Per Shri Atul D. Alsi – Hon’ble President.

              The brother of the complainant namely Umendra s/o Shivcharan Pardhi, R/o. Kanhartola, Post Kati, Tah & Distt. Gondia was working as a Insurance agent and was getting good commission from the office of the Non-Applicant i.e. L. I. C.

2.            The Non – Applicant has offered one scheme to all the Insurance agent to get insurance policy from the office of the Non – applicant and the premium of the policy will be deducted from the commission of the Insurance agent.  The brother of the complainant namely Umendra s/o Shivcharan Pardhi had purchased one policy bearing policy no. 973280378 of Rs. 1,90,000/- and all the premium was regularly deducted from the commission of the deceased Umendra s/o Shivcharan Pardhi.  The complainant is the nominee of the policy.   

3.            Umendra s/o Shivcharan Pardhi was suddenly died on 21/05/2012.  The complainant has submitted the death claim of the above said policy along with all the necessary documents on 20/07/2012.  The complainant was shocked after receiving one cheque bearing no. 084129 of Rs. 12,483/- from the non – applicant which is totally illegal and against the rules and policy of the L.I.C..  The complainant is entitled the amount of Rs. 1,90,000/- + bonus with interest.  But the O. P. has paid only Rs. 12,483/- to the complainant.   

4.            The complainant has issued a legal notice to the non – applicant through his counsel Adv. Vijay C. Pardhi and requested to the non – applicant to pay the insurance amount of Rs. 1,90,000/- + bonus with interest 18% p.a.  The non – applicant had neither replied the notice nor complied with the notice.

5.            The cause of action has been accrued to file the present complaint on 21/05/2012 when the insured brother of the complainant has died, also accrued on 08/09/2012 when the complainant issued notice to the non-applicant through his counsel and is continued till today.  

6.            The complainant prayed that, it be declared that the non-applicant has committed deficiency in service and also committed unfair trade practice.  The non-applicant be directed to pay an insurance amount of Rs. 1,90,000/- + bonus + interest @ 18% p.a. and also be directed to the non-applicant to pay Rs. 20,000/- for cost of proceeding and Rs. 50,000/- for physical agony and mental harassment.   

6.            After receiving the notice issued by the Forum, the O.P. appeared through their counsel and filed their written statement before the forum. 

7.            In their reply, the O. P. mentioned that Umendra Shivcharan Pardhi was working as insurance agent at the office of the Non – Applicant/Opposite Party.  But his services were terminated once on 01/02/2010 for non fulfillment of minimum business guarantee as an insurance agent.  It is not disputed that the deceased Umendra s/o Shivcharan Pardhi had purchased one policy bearing No. 973280378 for a sum of Rs. 1,90,000/-. 

              In their specific submission the opposite party submitted that the O. P. had issued a policy vide policy No. 973280378 with policy details as under:

P.No.              P & T                 S. A.              DOC           Premium

973280378      150-29   Rs. 1,90,000/-   28/07/05      Rs. 171/- (Mly)

Nominee  Ajaykumar Pardhi – relation is shown as brother.  The complainant was paid Rs. 12,483/- vide cheque No. 0084129 dt. 30.07.2012 towards the policy claim of the above said policy.  The policy was in lapsed condition on the date of death of policy holder, and as per the policy condition the claimant/complainant was paid the above said amount as stated in the policy conditions, i.e. the claimant is entitled only for premiums paid till date.

              As per policy condition No. 4 Non-Forfeiture Regulation : “If, after at least 3 full years premiums have been paid in respect of this policy, any subsequent premiums is not duly paid, this policy shall not be wholly void, but the death Benefits/maturity Benefit by it shall be reduced to the total premiums paid less total extra premiums if any”.

              As per the status report of policy at the time of death of policy holder, there were 10 premiums gaps, for which the premiums have not been received till the death of policy holder, i.e. 09/2005, 04/2006, 05/2006, 01/2010, 02/2010, 03/2010, 05/2010, 08/2011, 10/2011 and 02/2012.  Due to above said premium gaps; the policy was in lapsed condition as on the date of death of policy holder.  Hence, as per policy condition full sum assured is not payable.  Further the Deceased Life assured services as agent was terminated once on 01/02/2010 for non – fulfillment of minimum business guarantee.  Further it is the duty of the policy holder to keep the policy in force to avail any benefits under the policy as per the terms of contract between the parties and agreed by the parties.  As per policy conditions (4) Non-forfeiture clause, the premiums received for 73 months i.e. Rs. 12,483/- is already paid to the complainant.  Hence, the complainant is not entitled for any further amount or full sum assured.   Under the above stated circumstances the complaint is liable to be dismissed with exemplary cost.                 

8.            The complainant has filed Copy of letter given by complainant to L.I.C. Gondia at page no. 08, Copy of notice issued by counsel of complainant to L.I.C. at page no. 09, Copy of postal receipt and acknowledgement at page no. 11 & 12, Copy of insurance policy at page no. 15, Copy of death certificate at page no. 16 on record.

9.            The opposite party has filed Copy of policy at page no. 30, Copy of status of policy at page no. 35, Copy of status of agency of deceased at page no. 37 on record.

10.                   The learned counsel Mr. S. V. Khanted, Advocate for the complainant argued that unfortunately on 21/05/2012 the brother of complainant Umendra died.  That, after performing last rites and other rituals the complainant had submitted the death claim on 2007/2012 along with all necessary documents as per the insurance policy stated above.  That, in response to the claim of the complainant the opposite party LIC had sent cheque bearing No. 084129 of Rs. 12,483/-.  Whereas the complainant is entitled to the amount of Rs. 1,90,000/- + bonus along with interest @ 18% per anum as per the policy.  The opposite party had adopted an unfair trade practice by not settling the claim as per claim form and paying only Rs. 12,483/- and therefore liable to pay entire amount as prayed along with litigation charges and amount towards mental harassment caused to the complainant.

11.                   The learned counsel Mr. C. N. Telang, Advocate for the opposite party argued that the deceased was working as agent of the O. Ps.  However there was no understanding that premiums would be deducted from his accrued commission as such agent.  The deceased was required to make premium payments on the due date independently.  The opposite party has filed documents as per list and includes the copy of the policy, status report of the policy and status report of the agency.  These documents clearly show that the premiums were not paid regularly and the license of deceased was terminated.  That in the circumstances the O. Ps. rightly paid the amount of premium paid for 73 months vide cheque No. 0084129 dt. 30.07.2012. The complaint therefore deserves to be dismissed with costs.                        

12.                   Considering the rival contention of the party & submission made before us the following points arise for consideration & finding there on along with reasons.

REASONING & FINDINGS

13.                   As to Point 1 :-     It is admitted by the opposite party in written statement filed on page no. 24 that the deceased Umendra Shivcharan Pardhi was working as insurance agent at the office of opposite party.  But the service of agent was terminated since 01/02/2010 for non-fulfillment of minimum business target given to agents.  The policy holder died on 21.05.2012.  The policy bearing no. 973280378 for Rs. 1,90,000/- is admitted by opposite party.  The opposite party settled the claim of deceased who died on 21/05/2012 for Rs. 12,483/- vide cheque no. 084129 on 30/07/2012.    

              The policy was in lapsed condition at the time of death of policy holder & therefore the claimant is paid & entitled only the premium paid amount till date.  As per policy status report filed on page no. 35 the premium for the period 09/2005, 04/2006, 05/2006, 01/2010, 02/2010, 03/2010, 05/2010, 08/2011, 10/2011 and 02/2012 were outstanding.  As per clause no. 4 of policy “Non-forfeiture Regulation – If after at least 3 full years premiums have been paid in respect of this policy, any subsequent premiums is not duly paid, this policy shall not be wholly void, but the death Benefits/maturity Benefit by it shall be reduced to the total premiums paid less total extra premiums if any”.  The complainant has filed a copy of policy which is a contract of insurance & binding upon both the parties.  As per terms of policy when the policy is not in “full force” the premium collected after 3 years are payable as per clause-4 of policy.   Therefore the policy of deceased was in lapsed condition hence the complainant is not entitled to receive Rs. 1,90,000/- along with the benefit of bonus & interest thereon as per contract & terms of policy which is written on the back side of policy and therefore those terms are binding upon the insured.   

14.                   As to Point 2 :-     The opposite party has paid the premium amount collected till date to the complainant by issuing a cheque of Rs. 12,483/- on dt. 30.07.2012.   Therefore the opposite party has not committed any negligence of service. 

              Hence the following order is passed.       

-: ORDER :-

     1.                 The complaint is dismissed.

     2.                 No order as to cost.