BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 52/2013.
THIS THE 20th DAY OF DECEMBER 2013.
P R E S E N T
1. Sri. Prakash Kumar B.A. LLB. PRESIDENT.
2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.
3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER.
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COMPLAINANT :- Smt. Reshma W/o. Late Ameer Pasha,
C/o. Lingangouda Plots Ballatagi Village, Tq; Manvi, District Raichur.
//VERSUS//
RESPONDENT :- The Manager, Life Insurance Corporation of
India, LIC office Manvi, District. Raichur.
Date of institution :- 27-08-2013.
Date of disposal :- 20-12-2013.
Complainant represented by Sri. Gowreesh, Advocate
Respondent represented by Sri. Munna Kumar, Advocate
ORDER
By Sri. Prakash Kumar, President:-
The complaint is filed by the complainant against the Respondent U/sec. 12 of Consumer Protection Act 1986.
2. The complaint in brief is that, the complainant’s husband deceased Ameer Pasha obtained Life Insurance Policy from Respondent’s Insurance Corporation on 08-12-2006 for Rs. 45,000/- for which the half yearly premium payable was Rs.1,274/-. The complainant’s husband died on 10-10-2012 in a motor vehicle’s accident. After that the complainant submitted her claim before the Respondent’s Insurance Corporation to pay her the amount assured under the policy with accident benefit relief which is twice the amount assured she being the nominee under the policy. She is actually entitled for more than Rs.1,00,000/-. However the Respondent’s Insurance Corporation paid her only Rs. 45,000/-. Therefore the complainant through several letters asked the Respondent’s Insurance Corporation to pay her the balance amount due to her under the policy. For the said letters there was no response. Hence the complainant got issued legal notice to the Respondent’s Insurance Corporation asking them to pay the amount due to her. But there was no response for this notice also. Therefore, the complaint seeking reliefs as prayed for.
3. The Respondent filed the written version stating that, the Para- 1 & 2 of the complaint needs no reply. It is true that Ameer Pasha had taken the policy as mentioned in para-3 of the complaint. On verification of records it is found that the policy is in lapsed condition for non payment of half yearly premiums due from 11/2010 to 05/2012. The life assured had paid 05/2010 half yearly due on 16-06-2010. Subsequent premiums were not paid by the life assured. The policy being the “New Bima Gold Plan” it has a special feature called “Auto Cover Period” i.e, if the premiums are paid for at least 2 full year policy is eligible for full basic sum assured for 2 years from the first unpaid premium. The life assured died on 18-10-2012. The first unpaid premium was 28-11-2010 which was within two years from the first unpaid premiums. Therefore the Respondent’s Insurance Corporation has extended the benefit of “Auto Cover” and has paid the basic sum assured of Rs.50,000/- after deducting Rs. 5,000/- already paid towards survival benefit, on 21-11-2010. The policy condition 4 which is printed on 2nd page of the policy bond under the paragraph “Non forfeiture Regulations” deals with this condition. It is mentioned that Accident benefit rider will not be available in the auto cover period. The complainant had signed discharge voucher of Rs.45,000/- on 01-08-2013 acknowledging that she had received full and final settlement of the policy money. Therefore the complaint be dismissed with cost to meet the ends of justice.
4. Complainant to prove her case filed her affidavit evidence which is marked as PW-1 and relied on thirty two documents which are marked as Ex.P-1 to Ex.P-32. The Respondent to prove his case filed his affidavit evidence which is marked as RW-1 and relied on three documents which are marked as Ex.R-1 to Ex.R-3.
5. Respondent filed written arguments.
6. The points that arise for our consideration are:
1. Whether the complainant proved deficiency in service on the part of the Respondent’s Insurance Corporation against her.?
2. Whether the complainant is entitled for the reliefs prayed for.?
3. What order?
7. Our answer on the above points are as under:
(1) In Negative
(2) In Negative.
(3) As per final order:
REASONS
POINT NO.1 :-
8. The Respondent admitting the issuing of their “New Bima Gold Plan” policy in the name of the complainant’s deceased husband Ameer Pasha and admitting the amount assured under the policy as Rs.50,000/- with accident benefit rider, repudiated the claim made by the complainant to pay the amount assured under the accident benefit rider on the ground that though the said policy had special feature called “Auto cover period” under which if premiums paid for at least 2 full year, policy is eligible for full basic sum for 2 years from the first unpaid premium and as the life assured failed to pay premiums due on 11/2010 to 05/2012 and he having paid last premiums due on 05/2010 and life assured having died on 10-10-2012 and the first unpaid premium being due 28-11-2010 and the death being within two years from the first unpaid premium they extended the benefit of “Auto cover period” and paid the basic sum assured of Rs.50,000/- after deducting Rs.5,000/- already paid towards survival benefit and as per condition No.4 of the policy the accident benefit rider will not be available in auto cover period and therefore the complainant being paid the amount assured under the policy under auto cover period, the policy being is in lapsed condition as on the date of death of the life assured, the complainant is not entitled for compensation under accident benefit rider. In this regard the copy of the policy Ex.P-10 issued in favour of the complainant’s husband is perused and at condition No-4 it is clearly mentioned that the accident benefit rider will cease to apply if the policy is in lapsed condition and during the auto cover period, the accident benefit rider shall not be available. The complainant has not challenged the contention raised by the Respondent that the policy of insurance as on the date of the death of the life assured was in lapsed condition and as per condition No-4 of the policy the complainant is only entitled for the sum assured under the policy as per auto cover period feature and she is not entitled for accident benefit as the policy was under lapsed condition. The parties are bound by the terms and conditions of the policy and we cannot go beyond the said terms and conditions of the policy. Therefore there is no merit in the claim of the complainant that she is entitled for compensation under the accident benefit rider of the policy and therefore the said claim has to be rejected. Under these circumstances deficiency in service cannot be attributed against the Respondent’s Insurance Corporation. Accordingly this point is answered in the Negative.
POINT NO.2:-
9. As complainant has failed to prove her case and failed to prove deficiency in service against the Respondent’s Insurance Corporation she is not entitled for any of the reliefs prayed for in the complaint. Accordingly this point is answered in Negative.
POINT NO.3:-
10. As per order below:
ORDER
The complaint filed by the complainant is dismissed.
There is no order as to cost.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 20-12-2013)
Smt.Pratibha Rani Hiremath, Sri. Gururaj Sri. Prakash Kumar,
Member. Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur. District Consumer Forum Raichur.
