Orissa

Cuttak

CC/7/2023

Parbati Muljani - Complainant(s)

Versus

Managing Director,Max Life Insurance Company Limited - Opp.Party(s)

A Pal & associates

19 Jul 2023

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C.No.7/2023

 

1.           Parbati Muljani,

                     W/O: Shyam Sundar,

                     (Mother of late Rajesh Kumar)

 

2.           Simran Jhamtani,

                     W/o: Late Rajesh Kumar.

 

         Both are presently residing:

                C/o: Shyam Sundar Agarwal,

    At:Kaligali, Infront of High Court,

                      P.O:Chandinichowk,Town/Dist:Cuttack.                            ... Complainants.

 

                                   Vrs.

1.          Max Life Insurance Company Limited,

                       Plot No.90-A,Sector-18,Gurugaon-122015

                    Haryana, India, represented through

                    Its Managing Director having his

                    Registered office at 419.Bhai Mohan Singh Nagar,

                    Railmajra,Thsil-Balachaur,Dist:Nawanshahr,Punjab-144533.

 

2.        Senior Manager(Claims),

Max Life Insurance Company Limited,

                    Plot No.90-A,Sector-18,Gurugaon-122015

Haryana, India.

 

3. ICICI Bank Ltd,

Plot No.N5/535,Indradhanu Market,

IRC Vilalge,Nayapalli,Bhubaneswar-751015

Represented through its Branch Manager.                         ... Opp. Parties.

 

 

Present:               Sri Debasish Nayak,President.

                   Sri Sibananda Mohanty,Member.

 

Date of filing:       09.01.2023

Date of Order:     19.07.2023

 

For the complainant:          Mr. A.Pal,Adv. & Associates.

For the O.Ps.             :               None.

 

Sri Sibananda Mohanty,Member.               

Case of the complainants in short is that complainant no.1 is the mother of deceased life assured namely Rajesh Kumar and the complainant no.2 is the wife of said Rajesh Kumar.  It is stated by the complainants that deceased Rajesh Kumar had insured his life with the O.Ps no.1 & 2 bearing policy No.543055560 on 23.11.2018 for a period of 30 years and the premium amount payable was on monthly basis i.e. due on 23^rd of every month and the premium amount was fixed at Rs.993.73p.  It is further case of the complainants is that premium amount of the policy was being paid on auto-debit mode from the ICICI Bank Credit card held by the complainant no.1.  Surprisingly, after death of the life assured, it is noticed by the complainant no.1 that premium amount for the month of April,2021 and May,2021 has not been debited by the O.P no.3.   It is stated by the complainants that on 9.6.2021 the insured died due to Cardiac Arrest.  The O.Ps 1 & 2 had deducted premium amount from the account of the complainant no.1 on 13.8.2021,14.9.2021,23.9.2021 and 12.10.2021 towards the monthly premium of the life assured and credited to the account of the O.P no.1.  The complainant no.1 who was the nominee of the policy applied to the O.Ps no.1 & 2 on 28.11.2021 for settlement of death claim of his deceased son claiming an amount of Rs.60,00,000/- towards death benefit and further claimed Rs.10,00,000/- for accelerating critical illness as per the policy.  But surprisingly, the O.P no.1 on 31.12.2021 rejected the claim of the complainant no.1 stating that the policy had lapsed on expiry of the grace period with effect from 23.4.2021.  Thereafter on 29.3.2022 the O.P no.1 had refunded the premiums collected from August,2021 to October,2021 from the complainant no.1.  The complainant no.1 on 20.5.2022 sent a legal notice to the O.Ps no.1 & 2 as they have rejected her claim as well as she had demanded compensation of Rs.10,00,000/- for their mental agony and harassment and a sum of Rs.5,00,000/- towards the litigation expenses besides the claim amount.  The O.P no.1 on 4.1.2022 refused to pay the sum assured on the ground that the policy had already lapsed on expiry of the grace period with effect from 23.4.2021.  It is further alleged by the complainants that there is no fault of the life assured in not sending the premium amount to the O.Ps no.1   as it was being paid through  auto debit mode against the credit card as stated above and non-debit of the said premium from the said credit card to the account of the O.P no.1 for the months of April,2021 and May,2021 is not at all the fault  at the end of the insured.  It is alleged by the complainants that even after the death of life assured, the O.Ps had deducted the insurance premium for the month of August,21,September,21&October,21  which were debited from the aforesaid credit card in auto debit mode and in order to escape from their liability under the insurance policy, the O.P no.1 had refunded the said amount of Rs.4690.40p through the  cheque on 29.3.2022 in favour of the complainant no.1.  However, the complainants have filed the present case as the O.Ps had repudiated the claim of the life assured and had prayed for refund of the consideration amount which were paid by way of premium amount for 29 months amounting to Rs.28,058.26p alongwith interest thereon @ 12% as well as have claimed Rs.10,00,000/- towards compensation for mental agony and harassment besides Rs.5,00,000/- towards their litigation expenses.

The complainants have filed copies of documents alongwith their complaint petition in order to prove their case.

2.            Having not preferred to contest this case, the O.Ps have been set exparte.

3.            The points for determination in this case are as follows:

                i.              Whether the case of the complainant is maintainable?

ii.             Whether there was any deficiency in service on the part of the O.Ps?

iii.            Whether the complainants are entitled to the reliefs as claimed by them?

Point no.ii.

Out of the three points, point no.ii  being the pertinent one, is taken up  first for consideration here in this case.

On perusal of the complaint petition, it reveals that the son of the complainant no.1 had taken the policy bearing No. 543055560 from the O.Ps no.1 & 2.  The premium amount of the said policy was being paid by the complainant no.1 through her ICICI Bank credit card.  The policy holder died on 9.6.2021 due to cardiac arrest. The complainants have filed copy of the policy and payment particulars showing payment of insurance premium to the O.P no.1 & 2.  The policy is of monthly premium payment scheme and the premium amount was being paid to the O.Ps no.1 & 2 on auto-debit mode from the credit card of the complainant no.1.  The premium amount for the month of April,2021 and May,2021 was not debited from the ICICI Bank credit card, which was not within the knowledge of the life assured as well as of the complainant no.1.  But the O.Ps have deducted premium amount even after the death of the policy holder on 13.8.2021,14.9.21 and 23.9.21.  Subsequently, after knowing about the death of life assured, they had refunded such premium amount to the complainant no.1 in total Rs.4690.40p. The O.Ps no.1 & 2 had repudiated the claim of the complainants on the ground that the policy was lapsed due to non-payment of the premium amount which was due, to be paid by 23.4.2021.  The life assured had died during the Covid-19 pandemic period.  The O.Ps no.1 & 2 should have intimated the life assured about the lapse of his policy which has not been done by them.  Be that as it may, the O.Ps no.1 & 2 should have refunded the total premium amount as received from the life assured as soon as possible when the complainants lodged the claim.  The O.Ps no.1 & 2 had refunded the premium amount which was received after the death of the policy assured but did not refund the premium amount which they had taken before the death of the life assured.  In this context there is a pertinent decision of the Hon’ble Apex Court in the case of Harshad J Saha and another Vrs. L.I.C of India and others, wherein their lordships have held that in case of lapsed policy the insurer is required to refund the entire premium amounts paid alongwith interest @ 15% per annum.

 Thus, in view of the above observation and as per the decision of the Hon’ble Apex Court, it can be concluded here that by not returning the premium amount as received on behalf of the policy holder, when the complainants have made a claim after the death of the life assured, who was the policy holder, the O.Ps no.1 & 2 are undoubtedly found to be deficient in their service.

Issues no.i & iii.

From the above discussions and from the facts and circumstances of the case, it is noticed that the case of the complainant is partly maintainable and they are entitled to a reasonable amount of relief.  No relief has been claimed by the complainant against the O.P no.3.   Hence it is so ordered;

 

                                                                ORDER

Case is decreed partly exparte against the O.Ps no.1 & 2 who are found to be jointly and severally liable here in this case.  The O.Ps no.1 & 2 are directed to return the complainants the total premium amount of Rs.28,826/- vide policy no. 543055560 from 28.11.2021 when the complainant no.1 being the nominee had lodged the claim onwards alongwith interest thereon @ 12% per annum till the total amount is quantified.  The O.Ps are also directed to pay the complainant a sum of Rs.5,00,000/- towards compensation for their mental agony and also to bear their litigation expenses to the tune of Rs.50,000/-.  This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on the 19^th day of July,2023 under the seal and signature of this Commission.             

                                                                                                                           

                                                                                                             Sri Sibananda Mohanty

                                                                                                                            Member

 

                                                                                                                   Sri Debasish Nayak

                                                                                                                           President