P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD
FA 1022/2005 against CD No. 102/2005 on the file of the
District Consumer Forum, West Godavari District at Eluru
Between:
Gampa Rajeswari,
W/o Rama Rao,
Hindu,female,
Aged 53 years,
Prasanti Nagar Colony,
Southern Street, Eluru … Appellant/complainant
And
1. The Branch Manager,
LIC of India, Papasaheb street,
R. R. Pet, Eluru.
2. The Senior Divisional Manager,
LIC of India, Divisional Officer,
Danavaipet, Rajahmundry. Respondents/opposite
parties.
Counsel for the Appellant : Mr. T. N. M. Ranga Rao
Counsel for the Respondents : Mr. C. Srinivas.
CORAM : HON’BLE SRI JUSTICE D. APPA RAO … PRESIDENT
SMT. M. SHREESHA … LADY MEMBER
AND
SRI G. BHUPATHI REDDY … MALE MEMBER
Monday , the Fourth Day of August, Two Thousand Eight
Oral order : ( as per Sri G. Bhupathi Reddy, Hon’ble Member )
* * *
This is an appeal filed by the appellant/opposite party U/s.15 of the Consumer Protection Act to set aside the dismissal order passed by the District Forum, West Godavari District at Eluru in CD No 102/200 dated 28th day of June, 2005.
The case of the complainant in brief is that her son Gampa Murali Krishna obtained an insurance policy bearing No. 8000001839544 from the first opposite party on 28.1.2002 for a sum of Rs.5,00,000/- and quarterly premium payable is Rs.6,319/- and she is the nominee for the same. The assured died on 13.3.2004. After the death of the assured the complainant preferred the claim. The opposite parties paid only the paid up value and guaranteed additional amount stating that the policy was lapsed. The premium of January, 2003 is to be paid by the insured and the policy would be lapsed only after 5 months from the date of last premium. There is deficiency in service on the part o the opposite parties in not paying the balance amount. Hence the complaint praying to direct the opposite parties to pay a sum of Rs.4,37,500/- and compensation of Rs.10,000/- and costs.
While admitting that the complainant is the nominee of the policy of his deceased son, the opposite parties contended that the policy was lapsed on 28.1.2004 as the premium paid for the previous quarter, i.e., October, 2003 only and he failed to pay the premium of January, 2004 in grace period of 30 days as per the policy conditions. The assured died on 13.3.2004 after the policy was lapsed. As per condition no. 2 of terms and conditions of the policy, the opposite parties paid the paid up value of the period for which the premium paid. Hence the complainant is not entitled for the amount claimed. There is no deficiency in service on their part and prayed for dismissal of the complaint.
The complainant filed Ex. A1 to A4 in support of his case and Ex B1 is marked on behalf of the opposite parties. Based on the evidence adduced on record , the District Forum dismissed the complaint. Aggrieved by the said order, the present appeal has been filed.
The point that arises for determination in this appeal is, whether the order passed by the District Forum is sustainable.
The appellant submits that the District Forum has not properly appreciated the documentary evidence Ex A1 to A4 and the guideline No. 27 for settlement of the Death Claim Policies was not taken into consideration by the District Forum. The order passed by the District Forum may be set aside. The appellant further submits that as per the Insurance Policy Rules, policy will be lapsed after 5 months 29 days to the date of last premium paid. The deceased paid last premium in October, 2003 and died on 13.3.2004 and hence the premium paid is within the time. The order of the District Forum may be set aside and the claimed insurance amount may be paid.
There is no dispute that the complainant, being the mother of the deceased, is the nominee of the said policy and she has submitted the claim before the insurance company. As the Insurance Company has repudiated the claim, the complainant filed the complaint before the District Forum claiming the policy amount. The complainant’s son died on 13.03.004. After the death of the insured, the complainant preferred the claim. The respondents paid the paid up value. Granted additional amount stating that the policy was lapsed. After filing of this appeal in the year 2005, either the complainant or her counsel is not appearing before this Commission. Suo motu several times adjourned the matter. Even after, when neither the appellant nor the respondents failed to appear, this Commission posted fro orders. In the mean while, they were given an opportunity to file written arguments. The appellant has contended that her son died on 13.3.2004. The last premium was paid by her son in the month of October, 2003. As per the policy terms and conditions and guideline no. 27 she is entitled te insurance claim. The submission made by the appellant is concerned, the appellant has not produced the guideline instruction, but, only filed copy of Service Manual for Agents which cannot be taken into consideration. On the other hand, we have gone through Ex B1 policy and condition no. 2. As per condition no. 2, a grace period of one month but not less than 30 days will be allowed for payment of yearly, half yearly or quarterly premiums. If death occurs; within this period and bfore the payment of the premium then due, the policy will still be valid and the sum assured paid after deduction of the said premium as also unpaid premium/s falling due before the next anniversary of the policy. If the premium is not paid before the expiry of the days of grace, the policy lapses. If the policy has not lapsed and the claim is admitted in case of death under a policy where the mode of payment of premium is other than yearly, unpaid premiums, if any, falling due before the next policy anniversary shall be deducted from the claim amount. The terms and conditions of the policy discloses that the complainant is not entitled for the insured sum. The District Forum has elaborately discussed the said condition no. 2 and given finding. On the other hand, Ex B1 is the policy and terms and conditions of the said policy, which, goes to show that the death claim was paid to the complainant on 17.01.2005. Ex. A4 is the letter addressed by the Branch Manager, Life Insurance Corporation of India to the appellant on 14.10.2004, which, discloses that the policy was under the lapsed condition, the claim is admitted for paid up value only and a discharge form is enclosed along with the letter for signature of the complainant and necessary entries thereon requesting the complainant to complete the form and sent it for payment. The Discharge Death Claim Form discloses that the insurance company settled the claim of the complainant for an amount of Rs.62,500/- and guaranteed additions for Rs.75,000/- , total amount paid is Rs.1,37,500/- and the said amount was already received by the appellant. As per the documentary evidence filed by the appellant itself discloses that the next premium payable by 28th January, 2004 and it is to be paid within the grace period, i.e., by the end of February, 2004 but the premium was not paid by the end of February, 2004. Hence the policy was lapsed as per condition no. 2 of the policy. But the insured died on 13.3.2004 after lapse of the policy. The District Forum has elaborately discussed and given its finding that the complainant is entitled only for payment of prema with accrued benefits only and the same was already paid by the respondents to the complainant. After receiving the said amount, the complainant has filed this complaint. There is no reasonable ground to interfere with the order passed by the District Forum. The order passed by the District Forum is a well considered order. Therefore, the order of the District Forum is confirmed. The appeal is dismissed. In the circumstances of the case, but, without costs.
President Lady Male
Member Member
Dated : 04.08.2008.
