- This is a petition filed by one Smt. Ranjita Bordoloi (hereinafter referred to as the petitioner) against the Branch Manager, Life Insurance Corporation of India Limited Nagaon Branch (hereinafter referred to as the opposite party) U/S 12 of the consumer Protection Act, 1986 praying for recovery of money, compensation and other relief.
- The facts and circumstances for filing of the aforesaid petition as narrated by the petitioner are as follows:-
The father of the complainant, namely, deceased Hiteswar Bordoloi opened a policy with the Life Insurance Corporation of India, Nagaon Branch on last 12/02/2018 and accordingly, the opposite party issued policy in his name vide policy number 401530042 for sum assured Rs.1,15,000.00 (Rupees One Lakh and Fifteen Thousand)only and monthly premium was paid upto the month of October 2019. The petitioner states that she is the only daughter and legal heir of deceased Hiteswar Bordoloi who was predeceased by his wife Late Someswari Bordoloi. Further case of the complainant is that policyholder Hiteswar Bordoloi paid the monthly premium upto the month of October 2019 and thereafter, he was admitted at Haiborgaon Nursing Home unit P.K.B. Nursing Home (Private) Limited, Laokhowa Road, Haibargaon, Nagaon Town on last 03-11-2019 for his illness and after discharge from the Hospital, he suddenly expired on last 05-12-2019. Further case of the complainant is that after expiry of her father Hiteswar Bordoloi, she being his only legal heir placed her claim regarding his policy before the opposite party along with all relevant documents to get the insurance benefit but the opposite party repudiated all her claim and informed her that the “claim not payable”. The complainant submitted that she being the only legal heir of the deceased policy holder entitled to get the insurance benefit against the said policy but the opposite party without any sufficient cause repudiated all her claim by informing that the “claim not payable” and such acts on the part of the opposite party, amounts to deficiency of service on his part. Hence, this claim petition is before this Commission praying for the relief.
The opposite party filed his written version denying all the claim of the petitioner leveled against him. By his written version, the opposite party pleaded inter-alia that there is no cause of action for the complainant to file the petition, that the petition is barred by limitation and that the petition is unsustainable in law and liable to be dismissed. The opposite party admitted the fact of opening the policy by the deceased policy holder Hiteswar Bordoloi and paying the monthly premium upto the month of October 2019 by him. The plea of the opposite party is that last monthly premium was paid on last 12/10/2019 and the next premium was due on 12/11/2019 which must be paid on or before 27-11-201, 15 days from the due date being the grace period and thus, the policy holder having failed to pay the premium due on 12-11-2019 in due time, his policy became lapse as on the date of his death i.e. on 05/12/2019. The opposite party submitted further that as the status of the policy was lapse which means of breach of contract, the policy in question was not in force on the date of death of the deceased policy holder, hence, nothing is payable to the complainant under the said lapse policy. The opposite party again submitted that the repudiation of the claim in the instant case is as per the terms and condition mentioned in the contract of insurance policy and the complainant is not entitled to any relief in this case. Under the above premises, the opposite party prays for dismissal of the claim petition.
3. Upon pleading of parties, the following points are found for discussion and decision in the case:-
- Whether the opposite party illegally denied to extend the benefit to the complainant for the insured policy 401530042 for sum assured Rs.1,15,000.00 (Rupees One Lakh and Fifteen Thousand)only as the only legal heir for the deceased policy holder Hiteswar Bordoloi without any justified cause and such act on the part of opposite party amounts to deficiency in service?
- 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 her claim. The opposite party 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.
6. Decision and reasons thereof:-
7. For the sake of brevity both the Points (i) & (ii) are taken jointly for discussion and decision:-
The claim of the complainant is that her father deceased Hiteswar Bordoloi during his life time opened a policy with the Life Insurance Corporation of India, Nagaon Branch and she being his daughter and only legal heir filed her claim for getting the insurance benefit of the said policy but the opposite party namely, the Manager, Life Insurance Corporation of India, Nagaon Branch without any justified cause refused to pay her the insurance amount and informed her that her claim is not payable. In support of her claim, she as P.W.1 adduced evidence to the effect that her father, namely, deceased Hiteswar Bordoloi opened a policy with the Life Insurance Corporation of India, Nagaon Branch on last 12/02/2018 and accordingly, the opposite party issued policy in his name vide policy number 401530042 and the monthly premium for the said policy was paid upto the month of October 2019. Further evidence of this P.W. is that she is the only daughter and legal heir of deceased Hiteswar Bordoloi who was predeceased by his wife Late Someswari Bordoloi. She again deposed that policyholder Hiteswar Bordoloi paid the monthly premium upto the month of October 2019 and thereafter, he was admitted at Haiborgaon Nursing Home unit P.K.B. Nursing Home(Private) Limited, Laokhowa Road, Haibargaon, Nagaon Town on last 03-11-2019 for his illness and after discharge from the Hospital, he suddenly expired on last 05-12-2019. P.W. 1 also deposed that she being the only legal heir of her deceased father placed her claim regarding his policy before the opposite party along with all relevant documents to get the insurance benefit but the opposite party repudiated all her claim and informed that the “claim not payable”. The complainant as P.W.1 also adduced evidence that she is entitled to get the insurance benefit against the said policy of her deceased father and the opposite party without any sufficient cause refused to extend her the insurance benefit and such act on the part of the opposite party amounts to deficiency of service on his part.
The opposite party while filing his written version submitted that the monthly premium for the policy which was due on last 12/11/2019 not being paid on or before 27/11/2019, the said policy was lapsed as per terms and condition of the policy and hence, the insured amount could not be paid to the complainant and thus, there was no negligence on his part. In support of the written version, the opposite party examined one Gautam Paul as D.W.1. In his evidence in affidavit this D.W. deposed to the effect that. the policy was opened by the deceased policy holder Hiteswar Bordoloi who paid the monthly premium of Rs.922.00 only upto the month of October 2019 and the next premium was due on 12/11/2019 which was not paid within the grace period of 15 days from due date. He deposed that the monthly premium which was due on 12/11/2019 must be paid on or before 27-11-2019, 15 days from the due date being grace period and the policy holder having failed to pay the said premium in due time, the policy was lapsed and as on the date of death of the deceased policy holder i.e. 05/12/201, the status of the policy was lapse which means of breach of contract , so, nothing is payable to the complainant under the said lapse policy. His further adduce evidence is that the repudiation of the claim in the instant case was as per the terms and condition mentioned in the contract of insurance policy and the complainant is not entitled to any relief in this case.
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 Hiteswar Bordoloi and payment of monthly premium upto the month of October 2019 were not disputed. The fact that monthly premium which was due on 12/11/2019 was not paid on or before 27-11-2019 i.e. within the grace period of 15 days is also not disputed. The death of the policy holder Hiteswar Bordoloi occurred on last 05-12-2019. The opposite party pleaded and also adduced evidence that as on the date of death of deceased policy holder, the status of the policy was lapse due to non-payment of monthly premium in due time, no insurance benefit can be claimed on the said policy. From the Insurance policy which was exhibited vide Ext.1, it is seen that clause 2 of the policy read as follows:-
- Payment of premium:- A grace period of one month but not less than 30 days shall be allowed for payment of yearly or half yearly or quarterly premium and 15 days for monthly premium. If the premium is not paid before the expiry of the days of grace, the policy lapses
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 12/11/2019 which was not paid on or before 27-11-2019 i.e. within the grace period of 15 days. The death of the policy holder Hiteswar Bordoloi occurred on 05-12-2019. Hence, on the date of death of policy holder, the policy in question was not in force and was lapsed. The policy holder during his life time did not apply for revival of his discontinued policy as per clause 3 of the Insurance policy.
Thus, in view of above observation we do not find any cogent and plausible reason to allow the petition filed by the complainant. She can not claim any insurance benefit under the policy of her father which not in force on the date of death of her father Late Hiteswar 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.
Inform all the parties concern.
Given under the hand and seal of this Commission, we signed and delivered this Judgment on this 31st Day of July 2023.
