BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 08 of 2014
Date of Institution : 21.1.2014
Date of Decision : 06.10.2016.
Jaitoon Khan widow of Dr. Vajid Ali, resident of D.C. Colony Sirsa, Tehsil and District Sirsa.
….Complainant.
Versus
1. Vice Chancellor/ Registrar Ch. Devi Lal University, Sirsa, Distt. Sirsa through its Vice Chancellor/ Registrar.
2. Life Insurance Corporation of India, having its Branch Office at Sangwan chowk, opp. Spar Banquet Hall, Sirsa.
3. Life Insurance Corporation of India, Pension and Group Schemes, Departments, Karnal Unit, LIC Divisional office, Jeevan Parkash, 3rd Floor, 489, Model Town Karnal, Haryana, 132001.
..…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.LOHIA………………………………..PRESIDENT
SHRI RANBIR SINGH PANGHAL ……….……MEMBER.
Present: Sh.Sandeep Kamboj, Advocate for the complainant.
Sh. Vikram Yadav, Advocate for opposite party No.1.
Sh. S.K. Puri, Advocate for opposite parties No.2 & 3.
ORDER
Brief facts arising out of the present complaint are that complainant is widow and legal heir of deceased Vajid Ali life assured with op no.2 through group insurance policy of op no.1. As alleged, deceased Vajid Ali was posted as Lecturer in Chemistry Department with op no.1 and op no.1 availed the life insurance policy under the Group Insurance Scheme of the university. Insurance policy bearing No. GSLI 329862 dated 20.9.2010 was issued in favour of the husband of the complainant for the sum assured of Rs.2,00,000/-. This policy was purchased by the deceased through op no.1 who is the Master Policy Holder of the insurance. Premium of the policy was being paid on monthly basis as deducted from the salary of the deceased life assured by op no.1. In the year 2011, Vajid Ali husband of the complainant suffered from cancer disease and for treatment he went to Mujaffar Nagar (Uttar Pardesh) at his parental house. Later on, cancer disease became serious and he got treatment from Safdarjung Hospital, New Delhi and in this regard intimation to op no.1 was given through fax message alongwith medical papers and deceased had applied for the leave from 21.8.2012. Thereafter, on 12.9.2012, the husband of the complainant expired due to cancer disease and complainant being legal heir of the insured applied for the benefits of the policy to the ops but op no.3 repudiated the genuine claim of the complainant simply on the ground that as the premium for the month of September, 2012 has not been paid by holder of the insurance policy, consequently the policy has been lapsed. It is further alleged that according to clause-4 of the insurance policy, if the holder of the Insurance policy did not draw the salary or the salary of the employee has been stopped for any of the reasons, even though it is the duty and liability of the employer of the said employee to deposit and make payment of the said premium amount, meaning thereby as the Registrar university being the Master of the Insurance Group of the insurance policies, he was duty bound to make payment of the premium amount if the complainant’s husband failed to join the duty (although the medical leave has been sanctioned to the deceased for the said period) or could not draw the salary or even if his salary has been stopped by the Employer. Moreover, in the case of the deceased Vajid Ali, all the premium amount had already been paid by op no.1 at his own level because the deceased did not deposit the amount of his own. Further more, according to the clause IV of the corporation “in case death of such member take place and the premium has not been received for the continuous period of six months prior to the date of six months, then it has been laid down that it shall not become payable.” But in this case, there is lapse of non payment of the premium amount only for the period of one month and the op corporation in order to usurp the sum assured has taken the totally false and baseless stand and repudiated the claim of complainant on 29.11.2012. It is also pertinent to mention here that a meeting was held by the University in the month of July, 2009 in the office of Convener, wherein it was decided and undertaken in clause-VIII of the meeting and was reduced into writing that “ the premium of the employee, who is covered by the scheme, but whose salary are not drawn due to one reason or the other viz. extraordinary leave/ deputiation/ withholding of payment on any account etc. may be paid out of the University Salary head of the employee concerned for a period of 3 months and the amounts should be recovered after the salary of such employee are drawn. The risk cover of the employee whose premium amount is not received for a period of three months, would no longer continue. As such it is the legal and sole liability of the University to pay the premium amount for the period of September, 2012. Thus, sum assured has been withheld and claim has been repudiated by the company just in collusion with op no.1 because if there would have been any deficiency in the payment of the premium amount, then the same has occurred due to the conduct of op no.1. The ops are liable for the payment of the sum assured to the complainant. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statements. Op no.1 in its separate written statement replied that order of repudiation passed by other ops is against terms and conditions of the policy. The policy term PREMIUMS (schedule of policy) clearly defines that the membership of scheme of any employee will cease only after six months continuous default in payment of premium. Regarding the member in question, the premium for the month of August, 2012 is only delayed. The LIC has not issued any order of cease regarding the member in question. The case is covered in the grace period and the claim is payable. There is no deficiency on the part of University employer as the claim has been submitted in time with the LIC. The LIC is only liable to pay the sum assured with interest and costs because of the illegal order of repudiation passed against the terms of the policy itself. It is further submitted that at the time of illness period of Dr. Vajid Ali, his salary was not released, his GIS subscription was not deducted. The GIS of remaining employees were deposited only, whose salary had been drawn. It is fact that GIS subscription was deposited one month after for the month of August, 2012 as his salary was not drawn, whereas the same was deposited during the month of October, 2012.
3. Opposite parties No.2 & 3 replied that complainant has to prove that she is the only legal heir and no other person is having the same status. She has not submitted any succession certificate with regard to her rights as a sole legal heir of the deceased. It is further replied that deceased was a member of Group Insurance. As per the record, the policy number is 329862 and the master policy holder is Registrar Ch. Devi Lal University, Sirsa. It is further replied that for the mistake on the part of op no.1, the other ops are not responsible because the policy was in lapsed condition and the premium was not paid by the Master policy holder. So many registered reminders, e-mails were sent to the Master Policy Holder for not remitting the premium in time, but op no.1 did not care the correspondence made by the LIC. It is further replied that Master policy holder failed to provide form No.36 to the LIC which is required to ascertain that how many persons have joined or left the policy as on annual renewal date. It is further replied that op no.1 is bound to remit premium in time and as per the policy terms and conditions, premium of each month should be remitted to the ops by 20th of every month. Other averments of the complaint have been denied.
4. The complainant has placed on file her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C13. On the other hand, op no.1 tendered affidavit Ex.R1 and documents Ex.R2 to Ex.R16, Ops no.2 & 3 tendered affidavit Ex.R17 and documents Ex.R18 to Ex.R30.
5. We have heard learned counsel for the parties and have gone through the case file carefully.
6. It is an admitted case of the parties that deceased Vajid Ali was insured under Group Insurance scheme issued by ops No.2 & 3 in favour of op no.1 being Master Policy Holder. It is also admitted that premium only for the month of September, 2012 has not been paid in time but the same has been paid later on. Further, as per the terms and conditions of the policy, the premium has been remitted to the ops No.2 & 3 well in time within grace period of six months and therefore, it cannot be said that policy was in lapsed condition. The authorities relied upon by learned counsel for ops No.2 & 3 in case titled as LIC & ors. Vs. Smt. Kiran Sinha, AIR 1985 Supreme Court 1265 and in case titled as LIC of India & Ors. Vs. Miss Anu & ors. 1997 CPJ 129 (NC) are not applicable to the facts and circumstances of the present case being on different footings.
7. Keeping in view the facts and circumstances of the present case, we are of the view that there is deficiency in service in refusing the genuine claim of the complainant and in our view the ops No.2 & 3 are guilty of deficiency of service. In these circumstances, present complaint is hereby accepted with the direction to the opposite parties No.2 & 3 to pay sum assured i.e. Rs.2,00,000/- to the complainant with interest @9% per annum from the date of filing of present complaint i.e. 21.1.2014 till the date of actual payment. We also direct the ops No.2 & 3 to pay a sum of Rs.2000/- as litigation expenses to the complainant. However, ops are at liberty to complete papers work including succession certificate, if any required from the complainant before releasing the amount. This order should be complied within a period of 45 days from today, failing which complainant will be at liberty to initiate proceedings under Section 25/27 of the Act against ops no.2 & 3. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.
Announced in open Forum. President,
Dated: 06.10.2016. District Consumer Disputes
Redressal Forum, Sirsa.
Member.
