CONSUMER DISPUTES REDRESSAL FORUM
Palakkad, Kerala
Dated this the 22nd day of April 2014
CC.NO.115/2013
PRESENT : SMT. SEENA. H, PRESIDENT Date of filing: 15/07/2013
: SMT. SHINY.P.R ,MEMBER
: SMT.SUMA K.P, MEMBER
M. Felix Leo,
S/o. Maria Das,
Mettukada, Kozhippara P.O,
Chittur, Palakkad. : Complainant
(By Adv. Ramachandran .E)
Vs
The Manager,
Life Insurance Corporation of India,
Chittur Branch, Anicode Junction,
Chittur. : Opposite party
(By Adv. T.P. George)
O R D E R
By Smt. Shiny . P. R. Member.
Brief facts of the complaint:- The complainant as a proposer has taken a Komal Jeevan Policy bearing Policy No. 77168326 for the assured sum of Rs. 1,00,000/- (Rupees One Lakh only) in the name of his minor child Max Celin. The monthly premium is Rs. 640/- (Rupees Six Hundred and Forty only), which includes additional premium of Rs. 21/- for premium waver benefit. On 21/01/2007, the complainant met with a Motor Vehicle Accident and suffered serious injuries whereby he has been completely disabled and bedridden. Now he is not in a position to do any job. The treated doctor has given 100% disability certificate to the complainant. The complainant has paid the monthly premium up to March 2008. Due to complainant’s total physical disability, he is not in a position to pay the further premium. The complainant claimed for waiver benefit of policy from opposite party. But opposite party declined the premium waiver benefit to the complainant. Then complainant preferred a complaint before Insurance Ombudsman. But the Ombudsman dismissed the complaint. Due to the deficiency in service of opposite
Party, the complainant is undergoing great mental agony and pain. So the complainant seeking an order directing the opposite party to give premium waiver benefit along with Rs 5000/- as compensation for mental agony suffered by the complainant and cost of the proceedings.
Opposite party entered appearance and filed their version. Opposite party admitted the policy and submitted as follows: - Father Felix Leo has taken the policy in the name of minor son. Father is the proposer of the policy and the minor son is the life assured. The term of the policy is 26 years and the term of premium is 18 years. Risk will commence on the life of the child after completion of 7 years of age. When the minor attained 18 years the policy will vest with the child. Opposite party admitted that the complaint had paid premium up to March 2008 and on 21/07/2007 complainant met with an accident. Opposite party’s contention is that in page one of Ext. B1 special provisions, clause 4 clearly stated that the payment of premium falling due after the date of death of the proposer and before the vesting date shall be waived. Disability benefit is not available under the policy. Only in case of death of the proposer and before the date of vesting, policy provides for premium waiver benefit. Opposite party also admitted that they had collected an amount of Rs. 21/- as additional premium for premium waiver benefit. This benefit is available to the life assured only in case of death of the proposer and so long as the proposer is alive that claim does not arise at all. The policy conditions do not provide for waiver of premiums in case of disability of the proposer. So there is no deficiency of service on the part of this opposite party. Hence the complaint is liable to be dismissed.
Both parties filed their chief affidavits. Ext. A1 and A2 were marked on the side of
Complainant and Ext.B1 to B4 were marked on the side of opposite party.
- Whether the complainant is entitled to get the premium waiver benefit?
- If so, what is the relief and cost?
ISSUES 1 & 2
Heard both parties: - We have perused the documents on record. Opposite party admitted the policy and physical disability of the complainant occurred due to the Motor
Vehicle accident. By this accident, the complainant is not in a position to do any job
or he has no other source of income. Complainant’s treated Doctor issued a certificate (Ext A2.) which shows that he has 100% disability which is likely to be permanent. But as per policy conditions specified in Ext. B1 special provisions 4(1)(a) states that the payment of the premium falling due after the death of the proposer and before the vesting date shall be waived. It is true that the additional premium of Rs. 21/- was collected, but the benefit of which in available to the life assured only in case of death of the proposer not on disability of the proposer. Honb’le Supreme court in United India Insurance Company Ltd V M/s Harchand Rai Chandran Lal V (2004) SLT 876 has held that “ the terms of policy have to be construed as it is and nothing can be added or subtracted from the same.” Hence we cannot attribute the deficiency in service on the part of Opposite party.
In view the above discussions, we are of the opinion that there is no deficiency in service on the side of opposite party and complainant is not entitled to get the premium waiver benefit. Hence complaint is dismissed with no cost.
Pronounced in the open court on this the 22nd day of April 2014.
Sd/-
Smt. Seena. H
President
Sd/-
Smt. Shiny. P.R
Member
Sd/-
Smt. Suma. K.P
Member
APPENDIX
Exhibits marked on the side of the complainant
Ext.A1 - Copy of Insurance Policy ( Policy No. 771683261) dated 18/03/2003.
Ext.A2 - Attested copy of Medical Certificate issued by the Senior Civil Surgeon K.G.
Hospital, Coimbatore to Complainant dated 10/03/2012.
Exhibits marked on the side of the opposite party
Ext. B1 – Copy of Insurance Policy No. 771683261 dated 18/03/2003
Ext. B2 – Policy copy of Plan 93-25-25
Ext. B3 – Policy copy of Plan 103-25-25
Ext. B4 – True copy of Order of the Insurance Ombudsman
Witness examined on the side of complainant
Nil
Witness examined on the side of opposite party.
Nil
Cost allowed
Nil
