Haryana

StateCommission

A/481/2015

LIFE INSURANCE CORP.OF INDIA - Complainant(s)

Versus

SATBIR SINGH - Opp.Party(s)

RAJNEESH MALHOTRA

19 Oct 2015

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      481 of 2015

Date of Institution:      26.05.2015

Date of Decision :       19.10.2015

 

1.     Life Insurance Corporation of India, through its Manager, Branch Office, Mahendergarh Road, Narnaul, District Mahendergarh, Haryana.

 

2.     Divisional Manager, M/s Life Insurance Corporation of India, SCO No.3-4, Sector-1, Rohtak, Tehsil and District Rohtak, Haryana.

                                      Appellants-Opposite Parties

Versus

 

Satbir Singh s/o Sh. Sultan Singh, Resident of Village and Post Office Sihma, Tehsil Narnaul, District Mahendergarh, Haryana.

                                      Respondent-Complainant

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member                                                                                                                                         

Present:               Shri Rajneesh Malhotra, Advocate for appellants.

                             None for respondent.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

This Opposite Parties’ appeal is directed against the order dated March 30^th, 2015, passed by District Consumer Disputes Redressal Forum, Narnaul (for short ‘the District Forum’).

2.      Satbir Singh-Complainant-respondent (hereinafter referred to as ‘the Insured’) obtained a Life Insurance Policy (Exhibit C-7/R-4) from Life Insurance Corporation of India (hereinafter referred to as ‘LIC’) under LIC’s New Bima Gold Table No.179 for a sum of Rs.1.00 lac on November 20^th, 2006. The premium payable was yearly.

3.      During the intervening night of October 31^st, 2009/November 1^st, 2009, the insured suffered injuries due to fall from the roof. He was taken to Kailash Hospital, Behror, where he remained admitted from October 31^st, 2009 (11.28 P.M.) to November 1^st, 2009 (8.30 A.M.).  The insured was referred to S.M.S. Hospital, Jaipur, where the Dr. Shankar Tejwani, M.D. Consultant Radiologist, examined the insured and observed as under:-

                   Findings:

Burst fracture is seen in D6 vertebral involving body and posterior elements.

Posterior displacement of fractured fragments caused narrowing of canal and compression of card.

Heterogenous hyperintense signals in cord of this level s/o Sh. Card contusion.

Rest of the vertebral bodies show normal heights and alignment.

No significant disc buldge or prolapse is seen.

Screening of rest of the spine: Unremarkable.”

4.      The insured also took treatment from ‘Getwell Poly Clinic & Hospital’ Jaipur. He suffered 100% disability as per the certificate (Annexure C-11) issued by Chief Medical Officer, Narnaul, District Mahendergarh.  According to the insured-complainant, he incurred Rs.2.00 lacs on his treatment. He filed claim with the LIC but the claim was not paid. The insured-complainant got a legal notice (Annexure C-4) served upon the LIC through Shri Pardeep Kumar Sharma, Advocate but to no avail. Hence, the complainant filed complaint under Section 12 of the Consumer Protection Act, 1986.

5.      The LIC-opposite parties, contested complaint by filing reply taking plea that the insured was asked to furnish the required documents for settling his claim but he did not do. Denying any kind of deficiency in service, it was prayed that the complaint be dismissed.

6.      On appraisal of the pleadings of the parties and the evidence available on the record, the District Forum allowed complaint issuing direction to the LIC-opposite parties as detailed in paragraph No.1 of this order.

7.      While assailing the impugned order, learned counsel for the appellant-LIC has referred to Clause 11 (a) of the Insurance Policy  (Exhibit R-4) which reads as under:-

“Clause No.11:   Accident benefit: If the accident benefit is opted for at any time when this policy is in force for the full sum assured, if life assured before the date of expiry of policy term or before the policy anniversary on which the age nearer birthday of the L.A. is 70 years, whichever is earlier, is involved in an accident, resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of:1

a)      Disability to life assured: (i) to pay in monthly instalments spread over 10 years an additional sum equal to the accident benefit sum assured under the policy. If the policy becomes a claim either by way of death or expiry of polcy term before the expiry of the said period of 10 years, the disability benefit instalments which have not fallen due will be paid alongwith the claim (ii) to waive the payment of future premiums.

                    The maximum aggregated limit of assurance under all polices including policies with in built accident benefit of the Corporation and that of insurers under individual as well as group policies on the same life to which benefit (i) and (ii) above shall not in any event exceed Rs.50 lacs. If there be more policies than one and if the total accident benefit exceeds Rs.50 lakhs, the benefit shall apply to the first Rs.50 lakhs assured in order of date of policies issued.

          ……………”

 

8.      As per clause 11 (a), in case of 100% disability, the insured amount is to be paid to the life assured in ten equated yearly instalments. However, in the event of death of the life assured before the expiry of ten years, the remaining amount from the equated instalments as well as the sum assured shall be paid in lump sum. Since the terms and conditions are binding upon the parties, the District Forum fell in error by directing the LIC to pay the benefits of insurance in lump sum instead of ten equated yearly instalments. Therefore, the impugned order to this extent needs to be modified. 

9.      In view of the above, the LIC-Opposite Parties are directed to pay the amount of Rs.1.00 lac to the complainant by spreading over ten years in instalments of equal amount.  Rest of the order is maintained.

10.    The impugned order is modified in the manner indicated above and the appeal stands disposed of.

11.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

Announced 19.10.2015

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

CL