Haryana

StateCommission

A/500/2016

FURURE GENERALI INDIA LIFE INSURANCE CO. - Complainant(s)

Versus

JAI GOPAL - Opp.Party(s)

HITENDER KANSAL

21 Nov 2016

ORDER

ATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  : 500 of 2016

Date of Institution: 01.06.2016

Date of Decision : 21.11.2016

 

 

Future Generali India Life Insurance Company Limited, 1^st Floor, Lot No. 401-402, Delhi Road, Model Town, Rohtak Haryana -124001 through The Branch Manager.

                                                                   Appellant –Opposite Party

 Versus

 

Jai Gopal S/o Sh. Sh. Hukum Chand R/o Nand Lal wali Gali No 1, Ward No.1, Gohana, Tehsil Gohana, Distt. Sonepat.

 

                                      Respondent –Complainant

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member   

 

Argued by:          Sh. Hitender Kansal, Advocate for the appellant.

Sh. N.S. Panwar, Advocate for the respondent.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

Future Generali India Life Insurance Company Limited-opposite party (for short ‘Insurance Company’) has filed the present appeal against the order dated 21.04.2016 passed by the District Consumer Disputes Redressal Forum, Sonepat (in short, ‘District Forum’) vide which the complaint was allowed and appellant-opposite party was directed to pay Rs.2,75,000/- being the accidental death benefit in addition to sum assured.

2.      Jai Gopal-complainant filed complaint under Section 12 of the Consumer Protection Act, 1986 with the submissions that Pankaj Kumar, his son, purchased insurance policy from Insurance Company with sum assured of Rs.2,75,000/- with Accidental Death Rider of Rs.2,75,000/-.  The policy commenced from 19.06.2009. Pankaj Kumar died on 09.10.2014 in an accident.  Complainant being nominee lodged the claim. Insurance Company paid only Rs.2,75,000/- being the assured amount and did not pay the double accidental benefit.

3.      Insurance Company-opposite party contested the complaint and in their written statement stating that though policy commenced with effect from 19.06.2009 and the term of the policy was 20 years, however, the policy lapsed for non-payment of premium due on 19.07.2014 and even thereafter not paid within grace period of 30 days.  Therefore, as per terms of policy, the Insurance Company paid Rs.2,75,000/- i.e. sum assured and because the policy had lapsed therefore, the nominee was not entitled to double accidental benefit. Opposite party prayed for dismissal of complaint.

4.      District Forum after hearing both the parties allowed the complaint and directed opposite party to pay Rs.2,75,000/- under the double accidental benefit.

5.      Aggrieved of the order of the District Forum, the opposite party has come up in appeal. 

6.      We heard learned counsel for the parties and perused the file.

7.      The undisputed facts are that Pankaj Kumar purchased Life Insurance Policy under the scheme Future Guarantee ULIP. There was a clause of Accidental Death Rider of Rs.2,75,000/-.  The policy commenced from 19.06.2009 and the term of the policy was 20 years.  The premium was payable annually on 19^th June. It is also not disputed that the premium due and payable on 19.06.2014, was not paid, thus policy lapsed on 19.07.2014 i.e. after the lapse of grace period of 30 days. The plea raised by opposite party/appellant was that accidental death rider was payable only if policy had been in force.  Opposite party has relied upon clause 6.1.2 of the terms and conditions of the policy, which is reproduced below:-

“If the due premiums have been paid for at least three consecutive years and subsequent premiums are unpaid, the insurance cover under the policy shall continue for the full Sum Assured till the end of revival period of two years from the due date of first unpaid premium.  The insurance and policy administration charges will continue to be deducted from your unit account by cancellation of units.  You will continue to participate in the performance of the unit funds chosen by you.

The policy may be revived within the revival period of two years from the due date of first unpaid premium or up to maturity, whichever is earlier.

At the end of the allowed period for revival, if the policy is not revived, the policy shall be terminated by paying the fund value. However, you may opt to continue the policy beyond the revival period (but not beyond the maturity of date of the policy) without paying any further premiums.  The insurance and policy administration charges will be deducted from your unit account by cancelling the units.  You will continue to participate in the performance of the unit funds chosen by you.  This option will be available while the fund value exceeds one full year’s premium.

On maturity, the fund value is payable.  The Guaranteed Maturity Addition is also payable. Provided due basic premiums have been paid for at least five years.

If at any point of time, the fund value reaches an amount equivalent to one full year’s premium, the policy will be terminated by paying the fund value.”

8.      The only question for consideration is as to whether despite lapse of policy, the beneficiary is entitled to Accidental Death Rider. 

9.      A perusal of the clause of the policy as reproduced above shows that policy has to run for at least three consecutive years.  In view of Clause 6.1.2 of the policy as reproduced above, in the event of policy having run for at least three years, the insurance cover under the policy would continue for full sum assured till end of revival periods of two years from the due date of first unpaid premium.

10.    The question is what is the full sum assured?  The sum assured would mean that “Sum Assured is the amount of any insurance policy guarantees to pay up before any bonuses are added.  In other words sum assured is the guaranteed amount the holders will receive.  This is also known the cover or coverage amount and is the total amount for which the individual is insured.”

11.    Since the maturity amount of the policy was Rs.2,75,000/- which the life assured was guaranteed to get upon the maturity of the policy including the funds if any declared or paid, and under the clause of the policy the sum assured is payable.  Therefore, the sum assured is the guaranteed sum payable on maturity of the policy. The Life Assured surviving at the time of maturity of policy would have been entitled to only Rs.2,75,000/- as that is the sum assured.  The beneficiary would have been entitled to the Accidental Death Rider in case the policy had not lapsed.  In this case, though the life insured died as a result of accidental injuries, since the policy had lapsed therefore, only the benefit applicable is sum assured i.e. Rs.2,75,000/- which has to be paid to the beneficiary. In the case in hand the opposite party has already paid the sum assured and Accidental Death Rider is not applicable as policy had lapsed. Thus the District Forum fell in error in allowing the complaint and as such, the impugned order cannot be allowed to sustain. The appeal is accepted, impugned order is set aside and the complaint is dismissed.

12.    The statutory amount of Rs. 25000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any

 

Announced 21.11.2016

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President