This revision petition has been filed by the petitioner Bajaj Allianz Life Insurance Co. Ltd. against the order dated 06.12.2016 of the State Consumer Disputes Redressal Commission, Haryana, (in short ‘the State Commission’) passed in First Appeal No.1063 of 2015. 2. On 12.01.2008, on receipt of proposal and first premium of Rs.10,000/- the petitioner Insurance Company issues Life Insurance Policy of Rs.1,00,000/- sum assured, being policy No.0081503211, with 12.01.2008 as date of commencement for a term of 20 years, under which annual premiums were payable on 12th January every year till 12.01.2027 as opted by the respondent’s husband Shri Mastan Singh and the date of maturity was 12.01.2028. On 12.01.2009, second annual premium of Rs.10,000/- fell due to be paid within 30 days grace period. On 12.2.2009, grace period expired. On 13.2.2009, the policy in question lapses as the policy holder did not pay the premium due within grace period. On 21.08.2009, the premium due on 12.1.2009 was paid by policy holder and he gets the policy revived from 12.01.2009 to 12.01.2010 only for a period of one year. On 12.01.2010 next annual renewal premium falls due to be payable within 30 days grace period. On 12.2.2010, grace period expires and the policy holder did not pay the premium due. On 12.2.2010, the policy again lapses. On 23.02.2010, the policy holder expired. The complainant lodges death claim with the petitioner Insurance Co. On 14.6.2010, as the policy in question was lying lapsed on the date of death of policy holder, the petitioner Insurance Co. refunded the surrender value amount of Rs.9,994/- in terms of the policy condition. On 18.10.2010, the respondent Smt. Sukhjinder Kaur filed consumer complaint being complaint No.982/2010 praying for payment of the sum assured Rs.1,00,000/- with 18% interest. On 30.9.2015, the District forum Yamuna Nagar allowed the complaint and directed the petitioner herein to pay Rs.1,00,000/- to the complainant with 9% interest and compensation of Rs.5,000/- and Rs.5000/- towards litigation expenses. On 11.12.2015, the petitioner Insurance Company files an appeal challenging the District Forum Yamuna Nagar order before Haryana State Commission. On 6.12.2015, the State Commission dismisses the appeal. 3. Hence the present revision. 4. Heard the leaned counsel for the parties and perused the record. Learned counsel for the petitioner stated that the commencing date of the policy was 12.01.2008 and next premium was due on 12.1.2009. However, the premium was not paid even within the permissible extended period of 30 days beyond the due date. However, the complainant got his policy renewed on 21.8.2009. Obviously, the policy was renewed from the date of its lapsing i.e. 12.1.2009 and the next premium was due on 12.1.2010. Even after the expiry of 30 days grace period the premium was not paid. The policy holder dies on 23.2.2010 when the policy was in lapsed condition. The complainant filed the complaint before the District Forum and the District Forum allowed the complaint on the ground that in the receipt issued for renewal premium of the policy on 21.8.2009, the following is mentioned at the end of the receipt:- “you are covered for Rs.1 Lac SA for Accidental Death under Group PA Policy OG-10-0060-00000011 of BAGIC for 1 yr from the revival date.” 5. On the basis of the above endorsement on the receipt, the District Forum has allowed the claim of Rs.1,00,000/- in respect of Group Insurance Policy by treating the group policy as valid for one year from the date of renewal i.e. one year from 21.8.2009. The petitioner preferred an appeal before the State Commission. However, the same was also dismissed by accepting reasoning given by the District Forum in this regard. It was argued by the learned counsel for the petitioner that the complaint was filed in respect of the life insurance policy No.0081503211, whereas the claim has been allowed by considering another policy, which is the group insurance policy for which no paper was submitted by the complainant either in the complaint or before the Insurance Company. It was further argued that the group insurance policy was issued by another Insurance Company and the petitioner Insurance Company is not responsible to pay that amount. Thus the orders of the fora below are basically illegal and cannot be sustained. 6. On the other hand, learned counsel for the respondent/complainant stated that both the fora below have given concurrent finding and this Commission cannot reassess the facts in the revision petition. The receipt for renewal of the policy dated 21.8.2009 was issued by the opposite party and therefore, the petitioner cannot say that he has no responsibility for the said endorsement on the receipt. The additional cover of Rs.1,00,000/- was clearly valid for one year from the revival date. Thus, this amount was payable if the death occurs during one year from 21.08.2009. 7. I have carefully considered the arguments advanced by both the learned counsel for the parties. Clearly, the receipt of the renewal premium dated 21.08.2009 was issued by the petitioner Insurance Company and it had a clear endorsement at the bottom of the receipt that sum assured of Rs.1,00,000/- in the Group Insurance policy shall be payable and this cover will be applicable for one year from the revival date. Clearly, the District Forum and the State Commission both have relied upon this endorsement and have allowed claim of Rs.1,00,000/- under this provision. It seems that the fora below have not accepted the claim under the main policy, but have allowed the claim of Rs.1,00,000/- as per the group Insurance Policy. However, a perusal of this endorsement clearly shows that this was a group insurance policy for accident. It is not clear whether the deceased life assured (DLA) died of an accident. From the complaint, it seems that DLA died of heart attack and there will be a question mark whether the heart attack would be treated as an accident. Moreover, no claim was submitted under the Group Insurance Policy. Hence, the concerned Insurance Company or the present opposite party/ Insurance Company had no occasion to deal with the insurance claim pertaining to the accident Group Insurance Policy. Clearly, question in dispute was regarding the main policy which was renewed on 21.08.2008. Hence, it is clear that both the fora below have erred in passing the respective orders so far as it relates to allowing the insurance claim on the basis of the Group Accident Insurance Policy. It is seen that the group accident insurance policy was not an independent policy, rather, it was given to the DLA, because of his having taken the main policy. Here it does not matter as to which Insurance Company was the actual insurer because the receipt has been duly issued by the OP Insurance Company and this Company has made the endorsement regarding the insurance of the complainant under the Group Accident Insurance Policy, thereby clearly making itself responsible for ensuring coverage of the complainant under the Group Accident Insurance Policy. The group insurance policy is valid for one year from the revival date, which is 21.08.2009. Therefore, the group accident policy was valid from 21.08.2009 to 20.08.2010. By making this endorsement on the premium receipt and by issuing coverage under a fresh group insurance policy, the parties entered into a new agreement, which would be considered as supplemental in nature with an express contract of additional accidental insurance w.e.f. 21.08.2009 for one year. As this policy was given to the DLA because the DLA paid the premium for renewal for the main policy, therefore, this group accident insurance policy should be valid till the main policy remained valid as the Group Accident Insurance Policy is only given to the complainant because of him continuing with the main policy. But the parties entered into a new contract that the group accident insurance policy shall be valid for one year from 21.08.2009, therefore, as per Section 9 of the Indian Contract Act, 1872, apart from the express contract, there was an implied promise that the main policy will also be valid till the validity of the Group Accident Insurance Policy i.e. for one year after the date of revival i.e. till 20.08.2010. Therefore, the DLA rightly remained under the impression that the policy shall be valid till 20.08.2010. Though clearly the renewal of a lapsed policy starts from the date of lapse, however, in the present case, because of endorsement of coverage of the DLA under the group accident insurance policy, the DLA entered into a new contract with the petitioner Insurance Company with express contract of coverage for one year from revival date i.e. from 21.08.2009 under the Group Insurance Policy and with the implied promise from the petitioner for validity of the main policy till 20.08.2010. Accordingly, as per implied contract between the parties the petitioner/opposite party is liable to pay insurance amount of the main policy to the complainant as the DLA died within this period on 23.02.2010. However, the benefit would only be available, if the policy was actually renewed on 12.01.2010 by paying premium of Rs.10,000/-. Therefore, the Insurance Company shall be entitled to have Rs.10,000/- as premium, which was required to be paid by the DLA. Similarly, the petitioner Insurance Company shall also be entitled to deduct Rs.9,994/-, which was paid to the complainant by the Insurance Company. 8. Based on the above discussion, the revision petition No.823 of 2017 is partly allowed and the Insurance Company is directed to pay only Rs.80,006/- (rupees eighty thousand six only) along with 7% p.a. interest from the date of order of the District Forum i.e. 30.09.2015 instead of Rs.1,00,000/- along with 9% p.a. interest as awarded by the District Forum and confirmed by the State Commission. The orders of the fora below stand modified accordingly. The order of the District Forum relating to compensation of Rs.5,000/- is set aside as interest is being given on the insurance amount. The cost of litigation awarded by the District Forum is maintained. |
