Kirpal Singh, complainant has filed the present complaint against the titled opposite parties U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short, the C.P.Act.) in which he has prayed that the opposite parties be directed to make payment of Rs.15,00,375/- as such assured on account of death of the policy holder i.e. Smt.Karamjit Kaur alongwith interest @ 18% per annum from the date of her death till its actual realization. Opposite parties be further directed to pay Rs.50,000/- as compensation for physical harassment and mental agony alongwith litigation expense, in the interest of justice.
2. The case of the complainant in brief is that the opposite party had allured to him that they are having tie up with the opposite parties no.2 and 3 and if he will take the policy of the opposite parties no.2 and 3 and then he will have to pay its 22 installments annually. The period of commencement of the said policy is from 30.6.2016 to 30.6.2038. It was asked by all the opposite parties that the said policy covers the risk of the said policy holder in case of any type of death. The said policy was money back policy. He came into the allurance of the opposite parties and had taken the policy at the instance of the opposite party no.1 and in order to make payment of the said policy, he has got encashed cheque amounting to Rs.1,03,748/- from the Bank Account of Harpal Singh. He has paid first installment of Rs.1,01,874.99 paise for the said policy, which he had taken in the name of his wife Smt.Karamjit Kaur. It was told by the opposite parties that in case of death of policy holder i.e. Smt.Karamjit Kaur during the pendency of the said policy, then he will get entitled to the amount of Rs.15,00,375/- i.e. sum assured. He has further pleaded that on 15.8.2016, his wife has delivered a female child and afterward she had died due to natural death. A D.D.R. entry to this respect bearing No.15 was registered in Police Station Kalanaur on 16.8.2016. The Post Mortem of his wife namely Karamjit Kaur has done by the concerned doctor of Civil Hospital, Gurdaspur. Afterward he has approached to the opposite party no.3 and lodged his claim and requested the opposite parties to make the payment of Rs.15,00,375/- as sum assured due to the death of his wife, but the opposite parties started procrastinating the matter pending with one pretext or the other. The opposite parties used to harass him without any cause or rhyme without giving any explanation. Due to the illegal act and conduct of the opposite parties, he has suffered great mental agony and has suffered mental and physical harassment from the hands of the opposite parties. Hence this complaint.
3. Upon notice, the opposite parties No.1 appeared and filed its written reply through its counsel taking the preliminary objections that the complainant is not a consumer of the opposite party; the complaint is not maintainable and the complainant has not approached the Hon’ble Forum with clean hands. On merits, it was submitted that the wife of complainant herself purchased the policy from opposite parties no.2 and 3 after submitting the necessary documents and completed all the formalities. The role of the opposite party no.1 is limited to acting as the corporate agent of opposite parties no.2 and 3 and assisted the complainant availing the concerned life Insurance Policy. It was further submitted that the policy holder who has declared her education level as graduate availed the policy, post completion of all necessary formalities including filling up the proposal form on her own post understanding the applicable terms. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.
4. Opposite parties no.2 and 3 appeared through their counsel and filed their joint written reply by taking the preliminary objections that no cause of action arisen in favour of the complainant to file the present case; the complainant does not fall under the definition of the Consumer as per Consumer Protection Act and thus, the Consumer Forum has no jurisdiction to try and decide the present complaint; the complaint is premature as the complainant had never lodged any claim with the opposite party and the complainant has not come to the Forum with clean hands and as such the complainant is not entitled for any relief as alleged by him in his complaint. On merits, it was submitted that the opposite party no.1 never allured the complainant to take the policy of opposite party. The complainant had purchased the insurance policy namely Max Life Monthly income advantage plan (12 pay) by submitting the proposal form No.126030972 which was duly signed by the policy holder and examined the terms and conditions of the policy which were explained to her by the authorized agent of the opposite parties. The LA has purchased the abovesaid policy as per her own requirement and desire with his own sweet will and without any pressure, under which the premium was to be paid annually. The sum assured under the said policy was Rs.15,00,375/-. The policy in question was issued to the LA only on the basis of the proposal form which is the base of the insurance contract. The terms and conditions were well explained to the LA and only after fully satisfied with same, the LA opted for the policy in question and paid the premium. It has been further submitted that complaint of the complainant is premature as the complainant had never approached to the opposite party and had never lodged any claim under the policy, so the question of mental agony and physical harassment does not arise. The complainant must approach to the opposite party and have to lodge the claim under the policy only then the opposite parties decided the grievance of the complainant. Thus, there is no deficiency in service on the part of the opposite parties. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.
5. Counsel for the complainant tendered into evidence affidavit of complainant Ex.C1, alongwith other documents Ex.C2 to Ex.C4 and closed the evidence.
6. Sh.Akashdeep Kohli, Branch Manager of opposite party no.1 tendered into evidence his own affidavit Ex.OP-1/1 and closed the evidence.
7. Counsel for the opposite parties no.2 and 3 tendered into evidence affidavit of Sh.Dhiraj Malik Deputy Manager- Legal Ex.OP-2,3/1 alongwith other documents Ex.OP-2,3/2 and Ex.OP-2,3/3 and closed the evidence.
8. We have carefully examined all the documents/evidence produced on record and have also judiciously considered and perused the arguments duly put forth by the learned counsels along with the incidental scope of adverse inference for of some documents that have been somehow ignored to be produced by the contesting litigants. We observe that the prime dispute prompted at the OP insurer’s non-settlement and alleged procrastination of the death-claim of the complainant’s wife who had since demised on 15.08.2016, soon after having delivered a child. The complainant has produced (Ex.C2) PMR Post Mortem Report and (Ex.C3) Police GDR General Diary Report that satisfactorily prove the ‘death’ of the DLI (Deceased Life Insured) entitling him (affidavit Ex.C1) to receive the related insurance claim as registered ‘appointee’ to his minor 3 years old ‘nominee’ daughter as per insurance (Ex.C4) proposal.
9. We also find that the OP1 Bank here has been admittedly (affidavit Ex.OP1/1) the corporate ‘agent/advisor’ to the instant insurance policy/ proposal (Ex.C4) and Gaganpreet Singh Bank Officer has duly signed upon the same as the ‘specified person’. Thus, it has been throughout the responsibility of the OP1 Bank to have assisted the complainant in getting the impugned claim settled with its principals, the OP2/3 insurers.
10. The OP2/3 insurers have admitted (affidavit Ex.OP2,3/1) the factum of purchase of the insurance policy (Ex.OP2,3/3) by the DLA (proposal Ex.OP2.3/2) with her complainant husband Kirpal Singh as ‘appointee’ to the minor ‘nominee’ daughter Ravpreet and thus they both are presently entitled to the status of statutory consumer(s). However, we find that the OP insurers, on the one hand, deny having received the related ‘death-claim’ while on the other hand they are vehemently contesting/raising objections to the genuineness and validity of the same. Further, the learned counsel for the OP insurers (during the course of arguments) has somehow pleaded that the impugned claim was simply deferred/set-aside on account of non-submission of requisite documents by the complainant and he instead of submitting the claim documents has filed the present complaint lurking in lap of immaturity and has further assured that the claim shall still be duly settled with the filing of the ‘gap’ information documents etc. However, we are not convinced with the pleadings as put forth here, for of the above-discussed situational logic.
11. In the light of the all above, we partly allow the present complaint and thus ORDER the OP2/3 insurers to pay the full proceeds i.e sum insured of the impugned claim to the complainant (in terms of the related policy) within a period of 30 days of the receipt of the copy of these orders besides to pay him Rs.10,000/- as cost and compensation, failing which OP No.2/3 shall pay the awarded amount alongwith interest at the rate of 9% p.a. from the date of filing of the complaint till actually paid. The OP1 Bank (being locally located) is directed to actively/purposefully assist the OP2/3 insurers to retrieve the desired document, if any, from the court’s records; for an expeditious compliance of the present orders.
12. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to records.
(Naveen Puri)
President.
ANNOUNCED: (Jagdeep Kaur)
January 24, 2018. Member
*MK*
