By Sri. K. Gheevarghese, President:-
The complaint filed against the opposite parties for repudiation of the insured sum.
2. The complaint in brief is as follows:- The complainant joined the New Bima Gold policy run by the 1st opposite party for an amount of Rs.2,00,000/-. Under basic plan Rs.1,00,000/- extended term cover benefit and Rs.2,00,000/- for accident benefit. The 2nd opposite party explained the benefit of the policy and the complainant joined the scheme on the assurance given by the 2nd opposite party. The policy has two schemes, the basic plan and
extended term cover which was up to 28.09.2026 and benefit accident up to 28.09.2036. If the insured sustains any accident of permanent disability opposite party is liable to compensate the complainant of an amount of Rs.2,00,000/.
3. The complainant met with an accident on 13.08.2010 in course of his carpentry work and three fingers of his hand were cut off there by caused permanent disability of 40% and the certificate was issued by medical board, District Hospital Mananthavady. The insured had undergone treatments in different hospitals to fix the fingers and finally lost his hope. The claim of the complainant to the 1st opposite party is repudiated. The complainant sustained heavy loss due to the accident and thrown in to a state of not to engage in the carpentry work. The repudiation of the claim by the opposite party is a deficit in service. There may be an order directing opposite parties to pay the complainant Rs.2,00,000/- along with cumulative bonus along with interest. Towards the mental agony and other loss the complainant is to be compensated with Rs.25,000/- with cost.
4. The 1st opposite party filed version in short it is as follows:- The policy named New Bima Gold having No.794866859 is the policy of the complainant. The date of policy began from 28.09.2006 and it extents to a period of 20 years for a sum of Rs.2,00,000/-. The premium payable by the complainant is Rs.665/-. The terms and conditions of the policy is binding on the party. The premium payable by the complainant became due on 28.07.2010, 15 days of the grace period is also there for the payments of the premium. However the complainant had not remitted the premium in time, if the insured fails to remit the premium before the expiry of the grace period
the policy lapse. The policy expired on 12.08.2010 midnight and the accident was on 13.08.2010. This was also intimated to the complainant that the policy during the period was in lapse condition. The life insurance is a bilateral contract it is binding on the parties to undertake the conditions of the policy, and in the policy conditions no lump sum payments is assured if the insured is alive as on date. The double accident benefit is possible if the life insured dies due to accident.
5. If the life insured sustains permanent total disability out of accident when the policy in full force, the benefits payable is in monthly installments spread over 10 years. No lump sum amount is payable the rejection of the claim of the life insured was on the ground of lapse condition of the policy. There is no deficiency on the part of the 1st opposite party and it is to be dismissed with cost.
6. The 2nd opposite party is declared exparte.
7. The points in consideration are:-
1. Is there any deficiency in service on the part of the opposite parties?
2. Relief and Cost.
8. Points No.1 and 2:- The evidence in this case consist of the proof affidavit of the complainant and opposite party. Exts.A1 to A4, oral testimony of the complainant and 1st opposite party are also considered .
9. The dispute in issue is the repudiation of the claim of the complainant who sustained 40% disability. Ext. A1 is the copy of the New Bima Gold policy and its terms and conditions. The premium payable in this scheme is on every month. The date of commencement of the policy is on 28.09.2006. The sum assured under basic plan is Rs.2,00,000/-, extended term cover benefit Rs.1,00,000/- and accident benefit rider sum assured is Rs.2,00,000/-. Installments premium for basic plan is Rs.648.34, installment accident benefit premium is Rs.16.66/- and total premium payable on 28th of every month is Rs.665/-. Clause 2 of the policy conditions reads that a grace period of one month but not less than 30 days will be allowed, half yearly or quarterly period and 15 days for monthly premiums. The policy lapse if the premium is not paid before the expiry of the grace period. It is admitted by the complainant that the due date of premium was on 28.08.2010 and remittance of the premium was after lapse of the policy. The complainant subsequently raised the point that the premium was entrusted to the agent whereas complainant has no such plea in the complaint. The opposite party on examination as OPW1 admitted that the policy was renewed on payment of premium with interest for the days of breakage. It cannot be justified that the acceptance of premium amount with interest during the period of breakage but at the same time the risk cover during the lapse period of the policy is not considerable. However it is clear from the evidence of the documents and testimony of the witness that the risk effected when the policy was lapsed. The opposite parties service cannot be considered deficit and points are considered accordingly.
In the result complaint is dismissed. No order as to cost.
Pronounced in Open Forum on this the day of 30th September 2011.
Date of filing:27.04.2011.
