1.        This is a petition filed by one Sr. Debajit Kr. Sarmah (hereinafter referred to as the petitioner) against the Branch Manager, Life Insurance Corporation Of India , claim department, Guwahati Divisional office and one another (hereinafter referred to as the opposite parties) U/S  12 of the consumer Protection Act, 1986 praying for recovery of money, compensation and other relief.

2.         The facts and circumstances for filing of the aforesaid petition as narrated by the petitioner are as follows:-

                The wife of the complainant, namely, deceased Nilutpala Bordoloi, during her life time opened a policy with the Life Insurance Corporation of India, Nagaon Branch vide policy no. 486296573 and monthly premium was to be paid on 10^th of every month 15 days being the grace period after the due date. The petitioner further submitted that the insured policy holder, namely, Late Nilutpala Bordoloi had fallen ill on last 29-09-2013 after severe headache and after consultation with physician and on due examination, she was referred to higher medical institution for further investigation and treatment. Further averment of the complainant is that he being the husband and nominee of the said policy of deceased Nilutpala Bordoloi took her to Mumbai Tata Memorial Institution where she was diagnosed of brain tumor and cancer and admitted for treatment at the said hospital on 3^rd October, 2013 but unfortunately during the course of treatment, she expired on last 26-10-2013 at Mumbai Hospital. The petitioner further submits that he being the husband of the deceased policy holder was away from the home town Nagaon and was badly busy in the treatment of the deceased policy holder and for this extenuating circumstances, it was not physically possible for him to pay the monthly installment premium within the grace period ending on 25-10-2013 and unfortunately the insured expired on last 26-10-2013. The petitioner also submits that the Insurance Ombudsmen, Guwahati Center, while arriving at the decision regarding the status of the policy and the lapse period of the same  was 16 days committed error as it would be evident that the monthly installment would have been paid within 25-10-2013. His further submission is that after considering 15 days grace period, the lapse period would have been only one day and  not 16 days as calculated by the  Insurance Ombudsmen, Guwahati Center. The petitioner also submits that he being the nominee of the deceased policy holder explained in detail that it would have been humanely impossible to pay the monthly installment payment within due date as both the Insurer and the Nominee husband were extremely busy for the treatment of the illness of the Insurer in far away at Mumbai. The petitioner submits that considering the extenuating and compelling circumstances, the petitioner as well as the Insurer were unable to pay the monthly Insurance during the grace period and hence, the decision of Insurance Ombudsmen was taken with utter non-application of mind and due to the wrong calculation of lapse period, the said decision is liable to be set aside and declared null and void. Hence this petition is before this Commission for appropriate relief.

3.             The opposite Parties filed written statement denying all the claim of the petitioner leveled against them. By their written version, the opposite parties pleaded inter-alia that there is no cause of action for the complainant to file the petition, that the petition is barred by the principle of waver estoppel and acquiesce, that the petition does not attract the provision under section 12 of the C.P. act etc. The opposite parties further submitted in the written version that the complainant has concealed the material facts in the case and hence, the petition is liable to be dismissed.

                The Opposite Parties submit that the Insurer as well as the nominee of the policy were found negligent in not paying the premium within due date and as such, the policy was lapsed on the date of death of the policy holder and hence, the complainant is not entitled to any insurance amount under the lapse policy. The Opposite Parties further submits that the Ombudsmen, L.I.C., Guwahati rightly closed the claim of the petitioner after considering the records and hearing both the parties and hold that the policy condition in case of ordinary monthly policy being 15 days as grace period , the policy of the deceased policy holder became lapsed on the date of death of the deceased policy holder and thus, the ground of repudiating the claim of the petitioner by this Opposite Parties is just and proper. The Opposite Parties further averred in the written version that the claim in question being an early claim, it was examined thoroughly and found that the policy being a monthly policy, the premium for the month of October, 2013 was not paid within the grace period and hence, there was a violation of policy conditions and nothing is payable under the said lapse policy and hence, there is no deficiency of service on the part of this Opposite Parties. Under the above premises, the Opposite Parties pray for the dismissal of the claim petition.

3.         Upon pleading of parties, the following points are found for discussion and decision in the case:-

1. Whether the Opposite Parties illegally denied to extend the benefit to the complainant for the insured policy No.486296572 as the husband and the nominee of the deceased policy holder, Late Nilutpala Bordoloi without any justified cause and such act, on the part of Opposite parties amounts to deficiency in service?

2. Whether the claimant is entitled to any relief as prayed for?

4.              The complainant filed evidence in affidavit of one witness and also exhibited several documents in support of his

claim. The Opposite parties also examined one witness as D.W.1.  Both the witnesses were cross examined by their opponents.

5.                Written argument filed by both the contesting parties and perused the same and oral argument also heard.

6.                               Decision and reasons thereof:-

7.             For the sake of brevity both the Points (i) & (ii) are taken together for discussion and decision:-

                The claim of the complainant is that his wife Late Nilutpala Bordoloi during her life time opened a policy with the Life Insurance Corporation of India, Nagaon Branch and he being her husband and nominee filed his claim for getting the insurance benefit of the said policy but the Opposite parties being the Divisional Manager of LIC as well as the Branch Manager, LIC, Nagaon Branch refused to pay him the insurance amount without any justified cause. In support of his claim, the petitioner as P.W.1 adduced evidence to the effect that his wife Late Nilutpala Bordoloi during her life time opened a policy being policy no. 486296573 with the LIC of India, Nagaon Branch and as per the terms of the policy due date for payment of monthly installment was the 10^th of

each current month and the grace period was 15 days. He further deposed that the policy holder Nilutpala Bordoloi suddenly fell ill on last 29-09-2013 and thereafter, she was treated by Doctor and after due examination referred to higher institution and thereafter, this P.W took her to Mumbai Tata Memorial Hospital, where she was diagnosed of brain tumor and cancer and admitted for treatment on 3^rd October 2013 but unfortunately she expired in the Hospital on last 26-10-2013. Further evidence  of this P.W. is that as both the insurer and this P.W were away from home town Nagaon and were badly busy in treatment of the insurer, so, it was not possible for them to pay the monthly installment premium within the grace period ending on 25-10-2013 and hence, the decision of Learned Ombudsman Insurance, Guwahati Center,   regarding the status of the policy and in computing the lapse period of the policy was 16 days was wrong as after considering 15 days grace period, the last date for monthly installment would have been end on 25-10-2013 and thus, the lapse period was only one day and not 16 days as calculated. His further evidence is that while making the claim, he explain in details that it would have been humanely impossible to pay the monthly installment amount as both he and his late wife (deceased policy holder) were extremely busy for treatment of the insurer at Mumbai which is far away from Nagaon.

             The opposite parties while filing their written version submitted that the monthly premium for the policy was due on 10^th of each month and the last payment was due on 10-10-2013 but the policy holder and the insurer voluntarily neglected to pay the premium within due date and as such, the policy lapsed on the date of death of the deceased policy holder for which no amount can be paid under the said lapse policy. In support of the written version, the opposite parties examined one Sri Debal Kr. Sarmah, the Assistant Administrative Officer of LICI, Nagaon Branch, as D.W.1. In his evidence, this witness stated that deceased Nilutpala Bordoloi, during her life time, opened a policy bearing no. 4186296573 commenced from 10-07-2013 and the mode of payment of premium was ordinarily monthly. His further evidence is that the premium for October, 2013 not being paid by the insurer within the due date, the policy was lapsed. He also adduced evidence that the clam in question being an early claim, it was examined thoroughly and found that the policy was lapsed for non payment of premium due for October 2013, so, there was a violation of policy conditions and nothing could be paid under the said policy. The D.W.1 also deposed that the complainant earlier approached the Insurance Ombudsman, Guwahati and after going through the record and after hearing the complainant and the opposite parties, the Insurance Ombudsman, Guwahati, rejected the prayer of the complainant by holding that the ground of repudiating the claim of the petitioner by this opposite parties was just and proper. The D.W.1 again deposed that the instant claim by the petitioner is absolutely false with mala-fide intention to make unlawful gains and there was no negligence or deficiency of service on the part of the LICI as alleged by the petitioner.  

               Thus, from the pleadings and evidence adduced by both the contesting parties it is clear that the fact of opening the policy by the deceased policy holder Nilutpala Bordoloi and payment of monthly premium up-to the month of September were not disputed. The fact that monthly premium which was due on 10/10/2013 was not paid on or before 25-10-2013 i.e. within the grace period of 15 days is also not disputed. The death of the policy holder Nilutpala Bordoloi occurred on last 26-10-2010 as asserted by the petitioner. The opposite parties pleaded and also adduced evidence that as on the date of death of the deceased policy holder, the status of the policy was lapse due to non-payment of monthly premium in due time and as such, no insurance benefit can be claimed on the said policy. The policy conditions of L.I.C. policy also includes payment premium for the insured amount and a grace period of one month but not less than 30 days is allowed for payment of yearly or half yearly or quarterly premium and 15 days for monthly premium. If death occurs within this period, the life assured is covered for full sum assured.

                The well settled legal position is that in a contract of insurance, there is a requirement of Uberrima fides i.e. good faith

on the part of the assured. Hon’ble Supreme Court in the case of Vikram Greentech(1) Ltd. V/s New India Assurance Co. Ltd. reported in (2009)5 SCC 599, while dealing with the contract of insurance held as follows:-

           “16. An insurance contact, is a species of commercial transaction and must be construed like any other contract to its own terms and by itself. In a contract of insurance, there is requirement of Uberrima fides i.e. good faith on the part of the assured. Except that, in other respects, there is no difference between a contract of insurance and any other contract.

             17.   The four essentials of a contract of insurance are(i) the definition of risk, (ii) the duration of the risk, (iii) the premium and (iv) the amount of insurance. Since upon issuance of the insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of the risk covered by the insurance policy, its terms have to be strictly construed to determine the extent of liability of the insurer.

               18. The endeavor of the court must always be to interpret the words in which the contract is expressed by the parties. The court while construing the terms of policy is not expected to venture into extra liberalism that may result in rewriting the contract of substituting the terms which were not intended by the parties. The insured can not claim more than  what is covered by the insurance policy. (General Assurance Society Ltd. v. Chandmill Jain(1966)3 SCR 500, Oriental Insurance Co. Ltd. v. Sony Cheriyan AIR 1999 Sc 3252 and United India Assurance Co. Ltd. v.  Harchand Rai Chandan Lal (2004)8 SCC 644)”

                   From the aforesaid proposition of law, it is clear that the terms of insurance policy have to be strictly construed and there is no scope for the court while interpreting the terms of insurance policy to rewrite the contract of substituting the terms which were not intended by the parties. In the instant case it is seen that the due date for payment of monthly premium was on 10/10/2013 which was not paid on or before 25-10-2013 i.e. within the grace period of 15 days. The death of the policy holder Nilutpala Bordoloi occurred on 26-10-2013. Hence, on the date of death of the policy holder, the policy in question was not in force and was  lapsed. The petitioner claimed that there was one day delay to pay the premium and it was humanely impossible to pay the monthly installment amount as both he and his late wife (deceased policy holder) were extremely busy for treatment of the insurer at Mumbai which is far away from Nagaon. However, in his cross examination, this P.W. admitted that in his family apart from himself and his wife he has got two daughters also and they were found matured at the relevant time and present near Nagaon. It was also admitted by the P.W.1 that his wife, the deceased policy holder had got 9 other policy which were settled by L.I.C.  The

admitted fact that the policy in question was started on last 10-07-2013. Thus, it is found that the premium for the month of October 2013 which was due on 10-10-2013 not being paid on or before 25-10-2013, 15 days being the grace period, the disputed policy was lapsed on 26-10-2013 i.e. on the date of death of the deceased policy holder. The observation of Hon’ble Supreme Court in the case of Vikram Greentech(1) Ltd. V/s New India Assurance Co. Ltd. reported in (2009)5 SCC 599, also guide this commission to hold such a view that the disputed policy was in lapse condition on the date of death of the deceased policy holder.  

               Thus, in view of above observation we do not find any cogent and plausible reason to allow the petition filed by the complainant.  He can not claim any insurance benefit under the policy of his wife which not in force on the date of death of Late Nilutpala Bordoloi. Hence, the petitioner is not entitled for any relief in this case.

                  In result both the points for discussion and decision are answered in negative and go against  the complainant.

                                     O   R  D   E  R

8.           In view of the above discussion, it is found that the petitioner has not succeeded to prove that there was a deficiency of service on the part of opposite party.

                  Accordingly,  the  prayer made by the petitioner U/S 12 of the Consumer protection is dismissed on contest.

                  Furnish copy of judgment free of cost to the parties.

                  Given under the hand and seal of this Commission, we signed and delivered this Judgment on this 22^nd Day of August 2023.