BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.171 of 2014

Date of Instt. 20.5.2014

Date of Decision :1.12.2014

Smt.Neena aged about 43 year wife of Ajay Kumar son of Gopal Rai R/o House No.NF-238, Gali Arayian, Adda Tanda Road, Jalandhar, previously resident of Gopal Nagar, Jalandhar.

..........Complainant

Versus

1. Life Insurance Corporation of India, Jalandhar, Branch-I,(Branch Code-141), Jeevan Parkash building, ground floor, Rear Wing, Model Town Road, Jalandhar-144001 through its Branch Manager.

2. Life Insurance Corporation of India, Yogakisema, Jeevan Beema Marg, Mumbai-400021 through its MD/Chairman/Authorized Person.

.........Opposite parties

Complaint Under Section 12 of the Consumer Protection Act.

Before: S. Jaspal Singh Bhatia (President)

Ms. Jyotsna Thatai (Member)

Present: Sh.RS Bhargav Adv., counsel for complainant.

Sh.Nipun Bajaj Adv., counsel for opposite parties.

Order

J.S. Bhatia (President)

1. The complainant has filed the present complaint under section 12 of the Consumer Protection Act 1986 against the opposite parties on the averments that Ajay Kumar son of Gopal Rai husband of the complainant resident of House No.NF-238, Gali Arayian, Adda Tanda Road, Jalandhar, took a new Bima Gold Policy No.133307170 dated 13.5.2011 commencing from 13.5.2011 from opposite party No.1 under the supervisory and administrative control of opposite party No.2 when the life assured was 46 years of age. All the installments of the premium has been regularly paid by the policy holder during the life time and till his last breath. Unfortunately life assured Ajay Kumar on 3.3.2013 fell down from the stairs of first floor of his house and sustained multiple internal and external injuries on the chest and backside of his body and immediately he has been carried to the doctor of nearby clinic and got checked up from the doctor. The doctor advised that the policy holder has sustained serious internal injury on his chest and advised the policy holder for bed rest. The policy holder has been called by the doctor for next day for check up. Unfortunately, on the next day i.e 4.3.2013 at 3.00 PM the policy holder become serious and he has been taken to Chawla Heart Care Centre, Guru Nanak Mission Chowk, Apex Hospital Complex, Jalandhar where he has been got admitted due to the seriousness of his condition. The doctor told the complainant that the policy holder is serious and required ventilator in ICU. The doctor has also told the complainant that the policy holder is serious. On the next day i.e on 5.3.2013 the doctor told the complainant that the policy holder has gone into COMA and his condition seems to be critical and he is advised to continue the treatment till the recovery in ICU. Thereafter on 27.3.2013 the doctor of the Chawla Heart Care Centre, Guru Nanak Mission Chowk, Apex Hospital Complex, Jalandhar referred the policy holder to Devi Talab Mandir Charitable Hospital, Tanda Road, Jalandhar where the policy holder remained under treatment in ICU under COMA till 7.4.2013 when the policy holder took his last breath. The doctors have declared the policy holder dead on 7.4.2013 and released the policy holder form the hospital. The complainant being nominee and wife of the policy holder submitted the death claim with the all necessary papers in original completing all necessary formalities as required by the opposite party No.1 and all the documents alongwith original policy has been attached with the death claim but the opposite party No.1 with flimsy ground and illegally, unlawfully rejected the claim of the complainant vide their letter dated 12.2.2014. On such like averments, the complainant has prayed for directing the opposite parties to pay Rs.2,50,000/- as death claim of the policy holder alongwith interest. She has also claimed compensation and litigation expenses.

2. Upon notice, opposite parties appeared and filed a written reply pleading that the present complaint is not maintainable and is liable to be dismissed as the deceased life assured Ajay Kumar failed to make the payment of the premium amount which was due on 13.2.2013 and within 30 days of grace period and as such the policy was in lapsed condition on the date of the death of the said life assured. As per condition No.2 of the policy bond, which is reproduced as under "2. 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 premium and 15 days for monthly premiums. If death occurs within this period and before the payment of the premium then due, the policy will still be valid and the sum assured paid after deduction of the said payment as also unpaid premium/s falling due before the next anniversary of the policy. If the premium is not paid before the expiry of days of grace, the policy lapses. The premium payable will be "Total Installment Premium" which is inclusive of

1. Installment premium for basic plan:

2. Installment accident benefit rider premium, if opted for".

3. Since the policy was in lapsed condition at the time of death of life assured, nothing is payable to the complainant and as such the complaint is liable to be dismissed on this ground alone. They denied other material averments of the complaint.

4. In support of her complaint, learned counsel for complainant has tendered affidavits ExCW1/A and Ex.CW2/Aalongwith copies of documents Ex.C1 to C10 and closed evidence.

5. On the other hand, learned counsel for opposite parties has tendered affidavits Ex.OP/A and Ex.OP/B alongwith copies of documents Ex.OP1 to Ex.OP4 and closed evidence.

6. We have carefully gone through the record and also heard learned counsel for the parties.

7. Ex.C-1 is copy of policy of the deceased. Premium under the policy was payable in February, May, August, November i.e quarterly. The premium which was due on 13.2.2013 was not paid by the policy holder or anybody else on his behalf. The same was also not paid within the grace period of 30 days. There is no evidence on record to prove that the complainant or anybody else on his behalf has paid the premium amount on 13.2.2013 or thereafter within the grace period of 30 days. Counsel for the complainant contended that the complainant has met with an accident on 3.3.2013 and thereafter he went into COMA after few days and remained in COMA till his death on 7.4.2013 and as such the premium could not be paid. He contended that in such circumstances, the opposite party was not justified in repudiating the death claim of the deceased. In support of above contentions he has relied upon United India Insurance Company Ltd Vs. Shalu & Ors, II(2011) CPJ 451, Krishan Wati Vs. LIC of India, I(2006) CPJ 21(NC), Life Insurance Corporation of India Vs. Vaijayanti Bai, II(2005) CPJ 445, New India Assurance Company Ltd Vs. Kiran Agnihotri, 2010(3) CLT 355, Branch Manager, LIC of India & Another Vs. V.Ramayya & Another, I(1993) CPJ 16, Jahuri Sah and others Vs. Dwarika Prasad Jhunjunwala, AIR 1967 Supreme Court 109(V 54 C 19), Life Insurance Corporation of India Vs. Consumer Education & Research Society & Anr, First Appeal No.255 of 1992 decided by Hon'ble National Commission, Delhi, Life Insurance Corporation of India & Anr Vs. Gowramma, III(2009) CPJ 25(NC).

8. On the other hand, it has been contended by learned counsel for the opposite parties that on the date of the death, the policy was in lapsed condition and as such no claim was payable to the complainant. We have carefully considered the contentions advanced by learned counsel for both the parties. The above cited authorities are on its own facts and not attracted in this case. However in case of Life Insurance Corporation of India & Anr Vs. Gowramma, III(2009) CPJ 25(NC), the Ho'ble National Commission has noted down the observations passed by Hon'ble State Commission regarding section 50 of the Insurance Act.

9. Section 50 of the Insurance Act lays down as under:-

"50. Notice of options available to the assured on the lapsing of a policy.-An insurer shall, before the expiry of three months from the date on which the premiums in respect of a policy of life insurance were payable but not paid, give notice to the policy holder informing him of the options available to him unless these are set forth in the policy".

10. So in case the conditions are mentioned in the policy itself, there is no need of giving any separate notice regarding lapsing of policy to the insured. In the present case, there is condition No.2 of the policy Ex.C-1 produced by the complainant herself that policy will lapse if the premium is not paid within the grace period of 30 days. Since the policy was lying in lapsed condition on the death of the insured as such the opposite parties have rightly rejected the claim of the complainant.

11. In view above discussion, the present complaint is dismissed with no order as to cost. Copies of the order be sent to the parties free of costs under the rules. File be consigned to the record room.

Dated Jyotsna Thatai Jaspal Singh Bhatia

1.12.2014 Member President