IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Tuesday the 31st day of May, 2016
Filed on 29.07.2015
Present
1.Smt. Elizabeth George (President)
2.Sri. Antony Xavier (Member)
3.Smt.Jasmine.D. (Member)
in
C.C.No.235/2015
between
Complainant:- Opposite Party:-
Sri. Sumithran. D. The District Insurance Officer
Surabhi, Asramam Ward District Insurance Office
Avalookkunnu P.O. Kerala State Insurance Department
Alappuzha – 688 006 Kottackal Building, Alappuzha – 1
O R D E R
SMT. ELIZABETH GEORGE (PRESIDENT)
The case of the complainant is as follows:-
The complainant has taken a policy No.KSID/LI/890116144 of State Life Insurance Department on June 2001. The monthly premium of Rs.150/- each is taken from his salary. On August 2003, he has got another appointment and accordingly he joined the Champakkulam Block Office after a six months training. Thereafter the premium amount was again taken from his salary till April, 2015. The premium was not collected from his salary from August, 2003 to May, 2004 during the time of his training. The policy period expired in April 2015 and he applied for the claim amount and he received only Rs.19,650/-. He had remitted Rs.23,550/-. When he complained about it to the opposite party, they stated that since the premium amount was defaulted he is not eligible to get the full amount. The opposite party did not inform the complainant to renew the policy. Alleging deficiency in service on the part of the opposite party, the complaint is filed.
2. The version of the opposite party is as follows:-
The complainant committed default in remitting the premium for 10 months from 8/2003 to 5/2004. As per the Rule 20.3 of KSID, “if a person committed default in remitting the premium for a continuous period of 6 months the policy will be lapsed.” The complainant remitted premium for 26 months thereafter he committed default for 10 months. Hence he is not entitled to claim the amount that he remitted for 26 months as per KSID Rule No.20.5. The complainant is not entitled to get any reliefs prayed in the complaint. There is no deficiency in service on the part of the opposite party.
3. The complainant was examined as PW1. The documents produced were marked as Exts.A1 and A2. On the side of the opposite party one document produced marked as Ext.B1.
4. The points that arose for consideration are as follows:-
1) Whether there is any deficiency in service on the side of the opposite party?
2) If so the reliefs and costs?
5. It is an admitted fact that the complainant has taken a policy from the opposite party. The policy certificate is marked as Ext.A1. As per the policy Rs.150/- was collected from the salary of the complainant towards monthly premium. According to the complainant after remitting 26 months premium, he has got another appointment and accordingly he joined for a training of 6 months. During this period the premium amount was not collected by the opposite party. Thereafter he joined the job at Champakkulam Block Office and the amount of premium was collected from his salary till the maturity period of the policy. From Ext.B1 it is clear that the date of maturity is 29.4.2015. According to the complainant after the maturity period he has got only an amount of Rs.19,650/- even though he remitted Rs.23,550/-. The opposite party filed version stating that since the complainant failed to remit the premium amount for a period of 10 months as per KSID Rule 20.3 the policy lapsed and he is not entitled to claim the policy benefits. In Ext.B1 it is clearly stated that, “It is hereby declared that the consideration of and subject to the due payment of the subsequent premia as set out in the schedule, till the maturity of the policy as specified in the schedule or the death of the insured whichever shall first occur, in the manner prescribed in rules framed by the Government in that behalf, the Director of Insurance to the Government of Kerala do by this policy agree to pay the sum assured (together with such sum or sums as may be allocated by way of bonus) on behalf of the Government of Kerala to the insured on completing the age of fifty five years or in the event of the insured’s death before completing the age of fifty five years to the nominee and failing such nominees, to the assignees or other legal representatives after surrender of the policy and production of satisfactory evidence of the death of the insured.” In the instant case it is an admitted fact that the complainant had first taken the policy when he joined in the service in the month of June, 2001 in Vigilance and Anti Corruption Department and he continued the payment of premium till 2003 and again joined in the Grama Vikasana Department as V.E.O. and after joining there he was allowed to continue to remit the premium in the very same policy which he had taken when joined in the Vigilance and Anti Corruption Department, without any objection from the part of the opposite party without considering the fact that, 10 months premium with respect to the said policy was in arrears and also that as per the policy conditions the policy remains lapsed.
6. In the particular facts and circumstances of this case, a policy holder who had taken the policy first in the year 2001 and continued to pay the premium till 2015, in the very same policy, of course with a gap of 10 months of non-payment of policy is deprived of the full benefit, in the policy solely for the reason that there is arrears of 10 months premium, which stands taken by the opposite party for whatever reason is according to this Forum is unjust and opposite party is estopped from denying the policy benefit saying that the first policy was lapsed especially for the reason that in the second time also the premium was accepted in the first policy itself. In the circumstances, this Forum is of the opinion that it will be just and equitable to allow all the policy benefits to the complainant by the opposite party by accepting the arrears of premium for the period of 10 months.
In the light of the above discussions, the complaint is allowed, the opposite party is directed to pay all the benefits under the policy in the name of the complainant, after deducting the 10 months arrears of premium. Since the primary relief is granted no further amount towards compensation and costs.
Dictated to the Confidential Assistant transcribed by her corrected by me and pronounced in open Forum on this the day 31st day of May, 2016.
Sd/- Smt.Elizabeth George (President) :
Sd/- Sri. Antony Xavier (Member) :
Sd/- Smt.Jasmine.D. (Member) :
Appendix:-
Evidence of the complainant:-
PW1 - Vidhukumar. B. (Witness)
Ext.A1 - Copy of the policy certificate
Ext.A2 - Copy of the application for claim in SLI policy
Evidence of the opposite parties:-
Ext.B1 - Copy of the policy certificate and directions of the policy holders
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite party/S.F.
Typed by:- pr/-
Compared by:-
