BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
FATEHABAD.
Complaint Case No.: 315 of 2015.
Date of Institution: 27.11.2015.
Date of order: 10.08.2016.
Smt. Bimla Devi wife of Jai Kumar, resident of village Kharaiti Khera, Tehsil & District Fatehabad at present resident of Nahar Colony, Fatehabad, Tehsil and District Fatehabad.
….. Complainant.
Versus
Life Insurance Corporation of India, Branch Office, Fatehabad, Tehsil & District Fatehabad through its Branch Manager.
….Opposite party.
Complaint U/s 12 of the Consumer Protection Act
BEFORE: Sh. Raghbir Singh, President.
Smt. Ansuya Bishnoi, Member.
Present: Shri K.K. Jangra, Advocate for the complainant.
Shri S.K. Dharnia, Advocate for the opposite party.
ORDER:
The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite party.
2. Briefly stated the facts of the present complaint are that son of the complainant namely Shashi Kant @ Sanjay had got himself insured with the opposite party vide insurance policy No.172628308 which was valid from 28.12.2001 to 28.12.2021 and the premium payable was Rs.1231/- half yearly. The date of last payment was 28.6.2021. The complainant is nominee in respect of the said insurance policy. It is further averred that life insured regularly made the payment of insurance premiums to the opposite party. It is further averred that son of the complainant suffered heart problems in the year 2014 and took the treatment of the same from various hospitals. It is further averred that inadvertently while taking the medicines for heart problem, her son took ‘Kide Maar Dawai’ (pesticide) which was kept near the medicines of heart problem and died on 29.7.2014 and in this regard DDR No.29 dated 29.7.2014 has been recorded in Police Station Ding, District Sirsa. The post mortem examination on the dead body of Shashi Kant @ Sanjay was conducted on 29.7.2014 in General Hospital, Sirsa and intimation regarding his death was given to the opposite party. It is further averred that from the above it is clear that the death was unnatural/ accidental and as such the complainant is entitled to benefits of sum insured as well as to accidental benefits. However, the complainant has been paid only a sum of Rs.30,700/- which amount was paid by the life insured to the opposite party in shape of insurance premiums and the insurance benefits of sum assured and the benefits of accidental death have not been paid to the complainant which the op was liable to pay to the complainant as per policy. It is further averred that complainant got served a notice dated 21.9.2015 upon the opposite party to make the payment of sum assured and accidental benefits to the complainant within 15 days, but in vain. It is further averred that there is deficiency in service on the part of the opposite party and as such, the complainant is entitled to compensation of Rs.25,000/- from the opposite party on account of mental agony and harassment. Besides this, the complainant is also entitled to amount of abovesaid benefits alongwith interest @18% per annum with effect from due date till the date of actual payment to the complainant. Hence, this complaint.
3. Upon notice, opposite party appeared and contested the complaint by filing reply taking certain preliminary objections regarding cause of action, suppression of true and material facts and estoppal. On merits, it has been asserted that Shashi Kant son of the complainant got insured his life with the opposite party vide policy No.172628308 dated 28.12.2001 and the last installment was deposited on 28.1.2014 in the office of op and after that next installment/premium of policy was payable and due on 28.6.2014, but the deceased life assured Shashikant did not deposit the premium amount on the due date and even the due installment/ premium was not deposited within the grace period of 30 days i.e. till 28.7.2014 and as such the policy of deceased life assured was lapsed as per the terms and conditions of the insurance policy. As per the version of the complainant, deceased life assured had died on 29.7.2014 and as such the death benefit cannot be granted to the complainant and no benefit of death except the notional paid up value under the policy was given to the complainant as per the terms and conditions of the policy because the insurance policy was in the lapsed condition on 29.7.2014 and as such the notional paid up value of Rs.30,775/- has already been paid on 17.9.2014 to the complainant. The question of payment of accidental benefit does not arise even as per the version of the complainant as alleged in the complaint that the life assured had died by consuming the “Kide Maar Dawai” and not by any accident and this is a clear suicide case. It has been further submitted that the complainant has filed the present complaint under her greed and malafide intention to grab the amount from the opposite party on false and baseless grounds and there is no deficiency in service on the part of the opposite party and as such the complainant is not entitled to get any amount of compensation from the opposite party. With these submissions, prayer for dismissal of the complaint has been prayed for.
4. The parties then led their respective evidence by way of affidavits and documents. Complainant has tendered in evidence her affidavit as Ex.CW1/A and documents as Annexures C1 to C9. On the other hand, the learned counsel for opposite party has tendered into evidence affidavit of Ms. Gurveen Kaur, Manager (Legal) as Annexure R1 and documents as Annexures R2 to R5.
5. We have heard learned counsel for both the parties and have gone through the case file carefully.
6. Learned counsel for the complainant has contended that the premium due on 28.6.2014 was payable within grace period of one month from 29.6.2014 as per the terms and conditions of the opposite party itself and which was to expire on 29.7.2014 as 31 days/ one month would have been passed on that day but unfortunately the life assured died on 29.7.2014 as he mistakenly consumed pesticide under the impression of medicines of heart disease as he was suffering from heart disease since the year 2014. He has further contended that opposite party has not acted fairly and has wrongly not released the genuine claim of the complainant for the accidental death of her son. It cannot be said that policy was lapsed before the death of life assured as the premium was to be paid up to 29.7.2014 i.e. within grace period of one month. He has further contended that life assured had regularly paid the premium amount up to 28.1.2014 i.e. for a period of thirteen years and so prayed that complaint may be accepted.
7. On the other hand, learned counsel for the opposite party has contended that first of all the policy became lapsed as the life assured had not paid the premium due on 28.6.2014 and even the same was not paid up to 28.7.2014. He has further contended that it was a suicide case and not a accidental death and the opposite party has already released the notional paid up value of Rs.30,775/- on 17.9.2014 to the complainant and prayer for dismissal of the complaint has been made. In support of his contentions, he has relied upon judgments of the Hon’ble National Commission in cases titled as LIC of India & 3 ors. Vs. Jawahar Lal Bajpayee, Revision Petition No.2547 of 2012 decided on 4.2.2015, Challa Sambi Reddy Versus Branch Manager, LIC of India & Anr. Revision Petition No.2184 of 2013 decided on 6.5.2015, Life Insurance Corporation of India & anr. Versus Manikappa N. Bhandari IV (2015) CPJ 386 (NC). He has also relied judgment of the Hon’ble Supreme Court of India in case titled as Life Insurance Corporation of India Versus Mani Ram III (2005) CPJ 31 (SC).
8. We have considered the rival contentions of the parties. First of all, we would like to mention few of the material facts which have not been disputed by the parties. It is not in dispute that son of the complainant namely Shashi Kant @ Sanjay got himself insured with the opposite party vide insurance policy No.172628308 for a sum assured of Rs.two lacs and the policy commenced from 28.12.2001 which was to be matured on 28.12.2021. The premium payable was Rs.1231/- half yearly and the date of last premium was 28.6.2021. It is also not in dispute that complainant Smt. Bimla Devi is nominee in the said insurance policy. It is also not in dispute that the policy had run for a period of thirteen years and life assured paid the premium regularly up to 28.1.2014. The next premium was due on 28.6.2014 but was not paid on the said date and same was payable within grace period of one month. However, life assured Shashi Kant @ Sanjay died on 29.7.2014. According to the complainant her son suffered heart problems in the year 2014 and was taking treatment from various hospitals. On 29.7.2014 he mistakenly consumed pesticides considering the same to be medicines of heart problem and died on the same day in Civil Hospital, Sirsa. Police was also informed and post mortem examination on his dead body was also conducted. It is further the stand of the complainant that death of life assured is accidental and opposite party was informed in this regard and the complainant is entitled to benefits of sum assured as well as accidental benefits. Whereas, the opposite party has averred that last premium was deposited by the life assured on 28.1.2014 and next premium was payable and due on 28.6.2014, but the deceased life assured did not deposit the premium amount on the due date and even the same was not deposited within grace period of one month i.e. till 28.7.2014 and as such the policy was lapsed as per the terms and conditions of the policy.
9. From the abovesaid facts and circumstances of the present case, the first and foremost question which arises as to whether the policy in the present case was lapsed on 29.7.2014 i.e. the date on which the life assured had expired or not? The condition No.2 of the policy reads as under:-
“ Payment of premium: A grace period of one month but not less than 30 days will be allowed for payment of yearly, half yearly or quarterly premiums and 15 days, for monthly premium. If death occurs within this period and before the payment of the premium then due, the policy will still be valid and the Death Benefit 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.
10. The last premium was paid by the life assured on 28.1.2014 and next premium was due on 28.6.2014 and it is clearly mentioned in the abovesaid condition of the policy that a grace period of one month but not less than 30 days will be allowed for payment of yearly, half yearly or quarterly premiums and 15 days, for monthly premium. If death occurs within this period and before the payment of the premium then due, the policy will still be valid and the Death Benefit paid after deduction of the said premium as also unpaid premium/s falling due before the next anniversary of the policy and if the premium is not paid before the expiry of the days of grace, the policy lapses. As the premium was due on 28.6.2014, the life assured was to pay the same either up to 28.6.2014 or within the grace period of one month. For the purpose of calculating the period of one month the said date i.e. 28.6.2014 shall have to be excluded having regard to Section 9 of General Clauses Act, 1897 and the period of one month has to be computed from 29.6.2014. The Hon’ble Supreme Court in case titled as State of Himachal Pradesh & Anr. Vs. M/s Himachal Techno Engineers & Anr. Civil Appeal No.5998 of 2010 decided on 26.7.2010 has held that “Section 9 of General Clauses Act, 1897, provides that in any Central Act, when the word “from’ is used it refers to commencement of time- The first of the days in the period of time shall be excluded.” Regarding counting of grace period of one month whether it is to be considered as 30 days or 31 days as there are 30 days in some months and 31 days in some other months, the Hon’ble Supreme Court in the above cited case of State of Himachal Pradesh & Anr. Vs. M/s Himachal Techno Engineers (supra) has held that “a month does not refer to a period of 30 days, but refers to the actual period of a calendar month. If the month is April, June, September or November, the period of the month will be thirty days. If the month is January, march, May, July, August, October or December, the period of the month will be thirty one days. If the month is February, the period will be twenty nine days or twenty eight days depending upon whether it is a leap year or not.” In the present case, since the month is of June, therefore, the month will be of thirty days. As the premium was due on 28.6.2014 and the period of 30 days to be counted from 29.6.2014 would expire on 28.7.2014 and as the premium was not paid up to 28.7.2014 and the deceased life assured had died on 29.7.2014 i.e. after grace period, the policy in question was lapsed as per the terms and conditions of the policy. So, the policy was in a lapsed condition on the date of death of life assured and therefore, the complainant is not entitled to the sum assured as per the terms and conditions of the policy. When the complainant is not entitled to the sum assured for lapsed policy, she is also not entitled to any accidental death benefits. Therefore, the Insurance Corporation is not legally liable to make payment and the claim of the complainant has been rightly rejected.
11. However, keeping in view the facts and circumstances of the present case that policy had run for a period of 13 years and policy became lapsed for non payment of one premium that too for just one day and in such like case, there are provisions of ex-gratia payment as per Clause 3.1 of Claim Manual for Ex-gratia claims and also provisions of Relaxation in the matter of settlement of Death Claim under Policies where premiums were paid for full two years as per Clause 4 of Claim Manual. The above said clauses of Claim Manual are reproduced hereunder for ready reference:-
3.1 Ex-gratia Claims:
“Ex-gratia payment of claims would arise where there is no legal liability on the Corporation to make payment as in the case of a repudiated claim or uncluded contract (imcomplete Proposal). Though there is no legal liability on the Corporation to pay the claim, in order to mitigate hardship to the claimants, payment by way of equitable relief may be considered. The analysis particularly of a repudiated claim for consideration of an ex-gratia payment is a skilful exercise.”
4 Relaxation in the matter of settlement of Death Claim under Policies where premiums were paid for full two years:
- “The following relaxations are now made in respect of Death Claims arising by the Death of the Life Assured on or after 1.10.1987:
After at least two full years premiums have been paid under a policy,
- If the death of the Life Assured were to occur after expiry of Days of Grace but within three months of the due date of the first unpaid premium, consideration of claim to the extent of the full Sum Assured together with the declared bonuses subject to recovery of the unpaid premiums.”
12. In the present case as the premiums have been paid for thirteen years and the death of the life assured occurred after expiry of days of grace but within three months of the due date of the first unpaid premium, therefore, in view of the above said Clauses 3.1 and 4 of Claim Manual, the complainant may file representation to the higher/appropriate authorities of the opposite parties who will consider the matter for payment to the complainant and take a decision within a period of one month of filing representation by the complainant. The present complaint stands disposed of accordingly. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.
Dt.10.08.2016. (Raghbir Singh)
President,
District Consumer Disputes
Redressal Forum, Fatehabad.
(Ansuya Bishnoi)
Member
