DATE OF FILING: 5.12.2012
DATE OF DISPOSAL: 17.12.2016
Dr. Alaka Mishra, Member (W)
The complainant has filed this consumer complaint U/S 12 of Consumer Protection Act, 1986 alleging deficiency in service against the Opposite Party (for short, the O.P.) and for redressal of his grievance before this Forum.
2. Briefly stated the case of the complainant is that the son of the complainant late Abhesh Kumar Sahu obtained L.I.C. policy bearing No.572967413 Jeevan Saral (with profits) with date of commencement 23.7.2010 with sum assured of Rs.5,00,000/-. The policy holder deposited quarterly premium of Rs.6125/- from 23.7.2010 to 9.12.2011totaling Rs.36,750/-While the matter stood thus, the son of the complainant (Policy holder) died in a road accident at Manapur Railway Gate, Manapur, PS: Kalinga Nagar, Dist: Jajpur on 4.5.2012. Death certificate issued by Registrar Birth & Death C.H.C. Danagadi, Dist; Jajpur on 17.5.2012. After sudhikriya the complainant being the nominee filed the death claim before the O.P. for its payment. The O.P. instead of making settlement of the death claim as per the aforesaid policy intimated in their letter 2.6.2012. This letter of the O.P. mentioning that nothing is payable as Death claim is neither lawful nor justified. The last premium payment was made on 9.12.2011 and hence next premium was to be made during January, 2012, for which grace period of one month is lapses on February 2012. The policy holder being at outside Berhampur was to deposit the two of the premium at a time during April with one month grace period, which is usually allowed by the O.P. Alleging deficiency in service on the part of the O.P. the complainant prayed to direct the O.P. to pay Rs.5,00,000/- with accidental benefits, compensation of Rs.30,000/- towards harassment and mental agony and Rs.5000/- forwards the cost of litigation in the best interest of justice.
3. Upon notice the Opposite Party filed written version/written argument through his advocate. It is stated that the deceased Abhesh Rama Sahu vide policy No. 572967413 had insured his life for a sum assured of Rs.5 Lakhs under Table & Term 165/21 having its date of commencement as 27.7.2010 and the complainant was the nominee therein. The policy bond does specifically stipulate for payment of premium on quarterly basis at the rate of Rs.6,125/- per quarter. The life assured continuously paid 6 (six) premiums and thereafter did not revive the policy. Therefore the Insurance policy lapsed with effect from February 2012 which includes the grace period of one month allowed in case of quarterly premium as per condition no 2 of the policy. After death of the policy holder on 4.5.2012 the complainant intimated this O.P. on 22.5.2012 about the same. The relevant authority of the Corporation had a thorough investigation into the matter, verified the conditions and privileges referred to in the connected policy and since the policy was in a lapsed condition by the date of death of the life-assured, the claim of the complainant as the nominee was repudiated. Further since the policy holder died prior to expiry of three (3) years from the date of commencement of policy no paid up value as per the policy condition is carried on it. In view of these facts the complainant is not entitled to the premium amount deposited by the life assured. Under such circumstances return of the premium paid on the lapses policy cannot be claimed by the nominee. Accordingly the relevant authority of the corporation has rightly intimated the complainant vide letter on 2.6.2012 that nothing is payable and in so intimating the O.P. has committed no negligence or/and deficiency of service and the same need no challenge. In support of the aforesaid submission this O.P. draws the attention of the Hon’ble Forum to condition No.2 & 4 of the policy which unambiguously revealed that a grace period of one month and not less than 30 days shall be granted for deposit of yearly, half-yearly and quarterly premiums and in the event of non-payment of the same before the expiry of the period of grace from the due date the policy lapses. Similarly condition No.2 read with condition No.4 of the policy does debar a nominee to be entitled to any amount whatsoever emanating from the policy in the event of death of the policy holder of the said policy is in a lapsed condition and less than three (3) years from the date of its commencement. Therefore repudiation of the claim of the complainant by this Corporation is just and proper. The quarterly premium on the policy of the deceased which had fallen due on January 2012 would have been paid by him till expiry of another 30 days counted there from and in the event of his death taking place during the said grace period the nominee would have had the benefit under the policy. To avail the benefits under the policy the death of the life assured should take place within the period of grace as allowed in case of policy where there is payment of quarterly premium. If death of the life assured taken place within the period of grace the nominee is entitled to the insured amount as per the policy after deduction of unpaid premium. Subsequent paragraph of the said condition No.2 provides that premiums remaining unpaid during the whole period up to arrival of the anniversary of the policy may be paid by the nominee to be eligible to the benefits under the policy. But in such a case the death of the life assured must have taken place within the grace period. In the instant case the premium payable was due on January, 2012 and the insured had the right to pay the unpaid premium till February 2012. Since the premium was not paid during this period the policy lapsed and since death of the life assured took place thereafter the nominee is not entitled to any benefits whatsoever. As submitted above since the date of deposit of the premium amount has been clearly mentioned in the policy bond there does not arise any duty on the part of this O.P. to intimate the policy holder in advance about such deposit and to intimate him about the lapse condition of the policy. In view of the aforesaid allegation of unfair trade practice on the part of this Corporation as alleged by the complainant is equally irrelevant, without any substance and untenable under law. Therefore the complainant is neither entitled to the assured benefits under the policy nor any fraction thereof as claimed by her and hence the complaint be summarily dismissed.
4. On the date of final hearing of consumer dispute both the learned counsel for the complainant as well as O.P. were present. We heard arguments from both sides at length and perused the complaint petition, written version, written arguments and all relevant documents filed by both parties which are placed on the record. During the course of hearing, the learned counsel for the complainant contended that the complainant is the mother of deceased policy holder bearing policy No. 572967413 with quarterly premium of Rs.6,125/- and the date of commencement policy is from 23.7.2010 for a assured sum of Rs.5,00,000/-. The deceased policy holder was deposited quarterly premium for six quarters regularly. As contended by the complainant the next premium was due by 31.3.2012 for depositing the premium for which he could not deposited in time. Subsequently, the policy holder died on a road accident on 04. 05. 2012. The policy holder was an engineer by profession and at that time he was only 30 years old and he was receiving Rs.52,000/- monthly salary. The policy holder died in a road accident after few days of lapse of his policy. He was regularly paying premium in time but there is no malafide intention not to deposit the next premium. The counsel for the complainant further argued that O.P. never communicated any letter to the policy holder with regard to lapse of policy in question. The O.P. has never asked the policy holder for deposit of the quarterly premium on the schedule date. Mere mentions in the policy can’t be taken as a condition or contract between the parties and on the same ground to deny the assured amount of the policy. The printed conditions in the policy bond are one sided signed by the O.P. and the policy holder never put his signature as a token of admittance. There is no provision of free look period in the policy bond. Hence the conditions stated on the policy bond are not binding either on the policy holder or on the nominee.
5. On the contrary, the learned counsel for the O.P. submitted his argument that deceased policy holder deposited six times regular quarterly premium of Rs.6125/-. Thereafter policy holder discontinued his policy from February 2012 with grace period of one month which was allowed in all policies. The policy holder died on 4.5.2012 which was intimated by the complainant to the O.P. on 22.5.2012. It is a lapsed policy so claim can‘t be settled. He further submitted that policy holder died prior to expiry of 3 years from the date of commencement of policy so no paid up value can be paid to the complainant as per the policy conditions. In view of above facts, the complainant is not entitled to get back any premium amount. In support of his arguments he also cited the authorities of Hon’ble National Commission, New Delhi vide Revision Petition No. 4159/2012 dated 11th March 2014 in Life Insurance Corporation of India versus Raghunath, where it was hold two quarterly dues of premium had not been paid as on date of death of the life assured. The claimant also could not prove that those premium dues were paid. The premium due months are noted in the policy cover itself. The Corporation has rightly repudiated the claim”. Similarly APEX Court of India uphold in Civil Appeal No. 4806 of 2005 in the case of LIC of India versus Mani Ram and in the case of S.V. Ramana Vs. LIC of India decided by A.P. State Consumer Dispute Redressal Commission and in the case of The Branch Manager, LIC of India, Nalgonda Vs.N.Pulamma vide FA No. 176/1997 against CD No.17/194 where it was held that policy lapsed within two years of its commencement. District Forum was in error in allowing refund of premium. In view of the above arguments and decisions, the learned counsel for the O.P. prayed before this Forum to dismiss the case in the interest of justice.
6. We have carefully perused the pleadings of learned counsel for both parties and have thoughtfully considered the contention advanced before us. On perusal of pleading and verification of documents placed on record we found force in contention of the learned counsel for O.P. It is evident that the policy was procured by the policy holder with a premium quarterly of Rs.6,125/- and a total of six regular installments were paid by the insured. There after no installments was paid by the policy holder in time even not within the grace period of one month. It is also a condition of the policy in dispute that if the policy premium paid for three full years then the policy holder gets paid up value. Similarly if death occurs within the due/ grace period then policy holder also can get claim amount but in this case the policy holder neither died within the due grace period of policy nor the policy continued for three full years. Hence, we are constrained hold that during the accidental death of the deceased policy holder the policy was not in force. Where the policy was not in force, the O.P. is not liable to pay anything with regard to claim of the complainant. Further, since in this case the policy holder has not paid the premiums for at least three years, in this case, the complainant also not entitled for any paid up value of the policy.
7. In the light of the above discussion and considering the facts and circumstances of the case, we dismissed the case of the complainant against the O.P. due to devoid of any merits. However, in the facts and circumstances of the dispute we are not inclined to allow any compensation or cost in this case. The case of the complainant is disposed of accordingly.
8. The order is pronounced on this day of 17th December 2016 under the signature and seal of this Forum. The office is directed to supply copy of order to the parties free of cost and be sent to the server
