BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SMT. K. SIREESHA, B.L., LADY MEMBER
SRI M.V.R. SHARMA, MEMBER.
Friday, 14th November 2014
CONSUMER COMPLAINT No. 08/ 2014
G. Peer Ahmmad, S/o Late G. Khader Hussain,
aged 63 years, R/at D.No. 16/132, Besta Street,
Porumamilla Village and Mandal, YSR District. ….. Complainant.
Vs.
1. LIC of India, Rep. by its Branch Manager,
Branch Office, Proddatur Branch, Proddatur,
Kadapa District.
2. LIC of India, Rep. by its Senior Divisional Manager,
Arts College Road, Kadapa city, YSR District. ….. Respondents.
This complaint coming on this day for final hearing on 29-10-2014 in the presence of Sri Y. Prasad, Advocate for complainant and Sri G.V. Raghava Reddy, Advocate for Respondents and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, Member),
1. Complaint filed under section 12 of the C.P. Act 1986.
2. The brief facts of the complaint are as follows:- it is submitted that the son of the complainant by name Late G. Jabeer Ahmmad had taken two life insurance policies bearing Nos. 653965391 commenced from 28-9-2005 and No. 655286318 commences from 28-7-2008. The first policy bearing No. 653965391 was obtained during minority of Late G. Jabeer Ahammad. The complainant was nominated as nominee to the above two policies. In case of death of insured, the complainant is entitled to receive the sum assures with benefits.
3. While so, the insured who is no other than the son of the complainant died in an accident on 26-8-2000 while discharging his duties in Boarder Security Force (BSF). After the death of insured, being the nominee to the above policies, the complainant made a claim with the respondents. Accordingly, the respondents settled the claim of the complainant in respect of second policy bearing No. 655286318 to an extent of sum assured together with accidental benefit. Whereas, for the first policy bearing No. 653965391, the respondent only paid the sum assured under the policy. Astonished by the decision of the respondents the complainant approached them and enquired about the non-payment of the accidental benefit of Rs. 1,00,000/- for the first policy bearing No. 653965391. On that the respondents did not respond properly to the complainant and kept their decision in pending. For all these days, the complainant went around the offices of the respondents for settlement of accidental benefit for the policy bearing No. 653965391. But, his efforts proved in vain. Having vexed with negligent attitude of the respondents, the complainant wrote number of letters and made correspondence with the respondents. But there is no response from their end.
4. Finally, the complainant lodged a complaint on 26-9-2013 with the insurance ombudsman, Hyderabad by bringing his grievance against the respondent. Without going into merits of the case, the Insurance Ombudsman has rejected his complaint on 7-10-2013 on the sole ground that his complaint is barred by limitation and the decision of insurance company is as per terms and conditions of the policy. The insurance Ombudsman advised the complainant to take up the matter with the any other court for the resolution of grievance. On the enquiries made by the complainant, he reliably learnt that the respondents are not settling his claim sole on the ground that at the time of commencement of policy insured is a minor and no accidental benefit is made applicable to the minor. It is pertinent to submit here that after getting majority by the minor, the respondents continued to collect the premiums and did not informed either insured or his nominee for remittance of accidental amount or enhanced premium enabling them for coverage of accidental benefit by this is crystal clear that there is a gross negligence on the part of the respondents in not intimating the insured or his nominee about the terms and conditions made applicable to the minors who attained majority. The respondents are liable to pay the accidental benefit an amount of Rs. 1,00,000/- together with interest from the date of death of the insured to the complainant for the policy bearing No. 653965391 and also are liable to pay compensation for the mental agony and physical strain caused by them to the complainant. Hence, this complaint.
5. The cause of action arose on 28-9-2005 when the insured taken a life insurance policy bearing No. 653965391 and on 26-8-2009 when the insured died in an accident and when the respondents failed to pay the accidental benefit for the policy bearing No. 653965391 and kept their decision till date and on the dates, the complainant made demands to the respondents for settlement of accidental benefit and when his claim was not considered and cause of action arose within the jurisdiction of Hon’ble forum as the respondents have offices within the jurisdiction of the Hon’ble forum. A fee of Rs. 200/- is paid by way of I.P.O.,
6. It is therefore, prayed that the Hon’ble forum may be pleased to allow the complaint and pass orders in favour of the comp and directing the respondents (a) to pay the accidental benefit an amount of Rs. 1,00,000/- together with interest from the date of death of the insured i.e. 25-8-2009 till the date of realization for the policy bearing No. 653965391, (b) to pay compensation of Rs. 50,000/- for causing physical strain and mental agony and (c) to pay Rs. 2,000/- towards cost of the complaint and other reliefs as the Hon’ble forum deems fit and proper in the circumstances of the case.
7. Written statement filed by R2 and the same was adopted by R1 by way of Memo.
8. It is submitted that the complaint filed by the complainant is just and not maintainable either in law or on facts of the case. This R2 subject the complainant to put to strict proof of all the averments mentioned in the compliant except those which are specifically admitted herein by this respondent.
9. R2 admits that the complainant had taken policy bearing No. 653965391 for the life of his minor son by name Jabeer Ahammad aged 16 years on 28-9-2005 and the details of the policy are given below.
Policy No. 653965391, P & T 179/20, S.a. Rs. 1,00,000/-
Mode : Half yearly Rs. 1,647/0 date of commencement 28-9-2005
F U D 09/2009 LPA 02-6-2009 proposer G. Peer Ahammed.
This respondent denying the remaining contentions mentioned in para No. 1 and the complainant is put to strict proof of the same.
10. This respondents denies the contentions mentioned in para – 2 as not correct and in this regard the respondents submits that the respondent company settled the basic sum assure don 18-8-2010 and replied them that the policy issued based on the proposal submitted by the complainant , as the policy holder was minor with age of 16 years and as per terms and conditions of policy Number accidental benefits is payable as the policy was taken during the minority of the policy holder and therefore, this respondent informed the same to the complainant that the policy is not eligible for the payment of accidental benefits hence, no negligence on the part of the of LIC.
11. This respondent No. 2 subject the complainant to strict proof of all averments in para No. 3 it is submitted that the insurance Ombudsmen, Hyderabad considered all particulars and report of the complainant and rejected his complaint stating that the policy amount was settled by the insurance company as per terms and conditions of the policy. The complainant is further mentioned in para – 3 that the respondents did not inform the terms and conditions of the policy properly and they are negligent as false. The R2 submits that the policy holder had the option to avail accident benefits rider on completion of 18 years age, by submitting the requisite form to the satisfaction of the corporation and payment of entire premium to be charged from the policy anniversary falling after date of his completion of 18 years of age. The policy holder did not approach the corporation of exercising option for accident benefit, and not submitted any option form to that effect and hence accident benefit was not granted. Therefore, there is no liability on the part of the corporation to the extent of accident benefits.
12. The complaint is barred by limitation and that there is no cause of action for the complainant as mentioned in para – 5 of the complaint. It is therefore prayed that the Hon’ble forum may be pleased to dismiss the complaint filed by the complainant in the interests of justice.
13. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is entitled to the relief as prayed by him or not?
- Whether there is negligence or deficiency of service on the part of the Respondents?
- To what relief?
14. On behalf of the complainant Exhibits A1 to A7 were marked and on behalf of respondents Exhibits B1 to B3 were marked.
15. Point Nos. 1 & 2. It is very clear that the deceased G. Jabbar Ahmmad, son of the complainant had obtained a policy from R1 bearing No. 653965391 commences from 28-9-2005 in the said policy the complainant is nominated as nominee. The deceased life assured G. Jabber Ahammad, had taken another policy from R1 with policy No. 655286318, which commences from 28-7-2008 in this policy the complainant was nominated as nominee. While so, the deceased G. Jabeer Ahammad, died in an accident on 26-8-2009 while discharging his duties in Boarder Security Force, after the death of G. Jabeer Ahammad the respondents settled the claim of complainant in respect of policy bearing No. 655286318 together with accidental benefits. Ex. A1 is the P/c of policy bearing No. 653965391. Ex. B1 is the original policy bond of the same policy. Ex. B2 is the proposal form. Ex. B3 is the original proposal review slip form No. 3104/OIC, dt. 5-10-2005. There is no dispute regarding the policies but policy bearing No. 653965391 is a life insurance policy of the minor son of the complainant i.e. deceased life assured G. Jabeer Ahammad. The policy was obtained by the deceased life assured G. Jabeer Ahammad at the age of 16 years as on the date of 28-9-2005. This policy does not cover the accidental benefit. Ex. A2 clearly proves the death of the deceased life assured G. Jabeer Ahammad, dt. 26-8-2009. The complainant addressed a letter to the insurance Ombudsmen dt. 26-9-2013 for accidental settlement of policy bearing No. 653965391 for the same the insurance Ombudsmen had replied dt. 7-10-2013, stating that as the complaint was time barred. The Insurance Ombudsmen will settle the complaint within one year time and the decision of insurance is as per terms and conditions of the policy conditions. Ex. A6 and Ex. A7 are letter to R1 and R2 by the complainant stating the above policy bearing No. 653965391 obtained by the deceased life assured G. Jabeer Ahammad does not cover the accidental benefit as at the time of obtaining policy the deceased life assured was minor, aged 16 years only. At the same time the policy No. 655286318 was settled by the respondents along with accidental benefits as per complaint. When one policy was settled by the respondents as per terms and conditions they will not do against the terms and conditions and they cannot settle the accidental benefit to the policy bearing No. 653965391. The employees will act as per terms and conditions and rules, regulations of the corporation only. It was very clear that the deceased life assured had obtained the policy bearing No. 653965391 at the age of 16 years, while he was in minority, which does not cover the accidental benefit. So the authorities have settled the claim for the sum assured only. It clearly proves that there is deficiency of service or negligence on the part of the respondents 1 & 2. It is duty of the complainant to verify the policies and if there is any chance to get more benefits from the policies and it is his duty to enhance the premium of the policy. But the complainant did not do so here. It is the burden of the complainant but not the burden of the respondents. Hence, the complainant is not eligible for compensation as prayed by him at the same time there is no deficiency of service or negligence on the part of the respondents 1&2
16. Point No. 3 In the result, the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 14th November 2014.
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Respondents : NIL
Exhibits marked for Complainant : -
Ex. A1 P/c of policy bearing No. 653965391.
Ex. A2 P/c of death certificate of late G. Jabber Ahmed, dt. 26-8-2009.
Ex. A3 P/c of complaint dt. 26-9-2013 lodged by the complainant to the insurance Ombudsman.
Ex. A4 Original letter dt. 7-10-2013 issued by the Insurance Ombudsman.
Ex. A5 correspondence made by the complainant under different letter of acknowledgements cards Nos. 8.
Ex. A6 Copy of request letter to the Manager, LIC of India, Proddatur Branch, dt. 11-6-2012.
Ex. A7 Copy of request letter to the Divisional Manager, Divisional Office, LIC of India, Kadapa dt. 10-12-2011.
Exhibits marked on behalf of the Respondents:
Ex. B1
Ex. B1 Original policy bond No. 653965391.
Ex. B2 Original proposal form dt. 22-9-2015.
Ex. B3 Original proposal review slip (form No. 3104/OIC), dt. 5-10-2005.
MEMBER MEMBER
Copy to :-
- Sri Y. Prasad, Advocate for complainant.
2) Sri G.V. Raghava Reddy, Advocate for R1 & R2.
B.V.P. - - -
