Chandigarh

StateCommission

A/397/2014

Thapar University - Complainant(s)

Versus

Bharti AXA General Insurance Limited - Opp.Party(s)

Sonal Datta, Adv.

13 Feb 2015

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

                                                                 

First Appeal No.	:	397 of 2014
Date of Institution	:	22.12.2014
Date of Decision	:	13.02.2015

 

 

Thapar University (deemed to be a University), Bhadson Road, Patiala through its Registrar.

 

……Appellant/Complainant.

Versus

1.    Bharti AXA General Insurance Limited through its Area Manager having its Office at SCO No.350-352, First Floor, Sector 34-A, Chandigarh.

2.    Bharti AXA General Insurance Limited having its registered office at 1st Floor, Ferns Icon, Survey No.28, Duddanakkundi Village KR Puram Hobli, Bangalore-37.

…Respondents/Opposite Parties.

 

Appeal under Section 15 of the Consumer Protection Act, 1986.

 

BEFORE:       JUSTICE SHAM SUNDER (RETD.), PRESIDENT

              SH. DEV RAJ, MEMBER

              MRS. PADMA PANDEY, MEMBER

 

Argued by: Sh. Vikas Mohan Gupta, Advocate for the appellant.

                Sh. Gaurav Bhardwaj, Advocate for the respondents.

 

PER DEV RAJ, MEMBER

              This appeal is directed against the order dated 11.11.2014, rendered by the District Consumer Disputes Redressal Forum-I, UT, Chandigarh (hereinafter to be called as the District Forum only) vide which it partly allowed the complaint and directed the Opposite Parties as under:-

“17. For the reasons recorded above, we do not find any just ground for making payment of the amount of Rs.4,86,838/- each as compensation to Mr. Deepak Singh and Mr. Anurag Palta.  However, the claim submitted by the complainant on account of the death of father of Miss Damanjit Kaur needs to be decided sympathetically. Accordingly, the complaint is partly allowed. It is directed that the OPs shall decide the claim of death of Sh. Ram Singh within a period of two months of the receipt of certified copy of this order.  The OPs are also directed to make payment of compensation of Rs.15,000/- to the complainant on account of deficiency in service in not deciding the claim submitted by the complainant on account of the death of Sh. Ram Singh.   The OPs shall also make payment of Rs.7,500/- to the complainant towards litigation costs. 

18.  This order be complied with by the OPs within two months from the date of receipt of its certified copy failing which they shall make the payment of an amount of Rs.3,80,162/-, on account of death of Sh. Ram Singh, and the compensation amount of Rs.15,000/- with interest @ 12% per annum from the date of filing of the complaint till realization, apart from the amount of litigation expenses, mentioned above.”

2.           The facts, in brief, are that the complainant, being a deemed University, took an Insurance Policy called ‘Group Personal Accident and Amartya Shiksha Yojna’ bearing No.APG/I1039421/91/09/D59119 (Annexure C-2) from the Opposite Parties covering the risk of accidental death and partial total disablement for its students and their parents.  It was stated that the said Policy was valid for the period from 1.10.2012 to 30.9.2013 and the total premium paid by the complainant to the Opposite Parties was Rs.7,30,956/-. It was further stated that except the documents appended with Annexure C-2, no other document including any alleged terms and conditions of the Policy were provided to the complainant by the Opposite Parties. It was further stated that the said Insurance Policy was obtained from the Opposite Parties to insure the payment of fee of the students whose parents expired during the course of their academic session with the complainant-University.  It was further stated that before taking the Insurance Policy, in question, the proposal dated 11.09.2012 alongwith the details of students, to be covered under the aforesaid Yojna was sent to the Opposite Parties, which was duly acknowledged by them and they (Opposite Parties) quoted the rate of premium of Rs.25 Lacs, which was later on reduced to Rs.24.50 Lacs. It was further stated that during the subsistence of the Policy, unfortunately, the fathers of three students namely Miss. Dhamnjit Kaur, Mr. Anurag Palta and Mr. Deepak Singh expired and the claims with regard to their sudden demise were submitted to the Opposite Parties. It was further stated that the Opposite Parties failed to pay the compensation amount on account of death of the parents, aforesaid, except partial payment of compensation in respect of only the students namely Mr. Deepak Singh and Mr. Anurag Palta.

3.           It was further stated that as per Annexures C-2 and C-3 respectively, the amount of compensation payable, as per the terms and conditions of Insurance Policy with respect to the death of Late Sh. Ram Singh, father of Miss. Damanjit Kaur, was Rs.4,90,000/- but till date, no payment was received with regard to the above said claim. It was further stated that the said compensation amount was payable as the sum insured corresponded to the balance fee payable by Miss Damanjit Kaur for her remaining years of academic course.

4.           It was further stated that with respect to the death claim of the father of Mr. Deepak Singh namely Sh. Brij Raj (expired on 15.12.2012), the complainant University submitted claim alongwith all the requisite information, and the documents to the Opposite Parties, and as per the Policy, an amount of Rs.8,67,000/- was payable as compensation. It was further stated that the Opposite Parties reimbursed the compensation amount of R.3,80,162/- only. It was further stated that similarly in the case of the death claim of Late Sh. Manoj Palta (expired on 02.01.2013), father of Mr. Anurag Palta, only an amount of Rs.3,80,162/- was paid whereas he was entitled to an amount of Rs.8,67,000/-. It was further stated that perusal of Annexure C-3 revealed that the compensation amount was insured to the extent of the remaining fee, to be paid by the students, whose parents expired during their academic course, as a student who is studying in the first year of his/her course and parents of such student expired, in that eventuality, the compensation amount would commensurate with the remaining fee and would be more if compared to the student whose parents expired, who is studying in the final batch with the complainant University.

5.           It was further stated that as the Opposite Parties failed to pay the compensation amount, complainant University vide various emails dated 01.08.2013, 03.12.2013 and 26.12.2013 (Annexure C-11 colly.) requested them (Opposite Parties) to pay the said compensation amount. It was further stated that when nothing was paid, the complainant University was constrained to issue legal notice dated 09.01.2014 (Annexure C-12) to the Opposite Parties but to no avail.

6.           It was further stated that the aforesaid acts of the Opposite Parties, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Parties, to pay an amount of Rs.14,65,676/- alongwith interest; compensation for mental harassment on account of deficiency in service and cost of litigation.

7.           The Opposite Parties, in their joint written version, admitted that the complainant got a Group Personal Accident Insurance Policy, from the Opposite Parties, for its 5530 students, and their parents for the period from 1.10.2012 to 30.09.2013 and the sum assured under the Policy was Rs.55,30,00,000/- i.e. Rs.1 Lac per student for accidental death & permanent disability; and Rs.2,10,23,00,000/- i.e. Rs.3,80,162/- per parent, for accidental death plus permanent disability. It was stated that, under the Policy, the claim was payable subject to its terms and conditions. It was denied that the complainant got “Amartya Shiksha Yojna” from the Opposite Parties. It was also denied that the Policy included the amount of compensation according to their specific course and batch including Insurance cover required for their parents. It was stated that there was no coverage for insuring the expenses of batch fee and the complainant concocted a false story. It was denied that the terms and conditions of the Policy were not supplied to the complainant. It was further stated that as per Annexure C-2, the coverage was for accidental death plus permanent total disablement and all other terms and conditions as per the Standard Group Personal accident Policy were applicable. It was denied that the Opposite Parties issued Amartya Shikha Yojna Policy, under which the fee of students enrolled for each course and for each batch were insured. It was further stated that Annexure C-3, produced by the complainant, was false. It was further stated that perusal of Annexure-II clearly revealed that the said document was falsely prepared only to get undue benefit because in the said list under batch 2009-10, the total number of students were mentioned as 1435, 1778 students for 2010-11, 2606 students for 2011-12 and 3004 students for 2012-13 whereas in the summary, the number of students was changed but the sum assured was shown to be the same, which clearly proved that the said document was falsely prepared.

8.           It was further stated that the Opposite Parties had already paid an amount of Rs.3,80,162/- each on account of the death of Sh. Brij Singh (father of Mr. Deepak Singh) and Sh. Manoj Palta (father of Mr. Anurag Palta) as per the terms and conditions of the Policy. It was further stated that amount of Rs.3,80,162/- was paid being full sum assured under both the claims. It was further stated that as per record of the Opposite Parties, no claim was lodged on account of the death of Sh. Ram Singh (father of Miss Damanjit Kaur) and, as such, there was no violation of Condition 11(a) of the Policy. It was further stated that the Opposite Parties were verifying the genuineness of the alleged email (Annexure C-5). It was further stated that Sh. Ram Singh died on 24.10.2012 whereas the present email was allegedly sent on 31.08.2013. It was denied that Rs.4,92,000/- were payable as per the Policy. It was further stated that the claim, if any, was payable as per the terms and conditions of the Policy. It was denied that the claim was payable as per Annexure C-3 i.e. sum assured for the balance fee. It was further stated that since there was no coverage for balance fee, therefore, there was no occasion for paying any compensation. Lastly, it was denied that the total claim amount was Rs.21,26,000/- and the complainant was entitled to get the amount of Rs.14,56,676/- from the Opposite parties. It was further stated that the Opposite Parties, were neither deficient, in rendering service nor they indulged into unfair trade practice. The remaining averments, made in the complaint, were denied.

9.           The Parties led evidence, in support of their case.

10.         After hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, partly allowed the complaint of the complainant (now appellant), as stated in the opening para of the instant order. 

11.         Feeling aggrieved, the instant appeal, has been filed by the appellant/complainant.

12.         We have heard the Counsel for the parties, and have gone through the evidence and record of the case, as also the written submissions of both the parties, carefully.

13.         The Counsel for the appellant/complainant, submitted that the complainant University obtained Insurance Policy, to secure its students, in case of death of students or if earning parents of a student expired on account of accident then compensation as mentioned in Annexure II attached with Annexure C-3, which was the sum insured as per the Insurance Policy was to be paid. He further submitted that at Page 30, batch-wise number of students was indicated and the total number of students was 5530. He further submitted that 5530 students were insured in the sum of Rs.5530 Lacs and 5530 parents in the sum of Rs.21023 lacs and the total sum insured was Rs.2,65,53,00,000/- and the University paid premium of Rs.7,30,956.86Ps. He further submitted that the purpose of insuring the parents was that, in the event of death of a parent, the remaining fee could be covered by the insurance claim and, therefore, the insurance cover for the parents of different batches was to vary. He further submitted that the parents of three students expired and the compensation sought was in the sum of Rs.4.92 Lacs, 8.67 Lacs and 8.67 Lacs respectively. He further submitted that the Insurance Company projected that each parent of a student was insured to the extent of Rs.3,80,362/- and not as per Annexure II attached with Annexure C-3. He further submitted that the Insurance Company also stated that Annexure II attached with Annexure C-3 was false. He further submitted that the Insurance Company stated that Group Personal Accident Policy, and not Amartya Siksha Yojna Policy, was issued. He further submitted that the appellant - University vide its letter dated 11.9.2012 alongwith Annexure I and Annexure II, attached with Annexure C-3, sought rates from the Opposite Parties. He further submitted that the Opposite Parties confirming the receipt of cheques towards payment of premium in respect of renewal of student GPA Policy, indicated the terms of coverage as “As per quote submitted”. He emphasized that the words “As per quote submitted” meant that the Opposite Parties had accepted the proposal as indicated in Annexure II of Annexure C-3. He further submitted that number of students in each batch was mentioned and the sum insured in respect of each batch was also mentioned. He further submitted that the only restriction was that in case number of students in a particular batch exceeded the number given in Annexure II, the claim was not payable. He further submitted that Clause 3 of the Insurance Policy corresponded to the information provided in Annexure II attached with Annexure C-3 and had earning parents of each student been insured for Rs.3,80,162/- as claimed by the Insurance Company, then there would not have been any requirement of incorporating such clause in the terms and conditions of the Insurance Policy. He, therefore, submitted that the findings of the District Forum, in the impugned order, were totally against the record and law and were liable to be set aside and the complaint was liable to be allowed in totality with costs.

14.         The Counsel for the respondents/Opposite Parties, submitted that as per Group Personal Accident Insurance Policy, the total sum assured was to be divided by the total number of persons insured and the figure achieved was the sum assured for each person. He further submitted that since 5530 students were insured, each student having been insured for Rs.1 Lac, the total sum assured was Rs.55,30,00,000/- and 5530 parents were insured for a total sum of Rs.2,10,23,00,000/- i.e. @Rs.3,80,162/- each parent. He further submitted that nowhere in the Policy or its terms and conditions, it was mentioned that fee to be paid by each student was to be indemnified by the Insurance Company. He further submitted that in Annexure C-3, attached with the complaint, the appellant/complainant sought the accident covering the contingency of death/permanent total disablement resulting directly from external, violent & visible means and death during surgical operation or within 7 days period thereafter at hospital was treated as death due to accident and nowhere the word ‘fee of the student’ was mentioned. He further submitted that the appellant/complainant was mentioning Amartya Shiksha Yojna Policy of their own and there was no such Policy of the Company. He further submitted that Annexures I & II of Annexure C-3 (Pages 30 & 31) were never accepted by the respondents/Opposite Parties. He further submitted that the respondents/Opposite Parties covered risk I & II and the same was mentioned at Page 32 of the complaint and it was clearly mentioned that Accidential death _ Permanent Total Disability was covered in the Policy. He further submitted that the appellant/complainant might be mentioning anything in its prospectus but the Insurance was to governed by the terms and conditions of the Policy and the claim was to be regulated as per the Policy. He further submitted that the terms and conditions of the Policy were supplied and it was specifically mentioned in Annexure C-2 that “Your Group PA Policy is enclosed.” He further submitted that the appellant/complainant never raised any protest after receiving the Policy regarding the basis and coverage of the Policy. He further submitted that the words “As per quote submitted” meant the premium quoted by the Opposite Parties. He further submitted that the respondents/Opposite Parties did not prefer any appeal though there was breach of Condition No.11 of the Policy in lodging the claim, but they have complied with the order passed by the District Forum on humanitarian grounds. He, therefore, submitted that the appellant/complainant is not entitled to any relief claimed in the appeal and the same be dismissed in the interest of justice.

15.         It is evident, from record, that the appellant/complainant obtained Group Personal Accident Policy, effective for the period from 1.10.2012 to 30.09.2013. The Policy, so obtained, covered 5530 students @Rs.1 Lac per student, for the total sum insured of Rs.55,30,00,000/- and 5530 parents in the sum insured of Rs.2,10,23,00,000/- i.e. @Rs.3,80,162/- each parent. The Insurance Company vide its email dated 27.09.2012 had given premium chargeable, which was in the sum of Rs.1,52,231/- for students and in the sum of Rs.5,78,725/- for parents for a combined Policy of students and parents. The letter dated 01.10.2012 of the respondents/Opposite Parties, as per quote submitted, is apparently with reference to rates of premium quoted/submitted by the respondents/Opposite Parties and not the rates submitted by the appellant/complainant as contended by it. The Insurance Policy No.APG/I1039421/91/09/D59119 (Annexure C-2), contained the following terms and conditions:-

1)	Unnamed GPA policy – from the date of policy inception 5530 students & 5530 Parents are covered under the policy. Students and Parents members needs to submit a valid proof of the school ID card and Roll Register at the time of claim.
2)	For Students & Parents – Accidental Death + Permanent Total Disability is covered under the Policy.
3)	It is hereby warranted that the total no. of each class/band Students/Parents as on the date of any incident giving rise to any claim under the policy should not be more than the total no. of Students/Parents for each class/band on rolls of the company as on such date and if the no. of Students/Parents is found to be more than the persons covered under the policy the person in whose respect the claim is being preferred would be deemed not to be covered under the Policy and no claim in respect of such persons(s) shall be admissible under the policy.
4)	All other terms and conditions as per standard GPA policy will be applicable.

 

16.         Firstly, the details given in Annexure-II do not reveal that the Policy, in question, was secured to utilize the claim, in the event of death of a parent, to cover fee for the remaining period of course. On the other hand, the respondents/Opposite Parties have also categorically denied the same and have contended that they neither received the same nor such was the proposal at any stage. Not only this, the respondents/Opposite Parties, have stated that even the Policy was ‘Group Personal Accident Policy’ and not ‘Amartya Shiksha Yojna’ as contended by the appellant/complainant. The respondents/Opposite Parties have submitted that by dividing the sum assured for the parents viz. Rs.2,10,23,00,000/- with number of students viz. 5530, the claim in case of death of a parent came to be Rs.3,80,162/-  and that was the amount payable. There is force in the argument of the respondents/Opposite Parties that the Policy did not indicate that the same was obtained to ensure payment of fee of the student whose parent expired during his/her academic course, as the terms and conditions of the Policy (Annexure C-2) do not corroborate this averment of the appellant/complainant. The respondents/Opposite Parties have also rightly questioned the genuineness of Annexure –II, on the ground, that while the number of students for the years 2009-2010, 2010-2011, 2011-2012 and 2012-2013 was 1435, 1778, 2606 and 3004 respectively, the number in the summary was changed.

17.         In M/s.Suraj Mal Ram Niwas Oil Mills (P)     Ltd. v. United India Insurance Co.Ltd. (SC) in Civil Appeal No.1375 of 2003, decided on 8.10.2010, the Hon’ble Apex Court  held that “It is trite that in a contract of insurance, the rights and obligations are governed by the terms of the said contract. Therefore, the terms of a contract of insurance have to be strictly construed, and no exception can be made on the ground of equity…..”  In Export Credit Guarantee Corpn. Of India Ltd. Versus M/s Garg Sons International’s case, the Hon’ble Supreme Court of India in Para 8 held as under:-

“8. It is settled legal proposition that while construing the terms of a contract of insurance, the words used therein must be given paramount importance, and it is not open for the Court to add, delete or substitute any words. It is also settled, that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the policy, its terms have to be strictly construed in order to determine the extent of the liability of the insurer. Therefore, the endeavour of the Court should always be to interpret the words used in the contract in the manner that will best express the intention of the parties. (Vide: M/s. Suraj Mal Ram Niwas Oil Mills (P) Ltd. v. United India Insurance Co. Ltd., (2010) 10 SCC 567 = 2010 (3) CPC 222 S.C.).”

18.         Apparently, the relevant provisions of the prospectus relating to Amartya Shiksha Yojna Policy, as stated by the appellant/complainant in Para 10 of its complaint, were not incorporated in the Policy (Annexure C-2). As such, simply on the basis of the documents Annexure I and II, appended with Annexure C-3, it could not be assumed that the respondents/Opposite Parties accepted the Amartya Shiksha Yojna Policy, mentioned in the Prospectus of the appellant/complainant University and agreed to make payment of the fee of the accidental contingency to the insured parents/guardians of the insured student for continuation of education in respect of the covered course till completion of the course.  Since the rights and obligations were to be strictly governed by the Insurance Policy, the District Forum rightly held that while construing the terms of the Policy, it was not expected to venture into extra liberalism to re-write the contract or substituting the terms, which were not intended by the parties. Thus, the contention of the appellant/complainant that in case of death of a parent, the entire fee of the remaining course period of the two students namely Mr. Deepak Singh and Mr. Anurag Palta was to be paid by the respondents/Opposite Parties was rightly turned down by the District Forum. Since 5530 parents were insured for an amount of Rs.2,10,23,00,000/-, therefore, the sum assured per parent was Rs.3,80,162/- and as the respondents/Opposite parties had already made the payment of an amount of Rs.3,80,162/- each towards the claims of Sarvshri Brij Singh and Manoj Palta, fathers of Deepak Singh and Anurag Palta, therefore, the amount of compensation was duly paid in accordance with the terms and conditions of the Policy.

19.         So far as the averment of the appellant/complainant, that it was never conveyed the terms and conditions of the Standard Group Personal Accident Policy was concerned, Term and Condition No.4 of Policy information at pages 20 & 21 of the District Forum file, as extracted above, clearly revealed that all other terms and conditions as per standard GPA Policy would be applicable. The District Forum has rightly held that the officers of the appellant/complainant-University, being educated persons, could easily obtain the terms and conditions as per standard GPA Policy from internet or they could also ask the respondents/Opposite Parties to send the same, which was not done. Even the appellant/complainant did not lodge any protest with the respondents/Opposite Parties, when it received the Policy information (Annexure C-2) that the terms and conditions of the Policy were not in accordance with their proposal and the same did not secure the fee to be charged by it in case of death of earning parents of a student.  Since the appellant/complainant did not adopt this course, the District Forum rightly observed that the respondents/Opposite Parties were not bound to pay compensation to the tune of Rs.8.67 lakhs each towards the fee of Sh. Deepak Singh and Sh. Anurag Palta.

20.         As regards death claim of Sh. Ram Singh, father of Miss Damanjit Kaur, the District Forum, in Para 16 of its order, rightly observed that the claim was duly lodged by the appellant/complainant through email message dated 31.8.2013 (Annexure C-6) and, as such, the contention of the respondents/Opposite Parties, that they did not receive the death claim of Sh. Ram Singh was not accepted. In our considered opinion, the District Forum was also right in holding that the respondents/Opposite Parties, ought to have sympathetically considered the case of compensation on account of the death of Sh. Ram Singh. To this extent, there was deficiency, in rendering service, on the part of the respondents/Opposite Parties, for which, the District Forum rightly directed the respondents/Opposite Parties to decide the death claim of Sh. Ram Singh within a period of two months of the receipt of certified copy of its order and to pay Rs.15,000/- as compensation on account of deficiency in rendering service besides Rs.7,500/- towards litigation costs. As submitted by the Counsel for the respondents/Opposite Parties in its written submissions, the order has been complied with.

21.         No other point, was urged, by the Counsel for the parties.

22.         In view of the above discussion, it is held that the order passed by the District Forum, being based on the correct appreciation of evidence, and law, on the point, does not suffer from any illegality or perversity, warranting the interference of this Commission.

23.         For the reasons recorded above, the appeal filed by the appellant/complainant, is dismissed, with no orders as to costs. The impugned order, passed by the District Forum, is upheld.

24.         Certified Copies of this order be sent to the parties, free of charge.

25.         The file be consigned to Record Room, after due completion.

Pronounced.

February 13, 2015.

 

Sd/-

 [JUSTICE SHAM SUNDER (RETD.)]

PRESIDENT

 

 

Sd/-

 [DEV RAJ]

MEMBER

 

 

Sd/-

[PADMA PANDEY]

MEMBER

 

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