This C.C. is coming before us for hearing in the presence of Sri. Gogula Brahmaiah, Advocate for complainants; and of Sri. Kandibanda Srinivasu, Advocate for opposite parties No.1 and 2; upon perusing the material papers on record; upon hearing arguments and having stood over for consideration, this Forum passed the following:-

O R D E R

(Per Smt.V.Vijaya Rekha, Member)

This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. 

2.      The brief facts as mentioned in the complaint are that the husband of complainant No.1 and the father of complainant No.2 had obtained life insurance policy from the opposite parties vide policy No.0155107400 for an assured amount of Rs.62,500/- by paying Rs.12,500/- towards yearly premium.  The policy was started on 01-03-2010 for  a term of 20 years till 01-03-2029.  After payment of 3 yearly premiums, the policy holder was died on 12-06-2013 in a Motor Accident.  The police, Palvoncha registered the case U/Sec. 304(A) of IPC.  As per inquest and PME report the policy holder was died due to rapture of vital organs.  After submission of claim form the opposite parties paid Rs.62,500/- towards assured amount on 17-10-2013 through online payment but failed to pay death benefits including fund value.  Upon which, issued legal notice to the opposite parties on 30-10-2013, in turn they have sent reply notice by denying their liability under policy.  The complainant also submitted that the contents of reply are not genuine and correct, in fact, they received only Rs.62,500/- but not Rs.65,000/- as mentioned in the reply.  Having no other go, approached this Forum by praying to award Rs.62,500/- towards death benefits including fund value under policy and costs.

3.      In support of their case, the complainant No.1 filed affidavit.  Exhibits   A-1 to A-5 were marked on behalf of complainants.

4.      After receipt of notice, the opposite parties appeared through their counsel.  The opposite party No.1 filed counter by denying the averments of complaint.  No counter was filed on behalf of opposite party No.2. 

5.      In it’s counter, the opposite party No.1 admitted the issuance of policy for an assured amount of Rs.62,500/- but denied the other averments by contending that the allegations leveled in the complaint are not true and correct and as such the present complaint is not maintainable either in law or on facts.  Further they also submitted that after receipt of application regarding death claim, they have paid Rs.62,500/- on 17-01-2013 towards sum assured amount.  As per terms and conditions of policy, if the life assured dies on or after the age of 7 years and before attaining the age of 60 years, then the death benefit will be the greater of sum assured in respect of regular premium reduced by the value of units withdrawn through partial withdrawals from regular premium fund value in the last 24 months prior to the date of death.  The opposite party No.1 also referred the decision of Hon’ble Apex Court in Ravneet Singh Bagga Vs. KLM Royal Dutch Airlines (2000) 1 SCC 66 and prayed to dismiss the complaint as it is frivolous and vexatious and also there is no deficiency of service on their part.      

6.      In support of their contentions, the opposite parties filed premium receipts and policy schedule under B-1 and B-2 through the petitions vide IA.No.31/2016 and 33/2016, those were marked as exhibits.

7.      The complainant No.1 filed written arguments by reiterating the same averments as mentioned in the complaint. 

8.      In view of the above submissions, now the point that arose for consideration is,

Whether the complainant is entitled to the relief as prayed for?

Point:-       

It is an admitted fact that after death of policy holder the opposite parties paid an amount of Rs.62,500/- towards policy amount through online transaction on 17-10-2013 and also an undisputed fact that the policy holder was died after 3 years from the date of commencement of policy.  The only dispute is with regard to the non-payment of death benefits and fund value in addition to receipt of Rs.62,500/- towards assured amount.  It is the case of the complainants that the opposite parties have paid only sum assured amount of Rs.62,500/- but failed to pay the other death benefits of Rs.62,500/- including fund value under policy.  On the other hand the opposite parties resisted the same by contending that there is no liability on the part of them in payment of death benefits and fund value except payment of sum assured amount under terms and conditions of present policy and as such there is no deficiency of service on their part, in support of its averments, the opposite party No.1 placed terms and conditions of policy, marked under Exhibit B-2.  As per policy schedule, which is a part and parcel of Exhibit B-2, the sum assured amount was mentioned as Rs.62,500/- and the minimum death benefit is also mentioned as Rs.62,500/- subject to relevant death benefit section of policy.  As per Sec. 7 of policy conditions, the policy benefits were categorized as a) death benefit b) maturity benefit c) surrender value.  In the instant case, the policy was obtained on 01-03-2010 at the age of 51 years and the policy holder was died on 12-06-2013 i.e. after 3 years 3 months from the date of commencement of policy.  And as per Section 7 of terms and conditions of policy, in case of occurrence of death before maturity period, the entitlement is restricted to death benefit only.  Section 7 (a)(ii)(i)(a) and (b) clearly speaks that “If the life assured dies on or after date of commencement of risk and before attaining age 60 years: 1) higher of; a) The sum assured less the regular premium fund value reduced by all partial withdrawals, if any per section 8 b) below, in the 24 months immediately prior to the date of death and b) The top up premium fund value, if any, as on the date of receipt of intimation of death at the company’s office”.  There is no proof of record with regard to the partial withdrawals i.e. after commencement of 3 years of policy.  Therefore, the complainants are entitled only death benefit of Rs.62,500/-, evidenced under page Nos. 21 and 22 of Exhibit B-2.  So, the relief, claimed by the complainants are beyond the terms and conditions of policy, therefore, this Forum cannot go beyond the terms and conditions, those were agreed by the both the parties while entering into the contract, in this respect we have relied upon the judgments of Hon’ble National Commission in LIC of India Vs. Banwari Lal Yadav IV (2013) CPJ 38 (NC) and in LIC of India Vs. Shri Girraj Mehta in RP No.3123/2008 decided on 25-05-2010.  In LIC of India Vs. Shri Girraj Mehta’s case, the Hon’ble National Commission categorically stated that “the courts should give true import of terms and conditions of policy, without making any addition or even stretching those terms and conditions”.              

In view of the above circumstances, we cannot fasten any liability on the part of opposite parties beyond the terms and conditions of policy, therefore, the point is answered accordingly against the complainants.

9.      In the result, the complaint is dismissed. No costs.

           Typed to dictation, corrected and pronounced by us in the open forum, on this the 23^rd day of August, 2017.

Member                   Member               President

                                                          District Consumer Forum,

Khammam.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant                                                    For Opposite party  

       None                                                                          None

DOCUMENTS MARKED:-

For Complainant                                                    For Opposite party

Member                   Member               President

                                                          District Consumer Forum,

Khammam.