Tamil Nadu

North Chennai

127/2013

Bachchi Devi, 3MQ 104, DC1, - Complainant(s)

Versus

LIC of India, rep. by Manager, (Claim) - Opp.Party(s)

M/s.M.Chidambaram

15 Feb 2016

ORDER

                                                              Complaint presented on  :  20.06.2013

                                                                  Order pronounced on  :  15.02.2016

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,         :      PRESIDENT

                    TMT.T.KALAIYARASI, B.A.B.L.,            :     MEMBER II

 

MONDAY THE  15^th  DAY OF FEBRUARY 2016

 

C.C.NO.127/2013

 

 

Bachchi Devi,

Wife of late Nand Kishore Singh,

SMQ No.104, DC-1,

A.F.Station, Avadi, Chennai – 600 055.

                                                                                                 ..... Complainant

 

..Vs..

	1.LIC of India, Rep.by the Manager(Claims) Chennai, DO – II Annanagar Plaza, C-47, II Avenue (P.B.No.1209) Annanagar, Chennai – 600 040.   2.The Branch Manager, LIC of India, No.87, North Park Street, Venkatapuram, Ambattur, Chennai – 600 053.
	...Opposite Parties

Date of complaint                                  25.06.2013

Counsel for Complainant                      :M/S M.Chidambaram

 

Counsel for Opposite parties                   :M.B.Gopalan

 

O R D E R

 

BY PRESIDENT THIRU. K.JAYABALAN B.SC., B.L.,

          This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The Complainant’s husband taken  a policy “JEEVAN SURABHI POLICY WITH PROFITS” being Policy No.112247978, date of commencement 28.12.1996, Table & Term – 106 – 15 (12) from the 1^st Opposite Party Branch Office for a sum  assured of  Rs.50,000/- .  All the due premiums have been paid as early as 28.06.2008 and the said policy was to mature on 28.12.2011. The Complainant’s husband Nand Kishore Singh had met with an accident  on 24.06.2011 and subsequently died on 20.07.2011 even after  the prolonged treatment. He was a regular employee of Indian Air Force  and was drawing a salary of Rs.52,045/- including Rs.5,400/-  as CILQ (Cash In Lieu of Quarter) from his employer at the time of death. The Complainant’s name was duly endorsed as nominee in the said policy Bond and the same was later on transferred to the 2^nd Opposite Party Branch Office. The 2^nd Opposite Party settled the claim amount of Rs.1,33,850/- without paying accidental death benefit cover.  Further the 2^nd Opposite Party has directed the Complainant to approach the 1^st Opposite Party for the accidental death benefit cover. The 1^st Opposite Party denied the same and stated that accident benefit cover will be available during premium paying term only under this policy. Since the accident has taken place after the premium paying time is over, the accidental death benefit cover is not payable for this policy. The Complainant issued advocate notice dated 10.12.2012 and  the 1^st Opposite Party replied that the  accidental death  benefit cover would be  paid  only during the policy in force for this sum assured.  The terms and conditions of the life Insurance Policy should not be read with a non-benevolent. The Opposite Party committed Deficiency in Service by refusing to pay the amount in respect of accidental death benefit cover. Therefore the Complainant filed this Complaint claiming the assured sum of Rs.50,000/- towards accidental death benefit cover, compensation for mental agony and other reliefs.  

2.WRITTEN VERSION OF THE OPPOSITE PARTIES IN BRIEF:

          The Opposite Parties admits that the Complainant’s  husband had  taken a Jeevan Surabhi Policy with profits bearing Policy No.112247978 during April 2007 for a Sum Assured of Rs.50,000/-  The policy matures on 28.12.2011 and the premium payment terms is only up to 28.06.2008. The accident benefit is clearly stipulated and as per   the policy condition No.10.2 the policy payable if the life assured is involved in an accident before expiry of the period for which premium is payable. The claim for death of her husband,  the Life Assured, due to road accident on 20.07.2011. It is pertinent to mention that the accident occurred after expiry of the Premium payments term which ended on 28.06.2008. As per terms of the policy, the Opposite Parties on 07..12.2011 settled a total sum of Rs.1,33,850/- including Rs.50,000/- towards  Basic sum Assured, Rs.50,000/- towards Additional Sum Assured and Rs.33,850/- towards Bonus. No further benefit or amount is payable under the policy.  It is  true that the Complainant’s husband had availed life insurance policy that a claim was made for his death due to accident on 20.07.2011 and that the same was settled for Rs.1,33,850/- The Complainant has no locus standi to blame the Opposite Parties for any Deficiency in Service. There is no cause of action for the Complaint. The various relief sought are baseless and untenable. Hence it is prayed that the Complaint may be dismissed with costs.

3.POINTS FOR CONSIDERATION:

          1.Whether there is deficiency in service on the part of the opposite parties?

          2.Whether the complainant is entitled to any relief? If so to what relief?

4.POINT:1

          The admitted facts are that the Complainant’s husband taken  a policy “JEEVAN SURABHI POLICY WITH PROFITS” being Policy No.112247978, date of commencement 28.12.1996, Table & Term – 106 – 15 (12) from the 1^st Opposite Party Branch Office for a sum  assured of  Rs.50,000/- and  all the due premiums have been paid as early as 28.06.2008 and the said policy was to mature on 28.12.2011 and  the Complainant’s  husband Nand Kishore Singh had met with an accident  on 24.06.2011 and subsequently died on 20.07.2011 and the 2^nd Opposite Party settled the claim amount of Rs.1,33,850/- without paying accidental death benefit cover and the   2^nd Opposite Party has directed the Complainant to approach the 1^st Opposite Party for the accidental death benefit cover.

          5.Ex.A1 dated 28.12.1996 is the policy issued in favour of the Complainant’s husband and in the said policy this Complainant was nominated as a nominee. The Complainant filed this Complaint claiming accidental death benefit cover and in respect of the same the Opposite Parties refused to pay the amount and the Complainant contented that the Opposite Parties committed Deficiency in Service.

6.The Opposite Parties would contend that as per the condition 10.2 of the policy the accident benefit is payable if the life assured is involved in an accident before the expiry of the period for which the premium is payable and in the case in hand the expiry of the premium payment term was ended on  28.06.2008  and the insurer died in a road accident on 20.07.2011 and since the insurer died after premium payment term was ended, the Opposite Parties are not liable to pay the accident benefit to the Complainant.  It will be useful to extract below the relevant condition in Ex.A1 policy as follows:

“10.2 Accident Benefit:- If at any time when this policy is in force for the full sum assured the Life Assured, before the expiry of the period for which the  premium is payable or before the policy anniversary on which the age nearer birthday of the Life Assured is 70, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the corporation, the corporation agree in the case of.”

The above condition clearly states that before the expiry of the period for the  payment of the last premium, if the insurer dies the claimant is entitled for the sum assured. The last due date for payment of premium was on 28.06.2008 and the Complainant’s husband himself paid the entire premium within the due date. The date of maturity was on 28.12.2011. The insurer died after payment of the last premium and before expiry of the maturity date i.e on 20.07.2011.

          7. However the Complainant would contend that she is entitled for accident death benefit cover and in support of her contention she relied on the following judgment of the Supreme Court of India.

         

1. AIR 1987 SC 1184 (SKANDIA INSURANCE CO.LTD VS

               KOKILABEN CHANDRAVADAN 7 OTHERS)          

 

          2) 1990 (1) Crimes 165 SC (SHASHI GUPTA VS LIC OF INDIA)                

          3) 1996 SCC (5) 71 (B.V.NAGARAJU VS ORIENTAL INSURANCE  

             CO.LTD)        

 

          4) AIR 1999 SC 2346 (LIC OF INDIA VS RAJKUMAR RAJGARHIA 7

             ANOTHER)    

                            

The Opposite Parties would contend that as per the condition of the policy the Complainant is not entitled for accident death benefit cover and in support of the contention they relied on the following orders of the  National Commission

1. I (2012) CPJ 31 (NC) (LIFE INSRANCE CORPORATION OF INDIA VS. ABDUL SALIM
2. II (2012) CPJ 293 (NC) (LIFE INSURANCE CORPOTRATION OF INDIA VS. USHA WALIA

The 1^st and 3^rd judgment referred above by the Complainant that the facts  relates to the arising out of the Motor Vehicle Act, the 4^th judgment arising out of a suit and therefore the facts in these judgments are different from the facts of the case in hand and therefore those judgments are not applicable in this case. However in the 2^nd judgment referred by the Complainant, the Supreme Court held as follows:

  “As both the aforesaid interpretations are reasonably possible, we would accept the one which favours the policy holder, as the same advances the purpose for which a policy is taken and would be in consonance with the object to be achieved for getting lives assured.”

As per the above propositions interpretations are reasonable possible in favour of the policy holder. However the National Commission referred the judgment of the Supreme Court of India in I (2012) CPJ 31 (NC) para 10 as follows:

                                    It is also well established that an insurance policy is a contract between the two parties and its terms and conditions once accepted are binding on both parties. Further, the ruling of the Hon’ble Supreme Court in United India Insurance Co.Ltd., V.M/S. Harchand Rai Chandan Lal, IV (2004) COJ 15 (SC) = V (2004) SLT 876 = AIR 2004 SC 4794, is also relevant in this case wherein it has been ruled “that the terms of the policy have to be construed as it is and we cannot add or substract something. Howsoever liberally we may construe the policy but we cannot take liberalism to the extent of substituting the words which are not intended.”

The National Commission also further referred the judgment of the Supreme Court of India  in II (2012) CPJ 293 (NC) para 7 as follows:

                      “We are also not in agreement with the observation made by the State Commission in para 8 of its order as to how an insurance policy is to be interpreted and decided in such cases while settling the Insurance claims pertaining to ‘disease’ and ‘pre-existing disease’ with reference to mediclaim as well as to policy of life. As is well established through a catena of judgments including that of the Apex Court in United India Insurance Co.Ltd. V.Harchand Raj Chandan Lal. I (2003) CPJ 393 and Vikram Greentech (I) Ltd. & Anr. V.New India Assurance Co.Ltd., II (2009) CPJ 34 (SC) = IV (2009) SLT 35, that an insurance policy is to be construed strictly as per the terms and conditions of the policy document which is a binding contract between the parties and the obiter dicta of the State Commission on how these are to be interpreted is therefore unwarranted/unnecessary, and is set aside”.

The above referred ratio of the Supreme Court clearly says that the conditions of the policy document is binding contract between the parties  and the terms of the policy have to be construed as it is and we cannot add or substract something. Therefore  in the case in hand also we cannot interpret or substract something to the condition 10.2 of the policy.  The above views Supreme Court is the later view than the judgment  referred by the Complainant reported  in 1990 (1) Crimes 165 SC and therefore the judgment referred by the Complainant  is not applicable to the facts of the case in hand and in view of such conclusion, it is held that the Opposite Parties have not committed any Deficiency in Service.

8.POINT:2

          Since the Opposite Parties  has not committed Deficiency in Service the Complainant is not entitled for any relief in this Complaint and Complaint is liable to be dismissed.

          In the result the Complaint is dismissed. No costs.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 15^th  day of February 2016.

 

MEMBER – II                                                               PRESIDENT

 

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex. A1 dated 28.12.1996        Jeevan Surabhi Policy.No.112247978

Ex.A2 dated   April 2011                 Monthly pay slip of late Nand Kishore Singh

Ex.A3 dated 21.07.2011         Post Mortem Report

Ex.A4 dated 19.10.2011                   Death Certificate

Ex.A5 dated 26.11.2012         Legal Heir ship Certificate

Ex.A6 dated 10.12.2012                   Advocate Notice

Ex.A7 dated 26.12.2012                   Reply of 1^st Opposite Party

 

LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES:

                                                 …… NIL …….

 

 

MEMBER – II                                                               PRESIDENT