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The initial complaint was brought before the District Commission by Sharma’s wife, Jyotsana, and their son. They argued that Sharma, who purchased the policy in June 2020, had consistently made timely payments, including a critical premium payment on March 31, 2021, just days before he fell ill with Covid-19. Despite this, their claim, filed on May 20, 2021, was denied in June, with the insurer arguing that the policy had lapsed.
The core dispute centered on the March premium payment. According to PNB MetLife, Sharma’s policy, with a sum assured of Rs 1 crore, required monthly payments, and the company maintained that the March premium, due on March 29, 2021, was unpaid. However, records clearly indicated that Sharma made this payment on March 31, within the policy’s 15-day grace period. This crucial evidence led the District Commission to order the insurance company to honor the claim, providing Rs 1 crore as the sum assured, along with Rs 25,000 as compensation and Rs 10,000 towards litigation costs.
Upon appeal, the State Commission reviewed the matter, confirming that Sharma’s premium payment was recorded within the stipulated grace period. The commission noted that Sharma’s last payment was indeed made on March 31, as per official receipts. Furthermore, with the next premium date set for April 29, 2021, and Sharma passing away a day prior, on April 28, the policy was active at the time of his death. Therefore, the State Commission concluded that the insurer’s denial of the claim was unjustified, stating, “The appellants’ repudiation of the claim, which was based solely on the assertion that the policy had lapsed, lacks sufficient justification.”
This decision underscores the importance of accurate record-keeping and adherence to policy terms, providing reassurance for policyholders and their families regarding timely premium payments and policy validity.
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