By. Sri. Chandran Alachery, Member:
The complaint is filed under section 12 of Consumer Protection Act for an Order directing the opposite party to pay the remaining sum equal to the sum assured under the said policy and direct the opposite party to give cost of the proceedings.
2. Brief of the complaint:- The complainant's son took an insurance policy from opposite party with policy No.797375848 on 07.09.2012 under "Jeevan Anand Double Death Benefit" worth Rs.1,00,000/-. The policy entitles its holder for an additional sum equal to the sum assured under this policy in case the holder died in an accident during the policy period. On 22.02.2013 the policy holder Nisar. K. H. met with an accident and seriously injured and was hospitalized at Calicut Medical College Hospital. Later he died on 29.01.2013. As per claim the opposite party paid Rs.1,04,952/- to the complainant on 30.03.2013. The sum amounts to only half of the assured sum along with bonus amount. Aggrieved by the same, when made enquiry with opposite party the opposite party replied that the policy holder made a default in making the premium of the insurance and added that the petitioner ought to have made the payment before the grace period ie 30 days. It is further stated that the policy had lapsed when the policy holder met with the accident. Aggrieved by this the complaint has been filed.
3. On receipt of complaint, notice was issued to opposite party and opposite party appeared before the Forum and filed version. In the version, the opposite party stated that the complainant is not entitled for double benefit because on the date of accident the policy was not in force and in lapsed condition. The payment of Rs.1,04,952/- was made since the policy was revised before death. But revival before death will not entitle the complainant to claim double benefit. There is no deficiency of service from the part of opposite party.
4. On verifying the complaint, version and documents, the Forum raised the following points for consideration:-
1. Whether there is any deficiency of service from the part of opposite parties?
2. Relief and Cost.
5. Point No.1:- The complainant filed proof affidavit and is examined as PW1 and documents are marked as Ext.A1 to Ext.A8. The opposite party also filed proof affidavit and is examined as OPW1 and documents are marked as Ext.B1 and Ext.B2. On going through the documents and evidences, it is evident that the accident occurred on 22.01.2013. The quarterly premium due on 12.12.2012. It is not paid within the grace period of 12.01.2013 ie one month. After that, the policy is lapsed. But after accident and before death the policy got revived on 25.01.2013. The policy is a Double Death Benefit policy. Before the death of the policy holder, the policy has been revived by the opposite party admittedly. The Forum is of the opinion that when policy is revived by the opposite party, the opposite party is liable to pay double death benefit to the complainant. On revival, the policy came into existence in its earlier position and condition. Moreover, the complainant's son who is a student met with accident and tragic death happened. The loss sustained to the mother cannot be assessed in terms of money. In humanitarian consideration also, the complainant is entitled to get the full benefit of the policy. Denial of granting double accident death benefit to the complainant is a deficiency of service from the part of opposite party. The Point No.1 is found accordingly.
6. Point No.2:- Since the Point No.1 is found in favour of complainant, the complainant is entitled to get cost and compensation.
In the result, the complaint is partly allowed and the opposite party is directed to pay the remaining sum equal to the sum assured under the policy along with Rs.2,000/- (Rupees Two Thousand) only as cost of the proceedings. The opposite party shall comply the order within 30 days from the date of receipt of this Order.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and Pronounced in the Open Forum on this the 16th day of April 2015.
Date of Filing:11.03.2014.
PRESIDENT :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
PRESIDENT, CDRF, WAYANAD.
APPENDIX.
Witness for the complainant:-
PW1. Sulekha. P. K. (Affidavit).
Witness for the Opposite Party:-
OPW1. Narayana Naik. Assistant Divisional Manager, LIC, Calicut.
Exhibits for the complainant:
A1. Copy of Policy Document (5 pages).
A2. Copy of Policy Conditions and Privileges within Referred to.
A3. Copy of Death Certificate.
A4. Copy of Reply to Right to Information (2 Pages) Dt:29.05.2013.
A5. Copy of Renewal Premium Receipt. dt:10.10.2012.
A6. Copy of Renewal Premium Receipt. dt:25.01.2013.
A7(1). Copy of Cheque. dt:30.03.2013.
A7(2). Copy of Letter. dt:30.03.2013.
A8(1). Renewal Premium Receipt. dt:25.01.2013.
A8(2). Renewal Premium Receipt. dt:10.10.2012.
A8(3). Renewal Premium Receipt. dt:24.07.2012.
Exhibits for the opposite party:-
B1. Marked Portion of Ext.A2.
B2. Policy Schedule Marked Portion.
Sd/-
PRESIDENT, CDRF, WAYANAD.
a/-
