Complaint is filed on 7-7-2009
Compliant disposed on 4-8-2010
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM::AT:: KARIMNAGAR
PRESENT: HON’BLE SRI K. DEVI PRASAD, B.Sc., LL.B., PRESIDENT
SMT. E. LAXMI, M.A.,LL.M.,PGDCA (CONSUMER AWARENESS), MEMBER
SRI. K. CHANDRA MOHAN RAO, B.Com., LL.B., MEMBER
WEDNESDAY, THE FORTH DAY OF AUGUST, TWO THOUSAND TEN
CONSUMER COMPLAINT NO. 106 OF 2009
Between:
Dhanarekula Laxmi, W/o. Mallesham, @ Ganga Malliah, Age 24 years, Occ: Household, R/o. Ailapur village of Korutla mandal of Karimnagar district.
… Complainant
AND
Life Insurance Corporation of India, Metpally branch, Metpally proper and mandal, Karimnagar district, R/by it’s Branch Manager.
…Opposite Party
This complaint is coming up before us for final hearing on 22-7-2010, in the presence of Sri B.Srinivas and Smt. B. Geetharani, Advocates for complainant and Sri J. Sriramulu, Advocate for opposite party, and on perusing the material papers on record, and having stood over for consideration this day, the Forum passed the following:
:: ORDER::
1. This complaint is filed under Section 12 of C.P.Act, 1986 seeking direction to the opposite party to pay Rs.1,00,000/- towards sum assured under the Life Insurance Policy together with eligible benefits, interest, compensation and costs.
2. The brief averments of the complaint are that the husband of the complainant D.Mallesham obtained Life Insurance Policy for a sum of Rs.1,00,000/- on the life of his minor son D.Manideep aged 2 years. On receipt of insurance Premium of Rs.8,800/- the opposite party issued Insurance Policy no.685246381 for Rs.1,00,000/-. As per the terms and conditions of the policy in the event of death of the policy holder, the legal heirs will get an assured sum of Rs.1,00,000/- with eligible benefits. The policy holder died on 4.1.2009. After his death the complainant being the mother of the policy holder informed the opposite party about his death on 13.1.2009 and submitted a claim form by enclosing death certificate requesting the opposite party to settle the claim. But even after lapse of considerable time the opposite party failed to settle the claim, therefore the complainant got issued a Legal Notice on 14.5.2009 calling upon the opposite party to settle the claim. Inspite of service of legal Notice the opposite party failed to pay the sum assured under the policy, hence prayed for allowing the complaint.
3. The opposite party filed counter submitted that the father of the policy holder D.Ganga Mallaiah submitted a proposal for issuing life policy for an assured sum of Rs1,00,000/- on the life of his minor son D.Manideep aged 2 years. Accordingly the opposite party issued policy under Komal Jeevan Plan after receiving premium of Rs.8,800/-. The policy has commenced from 26.5.2008 and will be in force for a period of 16 years. The opposite party received a claim in the month of Jan 2009 that the policy holder died on 4.1.2009 after paying only one installment premium which was paid by his father. On receipt of the said claim submitted by the complainant, the opposite party asked her to submit original Death Certificate of her son and also informed her that father of the insured has to submit the claim form as there is no nomination. The opposite party sent letter on 13.2.2009 and 16.5.2009 calling upon the complainant to submit the original Death Certificate but so far she has not submitted the same. It is further submitted that the life assured died before commencement of risk under the policy and therefore the complainant is not entitled for the sum assured under the policy, but they are entitled to claim refund of the premium paid by them. When a notice is served by the complainant, the opposite party sent a reply asking the complainant to submit the claim by the father of the policy holder. As per the special condition no.2 contained in the policy the proposer is entitled for refund of premium paid by him if the life assured died before commencement of the risk under the policy. As per the said condition the husband of the complainant is entitled to receive Rs.8,622/- towards refund of the paid up Insurance Premium. The complainant is not entitled for payment of sum assured as there was no commencement of risk. There is no deficiency of service on the part of the opposite party, hence prayed for dismissal of the complaint.
4. The complainant filed Proof Affidavit reiterating the averments made in the complaint and filed documents which are marked as Ex.A1 to A8. Ex.A1 is the photo copy of policy Dt: 26.5.2008. Ex.A2 is the photo copy of Death Certificate issued by Grampanchayath Ailapur Dt: 5.1.2009. Ex.A3 is the office copy of application submitted to opposite party by the complainant Dt: 13.1.2009. Ex.A4 is the office copy of Legal Notice got issued by complainant Dt: 14.5.2009. Ex.A5 is the receipt of Professional courier addressed to opposite party Dt: 15.9.2008. Ex.A6 is the photo copy of Claimants Requisition for claim forms for consideration of death claim. Ex.A7 is the letter from opposite party addressed to husband of complainant Dt: 23.7.2009. Ex.A8 is the photo copy of passport of complainant husband issued by Consulate General of India, Dubai (U.A.E.).
5. The opposite party filed Proof Affidavit of it’s Administrative Officer reiterating the averments made in the counter and filed documents which are marked as Ex.B1 to B5. Ex.B1 is the original policy Dt: 26.5.2008. Ex.B2 is the original Status Report of policy no.685246381 Dt: 16.5.2009. Ex.B3 is the letter from opposite party addressed to complainant Dt: 13.2.2009. Ex.B4 is another letter from opposite party addressed to complainant Dt: 16.5.2009. Ex.B5 is the letter from opposite party addressed to counsel for complainant in respect of Claim Form Dt; 16.5.2009.
6. The points for consideration are:
- Whether there is any deficiency of service on the part of opposite party?
- If so, to what relief the complainant is entitled?
7. Heard both sides.
8. It is contended by the complainant that the opposite party is bound to pay the sum assured on account of death of policy holder in terms of the policy conditions under Ex.A1. To prove the death of her son the complainant submitted Xerox copy of Death Certificate of her son. But the opposite party did not pay the sum assured and repudiated the claim therefore the complainant got issued Legal Notice under Ex.A4. The learned counsel for the complainant relied on the judgment of Hon’ble National Commission 2009 (3) CPR at Page No.50 and also another judgment reported in 2005 (2) CPR at Page No.86 rendered by Hon’ble National Commission.
9. It is contended by the opposite party that the policy under Ex.B1 was issued in favour of D.Manideep aged 2 years and the policy commenced from 26.5.2008. As per the terms and conditions of the policy the risk will commence 2 years from the date of commencement of policy ‘or’ after completion of 7 years by the minor. In this case the risk commences from 26.5.2010, but the life assured died on 4.1.2009. Therefore, the opposite party is ready to pay an amount of Rs.8,622/- towards the refund of the premium paid by the proposer. Since the complainant was informed about settlement of the claim immediately after receipt of the claim, there is no delay ‘or’ deficiency of service on the part of opposite party, hence opposite party prayed for dismissal of the complaint.
10. A perusal of the policy under Ex.A1 and Ex.B1 the opposite party issued Life Insurance Policy on the life of D.Manideep aged 2 years for an assured sum of Rs.1,00,000/- by paying initial premium of Rs.8,800/-. The said policy commenced from 26.5.2008. A perusal of the terms and conditions of the policy as mentioned in Status Report under Ex.B2 the date of commencement of risk will be after 2 years of commencement of the policy or on attaining age of 7 years by the insured person. The mode of payment of premium is yearly and only one premium was paid by the father at the time of submission of proposal form. The death certificate under Ex.A2 discloses that the insured person died on 4.1.2009 i.e. within a period of 8 months from the date of commencement of the policy. Till his death the risk under the policy has not commenced as the insured was aged 3 years only as on his death.
11. The learned counsel for complainant relied on judgment of Hon’ble National Commission reported in 2009 (3) CPR at page no.50 in the said judgment it is held that ‘whenever there is an ambiguity in terms of issuance policy, benefit of interpretation should go to insured and not to insurance. This judgment is not applicable to the fact of this case as there is no ambiguity in terms of insurance policy, since the condition stipulated clearly discloses the date of commencement of risk. The learned counsel for the complainant relied on another judgment of Hon’ble National Commission reported in 2005 (2) CPR at page 86 in which it is held that “where Life Insurance Policy was issued on 16.8.1994 and insured died on 30.8.1994, policy could not have been repudiated on ground that half yearly premium which fall due on 28.6.1994 had not been paid”. In this case the claim was repudiated on the ground that half yearly premium has not been paid and there was no commencement of risk though the date of risk was specifically mentioned in the policy. The said judgment is not applicable to the facts of the case on hand as there is specific condition regarding commencement of risk for payment of sum assured in case of death of the policy holder.
12. The Status Report under Ex.B2 discloses that the father of insured paid Rs.8,800/- towards 1st premium installment at the time of submitting the proposal. The opposite party filed counter that they are ready to pay Rs.8,622/- towards refund of the insurance premium after deducting the process fee. As per the terms and conditions of the insurance policy the risk on the life of insured has not commenced as on the date of his death, therefore the opposite party is not liable to pay the sum assured. Therefore, we hold that the complainant is not entitled to claim for payment of sum assured under Ex.A1 policy, however she is entitled to receive Rs.8,622/- towards refund of the insurance premium paid by them. The complainant being the mother of the deceased policy holder is entitled to receive the said amount. In view of the said reasons, the claim of complainant for payment of Rs.1,00,000/- is rejected but the opposite party is directed to pay Rs. 8,622/- to the complainant towards refund of insurance premium. In the circumstances of the case the complainant is not entitled for any interest and costs of the complaint.
13. In the result the complaint is partly allowed directing the opposite party to pay Rs.8,622/- within one month from the date of receipt of this order. In the circumstances of the case the complainant is not entitled for any interest and costs.
Typed to my dictation by Stenographer and after correction the orders pronounced by us in the open court this the 4th day of August, 2010.
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MEMBER MEMBER PRESIDENT
NO ORAL EVIDENCE HAS BEEN ADDUCED ON EITHER SIDE
FOR COMPLAINANT:
Ex.A1 is the photo copy of policy Dt: 26.5.2008.
Ex.A2 is the photo copy of Death Certificate issued by Grampanchayath Ailapur Dt: 5.1.2009.
Ex.A3 is the office copy of application submitted to opposite party by the complainant Dt: 13.1.2009.
Ex.A4 is the office copy of Legal Notice got issued by complainant Dt: 14.5.2009.
Ex.A5 is the receipt of Professional courier addressed to opposite party Dt: 15.9.2008.
Ex.A6 is the photo copy of Claimants Requisition for claim forms for consideration of death claim.
Ex.A7 is the letter from opposite party addressed to husband of complainant Dt: 23.7.2009.
Ex.A8 is the photo copy of passport of complainant husband issued by Consulate General of India, Dubai (U.A.E.).
FOR OPPOSITE PARTY:
Ex.B1 is the original policy Dt: 26.5.2008.
Ex.B2 is the original Status Report of policy no.685246381 Dt: 16.5.2009.
Ex.B3 is the letter from opposite party addressed to complainant Dt: 13.2.2009.
Ex.B4 is another letter from opposite party addressed to complainant Dt: 16.5.2009.
Ex.B5 is the letter from opposite party addressed to counsel for complainant in respect of Claim Form Dt; 16.5.2009.
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MEMBER MEMBER PRESIDENT
