on date of receipt of intimation of death at the office the company”
7. It is worthwhile to mention here that the policy in question was admittedly for the benefit of the member of the society. The version of the OP No.4 is that before the death of the life insured Babu Ram his policy had already been lapsed as no premium after 31.07.2013 had been received by it from the policy holder. This plea of the OP No.4 is not sustainable in the eyes of law because once the employee/member is covered under the Group Insurance Scheme then they had vested interest in continuation of the said policy and the insurance company was required to notify the employees/master policy holder regarding non-receipt of the premium so that if the employees/member wanted they could have sent the premium to the insurance company. It was the duty of the OP No.4-insurance company to intimate the member/life insured qua the fact that the policy in question is in lapsed condition due to non-payment of the premium but the insurance company had neither intimated about this to the insured nor gave any notice before cancellation of the master policy. In the present case it appears that on one hand the insurance company had received premium from the insured in order to increase its business but on the other hand it is trying to avoid its liability after lodging the claim on account of death of insured on technical and lame excuses. It is worthwhile to mention here that the life insured- member being beneficiary was required to be noticed in as much as the decision would affect its right but in the present case the OP No.4-insurance company did not send any notice about discontinuation of the policy in question to the insured, therefore, the act and conduct of the insurance company in repudiating the claim of the complainant lodged on account of death of insured-Babu Ram is not justified, therefore, the same is set aside. On this point reliance can also be taken from case law titled as LIC of India Vs. K.Venkatalakshmamma & Anr. (1) 2011 (CPJ 305 (NC), wherein Hon’ble National Commission has held as under:
Once the employees were covered under the Group Savings Linked Insurance Scheme , they had vested interest in continuation of the said policy and the Insurance Company was required to notify the employees regarding non-receipt of the premium so that if the employees wanted they could have sent the premium to the petitioner - Petitioner is liable to pay the ordered amount to the complainant specially in view of the fact that Master Policy in question was cancelled on 21.12.2002 and the husband of the complainant had died more than a year prior to that on 21.7.2001 when the policy was in subsistence though it was stated in the lapsed condition - Order of the State Commission directing payment of the insured amount in the case of husband of the complainant does not call for any interference.
8. Thus, as a sequel to our above discussion and by following the legal position made in LIC of India Vs. K.Venkatalakshmamma & Anr. (1) 2011 (CPJ 305 (NC) (supra) and keeping in view the Cover Condition No.4 (a), we accept the present complaint and direct the OP No.4 to pay the amount of Rs.2,50,000/- (sum assured) after deducting Rs.26712/- which has already been paid to the complainant alongwith its benefits to the complainant alongwith interest @ 9% per annum from the date of filing of present complaint till actual realization. We also direct the OP No.4 to further pay a sum of Rs.5,000/- for harassment including litigation expenses to the complainant. This order should be complied within a period of 30 days from the date of this order, failing which the complainant will be entitled to initiate legal proceedings under Section 25/27 of the Act against the opposite party. Since the OP Nos. 1 to 3 have no role to play in the present case, therefore, present complaint stands dismissed against them. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.
Announced in open Forum.
Dated: 31.01.2017
(Raghbir Singh)
President
(Ansuya Bishnoi) Distt.Consumer Disputes
Member Redressal Forum, Fatehabad.
