STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA
Date of Institution: 07.05.2018
Date of final hearing: 04.08.2023
Date of pronouncement: 25.09.2023
First Appeal No.585 of 2018
IN THE MATTER OF:-
- Life Insurance Corporation of India, Branch Office: Model Town, Pehowa, through the authorized person, Manager (Legal & HPF), LIC of India, Sector-17, Chandigarh.
- Life Insurance Corporation of India, Divisional Office, 489 Model Town, Karnal, through its Divisional Officer.
....Appellants
Versus
Jagir Singh S/o Sh. Bishan Singh, R/o Village Garhi Langri, Plot No. 2, P.O. Karan Sahib, Tehsil Pehowa, District Kurukshetra.
…..Respondent
CORAM: Naresh Katyal, Judicial Member
Argued by:- Ms. Anisha Sharma, proxy counsel for Sh. Keshav Kataria, counsel for the appellant.
None for respondent.
ORDER
NARESH KATYAL, JUDICIAL MEMBER:
Delay of 29 days in filing of present appeal stands condoned for the reasons stated in application for condonation of delay.
2. Challenge in this appeal No.585 of 2018 has been invited by OPs/Insurer to the legality of order dated 07.03.2018 passed by District Consumer Disputes Redressal Forum-Kurukshetra (In short “District Commission”) in complaint case No.63 of 2017.
3. Complainant’s son Balbir Singh obtained policy No. 178002745 for sum of Rs.1.00 lacs. Date of its commencement was 28.09.2012. He was regularly paying installments. On 16.06.2013, he died due to electric shock. DDR No. 19 dated 16.06.2013 was lodged with Police. Postmortem on dead body of complainant’s son was conducted. Complainant lodged claim with OPs and submitted required documents. OPs/appellants released Rs.1.00 lacs to complainant on 08.08.2013, instead of Rs.2.00 lacs. It is alleged that as per terms and conditions of policy; OPs/appellants were bound to release death claim i.e. “double of the sum insured of policy” but it did not do so. Thus, complainant has alleged deficiency in service on the part of OPs/appellants and filed complaint for issuance of directions to appellants; to pay balance amount of Rs.1.00 lacs; to further pay Rs.50,000/- as compensation on account of harassment and mental agony and also to pay Rs.22,000/- as litigation charges.
4. Upon notice, OPs raised contest. In defence; it is asserted that complainant has no locus standi and cause of action; complaint is not maintainable. Complainant has concealed true and material facts. Proposal form on the life of Balbir Singh (minor D.O.B. 20.09.1995, age 17 years) was introduced by his father Jagir Singh on 15.10.2012 for sum assured of Rs.1.00 lacs. It is pleaded that life assured Balbir Singh was ‘minor’ at the time of purchasing policy and as per rules; accidental benefit cannot be extended to minor. No premium was charged for accidental benefit under policy and there is no provision to issue policy with double benefit on the life of a minor. Minor on attaining majority, could opt for accidental benefits on payment of requisite amount of premium. Since, no option was exercised, therefore, no amount on this account (accidental benefit) was payable. Basic Claim amount of Rs.1.00 lacs under policy had already been paid to complainant on 08.08.2013. OPs/appellants have asserted that there is no deficiency in their service and complaint deserves dismissal.
5. Complainant led evidence, oral as well as documentary. No evidence was led by OPs.
6. On analyzing the evidence; learned District Consumer Commission-Kurukshetra vide order dated 07.03.2018 allowed the complaint and directed OPs/appellants to pay remaining amount of Rs.1.00 lacs to complainant.
7. Feeling aggrieved; OPs/insurer has filed this appeal.
8. It is apparent from record of this appeal that: only on two dates viz. (10.05.2019 & 06.03.2020); Sh. Pawan Attri had appeared on behalf of complainant/respondent in the proceedings of this appeal. On rest of dates so fixed in this appeal; nobody had represented complainant/respondent. Even on 04.08.2023, when arguments in this appeal were heard on merits; nobody had appeared on behalf of complainant/respondent.
9. Learned counsel for appellants/insurer has contended that impugned order dated 07.03.2018 passed by learned District Consumer Commission-Kurukshetra is erroneous on all fronts, legal and factual. Facts have not been appreciated in right legal perspective. It is urged that as per terms and conditions of policy; insurer has no subsisting liability towards complainant to pay accidental benefit of Rs.1.00 lacs on account of death of his minor son (who was life assured). Liability has been illegally and erroneously fastened upon it through impugned order dated 07.03.2018 of learned District Consumer Commission.
10. This Commission has critically analyzed the submissions noted above. Policy No. 178002745 is in the name of Balbir Singh, whose date of birth is 20.09.1995. He was 17 years of age and thus minor. It is apparent from policy that proposal of the policy was made on 10.10.2012 vide proposal number 6841. Sum assured under policy was Rs.1.00 lacs. Life Assured-Balbir Singh had died due to electrocution on 16.06.2013 and incident was reported to police vide DDR No. 19 dated 16.06.2013 (Ex.A-3). His postmortem was also conducted vide PMR Ex.A-4. Death certificate is Ex.A-2. Status report of policy No. 178002745-Ex.A-1 reflects that Rs.2537/- has collected as premium and Rs.1.00 lacs is the amount paid on 08.08.2013. There is no denial on above mentioned facts on the part of appellants.
11. It is specific defence of appellants in its written version that: life assured Balbir Singh was ‘minor’ at the time of taking policy and as per rule; accident benefit cannot be extended to minor. It is also appellants’ express defence that: minor, on attaining majority can opt for accidental benefit by paying requisite premium. This situation in the present case has admittedly not arisen, because life assured-Balbir Singh-minor had died before attaining age of majority (he was to attain majority on 20.09.2013 as his D.O.B was 20.09.1995) and thus option could not be exercised. No accidental benefit is available to minor in wake of above factual scenario. While observing so, this Commission gains strength from ratio of law laid down by Hon’ble National Consumer Commission, in Revision Petition No. 2605 of 2010 decided on 08.09.2017 titled as “LIC of India Vs. Shiv Mangal Ram Baghel and another”. That case before Hon’ble National Consumer Commission was also a case where minor deceased had died in road accident. He was minor (17 years of age) when policy was issued in his name by LIC. Proposal Form filled by him did not contain a clause for accidental benefit and it was specifically excluded from the policy in question. Life assured in that case could have been covered under accidental benefit upon his becoming major subject to condition that he opted for such benefit and paid premium for same. Though in that case life assured was just a few days over 18 years of age when he died, but fact remains that he did not exercise any option. On these facts; the core issue before National Consumer Commission was: whether grant of accidental benefit was covered under the terms and conditions of insurance policy? This issue was answered in favour of insurer/LIC. Following is the relevant part (Para No. 8) of the cited judgment:-
“8. The main issue that arises for our consideration is as to whether the grant of accidental benefit was covered under the terms and conditions of the insurance policy. The OP LIC stated that clauses 10.1 to 10.6 and 11 were not made applicable to the insurance policy, as the insured was a minor at the time of taking the policy. It has also been stated that after the insured had attained the age of majority, he could have opted to get covered under the accident benefit clause by exercising the requisite option on payment of the requisite premium. It is evident, therefore, that the accident benefit could not be paid to the complainants, as the same was not contemplated under the terms and conditions of the policy issued. The order passed by the consumer fora below, therefore, suffer from a material defect, because the accident benefit has also been ordered to be paid to the complainants, even when there was no provision for the same. It is true that it was the duty of the LIC to have taken up this issue at the time of filing their written statement before the District Forum and also in the repudiation letter. However, the LIC cannot be made to provide the accidental benefit, when there was no provision for the same in the insurance policy.”
In yet another case titled as “Rajendra Kumar Rastogi versus LIC of India” R.P. No. 3232/2006 decided on 02.12.2010; Hon’ble National Consumer Commission has held that accidental benefit could not be extended to a minor. On attaining majority, minor could opt for accidental benefit on payment of requisite amount of premium after exercising the necessary option.
12. Aforesaid pronouncements are squarely applicable to the facts of this case. Complainant cannot be allowed to enrich itself with amount of accidental benefit (Rs.1.00 lacs), over and above the actual assured amount of Rs.1.00 lacs, when the same is not tenable as per policy. Undisputedly policy is a binding contract between insurer and life assured. It has been held by Hon’ble Supreme Court in case titled as Suraj Mal Ram Niwas Oil Mills (P.) Ltd. Versus United India Insurance Company Ltd. and another IV (2010) CPJ Page 38 that: Terms and conditions of the policy have to be strictly construed in determining extent of liability of an insurer. The policy in question (bearing No. 178002745) does not recite that any extra premium has been paid for claiming accidental benefit. As a matter of fact, as already observed above, no extra premium could be paid in this case in hand, until life assured (Balbir Singh) remain a minor, as it is so in the present case. Option for accidental benefit is to be exercised by minor, only on attaining age of majority by paying extra premium. Learned District Consumer Commission has ignored, disarrayed and distracted itself by not considering these material aspects at all and as such its order dated 07.03.2018 is found faulty. The order dated 07.03.2018 (impugned herein) of the learned District Consumer Commission does not contain any reason, as to how complainant is entitled for extra payment of Rs.1.00 lacs (towards accidental benefit), and how, insurer/appellant cannot derive any benefit from its pleaded stance. Consequently, this order dated 07.03.2018 cannot stand at legal pedestal. It is totally unsustainable in legal parlance. Accordingly, order dated 07.03.2018 of the learned District Consumer Commission-Kurukshetra is hereby set aside. As a legal corollary so flowing, present appeal is allowed.
13. Application(s) pending, if any stand disposed of in terms of the aforesaid judgment.
14. The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants/LIC against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.
15. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.
16. File be consigned to record room.
Date of pronouncement: 25th September, 2023
Naresh Katyal
Judicial Member
Addl. Bench-II
