Delhi

New Delhi

CC/293/2017

Ved vati - Complainant(s)

Versus

LIC OF India - Opp.Party(s)

01 May 2023

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-VI

(NEW DELHI), ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN,

I.P.ESTATE, NEW DELHI-110002

 

 

 

Case No.CC-293/2017

 

IN THE MATTER OF:

Ved Vati (Nominee MukeshKumar)

S/o Sh. Attar Singh,

R/o 2/96, Harijan Basti, Karawal Nagar,

Delhi – 110094.

....Complainant

 

Versus

 

LIC of India

Divisional Office No. 1,

25, K.G. Marg,

New Delhi – 110001.

...Opposite Party

 

 

Quorum:

 

 

Ms. Poonam Chaudhry, President

Mr. Bariq Ahmad, Member

Mr. Shekhar Chandra, Member

 

                                                          Date of Institution:04.07.2017

 Date of Order     : 01.05.2023

 

 

ORDER

 

SHEKHAR CHANDRA, MEMBER

The present complaint has been filed under section 12 of the Consumer  Protection  Act, 1986 (in short CP Act) against Opposite Party (in short OP) alleging deficiency of services.

1. Briefly stated facts of the case are that the complainant is the nominee in respect of LIC Policy no. 116779338 taken by her son Late Mukesh Kumar from the OP. In terms of the said policy Rs.50,000/- was assured and in case of death of the policy holder another sum of Rs.50,000/- was payable by the OP as intimated to the complainant.
2. It is stated by the complainant that on 28.06.2015 in the noon time the neighbor of complainant’s son came to her house and took along the son of the complainant - Mukesh Kumar. It appears that they had gone in Yamuna for a bath where Mukesh Kumar was drowned. The complaint lodged with the Police Station which is still under investigation as no. F.R. appears to have been filed by the Police.
3. The complainant lodged the claim with the OP wherein it was informed that apart from sum assured of Rs.50,000/- she will be entitled for Rs.50,000/- also on account of death. It is submitted by the complainant that believing the assurance given by the OP, complainant handed over the original policy to the OP. However, to the surprise of the complainant OP released Rs.50,000/- of sum assured and declined to release another Rs.50,000/- to the complainant which was payable in case of a death/accident and repudiated the claim on the ground that Mukesh Kumar was drowned because of intoxication.
4. The complainant submits that Late Mukesh Kumar was teetotaler and the investigation of Police is still under way therefore, OP has no reason to withhold Rs.50,000/-.
5. It is submitted by the complainant that she was left with no other option but to send legal notices demanding the claim and provide the true copy of the LIC Policy as the policy was passed on in good faith without having the copy of the said policy to the OP. The complainant further states that she is an illiterate lady but sure that there was no such condition in the said policy to refrain the complainant from taking the claim. The OP chose neither to pay the amount nor provide the true copy of the policy inspite of notice.
6. The complainant submits that the act and omission on the part of OP is unfair trade practice to mislead the complainant who is a bonafide person.
7. Thus in the present complaint case, the complainant has prayed for a direction to the OP to pay Rs.50,000/- together with interest @ 18% p.a. w.e.f. 29.06.2015 till payment. Further prayed that a sum of Rs.25,000/- be awarded for mental agony suffered. She has also prayed for cost of litigation.
8. On receiving notice of the present complaint case, the OP has filed its reply. It is submitted by the OP that OP i.e. Life Insurance Corporation of India is a public sector undertaking established under the Life Insurance Corporation Act, 1956. Thus, it is the general duty of the Corporation to carry on life insurance business in India to the best advantage of the community.
9. It is submitted by the OP that on proposal of Mr. Mukesh Kumar a life insurance policy being policy no. 116779338 for a sum of Rs.50,000/- was issued by the OP. Date of commencement of the said policy was 14.10.2011. As per the special provisions of the policy, a sum of Rs.50,000/- was further payable under the policy, if the death of the life assured is caused by accident. Special provisions as mentioned on the policy bond is reproduced hereunder:

1. “Accidental Benefit Rider Option : If option is exercised and the premium paid; Condition No. 11 of  “Conditions and Privileges” will apply for an amount equal to the Accident Benefit Rider Sum Assured”.

 

10. Clause 11 of the policy is reproduced hereunder:-

“11. Accident Benefit : if the Accident Benefit is opted for, at any time when this policy is in force for the full Sum Assured, if the Life Assured before the date of expiry of policy term or before the policy anniversary on which the age nearer birthday of the Life Assured is 70 years, 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 agrees in the case of;

1. Disability of the Life Assured :          xxx             xxx
2. Death of the Life Assured : In addition to Sum Assured under Basic plan , an additional sum equal to the Accidental Benefit Sum Assured shall be payable under this policy, if the Life Assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means such injury shall within 180 days of its occurrence solely directly and independently of all other causes result in death of the Life Assured. However, such additional sum payable in respect of this policy shall not in any event exceed Rs.50 Lakhs taking all existing policies of the Life Assured and under individual as well as group schemes including policies within built accidental benefit taken with Life Insurance Corporation of India and other insurance companies.

The Corporation will not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of the Life Assured shall:

1. Be caused by international self injury, attempted suicide, insanity or immorality or whilst the Life Assured is under the influence of intoxicating liquor, drug or narcotic, or;….”.

 

11. It is pleaded by the OP that admittedly, the Life Assured had gone to river Yamuna where he died due to drowning on 28.06.2015. During investigation of the claim filed under the policy issued to the Life Assured, the OP realized that the Life Assured was under the influence Ethyl Alcohol and 73.10 mg of Ethyl Alcohol was found in 100 ml of blood of the Life Assured. Considering violation of the terms and conditions of the policy as abovementioned, the OP duly informed the complainant that accidental benefit is not payable under the policy. It is submitted that basic sum assured of Rs.50,000/- was duly paid to the complainant herein, which was admittedly received by the complainant herein.
12. In rejoinder to the reply filed by the OP, the complainant alleges that her son was provided only one page Insurance Policy and the complainant or her son were never provided with any such terms and conditions of the Policy.  The learned counsel for the complainant submits that his arguments that if terms and conditions of the Policy are not made known to the insured, the same will have no negative effect while making the payment of insurance has the support of a decision of the Hon’ble Supreme Court of India rendered in ‘S Modern Insulators Ltd. Vs. Oriental Insurance Company Ltd. I(2000)CPJ 1 (SC) wherein their Lordships have held as under:

“8. It is the fundamental principle of insurance law that utmost good faith must be observed by the contracting parties and good faith forbids either party from non-disclosure of the facts which the parties know. The insured has a duty to disclose and similarly it is the duty of the Insurance Company and its agents to disclose all material facts in their knowledge since obligation of good faith applies to both equally.

9.       In view of the above settled position of law, we are of the opinion that the view expressed by the National Commission is not correct. AS the above terms and conditions of the standard policy wherein the exclusion clause was included, were neither a part of the contract of insurance nor disclosed to the appellant, respondent cannot claim the benefit of the said exclusion clause.  Therefore, the finding of the National Commission is untenable in law.”  

 

13. After considering the rival contentions of the parties, we are of the view that the complainant has a case. We accordingly direct the opposite party to pay to the complainant a sum of Rs. 50,000/- with interest @ 9% per annum from the date of accrual till realization. The complainant shall also be entitled Rs. 25,000/- as compensation on account of mental agony and Rs. 25,000/- on account of litigation expenses. 

A copy of order be sent to all the parties free of cost. The order be also uploaded in the website of the Commission (www.confonet.nic.in).

File be consigned to the record room along with a copy of the order.

 

[Poonam Chaudhry]

President

 

[Bariq Ahmad]                                                                                                                        [Shekhar Chandra]

    Member                                                                                                                                 Member