Complaint filed on: 25.11.2015
Complaint Disposed on:04.10.2017
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AT CHICKMAGALUR.
COMPLAINT NO.143/2015
DATED THIS THE 4th DAY OF OCTOBER 2017
:PRESENT:
HON’BLE SRI RAVISHANKAR, B.A.L, LL.B., - PRESIDENT
HON’BLE SMT B.U.GEETHA, M. COM., LL.B., -MEMBER
HON’BLE SMT H. MANJULA, B.A.L., LL.B., - MEMBER
COMPLAINANT/S:
Smt Chikkamma,
W/o Sri M.C.Shiva murthy,
Aged about 55 years,
Kuvempunagara, Kote,
Chikmagalur City-577101
(By Sri/Smt. Jayavasanth Savur D., Advocate)
V/s
OPPONENT/S:
1. The Branch Manager,
LIC of India, Mudigere
Town and post-577132.
2. The Senior Divisional Manager,
LIC of India, Division Office,
Udupi-576101.
3. The Managing Director,
LIC of India, Central Office,
Yogakshema, Jeevan Bima Marg,
P.B.No.19953, Mumbai,
Maharastra-400021.
(Op 1 and 2 By Sri.H.C.Krishna, advocate)
By Hon’ble President Sri. Ravishankar,
:O R D E R:
The complainant filed this complaint U/s 12 of the Consumer Protection Act 1986 against Op 1 and 2 alleging deficiency in service in not paying the double accidental benefit to the complainant. Hence, prays for direction against Op 1 and 2 to pay the accidental benefit along with compensation of Rs.50,000/- for deficiency in service.
2. The brief facts of the complaint is that:
The son of the complainant one M.S.Ravi has obtained life insurance policy called Jeevan Saral in the year 2012 (with profits) bearing No.626706070 for a sum of Rs.1,25,000/-, the said policy is double benefit policy covering the two risk factors first being the sum assured of Rs.1,25,000/- and second benefit is the accident benefit including the death of the life assured. The complainant is the nominee to the said policy.
Such being the case, the son of the complainant M.S. Ravi (policy holder) met with an accident on 27.11.2014 and he was under treatment for head injury till 01.12.2014. There afterwards he discharged on 02.12.2014 from Kasturba Medical College Hospital, Manipal and he was on the way to Bangalore for further treatment at Nimhans Hospital, Bangalore just outskirts of Chikmagalur city he died due to injuries. After death of son of the complainant the nominee Smt.Chikkamma/complainant claimed for assured amount with accidental death benefit under policy and Op had paid only assured amount of Rs.1,25,000/- plus bonus in total Rs.1,36,759/- without giving total accident benefit. Even inspite of requests also Op 1 and 2 failed to pay the accident benefit to the complainant.
The son of the complainant had paid Rs.6,005/- on 01.12.2014 towards policy premium and the policy came into force as on 02.12.2014. Even inspite of policy is in force the Op 1 and 2 have not paid the accident benefit to the complainant, due to which complainant suffered financial loss and in-convenience.
Finally, complainant issued a legal notice on 29.09.2015 and called upon the Op 1 and 2 to pay the accident benefit to the complainant, but instead of complying the notice Op 1 and 2 replied untenably. Hence, Op 1 and 2 rendered deficiency in service in not paying the accident benefit to the complainant. Hence, complainant filed this complaint and prays for direction against Op 1 and 2 to pay the balance accident benefit along with compensation for deficiency in service as prayed above.
3. After service of notice Op 1 and 2 appeared through their counsel and filed version and contended that, Sri Ravi M.S. holder of Jeevan Saral life insurance policy issued from their office and policy bearing No.626706070 for a sum of Rs.1,25,000/- on 07.09.2012. The son of the complainant met with an accident on 27.11.2014 and died on 02.12.2014. On the date of accident the policy was lapsed for non-payment of premium due on 07.09.2014. The complainant paid the said due premium with interest Rs.6,147/- on 01.12.2014 that is four days after the accident and one day before the death. After payment of the premium with interest they brought the policy in force on 01.12.2014. The complainant was paid Rs.1,36,759/- on 31.01.2015 and the same amount was received by complainant without any protest.
Op 1 and 2 further contended that, the policy issued to the son of the complainant was not in force as on the date of accident which is the pre-condition for considering the settlement of accident benefit under the policy contract. The pre-condition is clearly stipulated under clause 11 of the policy bond issued to the son of the complainant, basing on the said clause the accident benefit was not payable. Hence, they have not paid the accident benefit to the complainant. Anyhow, they have paid the assured amount with bonus.
After receipt of the legal notice they have replied suitably and the matter was also referred to Zonal Claims Disputes Redressal Committee and they also taken a decision that complainant is not entitled to get the accident benefit in the policy. The same was intimated to the complainant and also suggested if she is not satisfied with the decision by the Zonal office she can give representation to the Insurance Ombudsman, Hyderabad for relief, but so far complainant had not approached the Insurance Ombudsmen in this regard.
Further under the captioned Jeevan Saral Policy, as per the conditions and privileges para 11 given on the policy bond, Accident benefit- the accident benefit on permanent disability or death may be admitted “if the policy is in full force as on date of Accident”. In the above case, the first unpaid premium was due on 07.09.2014 and the policy was in lapsed condition as on the date of accident i.e. on 27.11.2014. Hence, the accident benefit is not admissible. Grace Period – (para 2) – it is clearly stated that, “A grace period of one month but not less than 30 days will be allowed for payment of premiums. If a premium that has become due, is not paid before the expiry of the days of grace, the policy lapses”. As per the policy condition under Jeevan Saral Policy, the lapsed policy may be revived during the life time of the life assured subject to some condition. A policy can be revived within six months from the date of first unpaid premium with arrears of premium along with late fee without submitting any proof of insurability. If the lapsed period is beyond 6 months then the life assured has to submit proof of continued insurability to the satisfaction of the corporation. In the above case the policy was revived on 01.12.2014 on receipt of arrears of premium and late fee only, because the lapsed period was within six months from the date of first unpaid premium. As the first unpaid premium 07.09.2014 along with late fee was received, the policy was revived and brought into force on 01.12.2014 i.e., one day before the date of death. Hence, the basic sum assured paid to the nominee. Hence, there is no any deficiency in service on the part of these Ops in not paying the accident benefit as per the policy and complainant is not entitled to get any relief claimed in the complaint. Hence, prays for dismissal of the complaint.
4. Complainant filed affidavit and marked documents as Ex.P.1 to Ex.P.25. Op 1 and 2 also filed affidavit and marked documents as Ex.R.1 to Ex.R.5.
5. Heard the arguments.
6. In the proceedings, the following points do arise for our consideration and decision:
- Whether there is a Deficiency in service on the part of Ops?
- Whether complainant entitled for any relief & what Order?
7. Our findings on the above points are as follows:-
- Point No.1: Affirmative.
- Point No.2: As per Order below.
: R E A S O N S :
POINT NOs. 1 & 2:
8. There is no dispute that, the son of the complainant one Ravi M.S. on 07.09.2012 had obtained Jeevan Saral insurance policy from Ops by paying a premium amount of Rs.6005/-. It is also not in dispute that the son of the complainant met with an accident on 27.11.2014, due to which he died on 02.12.2014 due to failure of treatment. Subsequently, being the nominee and beneficiary of the policy complainant claimed for assured amount with accident benefit from Ops, but Ops instead of settling the claim of the complainant have only settled the assured amount of Rs.1,36,759/- which includes bonus, but have not settled the accident benefits to the complainant without any valid reasons. Hence, complainant alleges a deficiency in service and prays for direction against Ops to pay the said accident benefit to the complainant.
9. On contrary Op 1 and 2 have taken a contention that, as on the date of accident that is 27.11.2014 the policy issued to the son of the complainant was lapsed. There afterwards the said policy was renewed on 01.12.2014 by receiving premium amount with interest amounting to Rs.6,147/-. After receipt of the claim from the complainant they have settled the assured amount with bonus, but as on the date of accident the policy not in force. Hence, they rejected the claim towards accident benefit. They have rejected the claim as per clause 11 of the policy terms and conditions. Hence, submits no deficiency in service and prays for dismissal of the complaint.
10. On going through the documents produced by both complainant and Op 1 and 2, we noticed that complainant had paid yearly premiums from 2012 without any fail till 2013, but the son of the complainant was not paid the yearly premium in the year 2014 which is due on September 2014. Ops also provided a 30 days grace period for payment of the premium, even inspite of said grace period the son of the complainant had not paid the premium. Anyhow due to non-payment of the yearly premium the policy was comes into lapsed condition. Such being the case on 27.11.2014 the son of the complainant met with an accident and subsequently and unfortunately died after discharge from KMC Hospital, who was about to sent to Nimhans, Bangalore on 02.12.2014. We noticed here that before the death of the son of the complainant the premium amount for the year 2014 was paid and the same is admitted by Op also, as soon as the premium was paid the policy came into force and accordingly the policy assured amount was paid to the complainant. The learned advocate for Ops vehemently argued that as on the date of accident the policy not in force. Hence they denied to pay the accident benefit.
11. Here we are of the opinion that the Ops have to consider the date of death due to accident of the son of the complainant who suffered head injury who underwent treatment till 01.12.2014 at KMC hospital, when the son of the complainant was alive the premium was paid and Ops have accepted the premium and policy came into force. We consider the complainant is entitled to get the accidental death benefit because as on the date of death of the policy holder the policy was in force and the Op 1 and 2 without considering the date of death of the policy holder have repudiated the claim which amounts to deficiency in service. Hence, Op 1 and 2 are liable to pay the accident benefit also to the complainant as per the policy. Op 1 and 2 are also further liable to pay a compensation of Rs.10,000/- for deficiency in service in not considering the date of death at the time of settling the accident benefit to the complainant along with litigation expenses of Rs.1,000/- to the complainant. As such for the above said reasons, we answer the above point no.1 and 2 in the Affirmative and proceed to pass the following:-
: O R D E R :
- The complaint filed by the complainant is partly allowed.
- Op 1 and 2 are directed to settle the accidental death benefit along with compensation of Rs.10,000/- (Ten Thousand Rupees only) for deficiency in service and litigation expenses Rs.1,000/- (One thousand Rupees only) to the complainant within one month from the date of receipt of this order, failing which the payable amount shall carry interest @ 9% P.A. till realization.
- Send free copies of this order to both the parties.
(Dictated to the Stenographer transcribed typed by her, transcript corrected by me and then pronounced in Open Court on this the 4th day of October 2017).
(B.U.GEETHA) (H.MANJULA) (RAVISHANKAR)
Member Member President
ANNEXURES
Documents produced on behalf of the Complainant/S:
Ex.P.1 - Office copy of legal notice.
Ex.P.2 - Three postal receipts.
Ex. P.3 to 5 - Three Postal Acknowledgments.
Ex. P.6 - Reply notice by Op.
Ex. P.7 - Registered postal cover.
Ex. P.8 - Schedules of policy premium payments.
Ex. P.9 - Status Report of policy.
Ex. P.10 - Letter of complainant.
Ex. P.11 - Another letter dtd:12.02.2015.
Ex. P.12 - Another letter dtd:19.02.2015.
Ex. P.13 - Letter of Op 2 dtd:05.03.2015.
Ex. P.14 - Another letter dtd:26.03.2015.
Ex. P.15 - Reply letter of Ombudsman dtd:30.03.2015.
Ex. P.16 - Another letter of Insurance Ombudsman.
Ex. P.17 - Letter of Op 2 dtd:26.05.2015.
Ex. P.18 - Letter of complainant dtd:28.07.2015.
Ex. P.18(a) - Postal receipt.
Ex. P.19 - Letter of Op 2 dtd:05.08.2015.
Ex. P.20 - Photo copy of mode of calculation.
Ex. P.21 - Total premium paid on policy.
Ex.P.22 - Certified copy of FIR.
Ex.P.23 - 1st complaint dtd:29.11.2014.
Ex.P.24 - 2nd complaint dtd:02.12.2014.
Ex.P.25 - Death Certificate of M.S.Ravi.
Documents produced on behalf of the OP/S:
Ex.R.1 - Policy bond.
Ex. R.2 - Copy of FIR.
Ex. R.3 - Copy of Discharge Summary.
Ex. R.4 - Copy of Post Mortem Report.
Ex. R.5 - Death Certificate.
Dated:04.10.2017 President
District Consumer Forum,
Chikmagalur.
RMA
