BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.

CONSUMER COMPLAINT NO.156 of 2013

DATE OF INSTITUTION: - 5.4.2013

DATE OF ORDER: -8-9-2015

Smt. Asha widow of Shri Joginder Son of Shri Chander Bhan Brahaman, resident of Gosian Chowk, Bhiwani, tehsil and district Bhiwani.

    ……………Complainant.

VERSUS

Life Insurance Corporation of India, through its Branch Manager, Bhiwani, Near Huda City Centre, Bhiwani.

………….. Opposite Party.

COMPLAINT U/S 12 OF CONSUMER PROECTION ACT

BEFORE :-  Shri Rajesh Jindal, President

Shri Balraj Singh, Member

Smt. Ansuya Bishnoi, Member

Present: - Shri Ashok Gupta, Advocate for complainant.

      Shri Mukesh Jangra, Advocate, for the OP.

ORDER:-

Rajesh Jindal, President:

                    The case of the complainant in brief, is that her husband Joginder Singh (now deceased) had obtained insurance policy in his name covering the risk for a sum of Rs.2 Lac along with accidental benefit of Rs.2 Lac, thus the sum assured under both the plan was Rs.4 Lac and the complainant was nominated as nominee in the above said policy. Unfortunately, on 20.8.2010 the husband of the complainant expired due to electric shock and complainant being nominee in the above said policy had submitted all the necessary required documents for settlement of claim but she was only paid Rs.1,96,070/- after deducting an amount of Rs.3930/- as premium amount under the both plans on account of installment. The complainant further alleged that on enquiry it was came to know that her claim under the other plan i.e. accidental benefit was not repudiated/rejected without giving any opportunity for personal hearing. The complainant further alleged that she made several representations with the Opposite Party and requested to release the accident benefit plan amounting to Rs.1 Lack but it did not pay any heed. Hence, it amounts to deficiency in service on the part of OP and as such she had to file the present complaint.

2.                 OP on appearance filed written statement alleging therein that after receiving the intimation of the death of life assured the matter was investigated. It is submitted that the premium due on 28.7.2010 was not paid by the life assured within the grace period of 30 days i.e. up to 27.8.2010. It is also submitted that on 29.8.2010 when the death occurred the policy under the auto cover period and as such the corporation issued a cheque amounting to Rs.1,96,070/- in favour of complainant and the same was encased by her but the policy was not eligible for A.B. claim. It is further submitted that the policy was in lapsed condition on the date of accident and as such the accident benefit was not payable as per policy condition. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of OP and complaint of the complainant is liable to be dismissed with costs.

3.                In order to make out his case, the complainant has placed on record Annexure C1 Photostat copy of Insurance Cover Note, Annexure C2 Photostat copy of PMR, Annexure C3 Photostat copy of death certificate, Annexure C4 & C5 Photostat copies of applications and Annexure C6 & C7 Status Report along with supporting affidavit.

 4.               In reply thereto, the OP has placed on record Annexure R1 Photostat copy of letter dated 28.9.2011, Annexure R2 Photostat copy of Insurance Cover Note, Annexure R3 to R5 R6 Photostat copies of Status Report, Annexure R7 Photostat copy of letter dated 28.9.2011, Annexure R8 Photostat copy of death certificate and Annexure R9 Photostat copy of PMR supporting affidavit.

5.                 We have gone through the record of the case carefully and have heard the learned counsels for the parties.

6.                 Learned counsel for the complainant reiterated the contents of the complaint. It is submitted that the Ops have paid Rs.1,96,070/- after deducting Rs.3930/- from the basis insured amount of Rs.2 Lac. He further stated that the Ops after deducting Rs.3930/- on account of premium due on 28.7.2010, as such the Ops are liable to pay the accident benefit insured amount of Rs.2 Lac to the complainant.

7.                 Learned counsel for the opposite parties reiterated the contents of reply.  He submitted that the premium due on 28.7.2010 was not paid by the Life Assured and the Life Assured died on 29.8.2010, after giving benefit of grace period of 30 days and the premium of the policy was to be paid up to 27.8.2010. Therefore, as on the date of death on 29.8.2010 of the life assured, the policy in question was lying in lapsed condition. As per terms and conditions No.4 of the insurance policy Annexure R2, the auto cover period was applicable, hence the basic amount of insured was payable and thus after deducting Rs.3970/- the premium due on 28.7.2010 a sum of Rs.1,96,070/- has been paid to the complainant. As per said condition No.4 of the Insurance Policy Annexure R2, the accident benefit ceases to apply, if the policy in question is in lapsed condition. Therefore, no amount on account of accident benefit is payable to the complainant by the Ops/LIC.

8.                In the light of pleadings and arguments of the parties, we have examined the relevant material on record. The condition No.4 of the Policy Annexure R2 is reads as under:-

4. Non-forfeiture Regulations: It after at least two full years’ premiums have been paid, and any subsequent premium be not duly paid, full death cover shall continue for a period of two years from the due date of the First Unpaid Premium (FUP). This period of two years from FUP shall be called Auto Cover Period. During the Auto Cover Period, the Life Assured can pay one or more installments of premiums with interest without submission of any evidence of health. On payment of part or full arrears of premiums with interest, the Auto Cover Period of two years from the due date of new FUP shall again be available during the terms of Policy.

Notwithstanding what is stated above, if after at least full years’ premiums have been paid in respect of this policy, any subsequent premium be not duly paid, this policy shall not be wholly void after the expiry of two years Auto Cover Period from the due date of First Unpaid Premium, but shall subsist as a paid up policy for an amount equal to the total premium paid(excluding any extra/optional premium), less the survival benefits paid earlier, if any. This amount shall be called as Paid Up Value. This paid up value shall be payable on the date of expiry of policy term or at Life Assured”s prior death.  No survival benefit shall be payable under paid up policies. The Policy, thereafter, be free from all liabilities for payment of the within mentioned premiums.

The Accident Benefit Rider will cease to apply if the policy is in lapsed condition. During the Auto Cover Period, the Accident Benefit Rider shall not be available”.

8.                The Insurance policy is a contract and the complainant is bound by the condition of the contract of insurance. On the basis of the above said condition No.4 of the said Insurance Policy Annexure R2 the Opposite Parties have paid the basic sum assured to the complainant against the policy which was lying in lapsed condition. From the perusal of the above said condition No.4, we are of the view that the Opposite Party is justified declining the claim of accident benefit to the complainant and we do not see any infirmity in the decision of the LIC. Resultantly, the complaint of the complainant being devoid on merits is dismissed. No order as to costs.

Announced in open Forum.

Dated: 8-9-2015.                                      (Rajesh Jindal)

                                                                                President,   

                                                                      District Consumer Disputes

                                                                      Redressal Forum, Bhiwani.

(Ansuya Bishoni),                (Balraj Singh),

  Member.                                  Member.