Chandigarh

DF-I

CC/686/2015

Premwati - Complainant(s)

Versus

PNB Metlife India Insurance Co. Ltd. - Opp.Party(s)

K.L. Kohli

31 Aug 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

============

Consumer Complaint  No	:	CC/686/2015
Date  of  Institution	:	12/10/2015
Date   of   Decision	:	31/08/2016

 

 

 

 

 

Premwati w/o Sh. Ram Singh Malik, resident of House No.141, Gobind Nagar, Naya Gaon, SAS Nagar, District Mohali (Punjab).

 

…....... Complainant.

Vs

 

[1]  PNB Metlife India Insurance Company Limited having its registered Office at Birgade Sesha Mahal, No.5, Bani Vilas Road, Basabanagudi, Bangalore – 560 004, Karnataka, through its Chief Operating Officer.

 

[2]  The Branch Manager, PNB Metlife (India) Insurance Company Limited, SCO 2463-64, Second Floor, Sector 22, Chandigarh.

 

[3]  The Branch Manager, PNB Metlife (India) Insurance Company Limited, SCO 36, Second Floor, Sector 11, Panchkula.

 

…........... Opposite Parties

 

BEFORE:   DR. MANJIT SINGH             PRESIDENT

          SMT.SURJEET KAUR             MEMBER

          SH. SURESH KUMAR SARDANA     MEMBER

 

For Complainant	:	Sh. K.L. Kohli, Advocate.
For Opposite Parties	:	Sh. Vaibhav Jain, Advocate.

 

PER SURESH KUMAR SARDANA, MEMBER

 

          Succinctly put, the Complainant made death claim dated 31.01.2015 against the policy document of Insurance bearing No.21290734 issued on 25.03.2014 for the Base Sum Assured Rs.14,10,000/- in favour of her son Umed Malik, now deceased, who was employed as Assistant Sales Manager – Agency Sales in the F2 Grade under the Opposite Parties. As the ill luck would have it, the son of the Complainant met with a road accident on 29.3.2014 and was admitted in the Hospital on 30.3.2014, where he succumbed to his injuries on 15.01.2015. On receipt of the death claim dated 31.01.2015, the Opposite Parties credited an amount of Rs.27,148.20 only towards full and final payment of the aforesaid policy to the bank account of the Complainant taking a plea that the subject policy was in Disc-fund since 09.12.2014 due to non-payment of renewal premium due on 25.09.2014, therefore, the fund value was paid to the nominee and no pay out is due in the policy. Thereafter, the Complainant constantly follow up the matter with the Opposite Parties to pay the Base Sum Assured under the Policy, but nothing positive could come out. Hence, alleging the aforesaid act & conduct of the Opposite Parties as deficiency in service and unfair trade practice, the Complainant has filed the present Complaint.

 

2.      Notice of the complaint was sent to Opposite Parties seeking their version of the case.

 

3.      Opposite Parties in their joint reply, while admitting the factual aspects of the case, have pleaded that the risk commencement date of the subject policy was 25.03.2014. The renewal premium of Rs.15,000/- was to be paid on quarterly basis and the due date of the regular premium was 25^th June/ September/ December/ March of every year. Further, under the Policy, a grace period of thirty days was allowed from the premium due date, for payment of the premium without interest. It has been urged that the renewal premium due on 25^th September, 2014 was not paid by the deceased life insured. The renewal premium was not received by the Opposite Parties even within the grace period of 30 days and as a result the Policy of the deceased life insured moved into the discontinuance mode with no risk cover in line with the policy terms and conditions with effect from 09.12.2014. On receipt of the death claim intimation, the same was evaluated and it was found that the Complainant was not entitled to receive the death benefits under the policy as per the terms and conditions as the deceased life insured died during the time when the policy was in discontinuance fund status. Accordingly, the answering Opposite Parties paid the fund value of Rs.27,148.20/- to the Complainant through NEFT.  Pleading that there is no deficiency in service or unfair trade practice on their part, Opposite Parties have prayed for dismissal of the complaint.

 

4.      The Complainant also filed rejoinder wherein the averments as contained in the complaint have been reiterated and those as alleged in the written statement by the Opposite Parties have been controverted.

 

5.      Parties were permitted to place their respective evidence on record in support of their contentions.

 

6.      We have heard the learned counsel for the parties and have also perused the record.

 

7.      The case of the Complainant is that the insurance claim preferred by her consequent to the death of her son (Deceased Life Insured) was repudiated by the Opposite Parties. After scanning the entire documents placed on record by the Complainant, we find that the insurance policy was issued on 25.3.2014 for the base sum assured Rs.14,10,000/- in favour of the DLI (Complainant’s son). The insurance premium was payable quarterly. On perusal of Annexure C-3 we find that the DLI met with accident on 29.03.2014 and sustained a head injury and fell down unconscious. Annexure C-5 which is Lama Summary issued by PGIMER, Chandigarh shows that the DLI underwent multiple surgeries and his neurological status deteriorated. There is no denial of the fact that the second quarterly payment was deducted by the Opposite Parties from the DLI’s Bank Account on 25.06.2014 while he was hospitalized. As per the Opposite Parties the next installment was due on 25.09.2014 and the policy went into the disc mode. It is pertinent to note that on 25.09.2014 there is a debit of Rs.100/- on account of Cheque deposited and returned to the Opposite Parties. The DLI was an employee of the Opposite Parties and the Cheque returned was relating to the next premium payable in Sept. 2014 and it was a sufficient indication to the Opposite Parties that their employee’s salary was not being credited to his account. At any rate, any person of that condition, who had met a serious accident and had undergone multiple surgeries and remained unconscious for a long time would not be in a position to think of making any payment towards premium. Had the DLI, who was an employee of the Opposite Parties would have been not in a state of health, in which he was, he would have received the salary from the Opposite Parties and paid further premium also by the same mode of deduction from the salary account with the Bank. Hence, in these set of circumstances, we are of the concerted opinion the stand taken by the Opposite Parties to defeat the claim of the Complainant does not merit consideration and the same is hereby rejected.  

 

8.      In view of the above discussion, the complainant have produced cogent evidence to prove unfair trade practice and deficiency in service on the part of Opposite Parties. We find merit in the complaint and the same is allowed against Opposite Parties.  The Opposite Parties are, jointly and severally, directed :-

(i)  To pay the base sum assured of Rs.14,10,000/- minus fund value Rs.27,148.20P to the Complainant, along with interest @9% per annum from the date of repudiation till realization.

(ii) To pay a compensation of Rs.10,000/- to the complainant towards mental agony and harassment.

(iii) To pay Rs.5,000/- to the complainants as costs of litigation.

9.      This order be complied with by Opposite Parties within one month from the date of receipt of its certified copy, failing which they shall make the payment of the amount mentioned at Sr. No.(ii) above, with interest @9% per annum from the date of filing of the present complaint till realization, apart from compliance of directions at Sr. No.(i) & (iii) above.

 

10.      Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

31^st August,2016                                           

Sd/-

(DR.MANJIT SINGH)

PRESIDENT

 

Sd/-

(SURJEET KAUR)

   MEMBER

 

Sd/-

(SURESH KUMAR SARDANA)                                                                                                      MEMBER

 

 “Dutt”