STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UTTAR PRADESH, LUCKNOW.
(RESERVED)
APPEAL NO.1507 OF 2015
(Against the judgment/order dated 19.06.2015 in Complaint Case No.314/2013 of the District Consumer Forum, Ghaziabad.)
Life Insurance Corporation of India,
Branch Office No.1, Model Town-2,
G.T. Road, Ghaziabad. ..............Appellant
Vs
Meena Devi,
W/o Late Tikam Singh,
R/o H.No.498, Lane No.7,
Bheemnagar, N.H.-24,
Near L.R.P. School,
Vijay Nagar, Ghaziabad.
Originally R/o Village Mohammadpur,
Bathera, Post Lohgarh, Tehsil Atrauli,
District Aligarh. ...............Respondent
For the Appellant : Sri Sanjay Jaiswal, Advocate.
For the Respondent : Sri Sushil Kumar Sharma, Advocate.
APPEAL NO.1540 OF 2015
(Against the judgment/order dated 19.06.2015 in Complaint Case No.314/2013 of the District Consumer Forum, Ghaziabad.)
Meena Devi,
W/o Late Tikam Singh,
R/o H.No.498, Lane No.7,
Bheemnagar, N.H.-24,
Near L.R.P. School,
Vijay Nagar, Ghaziabad.
Originally R/o Village Mohammadpur,
Bathera, Post Lohgarh, Tehsil Atrauli,
District Aligarh.
...............Appellant
Vs
Life Insurance Corporation of India,
Branch Office No.1, Model Town-2,
G.T. Road, Ghaziabad. ...............Respondent
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BEFORE:
HON’BLE MR. JUSTICE AKHTAR HUSAIN KHAN, PRESIDENT
HON’BLE SMT. BAL KUMARI, MEMBER
For the Appellant : Sri Sushil Kumar Sharma, Advocate.
For the Respondent : Sri Sanjay Jaiswal, Advocate.
Dated: 19.08.2016
JUDGMENT
MR. JUSTICE AKHTAR HUSAIN KHAN
Present two appeals have been filed under Section 15 of the Consumer Protection Act, 1986 against judgment and order dated 19.06.2015 passed by District Consumer Forum, Ghaziabad in complaint case No.314/13 Meena Devi Vs Life Insurance Corporation of India whereby District Consumer Forum has allowed complaint partly for policy No.255115318 and has ordered to pay Rs.2.00 lakhs, the insured amount with bonus to complainant within one month, subject to condition that if said amount is not paid within time fixed the complainant shall be entitled to interest @8% p.a. The District Consumer Forum has awarded Rs.2,000.00 also as cost to complainant.
Above appeal No.1507/2015 Life Insurance Corportion of India Vs Meena Devi has been filed by OP Life Insurance Corporation of India.
Vide above impugned judgment and order District Consumer Forum has not allowed claim of complainant for policy No.255714927. Therefore feeling aggrieved with this part of judgment complainant Meena Devi has filed above appeal No.1540/15, Meena Devi Vs Life Insurance Corporation of India.
Sri Sushil Kumar Sharma learned Counsel appeared for complainant Meena Devi in both appeals.
Sri Sanjay Jaiswal learned Counsel appeared for Life Insurance Corporation of India in both appeals.
We have heard learned Counsel for the parties and perused impugned judgment and record.
In appeal No.1507/15 it has been contended by learned Counsel for appellant Life Insurance Corporation that policy No.255115718 is
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Endowment Assurance Policy under table 90. Claim of complainant for this policy has been accepted by Life Insurance Corporation. Basic sum assured on 27.01.2014 shall be paid to complainant on the date of maturity that is 09.09.2023 in terms of Provisions of plan 90 referred by learned Counsel.
It has been contended by learned Counsel for Life Insurance Corporation of India that the direction given by District Consumer Forum for immediate payment of insured amount is erroneous and against law.
Learned Counsel for complainant Meena Devi has opposed above appeal.
In appeal No.1540/2015 it has been contended by learned Counsel for appellant/complainant Meena Devi that the District Consumer Forum has wrongly disallowed claim of complainant Meena Devi for policy No.255714927.
It has been contended by learned Counsel for complainant Meena Devi that Life Insurance Corporation of India has wrongly repudiated claim of complainant on false ground. Nothing had been concealed by insured Sri Tikam Singh in proposal form.
It has been contended by learned Counsel for complainant that insured Tikam Singh was not suffering from any disease at the time of proposal. Evidence on record is insufficient to show that he had any disease at the time of proposal.
Learned Counsel for Life Insurance Corporation of India has opposed appeal.
It has been contended by learned Counsel for Life Insurance Corporation of India that insured Tikam Singh was suffering with Pulmonary Koch’s from 29.06.2009 and he was under treatment for said disease but he has concealed his disease in proposal form. As such repudiation of claim is justified.
It has been further contended by learned Counsel for Life Insurance Corporation of India that in view of provisions of Section 4 of contract Act, contract of insurance policy is not complete and cannot be enforced as the insured had died before communication of acceptance of proposal of insurance policy.
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Learned Counsel for Life Insurance Corporation of India has placed reliance on judgment of Hon’ble Apex Court rendered in the case of Life Insurance Corporation of India Vs Raza Vasireddy Konnacavachi and others reported in AIR 1984 SC 1014. He has further placed reliance upon following judgment of Hon’ble National Commission:-
- RP No.3061/10 Bajaj Allianz Life Insurance Co. Ltd. and another Vs Priyank Patil decided on 09.09.2015
- LIC of India & another Vs Saraswati Devi reported in I (2015) CPJ 246 (NC).
We have considered submissions made by parties.
Admittedly policy No.255115318 is Endowment Assurance Policy under table 90. Provisions of plan 90 is reproduced below:-
“Plan 90- Under this plan, basic sum assured or paid up value along with vested bonus shall be payable on the date maturity only, even though death of life assured takes place before date of maturity. Due to this provision, this plan provides for a sum assured to be kept aside to meet the expenses of marriage/education of children in the absence of life assured.
Death Claim under Plan 90- If policy is in full force or treated in force under calim concessions, then basic sum assured with vested bonus is payable at the end of selected term i.e., on the date of maturity and not immediately after death of life assured.”
In view of above provisions of plan 90 basic sum assured with vested bonus is payable on the date of maturity and not immediately after death of insured. The District Consumer Forum has committed error in directing immediate payment. As such the impugned judgment and order of District Consumer Forum is liable to be set-a-side.
Admittedly proposal form for policy No.255714927 was filed by insured husband of complainant Meena Devi on 09.07.2009. Thereafter he died on 26.07.2009 and policy bond was issued on 12.08.2009 for said policy after death of husband of complainant.
In the case of LIC of India Vs Raja Vasireddy Komlavalli Kamba and others Supra Hon’ble Apex Court has held as under:-
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“Acceptance is complete only when it is communicated to the offerer- Silence or receipt and retention of premium cannot be construed as acceptance.”
In the case of in RP No.3061/10 Bajaj Allianz Life Insurance Co. Ltd. and another Vs Priyank Patil decided on 09.09.2015 and in the case LIC of India & another Vs Saraswati Devi reported in I (2015) CPJ 246 (NC) Hon’ble National Commission has placed reliance upon above judgment of Hon’ble Apex Court.
Perusal of above judgment of Hon’ble Apex Court as well as judgments of Hon’ble National Commission shows that in those cases after death of insured policy bonds were not issued in pursuance of proposal and premium deposited by insured. But in present case before us after death of insured on 26.07.2009, the LIC has issued policy bond of policy No.255714927 on 12.08.2009 having retrospective effect from 09.07.2009. After death of insured nominee of insured is competent to accept said policy bond and to get benefits arising out of it. There is nothing on record to show that said policy bond has been revoked by LIC.
Admittedly complainant Meena Devi is nominee of the insured husband and per policy bond policy is effective since 09.07.2009. Insured husband of complainant has died on 26.07.2009 after commencement of policy. As such LIC is liable to pay amount insured in terms of policy bond.
Certificate of hospital treatment and medical attendants certificate obtained by LIC are not primary evidence of illness of insured. It does not contain details of admit card or extract of relevant registers. Further declaration of medical attendants certificate has been signed by doctor keeping it blank. There is no prescription or admission card or other document to show that insured was really under treatment of TB hospital Ghaziabad.
In view of proposition laid down by Hon’ble Apex Court in the case of Life Insurance Corporation of India Vs Aasha Goel AIR 2001 SC 543 burden is on LIC to prove that insured had disease prior to proposal and has concealed it. But LIC has failed to prove that insured
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had disease prior to proposal. No adverse presumption about prior disease may be drawn against insured merely on the ground that he has died soon after filling proposal form of policy. The conclusion drawn by District Consumer Forum in this respect is agaisnt law and evidence.
In view of discussion made above we are of the view that LIC has wrongly refused claim of complainant for policy No.255714927 and has failed to discharge his liability in terms of the policy bond issued which is tantamount to deficiency in service. As such complaint filed by complainant for claim of policy No.255714927 is liable to be allowed.
In view of conclusion drawn above, appeal No.1507/15 filed by LIC as well as appeal No.1540/15 filed by complainant Meena Devi both are allowed. Impugned judgment and order passed by District Consumer Forum is modified. Relief granted by District Consumer Forum for policy No.255115718 is set-a-side for immediate payment and it is directed that the benefits payable under this policy shall be paid on the date of maturity.
Claim of complainant for policy No.255714927 is allowed. LIC of India is ordered to pay insured amount of Rs.1.00 lakh to complainant Meena Devi in terms of policy bond with interest @6% p.a. from the date of complaint till date of actual payment. LIC shall ensure payment within one month.
(JUSTICE AKHTAR HUSAIN KHAN)
PRESIDENT
(SMT. BAL KUMARI)
MEMBER
Sarika
