BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri. K.V.H.Prasad B.A.LL.B., President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Friday the 5TH day of October, 2007
C.C.No. 55/07
1. Smt. E.Lalitha. W/o. Late E.Eswar Goud,
2. Kum. E.Shireesha, D/o. Late E.Eswar Goud,
3. Ch.E.Naveen Kurmar Goud, S/o. Late E.Eswar Goud,
All are resident of Door No. 69/505,
Joharapuram,Kurnool. … Complainants
Versus
1. Life Insurance Corporation of India, By its Divisional Manager,
Kadapa.
2. The Branch Manager, Life Insurance Corporation of India,
Kurnool Branch, Kurnool. … Opposite Parties
This complaint coming on this day for orders in the presence of Sri.Mohammed Ishaq, Advocate, Kurnool, for complainant, and Sri.I.Anantha Rama Sastry, Advocate, Kurnool opposite party 1 and 2 and upon perusing the material papers on record, the Forum made the following:-
ORDER
(As per Smt. C. Preethi, Member)
C.C.No.55/2007
1. This consumer complaint of the complainant is filed Under Section 12 of C.P.Act, 1986 seeking a direction on opposite parties to pay Rs.5 lakhs with 24 % interest per annum, Rs.50,000/- as compensation, cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the first Complainant is the wife and complainants 2 and 3 are the children of E. Eswar Goud who was taken a money back policy bearing No.652061114 for Rs.50,000/- On 29/30.4.2001 the policy holder met with accident and had gone in a set of coma and never regained from coma and ultimately died on 10.12.2005. The policy holder E.Eswar Goud paid premium promptly till he went into coma and there after the complainants paid premium up to January, 2004. After the death of policy holder the complainant informed the opposite parties and submitted relevant documents for policy amount. As the opposite parties did not respond the complainant got issued legal notice dated 9.9.2006 and opposite party No.2 gave reply dated 13.9.2006. As the opposite parties did not paid the amount, the complainant resorted to the forum for reliefs.
3. In support of their case the complainant relied on the following documents viz., (1) office copy of legal notice dated 9.9.2006 along with two postal receipts and two acknowledgements, (2) reply of opposite party dated 13.9.2006 to complainants counsel, (3) policy bond of the policy holder, (4) certified copy of F.I.R. in CR.No. 65/01 of P.S traffic, Kurnool, (5) certified copy of wound certificate of policy holder, (6) certified copy of out patient ticket of Eswar Goud , (7) certified copy of case summary discharge card pertaining to policy holder issued by Saint Johns Medical College Hospital, Bangalore , (8) certified copy of letter dated 23.12.2001 of National Institute of Mental Health Neuro sciences, Bangalore and (9) Upper Gastro Intestinal Endoscopy report dated 5.1.2002 of the policy holder issued by Saint Johns Medical College Hospital, Bangalore, besides to the sworn affidavit of the complainant No.1 and 3rd party E. Ayyanna Goud and the above documents are marked as Ex.A1 to A9 for its appreciation in this case. The complainant also relied on the commissioner’s report dated 29.8.2007 and Ex.X1 certified copy of case sheet bearing No. I.P.No. 14135 and X2 certified copy of case sheet bearing No.17935. The complainant caused interrogatories to the opposite party and the complainant and 3rd party suitablely replied to the interrogatories caused by opposite party.
4. In pursuance to the notice of this forum as to this case of the complainant, the opposite parties appeared through their standing counsel and opposite party No.1 filed written version and opposite party No.2 adopted the written version of opposite party No.1.
5. The Written version of opposite parties admits the deceased policy holder E. Eswar Goud has taken a policy bearing No. 652061114 for Rs.50,000/- and nominated the complainant as his nominee. It further submits that the nominee intimated the policy holders accident occurred on 30.4.2001 and he received grievances injuries and lost his consciousness and treated in a hospital, but never regained consciousness and ultimately died on 10.12.2005.The premiums to the above policy were paid up to 1/2004 and the first un paid premium was from 7/2004 as there is a gap of 1 year 5 months from the date of un paid premium to the death of life assured, hence the policy is in lapsed condition . As per condition No.10.2 of the policy, the full assured amount is not payable to the nominee when the policy is not in force as on the date of death of policy holder. Hence basing on the above condition the accident benefit claim is not entertainable. It further submits that as a premiums under the above policy are paid for more than 5 years the policy has acquired paid up value and bonus for 5 years . As the said policy is a money back policy, the survival benefit of 20% of sum assured i.e.,Rs.10,000/- was already paid to the deceased on 10.1.2003,hence the complainant is entitled to the proportionate paid up value and bonus totaling Rs.26,050/- only. Since, the proximate death of life assured is not due to accident and the duration of death of accident and the date of death is more than 4.½ years and the policy is lapsed condition, the accident benefit claim is not payable. Hence, there is no deficiency of service on part of opposite parties and the payment of any claim to the complainant does not arise and seeks for the dismissal of complaint with costs.
6. In support of their case the opposite parties relied on the following documents viz., (1) attested Xerox copy of policy bond issued to the policy holder , besides to the sworn affidavit of the opposite party No.1 in reiteration of his written version and the above document is marked as Ex.B1 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and 3rd party and the opposite party No.1 replied to the interrogatories of the complainant.
7. Hence the point for consideration is to what relief the complainant is entitled alleging deficiency of service ?.
8. It is the case of the complainant that she is the nominee of the deceased policy holder E. Easwar Goud, who was covered under the policy bearing No.652061114 vide Ex. B1/A3 and the policy holder met with accident on 30.4.2001 and was grievously hurt and went into coma and ultimately died on 10.12.2005. The complainant thereafter approached opposite parties for policy amounts, but there was no response, being vexed got issued legal notice vide Ex.A1 dated 9.9.2006 and the opposite parties replied vide Ex.A2 dated 13.9.2006 stating that the matter is under investigation.
9. The complainant in this case submitted that she is entitled to the policy amount under the policy bearing No. 652061114 of E. Easwar Goud but the opposite parties submits that the last premium to the said policy was paid on 1/2004 and the premium from 7/2004 remained unpaid and at the time of death of the policy holder E. Easwar goud, the policy remained lapsed for the past one year and five months. Hence, they are not liable to pay any amount to the complainant.
10. It is undisputed fact that the last premium to the said policy was paid on 1/2004 only and there after till 10.12.2005, the date of death of the policy holder the premiums remained unpaid. Hence, from the above it is clear that the policy of E. Easwar Goud was in lapsed condition on the date of death. As per condition
10.2 of the policy terms and conditions, “the full sum assured will be paid to the nominee when the policy was in force”, but as the above policy was not in force as on the date of death, the opposite parties are not liable to pay the policy assured amount to the complainant.
11. The opposite party submitted that as the premiums are paid for 5 years the policy has acquired paid up value and bonus for 5years and as per policy condition No.4, the opposite parties are liable to pay the proportionate paid up value and bonus only under the above said policy. Hence, the complainants are remaining entitled only to the paid up value and bonus. The opposite parties in their written version avernments submitted that as the above policy, is a money back policy, Rs.10,000/- survival benefit was already paid on 10.1.2003. Hence
The proportionate paid up value = Rs. 16,250/-
Vested bonus = Rs. 19,800/-
______________
Total Rs.36,050/-
Less amount of survival benefit paid Rs. 10,000/-
__________________
Balance amount now payable Rs. 26,050/-
___________________
12. Hence, the complainant is remaining entitled only to the said amount of Rs.26,050/-.
13. The opposite parties contended that the accident was not proximate cause of death which occurred nearly 4 ½ years after the accident. The Ex.A4 to A9 , deposition of PW.1, Ex.X1 and X2 clearly shows that the accident is the proximate cause of death to the policy holder, but as the policy was not in force on the date of death the complainants are not remaining entitled to the assured amount under the said policy.
14. Hence, as per policy terms and conditions the complainants are remaining entitled to the paid up value and vested bonus only. The opposite parties inspite of receipt of legal notice vide Ex.A1 did not pay the paid up value to the complainants and driven the complainants to the forum for reliefs, hence the complainants are remaining entitled to costs of Rs.2,000/-.
15. In the result, the complaint is allowed directing the opposite parties jointly and severally to pay to the complainant Rs.26,050/- with 9 % interest from the date of death of policy holder E.Easwar Goud i.e.,10.12.2005 till realization along with costs of Rs.2,000/- within a month of receipt of this order. In default the opposite parties are jointly and severally liable to pay the above award amount with 12 % interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench this the 5th day of October, 2007.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : For the opposite parties :Nil
PW.1 Depostion of P.W.1 (Subramanyam)
Dated 25.8.2007.
List of exhibits marked for the complainant:-
Ex.A1. Office copy of legal notice dated 9.9.2006 along
With two (2) postal receipts and two acknowledgements.
Ex.A2. Reply of opposite party , dated 13.9.2006 to
Complainants counsel ( No further response on Ex. A2)
Ex.A3. Original policy bond.
Ex.A4. Certified copy of FIR in Cr.No.65/2001 of PS traffic,
Kurnool (No. in 8 papers)
Ex.A5. Certified copy of wound certificate of Eswar Goud
(No. in 4 papers)
Ex.A6. Certified copy of out-patient ticket of Esswar goud
(No in 2 papers)
Ex.A7. Certified copy of case summary and discharge card
Pertaining to Eswar Goud issued St.Johns Medical
College Hospital, Bangalore.
Ex.A8. Certified copy of letter, dated 23.12.2001 of National
Institute of Mental Health and Neuro Sciences, Bangalore.
Ex.A9. Upper Gastro Intestival Endoscopy Report, Dated 5.1.2002
Pertaining to Esward Goud issued by St.Johns Medical College, Hospital, Bangalore ( No in 2 papers)
X1. Certified copy of case sheet bearing I.P.No.14135
(at page No.s 21 to 58)
X2. Certified copy of case sheet bearing I.P.No. 17935
(page No.s 59 to 66 & 67 to 108)
List of exhibits marked for the opposite parties:
Ex.B1. Attested copy of policy bond.
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
1. Sri.Mohammad Ishaq Advocate, Kurnool.
2. Sri.I. Anantha Rama Sastry, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
