1.                     The brief history of the case of the complainant is that he obtained an LIC Policy bearing No.571829905, DOC 28.3.2010 from OP No.1 for a sum assured of Rs.2.50 lacs on quarterly premium payable Rs.4078/- and was regularly paying the premiums but due to financial stringencies he could not pay the premiums due on 12/10 and the fact was intimated to OP.1.  It is submitted that the complainant faced a road accident on 19.5.11 and the fact of accident and nonpayment of premiums was intimated to OP.1 who suggested the complainant to deposit to deposit the back premiums in order to get the accident benefits.  Accordingly the complainant deposited the premiums for 12/10 & 3/11 on 26.5.2011 and incurred a sum of Rs.5.00 lacs towards medical expenses at different hospitals but unfortunately the complainant became paralyzed below the waist level.  It is further submitted that the complainant claimed disability benefits under the policy before the Ops and as per their directions furnished all relevant documents but on 19.5.15 the Ops repudiated the claim of the complainant.  Thus alleging deficiency in service on the part of the Ops, he filed this case praying the Forum to direct the Ops to settle the disability benefits and to pay Rs.10, 000/- towards compensation and costs to the complainant.

2.                     The Ops filed counter in joint admitting the alleged policy taken by the complainant with quarterly mode of payment of Rs.4078/- and contended that the policy was in lapsed condition due to nonpayment of quarterly premium of 12/10 & 3/11 and the accident took place on 19.5.2011.  Since the policy was not in force on the date of accident, the claim of the complainant could not be considered.  Denying any assurance to the complainant by OP.1, they contended that the allegations are required to be proved by producing relevant evidence.  It is further contended that in the month of March, 2015, the complainant came to the Ops with some documents and affidavit regarding his claim and the claim was repudiated on 19.5.2015 showing non eligibility of the claim.  Thus denying any fault on their part, the Ops prayed to dismiss the case of the complainant.

3.                     The complainant has filed certain documents in support of his case.  Heard from the parties through their respective A/Rs and perused the materials available on record.

4.                     In this case, Policy No.571829905 dt.28.03.2010 with quarterly mode of payment of Rs.4078/- for a Sum Assured of Rs.2.50 lacs issued by the Ops in favour of the complainant is an admitted fact.  The complainant submitted that he was paying the premiums regularly but due to financial stringencies he could not pay the premiums for 12/10 onwards and on 19.5.2011 he met with an accident.  On approach the OP.1 suggested that the accident benefit would be available under the policy if the policy continues with payment of back premiums and the complainant paid the premiums for 12/2010 and 3/2011 on 26.5.2011.  In spite of incurring a sum of Rs.5.00 lacs towards medical expenses, the complainant suffered PARAPLEGIA and lying in sick bed.  When the complainant claimed disability benefits under the policy, the Ops repudiated the claim on 19.5.2015.

5.                     The Ops stated that the policy was in lapsed condition for nonpayment of quarterly payments for 12/10 & 3/11 and the alleged accident took place on 19.5.2011.  As the accident occurs before the date of FUP or within the grace period, the Ops repudiated the claim.  The Ops also did not admit the contention of the complainant that as per advice of OP.1, the complainant deposited the back premium.

6.                     It is seen from the record that the complainant has paid the premium due for 9/10 on 23.12.10 and failed to deposit the next premium till the accident took place on 19.5.2011.  As on the date of accident there were 2 gap premiums i.e. 12/10 & 3/11 and the complainant has paid the above two premiums on 26.5.2011 and also remained with the policy by depositing the premiums till 3/2012.  It is also seen that the claim of the complainant has been repudiated by the Ops on 19.5.2015.

7.                     From the above discussions it was ascertained that the complainant has not deposited the premiums for 12/10 & 3/11 or within the extended grace period for which the policy in question was in lapsed condition when the accident took place on 19.5.2011.  Hence we do not see any fault on the part of the Ops in repudiating the claim.  Further the averment of the complainant that he deposited the back premiums at the instance of the OP.1 is not supported by any cogent evidence.

8.                     It is found that the complainant is lying in sick bed as he is suffering disability below his waist and also is not eligible to get such benefit under the policy. The complainant is also not paying the premiums after 3/2012.  He is also not entitled to the benefits as prayed for.  In the above circumstances and considering the present situation of the complainant, we feel a direction to the Ops for refund of total premiums without any interest would be just and proper.  It is seen that the complainant has paid premiums from 3/10 to 3/12 totaling a sum of Rs.37, 490/- as revealed from the assessment report of Ops dt.19.5.2015 addressed to the complainant.

9.                     Hence ordered that the complaint petition is allowed in part and the Ops being jointly and severally liable are directed to refund Rs.37, 490/- towards premium deposits without any other benefits to the complainant within 30 days from the date of communication of this order failing which the above awarded sum shall carry interest @ 6% p.a. from the date of this order till actual payment.

(to dict.)