MR. KUNDAN KUMAR KUMAI

This is an appeal u/s 41 of the Consumer Protection Act, 2019, preferred against the Order/Judgement dated 17/01/2023, passed by the Ld. DCDRC, Dakshin Dinajpur, in CC/32/2021.

The Appellants’ case in brief is that, the Respondent is an aged widowed lady, whose son, the deceased/Subhasis Mardi was a Policy Holder with the Appellants, having Policy No.135599873, with sum assured of Rs.10,00,000/- (Rupees ten lakhs) only, under Table -815, with a monthly premium of Rs.2940/- (Rupees two thousand nine hundred forty) only, which was debited from his salary account till 25/03/2021, as the Policy holder was an Assistant Teacher of Safarpur F. P. School under Kumargunj Circle, with the commencement date of policy, being 07/05/2017. The total amount of premiums debited was for 48 months, amounting to Rs.1,41,120/- (Rupees one lakh forty-one thousand one hundred twenty) only, till 25/03/2021. But the Appellants had not properly debited the premium amounts, from his salary account in the month of April, May, June and July for the year 2020. For the months of November, December, 2020 and also in the months of January, February, March & April 2021, with the outstanding unpaid premium being debited, on 25/03/21, after the death of the deceased/insured. But the deceased/Subhasis Mardi expired due to hanging on 11/09/2020 and a complaint had been lodged and post-mortem of the deceased had been done. The Respondent was therefore entitled to get the death benefit, under the said Policy, being the mother and the only legal heir of the deceased, as he had died a bachelor. The Respondent had submitted the death claim on the death of the deceased/Subhasis Mardi, but the Appellants had made a payment of Rs.52,651/- (Rupees fifty-two thousand six hundred fifty-one) only, in spite of repeated requests. She then issued a Legal Notice dated 04/05/2021 and on receipt of the same the Appellant No.1 replied that the revival was on 18/07/2020 and as the insured had committed suicide within 12 months from the date revival an amount which is higher of 80% of the premiums would be paid, till the date of death and no further claim would be entertained. Finding no alternative, the Respondent filed this case before the Ld. DCDRC, Dakshin Dinajpur, with necessary prayers.

The Appellants filed written version as well as additional written version to contest the claim, wherein they have mentioned that the Respondent was entitled to get only 80% of the premiums paid and the payment of premiums was paid by NACH and the demand for 05/2020 had been dishonored, with the remark “Not Arranged For” and the Policy had lapsed and the same was revived on 18/07/2020, after premiums had been deposited for 05/2020, 06/2020 & 07/2020 along with interest and thereafter the payments through NACH was regularized. It was also mentioned that there was an inadvertent mistake and the Respondent was entitled to further Rs.41,724/- (Rupees forty-one thousand seven hundred twenty four) only after deducting Rs.52,651/- (Rupees fifty two thousand six hundred fifty one) only, from Rs.94,375/- (Rupees ninety four thousand three hundred seventy five) only.

After going through the evidence and materials on record, the Ld. DCDRC, Dakshin Dinajpur, vide the impugned order, directed the Appellants to issue an A/c payee cheque of Rs.10,10,000/- (Rupees ten lakhs ten thousand) only, within 45 days, from the date of passing of the order.

Being aggrieved by the impugned order the instant appeal was preferred on the ground that the Ld. DCDRC, Dakshin Dinajpur had erred in law and facts while passing the impugned order.

Decisions with Reasons

Ld. Advocate for the Appellant at the time of final hearing, had submitted that the Ld. DCDRC, Dakshin Dinajpur, had miserably failed to understand, that the Policy of the deceased, was the Revival Policy as the deceased had committed suicide within 12 months from the date of revival, on the basis of the letter dated 24/1/2020 with Ref. No. CO/CRM/1190/23 issued by the Executive Director, the Respondent was entitled to get only 80% of the premiums paid. It was further argued that only an amount of Rs.41,724/- (Rupees forty-one thousand seven hundred twenty-four) only, was receivable by the Respondent, as there was an inadvertent mistake at the time of calculation of the dues payable to the Respondent. He has relied in the judgement passed in Satya Deo Malviya Vs. LICI reported in CPJ (I) 2004, 96(NC) and P. C. Chacko & Anr. Vs. Chairman, LICI reported in CPJ (III) 2008, 78(SC).

Ld. Advocate for the Respondent, on the other hand, had countered that the Policy of the deceased was under Plan No.815, as per the condition of the Policy Clause 11(b)(i), it was provided that in case of intentional self-injury and attempted suicide, the Life assured was entitled to get the basic sum assured and the LICI would not be liable to pay the additional sum equal to the accidental benefit sum assured and therefore the Respondent was entitled to get Rs.10,00,000/- (Rupees ten lakhs) only. He had relied in the judgement passed in Branch Manager, Reliance Life Insurance Ltd. Vs. Usha Soni reported in (2021) CJ 367 (NC), in Kamila Devi & Anr. Vs. TATA AIG Life Insurance Co. Ltd. reported in (2021) CJ 636 (NC), Ms. Manisha Gupta & Ors. Vs. Birla Sun Life Insurance Co. Ltd. reported in (2019) CJ 517 (NC), Sree Ambika Medical Stores & Ors. Vs. The Surat People’s Cooperative Bank Ltd. & Ors. reported in (2020) CJ 610 (SC), Kiranjit Kar & Ors. Vs. HDFC Standard Life Insurance Co. Ltd. reported in (2018) CJ 502 (NC) and Oriental Insurance Co. Ltd. Vs. Abhijit Purushottam Pathak reported in (2020) CJ 123(NC).

After going through the materials on record, it becomes clear, that as far as the facts of the Case are concerned, it is not disputed. The only dispute is with regard to the application of the letter Ref. No. CO/CRM/1190/23 dated 24/01/2020, to the instant case. The above letter is reproduced below for proper understanding:

For Plans introduced on or after 01.01.2014 the period of Suicide Clause is applicable from the date of risk and also from the date of revival. As per the Policy conditions and Product Regulations: A: If the Premium is not paid before the expiry of the days of grace the Policy lapses. B: Lapsed policy can be revived with a period of 2 consecutive years (now revised to 5 yrs for non-linked policies and 3 years for linked policies) from the date of unpaid premium but before the end of policy term on payment of all the arrears of premium together with interest (compounding half-yearly) at such rate as fixed by the Corporation from time to time, subject to submission of satisfactory evidence of continued insurability. From the above and the Board approved Underwriting Policy, it can be inferred that the revival of the lapsed policy may be carried out based on DGH/Medical Report/Special Reports or waiving such requirements. It is hereby clarified that if Premium is received after the days of grace, irrespective of whether evidences of continued insurability are obtained from the policy holder or waived it shall be treated as revival. As such the payment of premiums made after the days of grace (even during the claim concession period) shall be grated as revival for the purpose of applicability of Suicide Clause.

Hence, from the above it can be safely concluded that at the time of commencement of the Policy on 07/05/2017, there was no exclusion Clause for the Plan 815, which was opted by the deceased/insured. In this regard, the Appellants had filed one blank Policy Certificate, which does not establish that the Policy, executed between the Appellants and the deceased/insured was covered by the Clause mentioned above. Since the execution of the Policy between the Appellants and the deceased/insured was a contract, the same needs to be guided by the principles of Law of Contract. The contract jurisprudence, clearly lays down that the terms of contract, which was entered into at the time of execution of the Policy, between the Appellants and the deceased/insured, would prevail till such Policy was terminated. But vide the above letter Ref. No. CO/CRM/1190/23 dated 24/01/2020, the Appellants had sought to introduce new terms of contract to govern the Policy, which was executed long time back. That apart, the Appellants’ intent to introduce the new Clauses to govern the Policy without even intimating the deceased/insured, not only reeks of arbitrariness, but also tramples upon the principles of audi alterum partum. Therefore, the Appellants’ intent to include the Clauses mentioned in the above letter to the Plan of the instant Case, does not appear to be in synchronization with the canons of contract law. In other words, the application of the clauses, enumerated in the above letter Ref. No. CO/CRM/1190/23 dated 24/01/2020, would be to the policies purchased after the date mentioned therein. Under the circumstance, the Appellants’ reliance on the above-mentioned letter, to challenge the impugned order, appears to be impermissible in law. As already observed, there being no dispute, with regard to the facts of the case, the instant appeal is bound to fail.

                                                                      It is therefore

                                                                       ORDERED

That the instant appeal be and the same is dismissed on contest, but without cost.

The impugned order is hereby upheld.

The Appellants are hereby directed to comply with the directions mentioned in the impugned order within 45 days from the date of receipt of this order.

Copy of the order be sent to both the Parties, free of cost.

Copy of the order be sent to the Ld. DCDRC, Dakshin Dinajpur, for necessary information.

Statutory deposits, be returned from whom received.

Jt. Registrar, Siliguri Circuit Bench of WBSCDRC, to do the needful.