CONSUMER DISPUTES REDRESSAL FORUM
PALAKKAD, KERALA
Dated this the 31st day of October, 2012.
Present: Smt. Seena. H, President
: Smt. Preetha. G. Nair, Member
: Smt. Bhanumathi. A.K, Member Date of filing: 11/07/2012
CC /122/2012
Abdul Rahiman,
S/o.Abdul Kareem, - Complainant
Aged 45 years,
r/a 1/314, Maimanath, Thannissery P.O,
Koduvayoor, Palakkad.
(BY ADV. Ullas Sudhakaran)
Vs
1. Branch Manager,
Life Insurance Corporation of India,
Branch Office, Chittur Tower, - Opposite parties
Anicode Junction, Chittur 678 101
(BY ADV. T.P.George)
O R D E R
BY SMT. SEENA.H, PRESIDENT
Complaint in brief:-
Complainant's wife was appointed as IRDA agent of opposite party. She had availed a group insurance policy from LIC with effect from 1/09/2008 premium at Rs. 720/- was being deducted from the commission receivable by her. The premium was deducted for the years 2008-09, 2009-10 & 2010-11. Rs 3,00,000 is the insured amount payable by opposite parties as per the policy. While so complainant's wife was diagnosed to be suffering from breast cancer and subsequently expired on 1/04/2011. Complainant claimed for disbursement of agent's benefits and the insurance amount. Opposite party replied stating claim is not payable since the complainant's wife's service as an agent was terminated on 1/07/2009. Opposite party had collected the premium for the period 2008-09, 2009-10 and 2010-11. Hence the act of opposite party in repudiating the claim is not legal and proper. Complainant caused a lawyer notice to opposite party demanding group insurance claim amount and other benefits payable to the complaint's wife for which opposite party replied stating that at the time of death of the complaint's wife, the agency was not in force and as per condition of the master policy and agency regulations, complaint's wife is not entitled to terminal benefits such as group insurance payment or gratuity and that the premium wrongly deducted would be refunded to the complainant.
The act of opposite party has resulted in heavy monetary loss and mental agony to complainant. Act of opposite party amounts to clear deficiency in service. Hence the complaint.
Opposite party resisted the complaint with the following contentions.
Opposite party admits that the complainant's wife was an agent of opposite party with effect from 2002 and she was the beneficiary of the group insurance scheme. A sum of Rs. 720/- as premium was deducted from the agent's commission from 2008 onwards. As per term 8 of the scheme, the assurance effected on the life of the agent shall be terminated if he/she ceased to be an agent of the corporation. In this case complainant's wife Thahira's agency was terminated by the opposite party due to lack at business with effect from 1/07/2009. Thahira died on 1/04/2011. Since the agency was terminated on 1/07/2009, she is not eligible for the claim benefits. The premium due for 2009-10 and 2010-11 was mistakenly deducted and opposite party is ready to refund the said amount. Opposite party prays for dismissal of complaint.
Complainant and opposite parties filed chief affidavit, Ext A1 to A11 and Ext. B1 to B2 marked.
Issue for Consideration :-
1. Whether there is any deficiency in service on the part of opposite party?
2. If so, what is the reliefs and cost complainant is entitled to?
Issue No.1 &2
Complainant's wife was the agent of the opposite party is admitted. It is also admitted that she was a beneficiary under the agents group insurance scheme. Complainant has not disputed the fact that agency was terminated on 1/07/2009. It is also an admitted fact by opposite party that subsequent to the termination of agency also opposite party deducted insurance premium for two subsequent years. Complainant's wife died on 1/04/11 is evident from Ext. A5
The limited question to be decided here is whether complainant is eligible for the claim amount after termination of agency. Ext B1 Annexure B dealing with the rule of the scheme provides that
Clause 8 : - Termination of Assurance
The Assurance on the life of a Member shall terminate upon the happening of any of the following events and no benefit will become payable there under :-
(a) Discontinuance of contributions relating to the Assurance for any reason whatsoever.
(b) The Member reaching the Terminal Date.
(c) The Member ceasing to be agent attached to the Corporation.
Thus once the agency is terminated the party is not eligible for any claim amount but the opposite party subsequently deducted premium for 2 more years which according to them was an error. We find that only when the claim was made opposite party has noted this error. So admittedly there is deficiency in service on the part of opposite party for which complainant has to be adequately compensated. We are of the view that mere refund of the premium amount will not meet the ends of Justice.
In the result complaint partly allowed. Opposite party directed to pay complainant an amount of Rs. 20,000/- (Rupees Twenty Thousand only) as compensation and Rs. 1000/- (Rupees One Thousand only) as cost of the proceedings.
Order shall be complied within one month from the date of receipt of order, failing which the complainant is entitled for 9% interest per annum for the whole amount from the date of order till realization.
Pronounced in the open court on this the 31st day of October, 2012
Sd/-
Smt. Seena. H
President
Sd/-
Smt. Preetha.G.Nair
Member
Sd/-
Smt. Bhanumathi.A.K
Member
A P P E N D I X
Exhibits marked on the side of complainant
Ext. A1 – Appointment order of LIC agent on probation dt.21/06/2002 (Photocopy)
Ext. A2 – Agent I.D. Card dtd. 21/06/2002 (Photocopy)
Ext. A3 – Certificate of training dated 22/02/2008 (Photocopy)
Ext.A4– Agent's Licence in Insurance Regulatory Authority dtd. 16/05/2008 (Photocopy)
Ext.A5- Death certificate of AIMS Research Centre dtd. 1/04/2011 (Photocopy)
Ext.A6- Request letter of Group insurance claim dtd. 27/05/2011 (Photocopy)
Ext.A7- Reply letter of Group insurace claim dtd. 15/06/2011 (Photocopy)
Ext.A8 – Reply to petition under R.T.I dtd. 17/09/2011 (Photocopy)
Ext. A9- Lawyer Notice copy with postal receipt & ack card dtd. 1/02/2012(Original copy)
Ext. A10- Reply letter with LIC Branch office Chittur dtd. 17/02/2012 (original copy)
Ext. A11-Certificate issued by Dr. T.S. Ganesan of Amrita Institute of Medical Sciences dtd. 20/07/2011 (original copy)
Exhibits marked on the side of opposite party
Ext. B1 – True copy of Group insurance scheme for agents of the corporation dated 16/08/2007.
Ext. B2 – copy of agency termination letter to Tahira dtd. 03/07/2009.
Witness examined on the side of complainant
Nil.
Witness examined on the side of opposite party
Nil
Cost allowed
Rs. 1000/- ( Rupees One thousand only) allowed as cost of the proceedings.
