MS. NIPUR CHANDNA, MEMBER

ORDER

29.11.2024

1.       A complaint under Section 12 of Consumer Protection Act filed alleging deficiency in service on the part of OP. In brief the facts are that complainant’s husband purchased insurance policy bearing no. 19470962 from OP for a sum assured of Rs. 1 Lakh on 09.11.2011 with a premium of Rs. 9061.48/- to be paid for 16 years. It is alleged by the complainant that as per the policy the complainant was entitled for following benefits:

          a. on survival of the life assured upto 09.11.2015, 2018, 2021 and 2024, the amount of Rs. 20,000/- each will be payable.

          b. on survival of the life assured upto 09.11.2027 Rs. 20,000/- plus the vested bonus will be payable.

          c. on death of the life assured anytime prior to 09.11.2027 Rs. 1,00,000/- plus vested bonus will be payable.

2.       It is further alleged that on 09.11.2015, the complainant received Rs. 20,000/- from OP. Unfortunately on 27.01.2017 complainant’s husband expired due to T.B. He was hospitalized since 29.12.2016 and as such complainant was unable to pay the premium for the year 09.11.2016. It is further stated that in the month of 2017 complainant approached OP for payment of the lapsed premium but OP refused to accept the same and thereafter her husband expired.

3.       It is further alleged by complainant that complainant received Rs. 22,504.47/- on 01.06.2017 from OP but OP failed to release the death claim as well as the vested bonus amount. It is further alleged by the complainant that on various occasions she approached OP for getting the death claim in question but the OP repudiate the legitimate claim on illegal and unjustified ground. Being aggrieved by the rejection of her genuine claim complainant approached this Commission for redressal of her grievance.

4.       Notice of the complaint was sent to OP. OP filed its written statement wherein it denied any deficiency in service on its part. It is further stated that OP paid survival benefit of Rs. 20,433/- to the complainant being nominee of DLA on 30.05.2016. Since DLA failed to pay the renewal insurance premium due ton 09.11.2016 , the policy moved to lapse status. It is further stated that the intimation of the death of DLA received to OP and as per the policy terms and conditions OP processed the death claim and released a sum of Rs. 22,504.47/- in favor of the complainant toward full and final settlement of the claim of complainant as policy moved in lapse status. It is further stated that OP has acted in the four corners of the policy terms and conditions and accordingly released the claim amount to the complainant as such no cause of action arose in favor of the complainant and against the OP in filing the present complaint. It is further prayed that present complaint be dismissed with cost.

5.       Rejoinder to the written statement of OP filed thereby simply denying the averments made in the complaint. Complainant filed her evidence by way of affidavit wherein she has corroborated the contents of the complaint.

6.       Sh. Rajesh Patial AR of the OP filed evidence by way of affidavit on behalf of OP. Both the parties filed their respect written arguments.

7.       We have heard the arguments advance at the bar by Ld. Counsel for complainant Sh. Raj Kumar and Ms. Vani Gupta counsel for OP and have perused the record.

8.       Some facts are not denied by the parties such as policy in question, death of the insured, release of the claim by OP as well as non-payment of the due premium to OP. Admittedly, the OP released a sum of Rs. 20,000/- on 09.11.2015 as per the policy terms and conditions. Admittedly, complainant’s husband failed to pay the premium due for 09.11.2016 and the policy moved to lapse status. Husband of the complainant expired on 27.01.2017 and at that time the policy in question is not active, it is in lapse status and as such when the OP Ins. co. received the death claim, the same was settled by paying a sum of Rs. 22,504.17/- on 01.06.2017.

9.       In view of the above discussion, we are of the considered opinion that while deciding the claim of the complainant the OP Ins. Co. has acted in the four corners of the policy terms and conditions as such we do not find any deficiency in service on the part of OP. We therefore find no merits in the present complaint, same is hereby dismissed.

11.     File be consigned to record room.

12.     Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving the application from the parties in the registry. Order be uploaded on www.confonet.nic.in.

Announced in open Commission on   29.11.2024.

     Sanjay Kumar                  Nipur Chandna                      Rajesh       

 President                               Member                         Member