Andhra Pradesh
Chittoor-II at triputi
CC/60/2014
Smt. Saki Ramanamma, W/o. Venkata Subbaiah - Complainant(s)
Versus
The Chief Manager - Opp.Party(s)
G.Ramaiah Pillai
23 Dec 2015
ORDER
Filing Date:31.10.2014
Order Date:23.12.2015
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II,
CHITTOOR AT TIRUPATI
PRESENT: Sri.M.Ramakrishnaiah, President ,
Smt. T.Anitha, Member
WEDNESDAY THE TWENTY THIRD DAY OF DECEMBER, TWO THOUSAND AND FIFTEEN
C.C.No.60/2014
Between
Smt.Saki Ramanamma,
W/o. Venkata Subbaiah,
Hindu, aged 47 years, House-wife,
Gajulapalle Village,
Nadigallu Post,
Balayapalli Mandal,
Nellore District. … Complainant
And
1. The Chief Manager, No.65-E,
LIC of India Branch Office,
No.2/46, Jayaramarao Street,
Srikalahasti – 517 644.
2. LIC of India, No.65-N,
Branch Office,
Rep. by its Branch Manager,
GNT Road,
Near Railway Station,
Naidupeta,
Nellore District.
3. The Manager (Claims),
LIC of India,
Divisional Office,
Darga Mitta,
Nellore. … Opposite parties.
This complaint coming on before us for final hearing on 08.12.15 and upon perusing the complaint, written version and other relevant material papers on record and on hearing Sri.G.Ramaiah Pillai, counsel for the complainant, and Sri.A.Sudarsana Babu, counsel for the opposite parties, and having stood over till this day for consideration, this Forum makes the following:-
ORDER
DELIVERYED BY SRI. M.RAMAKRISHNAIAH, PRESIDENT
ON BEHALF OF THE BENCH
This complaint is filed under Section-12 of C.P.Act 1986 by the complainant for the following reliefs against the opposite parties 1 to 3, 1) to direct the opposite parties 1 to 3 to pay the benefits covered under the table No.133 under triple cover JEEVAN MITHRA towards accident benefit up to Rs.4,00,000/- or whichever the complainant is eligible and 2) to direct the opposite parties to pay Rs.2,000/- towards costs of the litigation.
2. The averments of the complaint in brief are:- that Saki Balakrishna, un-married son of complainant, got insured his life with LIC of India, Naidupeta Branch, Nellore District, under JEEVAN MITHRA TRIPLE COVER Endowment Plan with profits (accidental benefits) on 28.03.2010, for assured sum of Rs.1,00,000/- and annual premium amount of Rs.5,156/-, and policy duration is 21 years commencing from 28.03.2010 under Table No.133. Complainant is the nominee of insured. As per the terms of table No.133, 1) on maturity, basic sum assured + accrued bonus will be given, 2) on death, three times of sum assured + bonus will be given, 3) accidental death, four times of sum assured + bonus will be given provided policy was covered for accidental benefits. Opposite party No.2 issued policy bearing No.844186052 dt:28.03.2010 in the name of Saki Balakrishna, showing the complainant as nominee.
3. Prior to the said policy, S.Balakrishna also taken another policy from opposite party No.1 Jeevan Anand Scheme for Rs.1,00,000/- with annual premium of Rs.4,089/- for a period of 25 years commencing from 12.07.2005. His father S.Venkatasubbaiah, was shown as nominee under Table No.149.
4. The insured S.Balakrishna met with an accident on 01.09.2011, while he was proceeding from Srikalahasti to Parlapalle village, B.N.Kandriga route, as pillion rider on a two wheeler bearing regd. No.AP-26-A-9226 driven by his friend Muni Bhaskar, who lost control over the vehicle due to rash and negligent driving, both of them fell down, as a result of which both of them were sustained injuries and they were shifted to Government hospital, Srikalahasti, later the insured S.Balakrishna was shifted to Nellore for better treatment. A case in crime No.20/2013 under Section-337 IPC, was registered in II-Town Police Station, Srikalahasati, against the driver Muni Bhaskar. The accident was duly informed to opposite party No.1 and their surveyor was deputed and enquired into the matter, later the insured S.Balakrishna died on 10.04.2014 at his residence in Gajulapalle due to ill-health.
5. For the policy No.844186052, opposite party No.1 by his letter dt:27.06.2013, stated that as per the decision of their higher officials of the Divisional office, Nellore, “nothing is payable since the policy No.844186052 was in lapsed condition” and also added that the previous policy No.841536627 is settled and the claim amount was remitted to the bank account given in the claim form. Opposite party No.1 further stated that under policy No.841536627 disability benefit was sanctioned for 120 months or till the completion of premium paying period and further added that disability benefit was not covered under policy No.844186052, as the policy was in lapsed condition at the time of accident.
6. On the basis of the letters dt:27.06.2013 and 10.12.2013 issued by opposite party No.1, legal notice was got issued by the complainant on 09.08.2014, stating that policy No.844186052 was not in lapsed condition, as the 2nd annual premium of Rs.5,156/- due as on 28.03.2011 was paid along with late fee of Rs.172.20/- (totaling a sum of Rs.5,328.20/-) as per renewal premium receipt dt:05.09.2011, in which it was mentioned that next premium is due on March 2012. So, policy was not lapsed as alleged and requested opposite party No.1 to settle the claim under JEEVAN MITHRA within 7 days. Opposite party No.1 gave reply by his letter dt:18.08.2014, that the policy was in lapsed condition as on the date of accident and nothing is payable. Complainant got issued another notice dt:30.08.2014 by way of rejoinder to opposite party No.1 requesting to reconsider her case with regard to accident benefit under table No.133, for which opposite party No.1 gave reply on 02.09.2014, that as per his office records, accident occurred on 31.08.2011, subsequent premium was paid without any information to this office regarding accident on 05.09.2011. As per the policy condition, the policy was not in force as on the date of accident i.e. 31.08.2011. Hence, accident benefit is not payable. Complainant contended that once the premium is accepted belatedly along with late fee charge, table No.133 for triple risk cover endowment policy, Insurance Company is liable to pay the amount, but they are avoiding to pay the insured amount and its benefits. Hence the complaint.
7. Opposite party No.3 filed written version and the same was adopted by opposite parties 1 and 2. In the written version opposite parties 1 to 3 have categorically admitted that S.Balakrishna has insured his life with LIC of India, Naidupeta Branch, Nellore, with policy No.844186052 under Jeevan Mithra Triple Cover Endowment Plan, under table No.133 on 28.03.2010, with premium paying term of 21 years, with mode of payment of premium yearly at Rs.5,156/-. They also admitted that said S.Balakrishna taken another policy bearing No.841536627 under Jeevan Anand plan for Rs.1,00,000/-, which was issued in his favour on 12.07.2005 under table No.149, on yearly premium mode. That, S.Balakrishna has paid premiums up to 12.07.2010 for the policy No.841536627 and the next premium was due by 12.07.2011. For another policy No.844186052 said S.Balakrishna paid single yearly premium upto March 2010 and the next premium due by 28.03.2011. The opposite parties further submitted that when the matter stood thus the deceased life assured has not paid 6th yearly premium due by 12.07.2011 under policy No.841536627 and 2nd yearly premium due by 28.03.2011 under policy No.844186052 within the due date or within 30 days grace period. Therefore, the policies were under lapsed condition. The said S.Balakrishna has paid both policies premium on 05.09.2011 across the counter after 30 days of grace period and after 6 months of due date. In the present case also LIC accepted the premiums of the deceased life assured because 6 months period did not expire and as such received the payments and issued receipts and automatically the computer shows the next premium due. The LIC will communicate the policy holder that he has to revive his policy. This is the practice and procedure. The accident was occurred on 01.09.2011. On 03.09.2011 he was shifted to Nellore for better treatment but the deceased life assured, by suppressing the said fact of accident made the premium payable, on 05.09.2011. If the deceased informed about the accident, the LIC ought not have collected the premium. Deliberately, the complainant has suppressed the fact of accident with an evil motive of getting coverage of the policy. As the policy holder failed to pay the premium amount before lapse of 6 months, after due date, all of a sudden made such payment that too after the accident, evil motive can be attributed to such person.
8. The opposite parties further contended that as on the date of accident i.e. 01.09.2011 both the policies are under lapsed condition for non-payment of premiums, one is due by 28.03.2011 and another due by 12.07.2011. So far as policy No.8415366627 though it was under lapsed condition, since 5 premiums were already paid, the said policy is eligible for Chairman’s claim concession and extended permanent disability benefit for which the norms are payment of premium regularly for a period of minimum 5 years. Hence, treating this policy as in fully force as on the date of accident and future premiums were waived and the disability benefit at the rate of Rs.833/- per month for 120 months was granted and was paid till the death of the deceased life assured and later a total amount of Rs.2,37,195/- (Rs.1,00,000/- towards the basic sum assured, Rs.36,000/- towards the vested bonus, Rs.4,800/- towards interim bonus and Rs.95,798/- towards the unpaid extended permanent disability benefit) was paid. The same has been intimated to the complainant. In respect of policy No.844186052 this concession or benefit cannot be extended because a single premium was paid i.e. 3/2010 and the next premium due on 3/2011 was not paid. The said fact was also informed to the complainant through her counsel. Hence, there is no deficiency in service on the part of the opposite parties and prays the Forum to dismiss the complaint against the opposite parties.
9. In support of their case, both parties have filed their chief affidavits and respective written arguments, and got marked Exs.A1 to A11 for the complainant and Exs.B1 to B3 for the opposite parties. Heard both sides.
10. Now the points for consideration are:-
(i). Whether there is deficiency in service on the part of the opposite parties
1 to 3?
(ii) Whether the complainant being the nominee of deceased policy holder
S.Balakrishna, is entitled to the reliefs sought for?
(iii) To what relief?
11. Point No.(i):- to answer this point, I am to state that the claim is made by the complainant in respect of policy No.844186052 under table No.133. Therefore, we need not probe another policy bearing No.841536627. In the written version, the opposite parties admitted the contents of para.1 of the complaint to the effect that deceased S.Balakrishna has insured his life with LIC of India under Jeevan Mithra Triple Cover Endowment Plan with profits (with accidental benefits) on 28.03.2010 for a sum assured of Rs.1,00,000/- and paid the 1st premium of Rs.5,156/-, which is yearly premium and policy was for 21 years commencing from 28.03.2010. So, if the 1st premium is paid, the policy will be in force up to 28.03.2011 under table No.133. The next premium should be paid by 28.03.2011 and for the next year up to 28.03.2012, but admittedly 2nd premium was not paid within the due date. The opposite parties have admitted in para.8 of their written version that the averments of the complaint in para.5 that the accident was duly informed to opposite party No.1 is true and their surveyor (Investigating Officer) also deputed to enquire into the matter is also true. So, the allegation that the complainant did not informed about the accident cannot be accepted. Opposite party stated that a case in crime No.20/2013 under Section-337 IPC was registered in II-Town Police Station, Srikalahasti, against the driver of the two wheeler bearing Regn.No.AP-26-A-9226, was not known to the opposite party. When the opposite party categorically admitted that the policy holder has informed about the accident and the opposite parties have deputed their Surveyor / Investigating Officer, to enquire into the matter, they got sufficient knowledge about the accident. Further, they also admitted in para.10 of their written version that the complainant has paid the premium amount of Rs.5,156/- along with late fee of Rs.172/- on 05.09.2011 and opposite party has issued a receipt to that extent informing next premium date is due by 28.03.2012, for this the opposite parties stating that complainant has paid the 2nd premium for the policy No.844186052 by suppressing about the accident. On one hand, they are admitting that accident was informed to the opposite parties and they have deputed their Surveyor / Investigating Officer, on the other hand they are contending that the policy holder has paid the 2nd premium with late fee by suppressing the information about the accident, so they are intentionally making this allegation, it seems.
12. Copy of policy under Ex.A1 is found as Jeevan Mitra (Triple Cover Endowment Plan) with profits (with accident benefit). Under Ex.A1 itself in page.2 it was mentioned under Table.133 as Triple Risk Cover Endowment Policy, under which the following conditions are mentioned – a) on maturity, basic sum assured + accrued bonus is given. b) On death, 3 times of S.A. + Bonus is given, c) Accidental death, 4 times of sum assured + bonus is given, provided policy was covered for accident benefit. Thus, the policy holder was covered by accident benefits. The accident was occurred on 01.09.2011, insured S.Balakrishna died on 10.04.2014 i.e. about 3 years after the accident. So, we cannot say that death of insured is an accidental death, i.e. the death was not due to direct consequence of accident. Therefore, death benefits will be given to the assured as noted under Ex.A1. The sum assured is admittedly Rs.1,00,000/- and the policy is covered by accidental benefits. Under Ex.A1 in page.2, three examples were given and in Example-3, it is mentioned that if the above two examples are taken under T-133 the maturity amount remains same. However, the death benefit will be 3 times the sum assured + accumulated bonus and in case of death due to accident the benefit will be 4 times the sum assured + accumulated bonus. Here, in the case on hand, the death is not due to accident, therefore, the maturity amount of Rs.1,00,000/- remains the same and death benefits will be 3 times the sum assured, which comes to Rs.3,00,000/- + accumulated bonus shall be given to the complainant.
13. Once the Insurance Company / Insurer, has accepted the policy premium by levying late fee, it is deemed that the policy was in force and the delay was considered by accepting the premium due, along with late fee even after the due date. Admittedly, the opposite parties accepted the premium amount of Rs.5,156/- + Rs.172.20/- from the complainant under Table.133 on 05.09.2011 under Ex.A2 receipt No.3442126, totaling a sum of Rs.5,328.20/- In Ex.A2 next premium date is also given as March 2012. So, the policy will be in force upto March 2012. Since the opposite parties have accepted the premium due along with late fee, inspite of accepting the premium for the period from 28.03.2011 to March 2012, still the opposite parties are contending that the policy was in lapsed condition as on the date of accident (01.09.2011) and complainant is not entitled for the accidental benefit or any other benefit under policy No.844186052, which cannot be sustained.
14. Under the above circumstances, we are of the opinion that there is deficiency in service on the part of opposite parties as contended by the complainant. Accordingly, this point is answered.
15. Point No.(ii):- In view of our discussion on point No.1 and in view of the contents in Exs.A1, A2, A3 and A9 and also the contents of Ex.B1, we are of the opinion that complainant Smt.Ramanamma, mother and nominee of the deceased S.Balakrishna, is entitled to the relief sought for. Accordingly, this point is answered.
16. Point No.(iii):- In view of our discussion on points 1 and 2, we are of the opinion that complainant being the mother and nominee of deceased S.Balakrishna, is entitled to 3 times of the sum assured + bonus, which comes to Rs.3,00,000/- + bonus, whichever accrued on the policy and accordingly complaint is to be allowed.
In the result, complaint is partly allowed and opposite parties 1 to 3 are directed to pay 3 times the sum assured i.e. Rs.3,00,000/- (Rupees three lakhs only) + accrued bonus on the policy and also Rs.2,000/- (Rupees two thousand only) towards costs of the litigation. The opposite parties are further directed to comply with the order within six (6) weeks from the date of receipt of copy of the order, failing which the sum awarded shall also carry interest at 9% p.a. from the date of complaint, till realization.
Dictated to the stenographer, transcribed and typed by him, corrected and pronounced by me in the Open Forum this the 23rd day of December, 2015.
Sd/- Sd/-
Lady Member President
APPENDIX OF EVIDENCE
Witnesses Examined on behalf of Complainant.
PW-1: Smt. Saki Ramanamma (Chief Affidavit filed).
Witnesses Examined on behalf of Opposite Party.
RW-1: B.Srinivasulu (Evidence Affidavit filed).
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Exhibits (Ex.A) | Description of Documents |
Photo Copy of policy No.844186052 under JEEVAN Mithra triple cover policy issued by Opposite party No.2 in favour of S.Balakrishna showing the complainant has nominee along with Table No.133. Dt: 28.03.2010. | |
Renewal premium original receipt for Rs.5,328/- issued by Opposite Party No.2. Dt: 05.09.2011. | |
Claim benefit under policy No. 844186052 issued by the Opposite Party No.1. Dt: 27.06.2013. | |
Photo Copy of policy No.841536627 for Rs.1,00,000/- under JEEVAN ANAND issued by Opposite Party No.1 in favour of S.Balakrishna showing nominee to his father S.Venkatasubbaiah. Dt: 12.07.2005. | |
Photo Copy of FIR in Crime no.20 of 2013 of Srikalahasti, II-Town Police station along with Accident information Report and copy of charge-sheet. Dt: 12.02.2013. | |
Disability benefit under policy No.841536627 issued by the Opposite Party No.1. Dt: 10.12.2013. | |
Photo Copy of death certificate of the insured. Dt: 16.04.2014. | |
Copy of legal notice to Opposite Party No.1 with postal acknowledgment. Dt: 09.08.2014. | |
Reply from Opposite Party No.1. Dt: 18.08.2014. | |
Copy of Rejoinder to the opposite party No.1.Dt: 30.08.2014. | |
Reply to the rejoinder by the opposite party No.1. Dt: 02.09.2014. |
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTYs
Exhibits (Ex.B) | Description of Documents |
1. | Attested copy of the Policy bond No.844186052. Dt: 28.03.2010. |
2. | Attested copy of the policy bond with proposal in policy No.841536627. Dt: 12.07.2005. |
3. | Attested Extract of PDB & EPDB. |
Sd/-
President
// TRUE COPY //
// BY ORDER //
Head Clerk/Sheristadar,
Dist. Consumer Forum-II, Tirupati.
Copies to:- 1. The complainant.
2. The opposite parties.
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