Haryana

Ambala

CC/191/2015

Kusum Lata - Complainant(s)

Versus

LIC - Opp.Party(s)

Rajeev Bhardwaj

15 Nov 2017

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

AMBALA.

                                                           Complaint Case No.: 191 of 2015.

                                                           Date of Institution:     15.07.2015.

                                                           Date of order:           15.11.2017.

 

Kusum Lata wife of late Sh.Naresh Kumar resident of village Bakhtua, P.O. Kurali, Tehsil Naraiangarh District Ambala.

                                                                          ….. Complainant.

                                          Versus     

 

Life Insurance Corporation of India Branch Office Nariangarh, Neta Ji Subhash Chowk Dehradun Chandigarh Road Highway Naraingarh, District Ambala through its Branch Manager.

….Opposite party.

 

Complaint U/s 12 of the Consumer Protection Act

                                                                                

BEFORE: SH. DINA NATH ARORA, PRESIDENT

                   SH. PUSHPENDER KUMAR, MEMBER

                   MS. ANAMIKA GUPTA, MEMBER.

 

Present:          Shri K.C.Jain, Advocate for the complainant.

                  Shri G.S,Antal, Advocate for the opposite party.

ORDER:

 

                   The complainant has filed the present complaint on the ground that Naresh Kumar, husband of the complainant had purchased a policy No.176722651 Table term 165-16 from OP for sum assured of Rs.2,50,000/- and it was assured that the OP would also pay bonus as per rules besides paying of Rs.2,50,000/- in case of death of life assured in an accident. The half yearly premium of the policy was Rs.6065/- with date of commencement as 15.02.2010. The life assured had paid the installments regularly of the policy in question. The complainant has been appointed nominee in the said policy. On 03.11.2014, the husband of the complainant sustained burn injuries on his body due to catching of fire by the cylinder. He was taken to the Government Medical College and Hospital Sector 32-Chandigarh but he could not survived and ultimately died on 08.11.2014 and post mortem on his body was also conducted on the same day. The complainant intimated about the death of her husband to the OP and also requested to pay the sum assured, bonus and accidental benefit of Rs.2,50,000/-  but the OP only paid the sum assured and bonus thereupon. The complainant requested the OP to pay the accidental benefit of Rs.2,50,000/- but it flatly refused to do the same. The act and conduct of the OP clearly amounts to deficiency in service and unfair trade practice on its part. In evidence, the complainant has tendered affidavit Annexure CX and documents Annexure C1 to Annexure C5.

2.                          On notice, OP appeared and contested the complaint by filing reply wherein it has been submitted that life assured had obtained an insurance policy No.176722651 under TT-165-16 with date of commencement 15.02.2010 and the half yearly premium thereof was Rs.6065/-. The half yearly premium due on 15.08.2014 was not deposited by the life assured even after lapsing of grace period of 30 days which expired on 15.09.2014 and the policy was in lapsed condition at the time of death of life assured.  As per condition No.11 if the policy is inforce at the time of death then only the accidental benefit was payable. Since the life assured had not deposited the premium of the policy in question and at the time of death the policy was in lapsed condition due to non-payment of the premium of the policy, therefore, complainant is not entitled for the accidental benefit. After receiving of claim papers basic claim i.e. Rs.2,91,580/- had already been to the complainant vide voucher No.D/20142015/000246 on 07.02.2015. There is no deficiency in service and unfair trade practice on its part. In evidence, the Op has tendered affidavit Annexure RA and documents Annexure R1 to Annexure 4.

3.                          We have heard learned counsel for the parties and gone through the material available on the case file.

4.                          It is not disputed that the husband of the complainant has purchased the life insurance policy No.176722651 under TT-165-16 with date of commencement 15.02.2010 and the half yearly premium thereof was Rs.6065/- as is evident in Annexure R1. The life assured had died on 08.11.2014 annexure C1 due to the burn injuries during treatment at Government Hospital, Sector 32 Chandigarh Annexure C2 and post mortem on his body was also conducted  Annexure C3. DDR No.21 dated 08.11.2014 Annexure C4 was also registered.   

5.                The Op has come with the plea that the policy was in lapsed condition at the time of death of the life assured as the premium of the policy due on 15.08.2014 but the same was not deposited by the life assured even after lapsing of grace period of 30 days which expired on 15.09.2014.  As per condition No.11 if the policy is inforce at the time of death then only the accidental benefit was payable. The relevant condition No.11 is as under :

“Accident Benefit : At any time when the policy is in force for the full sum assured, or reduce sum assured in case of partial surrender of the policy, the life assured, before expiry 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 herein after defined or death and the same is proved to be satisfaction of the corporation agree in the case”.

Perusal of the case file reveals that the OP had already paid Rs.2,91,580/- to the complainant as is evident through Annexure R3 as sum assured and bonus because the policy had continued for more than three years as per condition No.4 of the policy which is as under :

“(a)If after atleast three full year’s premium have been paid in respect of the policy, any subsequent premium be not duly paid, this policy shall not be wholly void but shall subsist as a paid up policy for a reduced some assured. The reduced sum assured will be called as paid up value which shall be payable in case of death/maturity and shall depend on the number of years for which premiums have been paid and shall be the greater of a sum that bears the same ratio to the maturity sum assured as the number of premiums actually paid shall bear to the total number of premiums or originally stipulated in the policy.

                                      Or

The surrender value as para seven below assuming that the policy has been surrendered on the date of death/maturity as the case may be.

 

(b)If after the policy has been inforce for atleast full three years, any subsequent premium not duly paid, in the event of death of the Life assured within a period of twelve months from the due date of first unpaid premium, but before the date of maturity and before the policy holder exercises the option to terminate the contract, the policy moneys excluding the sum assured under Rider benefits, will be paid as if the policy had remained in full force”.

 

It is also not disputed that the deceased Naresh Kumar life insured had died on 08.11.2014 but the deceased has not paid the premium due for the policy in question on 15.08.2014 with grace period which expired in 15.09.2014 which shows that the policy was in lapsed condition at the time of death of the life assured Naresh Kumar.  The case laws relied upon by learned counsel for the complainant titled Life Insurance Corporation of India Vs. Jokham Lal 1998 (1) CLT page 337, Mahesh Maganbhai Trivedi Vs. Divisional Manager, Life Insurance Corporation of India, 2015 (4) CLT 406 and Life Insurance Corporation of India Vs. Smt.Paramjit Kaur Gill  1997 (2) CLT page 675 are not applicable to the case in hand, therefore, same are being distinguished. During the course of arguments learned counsel for the complaint has placed on record a document to show the status of the policy in question and argued that this document was issued by the OP wherein the status of the policy has been shown as In-force.  This document appears to be not plausible because it does not show as to who had issued this document because it has neither bear any signature or stamp of OP.

6.                Keeping in view the facts and circumstances of the case this Forum is of the view that the present complaint is without any merit as the OP has already paid the paid up value with bonus to the tune of Rs.2,91,580/- because life assured died within 12 months from the date of unpaid premium as per clause 4 (b) which is applicable in this case, therefore, the OP cannot be held deficient in providing service to the complainant, therefore, same is hereby dismissed leaving the parties to bear their own costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.

Announced: 15.11.2017

(Pushpender Kumar)             (Anamika Gupta)            (D.N.Arora)

Member                         Member                             President

                                                                   District Consumer Disputes                                                                      Redressal Forum, Ambala.