BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. DCFR. 14/11.
THIS THE 20th DAY OF JULY 2011.
P R E S E N T
1. Sri. Pampapathi B.sc.B.Lib. LLB PRESIDENT.
2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.
3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER
*****
COMPLAINANT :- 1. Mahantesh S/o. Dayavappa Talawar, Age: 36
years, Occ: Govt. Teacher, R/o. village Kollur,
Tq. Chitapur, Dist: Gulbarga.
2. Meerabai W/o. Sudarshan Walikar, Age: 47
years, Occ: Household, R/o. Nivargi village,
Tq. Indi, Dist: Bijapur.
//VERSUS//
RESPONDENTS :- 1. The Branch Manager, LIC of India, Branch office, Jeevan Ganga, Hosalli Road,
Gangavathi, Tq. Gangavati, Dist: Koppal.
2. The Divisional Manager, LIC of India, Divisional Office, Sath kacheri Road, Raichur,
Tq. & Dist: Raichur.
3. The Head Master, Government High School, Kanakagiri, tq. Gangavati, Dist: Koppal.
CLAIM :- For the reliefs of Rs. 2,00,000/- towards death
claim amount and its vested bonus, interest and
mental agony of Rs. 25,000/- and Rs. 10,000/- as
as cost of this proceedings.
Date of institution :- 22-02-11.
Notice served :- 18-03-11.
Date of disposal :- 20-07-11.
Complainant represented by Sri. V.S. Zalki, Advocate.
Respondent No-1 & 2 represented by Sri. Shantakumari, Advocate.
Respondent No-3 In person.
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This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.
JUDGEMENT
This is a complaint filed U/s. 12 of Consumer Protection Act by the complainants Mahantesh S/o. Dyavappa & Meerabai W/o. Sudarshanwalikar against the three Respondents (1) Branch Manager Life Insurance Corporation of India. Branch Office Gangavathi, (2) Divisional Manager LIC of India, Raichur and (3) The Head Master, Government High School, Kanakagiri, Tq. & Dist: Koppal, The brief facts of the complaint are as under:
The complainant No-1 is the husband of one late Uravashi and complainant No-2 is mother and nominee of one late Uravashi. The late Uravashi was an employee working as a High School Physical Teacher under Respondent No-3. During her service she had obtained LIC policy from Respondent No-1 & 2 under salary saving scheme on a monthly premium amount of Rs. 607/- by name New Bima Gold Policy bearing No. 661507252 dt. 14-06-08 for assured sum of Rs. 2,00,000/- with extended term cover benefit and accidental benefit. Respondent No-3 had undertaken for making the payment of premium amount of the above said policy to the Respondent No.1, out of salary amount of said Uravashi. The said Uravashi died on 25-10-08 at Wanless Hospital, Miraja, Maharastra due to the Respiratory failure by leaving behind her husband i.e, complainant No-1 as her legal heir and mother i.e, complainant No-2 as a nominee of the said policy. After her death the complainants have submitted death claim application with all required documents to the Respondent No-2 through the Respondent No-1 for getting the death claim amount of Rs. 2,00,000/- and available bonus from the above said policy of late Uravashi. After the receipt of the death claim application the Respondent No-1 assured the complainants that, the sum assured amount of Rs. 2,00,000/- and vested bonus will be paid after getting approval from Respondent No-2. Believing in the words of Respondent No-1 the complainants kept quiet for some days but utter surprisingly, all of a sudden the Respondent No-1 send a reputation letter on 20-11-10 on a ground that, the Respondent No-2 has taken a decision that, the policy was under lapsed condition due to non payment of premium. Further it is the case of the complainant that, after receipt of the repudiation letter dt. 20-11-10 the complainant No-1 has send letter/notice dt. 10-01-11 to the Respondents and requested to reconsider the death claim application but after receipt of the said letter the Respondent No-1 again repudiated the complainants request through letter dt. 13-01-11 stating same false and baseless reasons that, their competent authority i.e, Respondent No-2 given decision nothing is payable as the policy was under lapsed condition. It is the case of the complainant that, the attitude of the Respondents is clearly goes to show that, they are acting against the interest of the consumer like complainants and repudiated the claim of complainants without any valid and sound reasons, the act of Respondent is arbitrary and against the well established principles of law and natural justice, the Respondents have violated the rules and regulations of the IRDIA. The act of the Respondent is gross deficiency in service and because of this they have sustained huge loss, mental agony and hardship. Hence they have sought the reliefs of Rs. 2,00,000/- towards death claim amount and its vested bonus, interest and mental agony of Rs. 25,000/- and Rs. 10,000/- as as cost of this proceedings.
2. The Respondent No-1 place Ex-parte through order dt. 18-03-2011, however the same order has been set aside through detail order dt. 11-05-2011 and filed power on behalf of the Respondent No-1 by the Respondent No-2 counsel. Respondent No-3 appeared in person. The Respondent No-2 has filed written version and same has been adopted by Respondent No-1 through memo dt. 08-06-2011. Respondent No-3 has not filed his written version. In the written statement the Respondents 1 & 2 have admitted that late Uravashi the life assured had taken New Bima Gold policy bearing no. 661507252 on 14-06-2008 under salary saving scheme for sum assured of Rs. 2,00,000/- with extended term cover benefit and accidental benefit under a premium amount of Rs. 607/- and same was repudiated through letter dt. 20-10-10 as the policy holder not paid the premium amount consistently, consecutively for the month of September & October-2008, even availing the grace period. Further it is contended that, since the policy was under lapsed condition due to non payment of premium as stated above, the complainants are not entitled to get the Insurance amount of the deceased, the repudiation made by the Respondents is justified as per the terms of the compromise and terms and conditions of the policy which are binding upon both the parties to the policy, there is no wrong or illegality is committed, under such circumstances, there is no deficiency of service on the part of these Respondents. Further it is contended that, this Forum has no jurisdiction to try this complaint as cause of action if any, has arisen at Gangavathi Tq. & Dist; Koppal. Hence for all these reasons the Respondents have sought for dismissal of the complaint.
3. During the course of enquiry the complainant has filed her sworn-affidavit by way of examination-in-chief. In-rebuttal on behalf of Respondent No- 1 & 2 the sworn-affidavit of Respondent No-2 is filed by way of examination-in-chief. The memo dt. 06-07-2011 has been filed for to adopt the same by the Respondent No-1. The Respondent No-3 has not filed his evidence. In these affidavit-evidence filed by the complainant and Respondent No-2 have reiterated their stand in the complaint and written version respectively.
4. The complainant has filed (13) documents at Ex.P-1 to P-13 which are (1) Xerox copy of LIC policy at Ex.P-1, (2) Xerox copy of letter dt. 24-08-08 written by deceased Uravashi to the Respondent No-3 at Ex.P-2, (3) Death certificate of Urvashi at Ex.P-3, (4) Xerox copy of medical attendants certificate of late Urvashi at Ex.P-4, (5) Xerox copy Certificate of Hospital treatment of Uravashi at Ex.P-5, (6) Xerox copy of certificate of Identity and Burial or Cremation at Ex.P-6, (7) Xerox copy of certificate by employer is marked at Ex.P-7, (8) Xerox copy of intimation regarding discharge of death claim (Form No.3801) at Ex.P-8, (9) Xerox copy of letter dt. 20-11-10 written by Respondent No-1 to complainant No-1 marked at Ex.P-9, (10) Xerox copy of the letter dt. 11-01-11 by complainant No-1 to Respondent No-1 is marked at ExP-10, (11) Letter dt. 13-01-11 by Respondent No-1 to complainant No-1 is marked at Ex.P-11, (12) Xerox copy of extract of salary deduction of deceased issued by Respondent No-3 is marked at Ex.P-12, (1) Xerox copy of Family survival certificate dt. 12-11-08 is marked at Ex.P-13. Similarly the two documents filed by the Respondent No-2 are marked at Ex.R-1 & Ex.R-2.
5. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:
1. Whether the complainants proves deficiency in service by the Respondents 1 & 2 in not settling her claim under the policy, as alleged.?
2. Whether the complainants are entitled for the reliefs sought
for?
6. Our finding on the above points are as under:-
1. In the affirmative. 2. As per final order for the following.
REASONS
POINT NO.1:-
7. There is no dispute that late Uravashi W/o. complainant No-1 Mahantesh and daughter of complainant No-2 had obtained LIC New Bima Gold Policy under salary saving scheme and the said Uravashi died on 25-10-08. It is not disputed by the Respondents 1 & 2 that the complainant No-1 is the legal heir and the complainant No-2 is the nominee of the LIC policy. Further it is also not in dispute that, the complainants have filed death claim before the Respondent No-1 & 2 and same was repudiated and intimated by the Respondents through letter dt. 20-11-2010 at Ex.P-9.
8. After gone through the pleadings of the parties, and documents filed by them, now the points for our consideration are:
1. Whether the repudiation in respect of claim under the policy made by the Respondent No- 1 & 2 is proper one or not.
2. Whether this Forum has got jurisdiction to entertain this complaint.
9. It is the case of the Respondents 1 & 2 that, the deceased Uravashi was not regular in payment of premium amount in respect of the New Bima Gold Policy which was obtained during her lifetime and she was also due in payment of premium consecutively for the month of September & October-2008 inspite of availing the grace period and for this reason the policy has lapsed so that, they have taken decision for to repudiate the claim of the complainants under the policy. On perusal of the Ex.P-1 the deceased Urvashi has taken the policy on 14-06-2008. But as per Ex.P-2 the letter dt. 24-08-2008 she has availed medical leave on the ground of her ill-health. Further on perusal of the Ex.P-4 medical attendant’s certificate and Ex.P-5 certificate of hospital treatment, it appears that, she has suffering from multiple lung Abscess since from 07-09-2008 and she has taken treatment in hospital from 20-10-2008 till her lost breath i.e, 25-10-08. It means she was under treatment in the month of September & October-2008. No doubt she was under medical leave all these two months and admittedly the premium amount was not deducted under the salary and same was not paid to the Respondent Insurance Company by the Respondent No-3. But on perusal of the pleadings and documents filed by the Respondent Insurance Company we do not find a single piece of documents or evidence to show that, they have made any efforts to make get information regarding non payment of the premiums for the month of September & October-2008 and there was also no intimation given to the policy holder regarding non remittance of premium under the policy. Further we do not find any piece of evidence that, the employer was also not intimated to the deceased policyholder regarding non deduction of the premium amount pertaining to the policy. Under these circumstances, on the ground that for the due of two months premium repudiating the policy is not correct. In this regard, we have referred the following rulings submitted by the complainant (1) Rulings of Hon’ble Supreme Court in C.A. No. 6113/1995 decided on 28-09-1999, CPJ III 2009 at page 25 (NC), CPJ I 2009 Page 266 (NC), CPJ II 2009 314 Karnataka State Commission, CPJ II 2010 483 of Tamil Nadu State Commission, CPJ IV 2008 Page 560 Maharastra State Commission, and CPJ IV 2009 Page 239 Orissa State Commission, the dictums laid down under above rulings it is very clear that, mere non remittance of premium by the employer to the Insurance Company is not cause for repudaitin of claim of the policyholder who has got policy under salary saving scheme, hence we have considered above said rulings to the present case and come to the conclusion that, the repudiation made on the sole ground of non payment of premium for the month of September & October-2008 is improper and illegal one.
10. Another one point, the Respondents has taken regarding jurisdiction. No doubt the Branch office i.e, Respondnet no-1 is residing at Gangavathi but the Division office of the REspndnet No-1 is situated at Raichur and the policy issuing authority is Respondnet No-2 i.e, Raichur Division office situated at Raichur. Hence the contention taken by the Respondent in this regard holds no good, hence we have rejected the same. Hence to this extent we hold that the complainant has proved deficiency in service on the part of the Respondents. Hence Point No-1 is answered in the affirmative.
POINT NO.2:-
11. In view of our discussions and finding on Point NO-1 holding that the claim under policy is proper one, hence the complainants are entitled for to get death claim amount of Rs. 2,00,000/- and its vested bonus with interest at the rate of 9% from the date of receipt of death claim application in respect of Policy No. 661507252 of late deceased Urvashi, we feel it just and proper to issue direction to the Respondents 1 & 2 to expedite the claim matter of the complainant without causing further delay. Further, we have decided to award an amount of Rs. 3,000/- towards cost of the proceedings and Rs. 3,000/- towards mental agony and hardship etc., In this view of the matter we pass the following order:
ORDER
The complaint of the complainant is allowed in part.
The Respondent No.1 & 2 shall pay Rs. 2,00,000/- in respect of death claim amount of the policy bearing No. 661507252 and vested bonus at the rate of 9% interet from the date of receipt of the death claim and Rs. 6,000/- towards cost of the proceedings and mental agony and hardship etc., to the complainants.
The complaint against the Respondent No-3 is dismissed.
The Respondent No. 1 & 2 shall comply this order within (6) weeks from the date of receipt of copy of this order.
Office to furnish certified copy of this order to both the parties forth with free of cost.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 20-07-11)
Smt.Pratibha Rani Hiremath, Sri. Gururaj Sri. Pampapathi,
Member. Member. President,
Dist.Forum-Raichur. Dist-Forum-Raichur Dist-Forum-Raichur.
