Advocate Jayashree Kulkarni for the complainant
Advocate Monika S. Mane for the Opponent No.1
Opponent No.2 exparte
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Per Hon’ble Shri. V. P. Utpat, President
:- JUDGMENT :-
Date – 17th July 2013
This complaint is filed by the legal heirs of insured person against the Opponents for deficiency in service u/s 12 of the Consumer Protection Act, 1986. Brief facts are as follows-
[1] The complainant is the legal heir of the deceased Sushila Laxman Naidu who was covered by the “Jeevan Bima Yojana” through Group Insurance. She died on 16/06/2009. Complainant being nominee approached the Opponents and asked the insurance claim. The Central Government had implemented the scheme and under that scheme the premium was Rs.200/- out of which Rs.100/- was to be paid by the Central Government, Rs.50/- was to be contributed by the State Government and Rs.50/- was to be paid by the member of the scheme. If the insured person died during the period of coverage the legal heirs were entitled to receive Rs.30,000/-. Complainant had submitted application alongwith necessary documents. But the claim was repudiated on 24/11/2010 by saying that the Opponent No.2 i.e. N.G.O. has not renewed the policy and Sushila Laxman Naidu died when the policy was lapsed. It is the case of the complainant that the deceased had paid premium through N.G.O. but the same was not deposited with the Opponent No.1 and there was not fault of the deceased and Opponent No.1 is liable for the negligence of the Opponent No.2. Hence complainant- legal heir of the deceased has filed this complaint. Complainant has asked the insurance claim of Rs.30,000/- along with bonus, interest and compensation of Rs.25,000/-.
[2] Opponent No.2 though duly served remained absent. Hence complaint is proceeded exparte against the Opponent No.3.
[3] Opponent No.1 has resisted the claim by filing written version. The facts are regards the status of the deceased is not disputed. It is also admitted by the Opponent No.1 that the complainant was nominee of the deceased who was insured under “Janashree Bima Yojana”. The policy was taken by the Opponent No.2 i.e. NGO Santulan and payment was made by Nodal Agency through their office of the Opponent No.2. The said policy was renewable after one year. The Opponent No.2 has not renewed the policy from 20/3/2008 and Sushila Laxman Naidu died when the policy was in lapsed condition. It is specifically denied that the Opponent No.1 is responsible for the act of the Opponent No.2. Opponent No.1 had prayed for dismissal of the claim.
[4] After considering the pleadings of both parties, scrutinizing the documents, hearing the argument of both counsel following points arise for my determination. The points, findings and the reasons thereon are as follows-
S.No. | POINTS | FINDINGS |
1 | Whether complainant has proved deficiency in service on the part of the Opponent Nos. 1 and 2 ? | Partly proved against the Opponent No.2 only. |
2 | What order ? | Complaint is partly allowed against the Opponent No.2. |
Reasons-
As to the Point Nos. 1 and 2-
Complainant has adduced evidence in the form of affidavit and also produced documentary evidence i.e. death certificate of Sushila Laxman Naidu, letter issued by the Opponent No.1 regarding repudiation of the claim, statement of account as regards the payment of premium for the period of 20/03/2007 to 19/03/2008, copy of the card issued by the Opponent Nos. 1 and 2, copy of the application and the reply given by the Opponent No.2.
Admitted facts in the present proceeding are that the complainant is the nominee of the deceased Sushila Laxman Naidu from whom opponent No.2 had collected the premium for the Group Insurance Scheme. It reveals from the brochure of the said scheme that the premium was Rs.200/- out of which Rs.100/- was to be paid by the Central Government, Rs.50/- was to be contributed by the State Government and Rs.50/- was to be paid by the member of the scheme. As per the terms and conditions of the policy if the insured person died during the coverage of the policy, the legal heirs were entitled to receive Rs.30,000/-. It is the specific case of the Opponent No.1 that on the date of death of Sushila Laxman Naidu i.e. on 16/06/2009 Group Insurance Policy was not live. According to the complainant the deceased had deposited her share of premium. It reveals from the copy of the card which is produced by the complainant that the deceased had paid her contribution of Rs.50/- for the period of May 2009 to May 2010 and May 2008 to May 2009. However the Opponent No.2 has not deposited the premium with the Opponent No.1. It is informed by the Opponent No.1 that as the premium was not paid and the policy was not in live condition on the date of death of Sushila Laxman Naidu the complainant was not eligible to receive the insurance claim. It further reveals from the reply given by the Opponent No.2 that Sushila Laxman Naidu died on 16/06/2009 and the policy was renewed on 21/07/2009 hence the complainant is not entitled for the insurance claim. If the evidence before this Forum is minutely scrutinized it is crystal clear that deceased had deposited the premium with the Opponent No.2 but the same was not forwarded to the Opponent No.1. The learned Advocate for the Insurance Company argued before me that there is no deficiency in service on the part of the Opponent No.1 as the policy was not in live condition. According to the complainant as the premium was collected by the agent it should be presumed that it was received by the Insurance Company. In that context the learned Advocate for the complainant has placed reliance upon the ruling of the Hon’ble Supreme Court of India in Harshad J. Shah & Anr. v/s. L.I.C. of India bearing Civil Application Nos. 7202-7203 of 1996 decided on 4/4/1997. It reveals from the observations of the said ruling that the L.I.C. was not held responsible for the default of the agent but under specific circumstances the L.I.C. was directed to refund entire amount of premium paid to the L.I.C. alongwith interest. In the present proceeding the premium which was deposited by the deceased prior to her death was deposited for renewal of next year and the policy has life of only one year. Hence there is no question of refund of premium. Unless and until the premium is deposited the L.I.C. could not be held responsible. There is no record before this Forum to show that the premium which was deposited by the deceased was received by L.I.C. Hence it appears from the record that there is deficiency in service on the part of the Opponent No.2 i.e. N.G.O. Hence Opponent No.2 is alone is responsible to pay compensation.
I answer the points accordingly and pass the following order-
:- ORDER :-
1. Complaint is partly allowed as against the Opponent No.2 only.
2. It is hereby declared that the Opponent No.2 had caused deficiency in service by not depositing premium with the Opponent No.1.
3. Opponent No.2 is directed to pay Rs.30,000/- to the Complainant as insurance claim within six weeks from the date of receipt of copy of order.
4. Opponent No.2 is directed to pay Rs.5,000/- to the Complainant as compensation for deficiency in service as well as compensation for mental, physical sufferings and cost of the complaint within six weeks from the date of receipt of copy of order.
5. Complaint is dismissed as against the Opponent No.1.
6. Parties are directed to collect the sets which are provided for the Hon’ble Members within one month from the date of order. Else those will be destroyed.
Copy of order be supplied to both the parties free of cost.
Place- Pune
Date – 17/07/2013
