(Per Mr.P.N.Kashakar, Hon’ble Presiding Judicial Member)
(1) The appeal is filed by the original opponent No.1, L.I.C. against the judgement passed by the Addl. District Forum, Pune in Consumer Complaint No.549/98 decided on 30/09/2002.
(2) By allowing the complaint partly, the Forum below has directed appellant/original opponent No.1 to pay ex-gratia amount as per the Circular dtd. 16/10/1987 considering the case on compassionate ground, failing which it will carry interest @ 12 p.a. The respondent No.2 is also directed to pay provident fund to the complainant after scrutinizing the entire record. Both the appellant and respondent No.2 are directed to pay `5,000/- as costs to the complainant. Aggrieved by this order, only opponent No.1, L.I.C. filed this appeal.
(3) Case of the complainant, Smt.Susheela Dattatray Bhalerao is that her husband Dattatray Bhalerao was working with Mararashtra Rajya Sahakari Sangh Ltd., Pune and her husband had taken life insurance policy for `50,000/- from L.I.C., opponent No.1. Her grievance was that neither her policy amount as death claim was paid to her nor provident fund amount of her husband was paid to her. So she filed complaint against LIC as well as employer of her husband. In the complaint it is mentioned that her husband had taken money back policy for `50,000/-. It was the LIC policy taken by her husband. His employer was deducting monthly premium from his salary and transmitted it to the L.I.C. Her husband expired on 02/03/1997 after by a prolonged illness. After the death of her husband, the complainant/respondent No.1 lodged claim with the L.I.C. However, L.I.C. did not make any payment. L.I.C. informed that at the time of sad demise of the policy holder, the policy was in lapsed position and nothing was payable under the policy. It was informed to her on 30/11/1998 by registered A.D. Therefore, the complainant filed consumer complaint against L.I.C. and employer of her husband claiming `50,000/- sum assured from LIC and also claimed P.F. amount from husband’s employer i.e. opponent No.2, Mararashtra Rajya Sahakari Sangh Ltd., Pune . L.I.C. contested the complaint by filing written version and pleaded that deceased Dattatray Bhalerao had taken a policy under Salary Saving Scheme. Employer was to collect the premium from its employees and was to pay it to the L.I.C. As no payment was made, Corporation informed the employer on 17/01/1998 asking for installments due from July to Sept.1996. The employer communicated the L.I.C. that as the employee - deceased Dattatray Bhalerao was on medical leave from July 1996, he was not paid monthly salary, therefore his premium could not be sent. Therefore, due to non-payment of the premium, the policy lapsed from October 1996, as the dues of July, August and September 1996 came to be adjusted though the premium received late for the month of Oct. 1996. It was done as the gesture of goodwill for the sick person. The condition No.4 of the agreement provides that if the policy comes to be lapsed without at least 3 full years premium having been not paid, should become void and nothing would become payable to the policy holder in that case. The L.I.C. pleaded that it was also legal duty of the employer of the deceased Dattatray Bhalerao to communicate why the premium was not paid and therefore it pleaded that complaint should be dismissed on this count itself.
(4) The respondent No.2 appeared and contested and we are not concerned with them, for the simple reason that this appeal has been filed by the L.I.C. against repudiation letter. On considering rival pleas, the forum gave finding that L.I.C. was guilty in repudiating the claim of the complainant totally. It was the view that as per L.I.C. circular, the lady deserves to be given ex-gratia claim and Forum allowed the complaint partly. As per the circular dated 16/10/1987, the forum below considered the claim on companssionate ground. Aggrieved by this direction, L.I.C. filed this appeal. We heard Adv.Rajiv Chavan for the appellant and respondent No.1 in person.
(5) Adv.Rajiv Chavan submitted before us that the policy commenced on 28/07/1995, the premium from October 1996 till the death of life assured was not paid to the L.I.C. Hence, the policy went in lapsed condition. Thereofore, L.I.C. send repudiation letter to the complainant and informed her why the claim could not be paid to her. We found substance in the submission of Adv.Rajiv Chavan for the appellant L.I.C. However, directing the appellant to pay certain amount to the complainant under its circular dated 16/10/1987 is also not permissible under law for the simple reason ex-gratia claim could be made only when premiums were paid for full two years. So far the applicability of the circular is concerned, the condition was embodied in the circular. The death claim is payable under Ex-gratia scheme provided there should be two years full premium paid by the deceased. In the instant case, from the date of commencement i.e. 28/07/1995 till the death of deceased on 02/03/1997, two years’ period was not over and two years’ full premium could not be paid by the employer. Since deceased, Dattatray Bhalerao had not completed two years’ from the date of commencement of the policy. Premium was paid on behalf of the deceased insured upto October 1996 and from October 1996 till the death of life assured i.e. 02/03/1997, no premium was paid to the L.I.C. and policy was in lapsed condition and since policy was in lapsed condition and premium for two years was not paid, even ex-gratia could not be given in terms of circuar mentioned in Supra. As such Adv.Chavan for appellant submitted that the appeal should be allowed and judgement of the forum should be quashed. We are finding much substance in submission made by Adv.Chavan for the appellant. We have carefully gone through the circular taken into consideration by the District Forum. For the ex-gratia payment, primary condition is that full two years’ premium should have been paid. In this case, premium was paid upto October 1996 and from October 1996 till the death of employee i.e. 02/03/1997, no premium was paid under Salary Saving Scheme and therefore also the policy was lapsed. When the policy is lapsed, nothing is payable. That apart under the policy under the circular mentioned Supra referred to the District Forum premium was not paid by the deceased employee or his employer under Salary Saving Scheme for full 2 years period. For all these reasons, the order passed by the District Forum is held to be erroneous in law. However, we would like to ask appellant to consider the refund of premium paid by the life assured till his death on humanitarian ground. Hence, order.
ORDER
1) Appeal is allowed.
2) Impugned order dated 30/09/2002 passed by the Addl. District Forum, Pune is quashed and set aside so far as the appellant, L.I.C. is concerned.
3) The consumer complaint No.549/1998 stands dismissed as against this appellant only.
4) Inform the parties accordingly.
Pronounced on 12th August, 2011.
