Punjab

Moga

CC/16/150

Shinder Pal Kaur - Complainant(s)

Versus

The Manager, Exide Life Insurance - Opp.Party(s)

Sh. Sham Lal

22 Feb 2017

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 150 of 2016

                                                                                      Instituted on: 16.09.2016

                                                                                      Decided on: 22.02.2017

 

Shinder Pal Kaur wife of Gurmail Singh, mother of deceased Manjit Singh, resident of Bhara Patti, Patto Hira Singh, Tehsil Nihal Singh Wala, District Moga.

                                                                                ……… Complainant

 

Versus

1.       The Manager, Exide Life Insurance, 1^st Floor Building no.1267, 68, 69, Akalsar Road Chowk, G.T. Road, Moga, District Moga.

 

2.       Exide Life Insurance Company Limited, 1^st Floor, Gold Hill Square no.690, Hosur Road Begur Bobli, Bangalore-560068.

 

                                                                           ……….. Opposite Parties

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President

                   Smt. Vinod Bala, Member

                   Smt. Bhupinder Kaur, Member

 

Present:       Sh. Sham Lal, Advocate Cl. for complainant.

                   Sh. Ashwani Kumar Sharma, Advocate Cl. for opposite parties.

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the "Act") against The Manager, Exide Life Insurance, 1^st Floor Building no.1267, 68, 69, Akalsar Road Chowk, G.T. Road, Moga, District Moga and others (hereinafter referred to as the opposite parties) directing them to pay Rs.2,52,206/- alongwith interest @ 9% till the date of payment on account of insurance policy no.02907999. Further opposite parties may be directed to pay Rs.50,000/- on account of mental agony, harassment and deficiency in service and Rs.11,000/- as litigation expenses to the complainant or to pay any other additional or alternative relief, for which, the complainant may be found entitled to.

2.                Briefly stated the facts of the case are that in the month of April, 2014, one agent of opposite parties came to Manjit Singh son of Gurmail Singh and told him regarding the insurance policy and being allured by the agent of opposite parties, son of the complainant Manjit Singh purchased Life Insurance policy from opposite parties and deposited a sum of Rs.2098/-, being first insurance premium and was assured for Rs.2,52,206/-. Accordingly the opposite parties issued ING Secure Income Insurance plan policy no.02907999 commenced from 19.04.2014 and the premium was payable monthly. Unfortunately, said Manjit Singh died on 18.02.2015 and thereafter intimation regarding the death of Manjit Singh was given to the opposite parties by complainant being nominee in the aforesaid insurance policy and lodged claim of Rs.2,52,206/- and submitted all the original documents required by the opposite parties for the settlement of aforesaid claim. The complainant received a letter of Exide Insurance company stating that policy held by Late Mr. Manjit Singh had lapsed on 19.01.2015 due to non-payment of premium amount within the grace period, hence no benefit will be payable. The said Manjit Singh was paying insurance premium installments regularly to the agent of opposite parties. Installment due in December, 2014 was also paid by Manjit Singh to the same agent and he might have kept money with him and deposited the same with insurance company late. This was not the fault of Manjit Singh policy holder, it was agent, who deposited the premium late. The aforesaid repudiation letter of the opposite parties is illegal, null and void and against law. The complainant also served a legal notice date 01.08.2016, but to no effect. Due to the above said act and conduct of the opposite parties, the complainant has suffered mental tension, agony and harassment. Hence this complaint.

3.                Upon notice, opposite parties appeared through counsel and filed their written reply taking preliminary objections that the complaint is barred by the jurisdiction of this Forum as Consumer matters are summary proceedings and any case of fraud and cheating needs detailed trial. Hence only Civil and Criminal courts have such jurisdiction; that present complaint is not maintainable. The complainant is guilty of suppressing material and pertinent facts/information relevant for the adjudication of the present complaint; that the present complaint is false, malicious and incorrect and is filed with mala-fide intention. It is nothing, but the abuse of the process of law and it is an attempt to waste the precious time of this Forum, as the same has been filed by the complainant, just to avail undue advantage. Further submitted that policy of Life Insurance is a contract of utmost good faith, wherein Life Assured is under obligation to disclose all the facts and information pertaining to his/her age, income, habit and previous illness details in proposal form for accepting the life risk coverage for Life Insurance Company especially when it is non-medical policy). The complainant's son Late Mr. Manjit Singh (hereinafter referred as "Life Assured") had submitted a proposal for life insurance on 19.04.2014 for "ING Secure Income Insurance Plan" a life insurance product offered by opposite parties, which is approved by the Insurance Regulatory Development Authority of India (IRDAI) a statutory body created by an Act of the Parliament. The features of the above mentioned plan were explained in detail to the Life Assured and only after understanding the same in its entirety, the Life Assured had voluntarily opted for the said plan. The premium opted by the Life Assured was Rs.2032/- to be paid monthly for a premium paying term of 15 years for a sum assured of Rs.200,000/- for the tenure of 15 years. Nominee under the said policy is the complainant in this case. The life assured had confirmed that his health was sound on the date of proposal form and these facts were acknowledged with declarations made in the proposal form dated 19.04.2014. Believing the answers, statement and declaration made in proposal form by the Life Assured as true and correct, the opposite parties underwriter's had reviewed/evaluated the relevant factors such as the occupation, age, income and pre-existing health condition is declared by the life assured in the proposal form (being non-medical case) and upon receipt of the insurance premium, the opposite parties had issued Life Insurance policy bearing on 02907999 to Life Assured on 19.04.2014, which was also couriered to the address mentioned in the proposal form and same was delivered to life assured. Further submitted that the life assured thereafter paid only nine monthly renewal premiums for the policy bearing nos. 02907999 uptil 18.12.2014. Subsequently, the life assured has not paid any further premium with respect to the said policy and therefore the policy has become lapsed. The due date for paying the 10^th premium was on 19.01.2015. However, the life assured failed to pay the same within the grace period (15 days from the due date) and hence the policy got lapsed. As per the policy terms and conditions no benefits will be paid to the policyholder or the eligible person if the policy is in lapse stage. It has been further submitted that the complainant being the nominee made a death claim with the company by submitting 'Death Intimation Cum Claim Form' dated 14.03.2015 stating that the life assured died on 18.02.2015. The complainant made the death claim with the company only after the policy became lapsed. As the policy was in lapsed status, they decided to reject the claim. The complainant after the death of the life assured i.e. on 27.02.2015 had approached the branch office paid Rs.2,111/- towards the premium. Which manifests the fact the complainant deliberately paid the said premium in order get policy benefits. However, they have refunded the same to the complainant vide Electronic Fund Transfer, as we have decided to reject the benefits to the complainant as per the terms and conditions of the policy. The life assured in spite of knowing the terms and conditions of the policy complainant deliberately paid the 10^th premium after the death of the life assured and did not disclose the correct details about the death of life assured. Therefore, it is clear that the complainant had misrepresented with them by suppressed the material facts and thus played fraud with opposite parties; that the complainant has no 'locus standi' to claim any alleged sum assured, as the insurance policy was obtained by the life assured by misrepresentation of material facts in order to defraud the opposite parties. Hence, the contract of life insurance is void, and not tenable in the eyes of law as it is entered by life assured to defraud the opposite parties. Hence, the present complaint may be dismissed with costs.

4.                In order to prove the case, complainant no.1 tendered in evidence his duly sworn affidavit Ex.C-1 alongwith copies of documents Ex.C-2 to Ex.C-9 and closed the evidence. 

5.                On the other hand, opposite parties tendered in evidence duly sworn affidavit of Sh. Madhu N.R, Manager Legal Ex.OPs-1 alongwith copies of documents Ex.OPs-2 and Ex.OPs-5 and closed the evidence.

6.                We have heard ld. counsel for the parties and have very carefully gone through record placed on file.

7.                Ld. counsel for the complainant argued that that in the month of April, 2014, one agent of opposite parties came to Manjit Singh son of complainant and being allured by the agent of opposite parties, said Manjit Singh purchased Life Insurance policy from opposite parties and deposited a sum of Rs.2098/-, being first insurance premium and was assured for Rs.2,52,206/-. Accordingly the opposite parties issued ING Secure Income Insurance plan policy no.02907999 commenced from 19.04.2014 and the premium was payable monthly. Unfortunately, said Manjit Singh died on 18.02.2015 and thereafter intimation regarding the death of Manjit Singh was given to the opposite parties by complainant being nominee in the aforesaid insurance policy and lodged claim of Rs.2,52,206/- and submitted all the original documents required by the opposite parties for the settlement of aforesaid claim. The complainant received a letter of Exide Insurance company stating that policy held by Late Mr. Manjit Singh had lapsed on 19.01.2015 due to non-payment of premium amount within the grace period, hence no benefit will be payable. The said Manjit Singh was paying insurance premium installments regularly to the agent of opposite parties and the installment due in Decembe r, 2014 was also paid by Manjit Singh to the same agent and he might have kept money with him and deposited to same with insurance company late. This was not the fault of Manjit Singh policy holder, it was agent, who deposited the premium late. The aforesaid repudiation letter of the opposite parties is illegal, null and void and against law.

8.                On the other hand, ld. counsel for opposite parties argued that it is correct that the complainant's son Late Mr. Manjit Singh  had submitted a proposal for life insurance on 19.04.2014 for "ING Secure Income Insurance Plan" with  opposite parties. The premium opted by the Life Assured was Rs.2032/- to be paid monthly for a premium paying term of 15 years for a sum assured of Rs.200,000/-. The complainant was appointed as nominee under the said policy. The opposite parties had issued Life Insurance policy to Life Assured on 19.04.2014. Further argued that the life assured paid only nine monthly premiums uptil 18.12.2014, subsequently, the life assured has not paid any further premiums with respect to the said policy. The due date for paying the 10^th premium was on 19.01.2015. However, the life assured failed to pay the same within the grace period (15 days from the due date) and hence the policy got lapsed. As per the policy terms and conditions no benefits will be paid to the policyholder or the eligible person if the policy is in lapse stage. He further argued that the complainant being the nominee made a death claim with the opposite parties only after the policy became lapsed. As the policy was in lapsed status, so the opposite parties reject the claim. The complainant after the death of the life assured i.e. on 27.02.2015 had approached the branch office paid Rs.2,111/- towards the premium. Which manifests the fact the complainant deliberately paid the said premium in order get policy benefits. However, they have refunded the same to the complainant vide Electronic Fund Transfer. . The complainant deliberately paid the 10^th premium after the death of the life assured and did not disclose the correct details about the death of life assured. Therefore, it is clear that the complainant had misrepresented the opposite parties by suppressing the material facts and thus played fraud with opposite parties. Hence, the contract of life insurance is void, and not tenable in the eyes of law. As such, the present complaint may be dismissed with costs.

9.                The case of the complainant is that in the month of April, 2014 her son namely Manjit Singh purchased an insurance policy for securing his life from opposite parties. The opposite parties issued insurance policy in his favour commencing from 19.04.2014 for sum assured Rs.2,52,206/- and the premium was to be payable monthly. The complainant was appointed as nominee in that policy. The said Manjit Singh died on 18.02.2015 and the complainant duly gave intimation regarding the death of Manjit Singh to opposite parties and lodged the claim with them by submitting all the required documents. But the opposite parties repudiated the claim of the complainant vide letter dated 04.05.2015 stating that the policy held by Manjit Singh has been lapsed due to non payment of premium within the grace period. Hence no benefit will be payable. Manjit Singh during his life time was regularly paying the premium to opposite parties, through their agent. He also paid the installment due for December, 2014 through same agent and he might have kept the money with them and did not deposit the same with insurance company on time. As such, there is no fault on the part of Manjit Singh or the complainant for non deposit of premium. So, opposite parties wrongly and illegally repudiated the claim of the complainant. On the other hand, opposite parties admitted that Manjit Singh purchased the insurance policy from them securing his life commencing from 19.04.2014 with sum assured Rs.2 lac after admitting all the terms and conditions of the policy. He had to pay Rs. 2032/- as premium monthly for the term of 15 years. As per IRDA guidelines in case where customer opted for payment of premium in monthly installments in that case there was a grace period of 15 days for payment of premium after due date and in case of quarterly or annually installments, there was a grace period of one month. During this grace period the policy remained enforced and during this period if any mis-happening is occurred, the insured is entitled for the benefits under the policy, but if he failed to deposit the installment of premium on the due date or even within the grace period then in that case, the policy stands lapsed and no benefit under the policy in lapse condition is payable. In the present case, the insured have to pay the premium in monthly installments as opted by himself and the policy in question come in force on 19.04.2014 and the insured have to deposit the premium of every 19^th of the month. In the present case the insured have only paid nine monthly renewal premiums uptil 18.12.2014 and next premium was due on 19.01.2015, but he failed to deposit the renewal premium on time even in the grace period. As such, the policy in question got lapsed on 19.01.2015. The complainant being nominee submitted the death claim with opposite parties on 14.03.2015 stating the date of death of life assured as 18.02.2015. On 18.02.2015, the policy in question was in lapsed condition. So, no benefit under the policy is payable to insured or his nominee. Moreover, the complainant after the death of life assured i.e. on 27.02.2015 approached to opposite parties and deposited a sum of Rs.2,111/- towards the premium after the death of insured by suppressing the fact of his death in order to get undue benefits under the policy in dispute. However, during investigation this fact come into the knowledge of opposite parties, as such,  they repudiated the claim and also refunded the amount of Rs.2111/- paid by the complainant as premium after the death of insured to her. The insured or the complainant did not abide by the terms and conditions of the policy and not deposited the renewal premium on time or even in grace period, so their policy stands lapsed. So, they are not entitled for any benefit under the policy. The claim has rightly been repudiated by the opposite parties. On the other hand, ld. counsel for the complainant argued that they paid all premiums on time through some agent, who might have not deposit the premium on time. But they failed to prove this fact that they ever paid the premium to any agent, even they also failed to disclose the name of the agent through whom they allegedly paid premium to opposite parties. Rather complainant deposited the premium amount on 27.02.2015 i.e. after the death of life assured by suppressing the death of the life assured from opposite parties only to deceive them, which proves malafide intention of complainant.

10.              From the above discussion, we are of the considered opinion that the complainant or insured Manjit Singh failed to abide by the terms and conditions of the policy and to deposit the renewal premium on time with opposite parties. So, as per terms and conditions of the policy, the policy was in lapsed condition on the date of death of Manjit Singh insured. As such, complainant is not entitled for any benefit under the policy in question. Hence we found no merit in the present complaint and the same is hereby dismissed. Parties are left to bear their own costs. Copy of the order be supplied to the parties, free of costs. File be consigned to record room.

Announced in Open Forum.

Dated: 22.02.2017.

 

                               (Bhupinder Kaur)                 (Vinod Bala)         (Ajit Aggarwal)

                                            Member                             Member                President