DATE OF FILING: 08.02.2012
DATE OF DISPOSAL: 25.05.2017
Dr. N. Tuna Sahu, Presiding Member:
The complainant has filed this consumer dispute under Section 12 of the Consumer Protection Act, 1986 alleging deficiency in insurance service against the Opposite Parties (in short the O.Ps) and for redressal of her grievances before this Forum.
2. Briefly stated the case of the complainant is that as per the repeated approaches of the O.P.No.1 the life assured Latif Sayad obtained an insurance policy (FUTURE CARE TERM ASSURANCE PLAN) on payment of half yearly premium of Rs.5,030/- on 14.05.2010. Soon after the receipt of the premium, the O.P.No.1 issued the above insurance policy bearing No.00504097. The Life assured Latif Sayed deposited the premium for the period from 29.11.2010 to 29.05.2011 towards the 2nd installment and obtained the receipt. The husband of the complainant all of a sudden sustained severe injury to his right leg on 22.05.2011 and admitted in SAMVAB Community Health Care and Research Center, Berhampur and was in a bed ridden condition till 20.7.2011. In spite of all such treatment, finally the life assured passed away on 26.7.2011. After the death of the life assured the complainant came to know about the existence of aforesaid policy and thereafter the complainant gave death intimation to the O.P.No.1 on 29.7.2011 for the payment of the assured amount under the policy. The O.Ps instead of considering payment of assured amount under the policy due to accidental death arbitrarily repudiated the claim on baseless grounds vide letter dated 26.08.2011. Soon after the receipt of the above letter of repudiation, the complainant represented the entire pitiable story with supported documents to Claim Review Committee of the O.P.No.2 on 29.09.2011 by Regd. Post with AD. The O.Ps did not allow the claim on same baseless plea vide their letter dated 23.12.2011 with an advice to approach Insurance Ombudsman at Bhubaneswar. The complainant has approached from post to pillar by submitting all such relevant treatment papers. Instead of considering the relevant documents of the complainant the O.Ps repudiated the claim arbitrarily which amounts to deficiency in service as well as immoral trade practice. When the O.Ps did not give any heed to her grievances, the complainant has filed this complaint alleging deficiency in insurance service on the part of the O.Ps and prayed to direct the O.Ps to pay the insured amount of Rs.12,00,000/- with 18% interest per annum from the date of claim till payment is made and to pay compensation and cost as the Forum deems fit in the interests of justice.
3. Notice issued against all O.Ps by this Forum. The O.Ps after receipt of notice from this Forum appeared in this Forum through their learned counsel Sri S.K. Mohanty, Advocate and Associates and filed written version. In the written version it is stated that the O.P.No.1 & 3 are the branch office of Future Generali India Life Insurance Company Ltd, which is a company registered under the provisions of Companies Act, 1956 as well as the Insurance Act, 1938 and is engaged in the business of providing life insurance to its customers across the length and breadth of India. The O.P.No.2 is the officer who has signed the repudiation letter under the captioned policy. There is no conflict of interest between O.P.No.1, 2 and 3 and as such a common reply is being filed on behalf of all the three O.Ps. It is an admitted fact that the premium under the policy under dispute bearing No. 00504097 was paid only till 29.5.2011 and the life assured Mr. Latif Sayed was died on 29.7.2011 and as such the policy was in lapsed condition on the date of death of the life assured. Paragraph number 2 is admitted. It is admitted that the premium paying frequency under the said policy number 00504097 was half yearly and the premiums under the said policy fell due on 29th of May and 29th of November every year. It would further not be out of place to mention here that in order to receive the continuous benefits under the said policy the premiums were supposed to be paid on a regular basis on the respective due dates or within the grace period of 30 days as allowed under the clause of the terms and conditions of the policy. Paragraph number 3 is admitted. It is admitted that the premium for the period 29.11.2010 to 29.05.2011 was paid by the life assured. Contents of paragraph number 4 being matter of record do not need any revert. It is however, important to note here that the premium falling due on 29.05.2011 under the said policy remained unpaid and as such the policy was in lapsed state as on the date of death of life assured. Para 5 are being a matter of record does not need any reply. Para 6 is emphatically denied. It is denied that the claim of the complainant was declined arbitrarily. It is submitted that as per the terms and conditions of the policy no benefit becomes payable if the policy is in lapsed condition. It would further not be out of place to mention here that, though under no contractual obligation to do so, the O.Ps had duly sent the communication to the life assured intimating him about the due dates of premium payment. As such no case of deficiency in services is made out against the O.Ps. Para 7 being a matter of record does not need any comment. It is clear that the complainant is trying to gain sympathy of the Hon’ble Forum to get the relief and the same if not based on any valid legal and contractual ground. Para 8 being matter of record does not need any revert. Para 9 is denied. It is vehemently denied that the claim was rejected on a baseless plea. The claim is rejected purely on the basis of the terms and conditions of the policy. Para 10 is vehemently denied. It is submitted that non-payment of due premiums on time proves negligence on the part of the policy holder and life assured and not the insurance company. Para 11 is vehemently denied. it is a settled principle that nonpayment of claim is amounting to harassment. The claim of the complainant has been denied on a valid ground, which is duly in accordance with terms and conditions of the policy. Para 12 being a mere repetition of baseless allegations leveled in the foregoing paragraph is vehemently denied. It is further denied that the complainant is entitled to get any compensation from the O.Ps. Para 13 is denied. It is denied that merely because the branch office of the O.P. has been opened within the jurisdiction of this Forum, this Forum gets a jurisdiction to try the present dispute. It also needs to consider the question whether any case falling within the four corners of the Consumer Protection Act has been made out by the complainant. Para 14 and 15 being formal in nature do need any revert. Para 16 is denied. It is vehemently denied that the complainant is entitled to get any relief as prayed by her in Para under reply. It is further denied that the complainant is not entitled to get any relief as prayed by her in the prayer clause hence the O.Ps prayed to dismiss the case.
4. On the date of final hearing of the consumer dispute we heard the argument at length from the learned counsel for the complainant as well as for the O.Ps. We have also gone through the complaint of the complainant and written arguments filed by learned counsels for both parties.
During the course of hearing it has been submitted by the learned counsel for the complainant that as per repeated approaches of the O.P.No.1 the deceased life assured obtained an insurance policy bearing No.00504097 on payment of half yearly premium of Rs.5080/- on 14.5.2010 for an assured sum of Rs.12,00,000/- with accidental death rider and the policy was issued on 29.5.2010. The deceased policy holder deposited the premium for the period 29.11.2010 to 29.5.2011 vide Axis Bank cheque No.005868 dated 31.12.2010 towards second installment. Unfortunately, the husband of the complainant all of a sudden sustained severe injury to his right leg on 22.5.2011 and admitted to SAMVAB Community Health Care and Research Center, Berhampur and was in a bed ridden condition till 20.7.2011. The complainant was busy for the treatment of her husband but in spite of all such treatment finally the life assured passed away on 26.7.2011. The complainant on 29.7.2011 intimated the death of the policy holder to the O.P. No.1 but the O.P.No.2 arbitrarily repudiated the claim of the complainant on baseless ground by a letter dated 26.8.2011. The complainant represented her case before the Claims Review Committee of O.P.No.2 on 29.9.2011 by a letter through registered post but the O.P.No.2 did not consider the claim and turned down the request of the complainant on 23.12.2011 with an advice to approach the Banking Ombudsman. She has also mentioned in the complaint that due to the deficiency in service and negligence of the O.Ps the complainant widow suffered and harassed by the O.Ps and has taken a vague plea to avoid payment of assured amount. Therefore, the complainant has filed this complainant and prayed before this Forum to direct the O.Ps to pay Rs.12,00,000/- towards assured sum under the said policy along with interest @18% per annum and to pay cost and compensation as the Hon’ble Forum deems fit and proper in the interests of justice.
5. On the contrary, the learned counsel for the O.Ps submitted that it is not in dispute that the husband of the complainant availed a policy from O.Ps through an application on 14.5.2010. The frequency of premium is half yearly and the due date are 29/5 and 29/11 of each year and the premium payable is Rs.5,594/-. The life assured met with an accident on 22.5.2011 and passed away on 26.7.2011. Just after 3 days of death of life assured on 29.7.2011, the complainant claimed for payment of assured amount under the policy but the O.P.No.2 repudiated the claim through a letter dated 26.8.2011. For that, the complainant raised her claim before Claims Review Committee on 29.9.2011. The complainant in her letter dated 29.9.2011 admitted that her husband defaulted in paying premium. The Claims Review Committee later not allowed her claim and duly communicated the same through a letter dated 23.12.2011 with its observation. The learned counsel further submitted that the premium of disputed policy bearing No. 00504097 was paid only till 29.5.2011 and as such the policy in lapsed condition as on the date of death of the life assured hence the claim under the policy is not payable, therefore, there is no deficiency in service on part of the O.Ps, since the claim application of the complainant was duly received and repudiated by giving reasons and was communicated to the complainant in time. It is further contended that the complainant has admitted that her husband/life assured did not deposited premium for the period falling due on 29.5.2011 in her letter dated 29.9.2011 addressed to the Claims Review Committee and for that the policy was in lapsed stage on the date of death of the life assured. Even after giving several reminders to the life assured, the life assured did not prefer to deposit the premium after receipt of reminders. He also submitted that the O.P. has also given notice to the life assured on 29.6.2011 regarding lapse status of the policy. Since, the complainant admitted non-deposit of premium which leads to lapse of policy prior to death of life assured, the fact admitted need not required to be established. In order to receive continuous benefits under the policy, premiums were supposed to be deposited on regular basis as per clause 3.1 of the policy terms and conditions. In the terms and conditions of policy vide Part-B, clause-14, it is specifically agreed with regard to policy benefits, wherein it is admitted that the benefits applies if the policy is in force on the date of death of life assured. He has also contended that there is no cause of action against the O.Ps and the complaint is not maintainable at Berhampur and this is not a case of silence of contract where relief can be claimed an assumption and presumptive grounds. The learned counsel for the O.Ps has also cited a decision of Hon’ble National Commission vide Revision Petition No.211 of 2009 in the case of Reliance Life Insurance Co. Ltd Vs. Madhavachary and drew our attention towards the ruling of Hon’ble Apex Court in the matter of General Assurance Society Ltd Vs.Chandumull Jain & Anr reported in 1996 3 SCR in which it was held that “In interpreting documents relating to a contract of insurance, the duty of the court is to interpret the works in which the contract is expressed by the parties, because it is not for the court to make a new contract, however reasonable, if the parties have not made it themselves…………”. The learned counsel also contended that the complainant in this case failed to establish deficiency in service, unfair trade practice on part of the O.Ps and the admission of complainant with regard to non-payment of premium in time and materials brought to record by O.Ps to establish the status of policy as lapsed disentitles the complainant to get any relief hence the complaint is liable to be dismissed.
6. We have heard carefully the submissions made before us by the learned counsels for the complainant as well as for the O.Ps. We have also perused the pleadings of the parties and have also thoughtfully considered the contentions raised by all parties. We have also perused the material documents filed by the parties to this dispute and verified the policy documents and its conditions, premium details and medical treatment papers of the deceased policy holder placed on the case record.
On careful perusal of policy documents and premium details, it reveals that there is no dispute or doubt that the husband of the complainant deceased policy holder late Latif Sayed obtained a policy from O.Ps bearing policy No. 00504097 by an application dated 14.5.2010. The said policy was commenced w.e.f. 29.5.2010 and the risk was also commenced from the date of commencement of the policy. The deceased life assured obtained the said policy on payment of Rs.5,549/- towards half yearly premium and the sum assured under the policy is Rs.12,00,000/- towards future care and Rs.7,00,000/- for accidental death rider. The premium due date is 29/5 and 29/11 of every year and the present complainant Mrs. Shaida Sayad, wife of deceased policy holder was kept as nominee of the said policy. It is also beyond dispute that the deceased policy holder has paid the premium of Rs.5,549/- on 31.12.2010 vide Axis Bank cheque No. 5868 for the period 29.11.2010 to 29.5.2011 as is evident from the payment acknowledgement slip dated 31.12.2010 placed on the case record. It also reveals that the deceased life assured was undergoing treatment from 22.5.2011 to 20.7.2011 in Samvab Community Health Care and Research Centre at Berhampur due to severe injury to his right leg by an accident. It is also an admitted fact not in dispute that the husband of the complainant died on 26.7.2011 as is evident from the certificate of death issued on 5.8.2011 by the Registrar of Birth and Death and Health Officer, Berhampur Municipal Corporation, Berhampur, placed on the case record. The case record also discloses that the complainant intimated the death of her husband deceased life assured to the O.P.No.1 vide her intimation letter dated 29.7.2011 for settlement of her claim. The O.Ps in their letter No. 16862780/00504097 dated 24.8.2011 informed the complainant with regret that the half yearly premium of Rs.5,549/- due on 29.5.2011 was not received by the Company and hence as per provisions of the policy, the policy stood lapsed with effect from 28.6.2011. Therefore, the Company has no liability on the policy as on the date of death of the life assured and advised the complainant that if aggrieved may contact the Claims Review Committee. The complainant approached the Claims Review Committee on 29.09.2011 and the Claims Review Committee vide his letter No.16862780/T00235206/00504097/CLREPIL dated 12.10.2011 informed the complainant that her request is under consideration and the decision to be communicated her shortly. However, the Claims Review Committee in a letter bearing No.16862780/T00235206/00504097/CLREPIL dated 23.12.2011 rejected the request of the complainant and upheld the decision of the Company and did not accept the request of the complainant and advised to approach the Insurance Ombudsman at Bhubaneswar. In the aforesaid fact and circumstance of the case, the Forum is to consider the following points:
(a) Whether the policy of the deceased life assured was lapsed during the period of his treatment in the aforesaid Hospital due to accidental injury?
(b) Whether the deceased life assured was issued reminders by the O.Ps before expire of three months from the date on which the premiums in respect of the policy of life insurance was payable but not paid as required under Section-50 of the Insurance Act, 1938.
(c) Whether the nominee widow complainant of deceased life assured is entitled for any ex-gratia in this case under the fact and circumstance of the case?
7. With regard to the first point stated above, we would like to say that on verification of the case record and on perusal of documents placed on it, it reveals that the deceased life assured all of a sudden sustained accidental injury in his right leg on 22.05.2011 and admitted into Samvab Community Health Care and Research Centre, Berhampur for treatment and was in bed ridden condition till 20.07.2011. It is also an established fact that the due date for payment of premium of the said insurance policy was on 29.05.2011 as is evident from the policy document and premium receipts placed on the case record. Admittedly, the premium was not paid by the deceased life assured on the due date i.e. on 29.5.2011 and even the premium was not paid during the grace period of one month i.e. as on 29.6.2011. It is fact that the deceased life assured could not deposit the premium on due date and even during grace period due to under constant medical treatment for his accidental injury. During course of hearing of the consumer dispute the learned counsel for the complainant also submitted that due to continuous bed ridden condition of the deceased life assured he could not deposit the premium on the due date and even during grace period which was not intentional. He further submitted that due to his serious ill health, he failed to deposit the premium on the due date and even during the grace period which may be negligence on part of deceased life assured but at the same time the O.P. insurance company was also negligent in his duty and has contributory negligence for the lapse of the policy due to non-issuance of reminder to the deceased life assured prior to lapse of the said insurance policy as per the statutory provision under Insurance Act, 1938. He also drew our attention towards the contention of the O.P. insurance company and appraised the relevant Section of the Insurance Act regarding the statutory duty of the insurer. In that view of the case, we are convinced that the policy was lapsed due to non-deposit of the premium on the due date due to ill health of the deceased life assured and due his constant bed ridden condition but it was in force during the admission of the deceased life assured into the hospital for treatment.
8. Regarding second issue as mentioned above, we would like to state that in this case the due date for payment of premium was 29/5 and 29/11 of every year as per the policy condition. The premium installment was due on 29.5.2011 and it was also payable within a grace period of one month i.e. as on 29.06.2011 but unfortunately it was not paid by the deceased life assured even after elapsed of grace period due to under constant medical treatment. There is no doubt that the deceased life assured was negligent for non-payment of insurance premium on the due date and even after the grace period. On the contrary, if we examine the role of the O.Ps, it reveals that the O.Ps also did not issue any reminder to the deceased life assured before expire of 3 months from the date on which the premiums in respect of the policy of life insurance was payable but not paid as required under Section-50 of the Insurance Act, 1938. In this case the O.P. insurance company has contended that the deceased life assured was issued a reminder/intimation on 26.6.2011 regarding lapse of his insurance policy but on perusal of case record we could not find any convincing documentary evidence with regard to that except the contention since there is nothing placed on record to hold otherwise. During the course of the argument of the case, the learned counsel for the complainant has also drew our attention towards this issue and insisted on production of relevant documents but the learned counsel for the O.Ps failed to produce any convincing documentary evidence to prove his contention. The learned counsel only mentioned the date on which the company was intimated about the lapse of the said policy but failed to produce any documentary evidence. Moreover, it is evident from the date of intimation that the O.P. insurance company intimated the deceased life assured about the lapse of the policy after due date i.e. after lapse of the policy and not prior to three months as per the statutory provision under Insurance Act. In that view of the case, we would like to point out that the O.P. insurance company has contended that they have intimated the deceased life assured on 26.6.2011 regarding lapsed status of his policy but we failed to understand what purpose it was served after lapse of his policy. Section 50 of the Insurance Act imposes a statutory obligation on the insurance company to issue a notice before expiry of 3 months from the date on which a premium in respect of a policy of life assurance is payable and has not been paid and give a notice to the policy holder informing him of the options available to him. The relevant portion of the Section -50 is extracted hereunder for reference:
Section -50. Notice of options available to the assured on the lapsing of a policy – “An insurer shall [before expiry of three months from the date on which the premium in respect of a policy of life assurance were payable but not paid,] give notice to the policy-holder informing him of the options available to him [unless these set forth in the policy.]”.
9. From the bare reading of above provision of Section-50 of the Insurance Act 1938, it is clear that the statutory obligation can’t be waived of by the terms and conditions of the policy as it is settled principle of law that estoppel against a statute can’t be claimed by a contracting party. The Insurance Act is a beneficiary legislation and has to be construed liberally. From the aforesaid discussion, it is amply clear that the O.P. insurance company though contended to have intimated the deceased life assured regarding lapse of his insurance police but failed to produce any documentary evidence and establish the same. Moreover, as per the contention of the learned counsel for the O.P. insurance company, the deceased was intimated /informed on 26.6.2011 i.e. after lapse of the insurance policy but under the statutory provision it is mandatory to intimate the insured before expiry of three months from the date on which a premium in respect of a policy of life assurance is payable and has not been paid and to give a notice to the policy holder informing him of the options available to him. Therefore, it is established that the O.P insurance company did not inform the deceased life assured regarding lapse of his policy before expire of three months as was required under Insurance Act which is also one of the contributory negligence on part of the O.P. insurance company for lapse of the policy of the deceased life assured during his treatment. Hence, in the instant case Section 50 of the Insurance Act 1938 can be invoked and it is mandatory on part of O.Ps insurer to intimate the deceased life assured as per the provision discussed above. In view of the above discussion, in our view, in the instant case the O.Ps insurance company did not do so which amounts to deficiency in insurance service and the O.Ps can’t avoid its liability.
10. With regard to the third issue whether the nominee widow complainant of deceased life assured is entitled for any ex-gratia in this case. On this point we would like to say that in the instant case the policy of deceased life assured was lapsed during his treatment in Samvab Community Health Care and Research Centre, Berhampur from 22nd May 2011 to 20th July 2011 and finally died on 26.07.2011 as per the certificate of death placed on the case record issued by the Registrar of Births & Deaths and Health Office, Brahmapur Municipal Corporation vide Registration No.2673/2011 dated 4.8.2011. According to the conditions of aforesaid policy under the schedule of benefits, the deceased life assured was entitled for an assured sum of Rs.12,00,000/- towards future care (basic policy) and for an assured amount of Rs.7,00,000/- towards accidental death rider. Accordingly, in our view, the nominee complainant is not entitled for the assured sum of Rs.12,00,000/- towards future care (basic policy) since the complainant not deposited the premium on the due date so she is not entitled for the benefits of basic policy as assured under the policy and we are also not inclined to hold that the O.Ps should make payment of the same. However, under the schedule of benefits of the policy, the policy conditions assured that the deceased life assured is entitled for a sum of Rs.7,00,000/- under the benefit of Accidental Death Rider. On that point of view, the deceased life assured was died due to accidental death after undergoing treatment in Samvab Community Health Care and Research Centre, Berhampur from 22nd May 2011 to 20th July 2011. The policy of the deceased life assured was lapsed due to non- payment of premium amount on the due date i.e. on 29/05/2011. On careful perusal of the case record and treatment documents it reveals that the deceased life assured was under bed about the policy premium and to deposit the same on the date of payment of premium and even during the grace period since even during the grace period the deceased life assured was also under treatment and that is why he could not deposit the premium. But as discussed above, the O.Ps insurance company also did not make any prior intimation before three months of lapse of the policy to deposit the premium of the policy as mandated under Section 50 of the Insurance Act. We are, therefore, like to hold that both the deceased life assured as well as O.P. insurance company are equally negligent and liable for lapse of the insurance policy. The insurance Act is a beneficiary legislation and has to be construed liberally and at the same time the Consumer Protection Act is also a social welfare legislation intended to protect the interest of the poor consumers. In this case, the O.P. insurance company has not exercised his statutory obligation under Section 50 of the Insurance Act and not given prior intimation before three months regarding lapse of the policy and this can’t be waived off by the terms and conditions of the insurance policy as it is settled principle of law that estoppel against a statute can’t be claimed by contracting party. In this context, we would also like to point out that the submissions of the learned counsel for the O.Ps on points of law vide point -15 in his notes of submission, it has been contended that the policy was put to lapse condition after giving several reminders to the life assured but the life assured did not prefer to deposit the premium after receipt of reminders. In this view of the case, we would like view that the learned counsel for the O.Ps has misled the Forum since there is nothing placed on the case record to prove the same. The learned counsel for the O.Ps not filed any credible and convincing documentary evidence to prove his contention. In our considered view, the O.Ps are deficient in insurance service and they can’t claim immunity by putting merely terms and conditions as to protect their interest and liable to pay some ex-gratia to the nominee widow complainant of the deceased life assured. A person takes a life insurance policy to ensure social safety of his family members and on the sad demise of the deceased policy holder the widow is entitled to some ex-gratia amount under the policy since in this case the insurance company is also negligent in his duty by not issued prior intimation to the insured before the expiry of three month from the date of which a premium in respect of a policy of life insurance is payable and has not been paid.
11. With regard to ex-gratia for the nominee complainant under the policy, we would like to state that under the schedule of benefits of policy, the said policy assured a sum of Rs.7,00,000/- under accidental death rider benefit. In the instant case the deceased life assured was also died due to accidental injury and for that he was undergoing treatment in the Samvab Hospital and died on 26.7.2011 as is evident from the medical treatment documents placed on the case record. Though under the policy the deceased life assured is entitled for Rs.7,00,000/- towards accidental death benefit but in this case we are not inclined to direct the O.Ps to pay Rs.7,00,000/- since the policy was lapsed during the treatment of the deceased life assured due non-deposit of the policy premium on the due date and even after grace period i.e. on 29.06.2011 and no doubt this is also a negligence on part of the deceased life assured but it was not intentional on part of insured since he was under bed ridden conditions. At the same time the O.Ps are also liable for negligence since O.Ps. Insurance Company also did not issue a notice before the expiry of three months from the date on which a premium in respect of a policy of life insurance is payable hence the O.Ps insurance company is equally liable for the same. Under the present facts and circumstance of the case, the Section 50 of the Insurance Act can be invoked to compensate the loss of the deceased life assured and an ex-gratia amount of Rs.3,50,000/- (i.e. fifty percent of the death rider benefit) and be paid to the nominee widow complainant which in our considered view will be just and proper as per the fact and circumstance of the case. Our finding is fortified with the decision of Hon’ble High Court of Punjab and Haryana at Chandigarh vide CWP 26238 of 2016 decided on 23.01.2016 in the case of the Branch Manager, LIC of India and Ors. Vs. Annu and Ors where it was held that “Section -50 of the Insurance Act imposes a statutory obligation on the Insurance Company to issue a notice before the expiry of 3 months from the date on which a premium in respect of a policy of life insurance is payable and has not been paid and give a notice to the policy holder informing him of the options available to him. The statutory obligation under Section 50 of the Insurance Act can’t be waived of by the terms of the policy as it is settled principle of law that estoppel against a statute can’t be claimed by contracting party”. In the light of the decision of the Hon’ble High Court, in our considered view the O.Ps are negligent for not issuance of intimation to the deceased life assured hence liable to pay ex-gratia i.e. fifty percent of the death rider benefits of the policy.
12. In this case the learned counsel for the O.Ps has cited an authority of Hon’ble National Commission vide R.P. No.211 of 2009 decided on 02.02.2010 where in the decision of Hon’ble Apex Court of India was cited in the matter of General Assurance Society Limited Vs.Chandumull Jain & Anr reported in (1966) 3 SCR 500 in which it was observed that “In interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties, because it is not for the court to make a new contract, however, reasonable, if the parties have not made it themselves”. In that view of the case, we would like to say that the aforesaid citation of the Hon’ble Apex Court is not applicable to the instant case since we have not contemplated to interpret contract of insurance but have pointed out the negligence of the insurance company for non-intimation to the deceased life assured before 3 months of lapse of his insurance policy by invoking Section 50 of the Insurance Act hence the aforesaid citation is not at all applicable to this case due to factual difference of the case hence rejected. In a sequel to the aforesaid discussion, deliberation and decision of law and considering the peculiar facts and circumstance of the case, we partially allowed the case of the complainant against all O.Ps.
13. Resultantly, the complaint of the complainant is partially allowed against all the O.Ps and the O.Ps who are jointly and severally liable to pay a sum of Rs.3,50,000/-(Rupees Three Lakhs and Fifty Thousand) only under the aforesaid policy as ex-gratia towards the claim of nominee complainant within two months from the date of receipt of this order failing which the complainant is at liberty to realize the same under Section 25/27 of the Consumer Protection Act, 1986. However, in the fact and circumstance of the case we are not inclined to award any interest or cost in this consumer dispute. The case of the complainant is disposed of accordingly.
14. The order is pronounced on this 25th day of May 2017 under the signature and seal of this Forum. The office is directed to furnish copy of this order to the parties free of cost as per rules. A copy of the order be sent to the server of
