This C.C coming on before us for final hearing, in the presence of Sri.B.Kalyan Rao, Advocate for Complainants and of Sri.G. Sita Rama Rao, Advocate for the opposite party; upon perusing the material papers on record; upon hearing arguments, and having stood over for consideration, till this day, this Forum passed the following:-
ORDER
(Per R. Kiran Kumar, Member )
This complaint is filed under section 12(A) of Consumer Protection Act, 1986. The brief facts of the complaint are that the husband of the complainant No.1 and father of complainants No.2 to 4, by name Sri B.V.Satyanarayana, was subscriber of an insurance policy No.11607301 for Rs.1,80,000/- under Reliance Wealth + Health Plan and the policy commenced from 29-02-2008. The policy premium @Rs.10,000/- for two half yearly terms was paid by the insured to opposite party and late B.V.Satyanarayana purchased above policy with opposite party through their agent by name Sridevi vide advisor code No.20095924 at Khammam. The complainants further submitted that the insured B.V.Satyanarayana, met with a motor accident on 01-09-2008 at Khammam and sustained head injury and while undergoing treatment he died on 08-12-2008. The complainants further submitted that they informed about the treatment of late B.V.Satyanarayana from time to time and also about his death to the opposite party. The complainant also submitted that the personnel of opposite party have handed over a cheque for Rs.8,200/- in the month of March 2009 to the complainant No.1 by misrepresenting that the balance of assured amount would be sent by opposite party from its head office and it would take 2 months time and for that purpose they obtained signatures of complainant No.1. In spite of lapse of more than two months, balance of assured amount is not paid by opposite party company, on that the complainants issued legal notice on 23-09-2009 demanding balance amount of Rs.1,72,000/- insurance claim. The opposite party acknowledged the notice, but neither paid the amount nor gave any reply, as they committed deficiency of service for not paying total insurance amount of Rs.1,80,000/- the complainant approached the Forum.
2. To prove their case, the complainant filed the following documents, which are got marked as Exs.A1 to A5.
Ex.A1:- Photocopy of Insurance policy No.11607301, issued by
opposite party.
Ex.A2:- Photocopy of extract of medical bills for treatment of late Bussa
Venkata Satyanarayana at Yashoda Hosital, Hyderatbad.
Ex.A3:- Photocopy of death certificate of late Bussa Venkata
Satyanarayana.
Ex.A4:- Office copy of legal notice dt.23-09-2009 got issued by
Complainants to the opposite party.
Ex.A5:- Postal Acknowledgements (2 Nos.)
3. On receipt of notice, the opposite party appeared through their counsel and filed counter.
4. In their counter, they denied the contents of the complaint and submitted para wise reply. And also submitted that the policy terms and conditions were duly explained to the complainant and upon his satisfaction insured had applied for the said insurance policy, as per the terms of the policy document any event occurring during the laps status of policy, no insurance or rider benefit will be available to Principal insured, insured spouse and insured children. Anytime during this period, should the policyholder die, the fund value as on the date of intimation at the office will be paid. And also submitted that the Principal Life Assured has only paid First half yearly premium amount of Rs.10,000/- at the time of accident, hence the policy was in the lapsed state due to nonpayment of premium on August 29, 2008 and the payment acknowledgment receipt paid in the month of November 2008 handed over to the complainant clearly states that the second premium paid by the complainant for the said policy due on August 29, 2008 for an amount of Rs.10,000/-. In compliance with the policy terms and conditions fund value of Rs.8203.26/- was paid to the complainant. As such there is no deficiency of service on the part of opposite party company and they are not responsible for any loss suffered by the complainants and the complainants are not entitled for any relief and the complaint deserves to be dismissed.
5. To support their case, the opposite party company filed Certified copy of Policy bearing No.11607301, marked as Ex.B1.
6. Both parties filed written arguments.
7. Perused the oral and documentary evidence. Upon which the points that arose for consideration are,
- Whether the complainants are entitled to the claim amount under the policy?
- To what relief?
Point No.1:-
In this case the husband of the complainant No.1 and father of complainants No.2 to 4 had taken Reliance Wealth + Health Plan policy from the opposite party company on 29-02-2008 for a sum of Rs.1,80,000/- and nominated complainant No.1 as nominee. Unfortunately, the insuree met with a motor accident on 01-09-2008 and while undertaking treatment he died on 08-12-2008. The insuree paid the second premium in the month of November, 2008. However, since as per the terms and conditions of the policy, the policy continued to be valid during the grace period, the complainants as the insurees’ nominee filed an insurance claim and also issued legal notice on 23-09-2009 demanding an amount of Rs.1,72,000/- which was acknowledged by the opposite party company. As the opposite party neither paid the amount nor give reply, aggrieved by that complainants filed this complaint.
From the material available on record, we observed that the insuree paid the first premium on 29-02-2008 and he has to pay the premium on 29-08-2008. As per the terms and conditions, he has to pay the premium in grace period and the policy continued to be valid for that period. And also as per condition 8.5.1 “A Policyholder may revive a policy by paying the arrears of premiums and recommencing the payment of premiums at any time within a period of 2 years from the due date of first unpaid Premium but before the maturity date of the policy subject to satisfactory medical and financial underwriting.”
It is not in dispute that the insured paid the second premium in the month of November 2008 and the policy was revived. Since the insurance company has collected the second premium and revived the policy they cannot take plea that “That the policy was in lapsed condition due to nonpayment on 29-08-2008”.
In LIC of India and Others Vs H.Kudoubuthine II (2011) CPJ 98 NC the Hon’ble National Commission observed that “Opposite party as in writing granted grace time to insuree for paying premium-later can not take plea that policy lapsed”. In the above case, the insured was default in paying the premium amount within the stipulated date. But in the present case, the insured paid the premium and the policy was revived. In view of these facts, we agree with the reasoning of the complainants that the insurance policy was valid at the time of the accident of the deceased and the complainants are entitled to claim the amount. Hence this point is answered accordingly in favour of the complainants.
Point No.2:-
In the result the complaint is allowed, directing the opposite party to pay an amount of Rs.1,72,000/- (Rupees One Lakh Seventy Two Thousand only) to the complainants together with interest @9% p.a. from March 2009, (i.e. from the date of part payment of Rs.8,200/-) till the date of actual payment and also directed to pay an amount of Rs. 3000/- towards the cost of the litigation. Out of the above said awarded amount, the complainant No.1 is entitled to an amount of Rs.1,00,000/- (Rupees One Lakh only) along with interest and costs and Complainants No.2 to 4 are entitled to an amount of Rs.24,000/- (Rupees Twenty Four Thousand only) each.
Dictated to steno, corrected and pronounced by us, in this Forum on this 14th day of July, 2011.
President Member
District Consumers Forum, Khammam
APPENDIX OF EVIDENCE
Witnesses examined on behalf of the complainant: -None-
Witnesses examined on behalf of opposite party: - None-
Exhibits marked on behalf of the complainants:-
Ex.A1:- Photocopy of Insurance policy No.11607301, issued by
opposite party.
Ex.A2:- Photocopy of extract of medical bills for treatment of late Bussa
Venkata Satyanarayana at Yashoda Hosital, Hyderatbad.
Ex.A3:- Photocopy of death certificate of late Bussa Venkata
Satyanarayana.
Ex.A4:- Office copy of legal notice dt.23-09-2009 got issued by
Complainants to the opposite party.
Ex.A5:- Postal Acknowledgements (2 Nos.)
Exhibits marked on behalf of the opposite party:-
Ex.B1:- Certified copy of Policy bearing No.11607301.
President Member
District Consumers Forum, Khammam
