BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
FATEHABAD.
Complaint Case No.: 287 of 2016.
Date of Institution: 03.11.2016
Date of order: 07.06.2017.
Dalip Singh s/o Sh.Budh Ram, resident of village Khajuri Jatti, Tehsil Tohana District Fatehabad.
….. Complainant.
Versus
- The Fatehabad Central Cooperative Bank. Branch Office Fatehabad, District Fatehabad, through its Branch Manager.
- Bajaj Allianz Life Insurance Company Limited, West HUB, Second Floor, Bajaj Finserve, Survey # 208/I-B, Behind Weikfield IT Building, Viman Nagar, Nagar Road, Pune, Maharashtra, Pin Code-411014 through its Managing Director/Manager.
- Bajaj Allianze Life Insurance Company Limited, Dabwali Road, Sirsa, District Sirsa Through its Manager.
….Opposite parties.
Complaint U/s 12 of the Consumer Protection Act
BEFORE: Sh.Raghbir Singh, President.
Sh.R.S.Panghal,Member.
Smt.Ansuya Bishnoi, Member.
Present: Sh. B.R.Godara, Advocate for the complainant.
Sh. M.K.Dharnia, Advocate for the OP No.1.
Sh. Suraj Kiran, Advocate for the OP Nos.2 and 3.
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 No.1 under Sarve Shakti Suraksha Policy was master policy holder vide policy No.0162511596 with date of commencement 09.03.2010 issued by OP No.2. Smt.Maina Devi, mother of the complainant insured herself under individual coverage vide membership No.0216854877 with date of commencement 18.04.2011 for five years upto 18.04.2016 for a sum of Rs.2,50,000/- and she had made payment of Rs.10,000/- as premium thereof for five years on yearly basis. It has been further averred that after the death of insured Maina Devi on 05.01.2016, the complainant had submitted claim form alongwith all relevant documents to the Op No.3 through OP Nos.1 & 2 but he felt surprise when the OP No.3 had deposited Rs.37428/- only in his account and he also received a letter dated 20.07.2016 issued by the OP No.2 whereby it was intimated that the matter would be resolved within 10 days but to no effect. The complainant requested the OPs to make the payment of claim and also got served legal notice upon the Ops but all fell on deaf ears. 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 Annexure CW1/A and documents Annexure C2 to Annexure C15.
3. On notice OPs appeared and contested the complaint of the complainant by filing separate replies. OP No.1 in its reply has taken many preliminary objections such as cause of action, locus standi, maintainability and suppression of material facts from this Forum etc. It has been further submitted that Smt.Maina Devi had approached for insurance policy to the bank and also took the policy from OPs No.2 & 3. She had deposited five installments of the premium of Rs.10,000/- each and the same were sent to the insurance company. The documents submitted by the complainant were also forwarded to the Bajaj Allianz Insurance Company. It has been further submitted that amount of Rs.37,428/- received from the company was delivered to the complainant. Other pleas made in the complaint have been controverted.
4. OP Nos. 2 and 3 in their joint reply have taken many preliminary objections such as cause of action, locus stand, maintainability, concealment of material facts from this Forum and jurisdiction etc. It has been further submitted that due to non-deposit of premium amount the policy was lapsed but when the claim of the complainant was submitted then it was considered and as per terms and conditions of the policy an amount of Rs.37428/- has already been paid to the complainant which is duly admitted by him. There is no deficiency in service on the part of insurance company and prayer for dismissal of the complaint has been made. In evidence, the OPs have tendered affidavit of Sh.Rajinder Kalsi, as Ex.RW1/A and documents Annexure R1 to R24.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. This fact is not disputed that the mother of the complainant namely Maina Devi being member of OP No. 1 was insured with OP Nos.2 & 3. It is also not disputed that the payment of the said insurance was made to Op Nos. 2 & 3 through OP No.1. It is also established that insured Maina Devi had died on 05.01.2016 (Annexure C9). The sole ground of the insurance company is that an amount of Rs.37,428/- has already been delivered to the complainant duly accepted by him as due to non-payment of premium the policy had already been lapsed.
6. Perusal of the Annexure C2 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 Smt.Maina Devi was having membership number 0216854877 and he had obtained insurance policy for sum assured to the tune of Rs.2,50,000/- being individual member commenced from 18.04.2011. 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 insurance is that before the death of the life insured Maina Devi her policy had already been lapsed due to non-payment of premium. This plea of the insurance company 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 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 Nos.2 & 3 -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-Maina Devi 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. Further more, it is an admitted fact that mode of payment of premium of Rs.10,000/- for five years was on annual basis with a grace period of 30 days as is evident from Annexure C3 i.e. welcome letter. The OP No.1 through whom the premium of Rs.10,000/- was being paid to OP Nos. 2 & 3 by mother of the complainant has admitted that she deposited the premium of policy in their branch on 22.04.2011, second on 06.06.2012, third on 25.05.2013, fourth on 27.05.2014 and last premium was paid on 22.05.2015. This fact is also evident from documents Annexure C5, C6 and C7. It is further admission of the bank that all the above installments paid by the mother of the complainant in the bank were sent to the insurance company. There is no objection of the insurance company at any point of time at the time of receiving above said premiums that payment was not made in time. The OP Nos. 2 & 3 have relied upon document Annexure R6 wherein on page No.2, it is mentioned that “FUP 18.04.2015, DOD 05.01.2016 i.e. as on date of death of LA policy was in lapsed condition” but in our view the plea of OP Nos. 2 & 3 that policy was in lapsed condition on the date of death of insured has no force and cannot be looked into. As mentioned above, it is proved on record that the last premium of Rs.10,000/- was paid by mother of the complainant on 25.05.2015 through OP No.1 and there is no objection on the side of OP Nos. 2 & 3 that premium was received late at that relevant time, therefore, now at this stage after the death of mother of the complainant which took place on 05.01.2016 i.e. after almost seven months of receiving the premium on 25.05.2015 by the OP Nos.2 & 3, the Op Nos. 2 & 3 cannot allege that policy was in lapsed condition due to non-deposit of premium amount in time. When the Op Nos. 2 & 3 have already received the premium paid by mother of the complainant through OP No.1, it cannot be said that policy was in lapsed condition. It is very much clear from the record on file, that OP Nos.2 & 3 have taken this stand only to avoid payment of genuine claim.
9. 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 Nos.2 & 3 to pay the amount of Rs.2,50,000/- (sum assured) after deducting Rs.37428/- 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 Nos.2 & 3 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 No. 1 has 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: 07.06.2017
(Raghbir Singh)
President
(Ansuya Bishnoi) (R.S.Panghal) Distt.Consumer Disputes
Member Member Redressal Forum, Fatehabad.
