COMPLAINT FILED ON:06/03/2019

DISPOSED ON:02/03/2023

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, CHITRADURGA.

CC.NO:21/2021

DATED: 02^nd  March 2023

PRESENT: Kum. H.N. MEENA, B.A., LL.B., PRESIDENT

                  Smt. B.H. YASHODA, B.A., LL.B., LADY MEMBER        

  Sri. H.JANARDHAN, B.A.L., LL.B., MEMBER       

::ORDER::

By Sri. B.H.YASHODA, B.A., LL.B., LADY MEMBER.

        The above complaint has been filed by the complainant U/s 35 of Consumer Protection Act 2019 for seeking the relief/s of to directing the opposite party No.1 to settle the benefits of the death claim of the policy bearing No: 613349872 towards Rs. 5,00,000/- with interest in favour of the complainant with upto date interest in addition to the compensation by way of damages.

The Brief facts of the complaint:-

        2. It is stated by the complainant is the husband of policy holder late, Smt.Shashikala, staff Nurse at M.S.Ramaiah Medical College and Hospital, Bangalore, who insured her life with the opponent corporation OP No.1, issued the policy bearing No: 613349872 by covering the risk for sum assured.  The complainant has been duly made nominee of the same policy and his name has been duly entered in the policy in the prescribed column.  The policy issued by the opponent corporation was on monthly installment basis.  The policy with a arrangement of remitting the installment through account from Bank drawing directly from the salary of the policy holder.  The above said arrangement of remitting installments from the salary of the policy holder has been duly authorized and communicated from the concerned Department.

3. Further complainant stated that the wife of the complainant expired on 17/02/2020.  From the date of commencement of the policy i,e., 25/10/2017 till October 2019, the installments for the sum of Rs.1,827/- the salary of the policy holder.  That after complainant presented the claim petition, claiming the benefits of the policy being the nominee before the opposite party with all necessary documents.  It is surprised for the complainant to receive the letter to the effect by nothing the contents that the policy is lapsed, for the reasons that neither during the life time of the policy holder nor before the presentation of the claim petition before the opposite party, the opposite party have never intimated the same fact through written communication about lapse of the policy.  Further states that there were no dues in respect of payment of installments as it is internal arrangement and management from the opponent party No.2 to the office of the opponent party No.1.  Even otherwise neither the policy holder nor the complainant have received any notice from the OP No.1 regarding the lapse of the policy.  In this regard the complainant has issued letter address to the office of the insurance ombudsman, Bangalore, informing about the non-settlement of claim and requested the kind authorities to settle the same.  But, no reply so for have been received by the complainant.  The complainant being the nominee of the policy holder is duly entitled for the claim and benefits from the office of the OP No.1 under the policy bearing No:613349872.  The policy holder was a consumer of the OP No.1.  After the death of policy holder the complainant being the nominee stepping into the shoes of the policy holder and being the consumer of OP No.1 and presented the claim petition.  The non-settlement of policy benefits in favor of the complainant amounts to deficiency in the services of the opposite parties and causes heavy losses, pain and inconvenience to the complainant.  The complainant has got one male child by name Tejas and entire responsibilities has been shouldered upon him about the care, protection, education, qualification career and marriages of his son.  Further, the complainant contends that there are no default on the part of the either policy holder or her nominee I,e., the complainant.  The complainant is suffering from the acts of deficiency in service on the part of the opposite parties for no fault of him. 

4. Further complainant submits that it is the bounded duty of the opposite to inform and intimate to the policy holder about the non-payment of installment towards the policy insured, as it was an internal arrangement between two department of Ops through official communication.  And that non-intimating or informing the fact of installment dues and loss of pay by the Ops as they have taken the contention to the policy holder during her life time or before the presentation of the claim petition amounts to default on the part of the Ops and they cannot take shelter under the pretext for non-settlement of the policy benefits.  The OP No.1 legally bound to settle the claim in favor of the complainant and the complaint is legally, lawfully entitled for the same the policy issued from the office of the OP No.1 and payment of installments had been directly remitted from the office of the OP.No.2 as such, both the opposite parties are the necessary parties to the present petition.  Hence, the complainant has filed this complaint.

5. After registering the complaint on 25/03/2021 and the commission has issued the notice to the OPs and the same has been duly served on 27/04/2021, but the OPs have not appeared before this commission.  Hence OP No.1 and 2 have taken as exparte.  The complainant as examined as P.W.1 and marked the documents as Ex A-1 to A-7.  After that on 30/11/2021 the NTS advocate for OP No.2 have filed The application under Order IX Rule 7 R/w Section 151 of CPC for Set aside the Ex-parte Order along with version and further on 17/01/2022.  H.S.S advocate for OP No.1 has filed on application U/o IX Rule 7 of CPC for set aside the ex-parte Order on OP. No.1.  But the complainant has not filed any objection for the same.  The OP.No.1 filed the version.

6. Further, the OP No.1 stated that there is no cause of action arise to file present complaint.  It is submitted present complaint filed by the complainant is misconceived in facts and law.  There is no cause of action arise for the complainant to file the present consumer complaint before this Hon'ble commission as the Respondent herein has not made any breach of the terms and conditions of the insurance policy.  Hence, the complaint is not tenable in the eyes of law and as such the same deserves to be dismissed in limine.  Further, the commission lacks jurisdiction as the entire process of issuing policy recovery of premium are at Bangalore which does not comes under the jurisdiction of this Hon'ble commission.

7. It is submitted that complainant has not even prime facie established any breach of any of the terms and conditions of the insurance policy by these Respondents and therefore, there is no deficiency in service and unfair trade practice on the part of these Respondents and no cause of action arise to file present complaint.  As such, this Hon'ble commission has no jurisdiction to entertain the complaint under the provisions of the consumer protection act and complaint is liable to be dismissed on this Court alone.

8. Such of those which are specifically admitted herein this Respondent deny all other averments made in the complaint and the complainant is put to strict proof of the same.

9. The OPs have admitted in their version that one Smt.Shashikala.H has submitted proposal dated 17^th October 2017, for a sum assured of Rs.5,00,000/- under salary savings scheme as she was employed with OP No.2 M/S M.S.Ramaiah Hospital Bangalore which has extended the salary deduction scheme for its employees.  The proponent deceased Shashikala.H. has voluntarily choose the SSS mode and accordingly requested the corporation is issue the policy under SSS scheme upon opting the SSS scheme, the proponent along with proposal Form has submitted duly signed "AUHRISATION LETTER TO EMPLOYER TO REOVER THE PREMIUM FROM THE SALARY" and "ADDENDUM TO THE APPLICATION FOR INSURANCE UNDER SALARY SAVINGS SCHEME.

10. Considering the above documents as in Order this Respondent granted policy No.613349872 for a sum assured of Rs.5,00,000/- with date of commencement as 25/10/2017 under monthly premium of Rs.1,827/- under salary savings scheme mode I,e., salary to be recovered by the employee OP No.2 from the monthly salary of the deceased shastikala and to be remitted to this Respondent LIC of India, for considering the life insurance risk under the above policy. 

11. After completion of the policy, the duly executed authorization letter was sent to the employer OP.No.2 M/s Ramaiah Hospital for recovering the premium from the salary of the shashikala H. and remitted the same to this OP.No.1 from the month of December 2017 to September, 2042.  Based on this authorization letter the OP.No.2 effected the recoveries from the monthly salary of the deceased Shashikala and remitted the same to this OP No.1 up to the month of September 2019 and thereafter the premiums were not sent by the OP No.2 thus the complainant policy was inforce up to September, 2019 only and thereafter, on the date of death of the deceased life assured (17/02/2020) it was in a lapse condition.  The reasons for non-recovery and remittance of the premium from October 2019 is better known to the employer OP.No.2 and his employee / deceased Shashikala as the OP.No.2 has remitted the premiums under other employees, except deceased Shashikala for the moths October 2019 on wards.

12. The said deceased Shashikala has issued the Authorization letter to the OP.No.2.  Hence, it is the responsibility of the deceased life assured Smt. Shashikala to make arrangements when the salary is not recovered and remitted by his employer.  Further in the ADDENDUM TO THE APPLICATION FOR INSURANCE UNDER SSS, the deceased Shashikala declares that while deducting the premium from my salary and remitting it to the corporation in the event of the non-payment of the premium to the corporation by the employer for whatever reasons.  It shall be my responsibility to make the payment of premium directly to the corporation together with any additional charges as applicable for monthly payments of premium and with interest, if any to keep the policy inforce, when the deceased Shashikala declares that he is solely responsible for the non-remittance of the premium by her employer in the above declaration this Respondent is not necessary to inform the non-receipt of the premium.  However, this Respondent has sent a letter dated 6/01/2020 (system generated) to her Hospital address where she was working, enclosed herewith and may be exhibited and be read in evidence apart from the timely SMS alerts to the registered mobile number of the deceased Shashikala.  These S.M.S alerts are more authenticated rather than the registered AD letters as the messages can be instantly read and confirmed whereas registered letters to be opened from the cover and go through the contents.  Further the OP No.1 has stated that the policy bond is the evidence of contract where in privileges and conditions are printed and the contract is subject to these privileges and conditions.  The lapse is the status of the policy when due premium is not paid within the grace period.  Further the fore feiture regulation printed on the policy bond reads as "If less than two years" premium have been paid in respect of this policy and any subsequent premiums be not duly paid all the benefits under this policy shall cease after the expiry of the grace period from the date of first unpaid premiums and nothing shall be payable and the premium paid either to are also not refundable.

13. In view of the said condition, the compliant policy was in lapsed condition as on the date of death of the life assured, hence nothing is due for payment from this Respondent.

14. That the OP No. has relied the citation of LIC Vs Mani Ram by Supreme Court that in the event of lapsed policy the LIC has no responsibility to make payment of the policy amount.  Hence, we deny the statement of the complaint that there was deficiency on the part of the Respondent.  Further in case of LIC of India V/s S.Ramadevi RP/208/2008 NCDRC ORDER DATED:26/02/2016 and pushapadavi V/s LIC of India RP/1926/2018 in NCDRC once the policy holder obtained the policy from LIC under the salary savings scheme, it was his duty to ensure that premium was deducted from the salary from time to time and remitted to LIC.  In the absence of proper remittance, obviously, the said policy lapsed due to non-payment of premium and hence LIC is not liable to make the payment of claim under the policy.  The OP No.1 denies the other averments made in remaining paras of the complaint.

15. The OP No.2 stated in his version that the instant complaint filed by the complainant is not maintainable either in law or on fact and is liable to be dismissed in limine and with an ulterior intention to harass this opposite party.  The complainant has not approached this Hon'ble commission with clean hands and suppressed the material facts and hence on the said ground only the complaint is liable to be dismissed.

16. Further the OP No.2 stated in his version that the complainant has approached this Hon'ble Commission after an inordinate and on unexplained delay of one (1) year.  It is pertinent to mention that the complainant has not sought any relief against this opposite party in this complaint and hence under the said circumstances, the instant complaint as against this opposite party is not maintainable and is liable to be dismissed. Late Smt.Shashikala worked as a staff nurse at this opposite party medical college and Hospital.  It is pertinent to mention that the LIC premium of late Smt. Shashikala was remitted directly to LIC from her salary as along as she worked.  It is submitted that Smt. Shashikala was on unauthorized leave from October 2019 till February 2020.  All other averments made in the said paragraph are not in the knowledge of this OP.  Further it is stated that in Para No.3 that the averments made in the said paragraph is not within the knowledge of this OP.  The complainant is put to strict proof of the same.  Further in the paras 4 and 5 stated that the averments made in the said paragraph establishes the fact that this OP was only facilitating in remitting the LIC premium by deducting the same from the salary of Smt. Shashikala and then remitting it to her LIC premium.  It is emphatically stated that this Respondent is only a facilitator as long is the salary is given to the employee.  The complainant is put to strict proof of the averments made in the said paragraphs.  Further it is stated by the complainant in para No.6 that the untimely death and date of death of Smt. Shashikala is not within the knowledge of this OP.   This is the first time that this OP is notified about her death.  This OP is aggrieved by the untimely death of their staff so it stated by the OP No.2 is in no way competent or authorized to settle the claims of the complainant and hence the complainant cannot attribute the deficiency of service against the OPs.  The complainant cannot make vague and baseless allegations again this OP.

17. The complainant got himself examined as P.W-1 by filing his affidavit as a part of examination-in-chief and the documents Exhibit A-1 to A-7 were got marked and closed their side evidence.

18.The OP No.1 has examinee as DW.1and produced the documents marked as Exhibit B-1 to B-7 in support of their defense.

18. The OP No.2 have filed their version and no produced any documents and not lead any evidence in support of their defense.

19. The complainant and OP No.1 have filed the written arguments and same were heard.

20. After perusal of the complainant and OP No.1 evidence and all documents, the points that arise for our consideration for decision of above complaint are that.

1. Whether the complainant proves that he is the consumer of the OP No.1 ?
2. Whether the complainant proves that the OPs have committed deficiency of service in not settling the claims of the complainant?
3. Whether the complainant is entitled to get any benefits of the death claim of the policy bearing No.613349872 towards Rs.5,00,000/- lacs with interest from the OPs?
4. What Order?

    21. Our findings on the above points are as below :

1. Affirmative
2. Negative
3. Negative
4. As per final Order.

REASONS

22. Point No.1 : The complainant examined as P.W.1 and documents marked as Exhibits A-1 to A-7 ViZ Ex A-1-Xerox copy of the LICs New Jeevan Anand Band, Exhibit A-2 Xerox copy of the death certificate of Shashikala.H Exhibit A-3 xerox copy of the medical Attendants certificate of Shashikala H. Exhibit A-4 xerox copy of the certificate.  Hospital Treatment of Shashikala H. Exhibit A-5 Early Claim non early claim Disability Exhibit A-6 claim enequiry report, Exehibit A-7 xerox copy claimant's statement.  As per the above Exhibits are clearly shows that, the complainant is the consumer of OPs so, the point No.1 is affirmative.

 23. Point No.2 :  That as per the complaint, the complainant is the husband of policy holder late Smt. Shashikala, staff nurse at M.S.Ramaiah Medical College and Hospital Bangalore, who insured her life with the opponent corporation OP No.1 issued the policy bearing No.613349872 by covering the risk for sum assured.  The complainant has been duly made nominee of the same policy and his name has been duly entered in the policy in the prescribed column.  From the date of commencement of the policy is I,e., 25/10/2017 till October 2019 the installment for the sum of Rs.1,827/- per month has been duly deducted from the salary of the policy Holder.  The above said arrangement of remitting installments from the salary of the policy holder has been duly authorized and communicated from the concerned Department.

24. The complainant stated that the wife of the complainant expired on 17/02/2020.  That after the death of wife of the complainant, the complainant presented the claim petition, claiming the benefits of the policy being the nominee before the OP.  with all necessary documents.  It is surprised for the complainant to receive the letter to the effect by nothing the contents that the policy is lapsed, for the reasons that neither during the life time of the policy holder nor before the presentation of the claim petition before the OP. the op have never intimated the same fact through written communication about lapse of the policy.  Further states that there were no dues in respect of payment of installments as it is internal arrangement and management from the OP No.2 the office of the OP No.1.  Even otherwise neither the policy holder nor the complainant have received any notice from  the OP No.1 regarding the lapse of the policy.  But observed that complaint and documents the policy holder has not paid the premium amount through OP No.2 to OP No.1 from November 2019 to February 2020.

25. The OP No.1has examined as D.W.1 and documents marked as Exhibit B-1  to B-7 ViZ, Exhibit B-1-Xerox copy of proposal form / opted SSS mode, Exhibit B-2 Xerox copy of policy Bond-Lapse-Forfeiture  regulation, Exhibit B-3 Xerox copy of Authorization letter dated 25/10/2017, Exhibit B-4 Xerox copy of Addendum to the application for insurance under SSS, Exhibit B-5 policy clause No.22 Exhibit B-6 xerox copy of Gap intimation letter dated:06/01/2020 and Exhibit B-7 xerox copy  Format of the Bi partite Agreement between the OP No.2 and OP No.1.

26. It is noted that after completion of the policy, the duly executed authorization letter was sent to the employer OP No.2 M/S M.S.Ramaiah Hospital for recovering the premium from the salary of the Shashikala H. and remitted the same to this OP No.1 from the month of December 2017 to September 2042. Based on this Authorization letter, the OP No.2 effected the recoveries from the monthly salary of the deceased Shashikal and remitted the same to this OP No.1 up to the month of September 2019 and thereafter the premiums were not sent by the OP No.2.  Thus the complaint policy was inforce up to September 2019 only and thereafter, on the date of death of the deceased life assured (17/02/2020) it was in a lapse condition.  The reasons for non-recovery and remittance of the premium from October 2019 is better known to the employee OP No.2 and his employee / deceased Shashikala as the OP No.2 has remitted  the premiums under other employees, except deceased Shashikala for the months of  October 2019 onwards.

27. As per Exhibit B-4 ADDENDUM TO THE APPLICATION FOR INSURANCE DNDER SSS the deceased Shashikala declares that while deducting the premium from her salary and remitting it to the corporation.  In the event of the non-payment of the premium to the corporation by the employer for date ever reasons.  It shall be the responsibility of the complainants wife to make the payment of premium directly to the corporation together with the any additional charges as applicable for monthly payments of premium and with interest, if any, to keep the policy force.  And Also Agree That In The Event Of The Said Policy Becoming Lapsed On Account Of The Non-Payment Of The Premium To The Corporation Within The Stipulated Time For Whatever Reasons The Liability Of The Corporation Will Be Limited To Be Extent Of The Premium Actually Received By It And The Corporation Shall Not Be Held Responsible For Any Claim Behand This Liability As Accrued To The Said Policy At The Time Of Its Lapsation.  But the policy holder have not paid any premium September 2019 to 17/02/2020.  This is the default of the policy holder not a OPs that as per Exhibit B-2 page No.3 Para No.4 it is stated that "Non forfeiture regulations.  If less than three years premium have been paid in respect of this policy and any subsequent premium be not duly paid, call the benefits under this policy shall cease after the expiry of grace period from the date of first unpaid premium and nothing shall be payable and as per Exhibit B-7 para 9, it is also understood that if the premiums are not received by LIC within the stipulated due dates the policies will lapse and the liabilities  of LIC under such policies will be limited to the extent of thee premiums actually received at the offices of LIC.  For any loss suffered by the employee on this count the employer as principal shall be liable to the employee concerned".

28. That the OP No.1 relied the citation of LIC V/s Mani Ram by Supreme Court that in the even of lapsed policy the LIC has no responsibility to make payment of the policy amount.  Hence, we deny the statement of the complaint that there was deficiency on the part of the Respondent.  Further in case of LIC of India V/s S.Ramadavi RP) 2083/2008 NCDRC ORDER DATA:26/02/2016 and Pushapadevi V/s LIC of India RP/1926/2008 in NCDRC once the policy holder obtained the policy from LIC under the salary savings scheme, it was his duty to ensure that premium was deducted from the salary from time to time and remitted to LIC.  In the absence of proper remittance, obviously, the said policy lapsed due to non-payment of premium and hence LIC is not liable to make the payment of claim under the policy, in this case also the policy holder not paid premium amount from October 2019.  Hence above authority is applicable in this case.

29. That as per the version of OP No.2 that, Late Smt. Shashikala worked as a staff nurse of this OP No.2 medical college and Hospital.  It is true that LIC premium of late Smt. Shashikala was remitted directly to LIC from her salary as long as she worked.  It is that Smt. Shashikala was on unauthorized leave from October 2019 till February 2020.  It is shows that the policy holder not paid the premium from October 2019 till February 2020 I,e., till the date of her death.

30. On perused of the complainant and documents submitted by the complainant and OP No.1 and 2 it shows that the complainant's wife was died on 17/02/2020, but, the last monthly premium has been paid on October 2019.  After that no monthly premium amount has been paid to the corporation so, there is continues gap of 4 months, premium amount has been paid by the deceased Shashikala.  As such, the complaint filed by the complainant before this Hon'ble Commission is not maintainable and there is no deficiency in service on the part of opponents.   As such, the Point No.2 and 3 taken into consideration as negative.

31. Point No.4: As discussed on the above points and for the reasons stated in we pass the following Order.

:: ORDER ::

        The present complaint filed by the complainant under section 35 of CP Act 2019 against the opponents is dismissed.

Communicate the order to parties.

(Dictated to the Stenographer, typed by him, the transcript corrected, revised and then pronounced in the open commission by us on 2^nd March 2023.)

LADY MEMBER                  MEMBER               PRESIDENT

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

PW-1: Sri Nataraj L S/o Lakshmana, by way of affidavit evidence.

Witness examined on behalf of opponent No.1

DW-1: Sri Smt. Seethalakshmi D/o N.Subamanya sastry by way of affidavit evidence.

Witnesses examined on behalf of opponent No.2

Nill

Documents marked on behalf of Complainant:

Documents marked on behalf of opponent: No.1

Documents marked on behalf of opponent: No.2

Nill

LADY MEMBER                  MEMBER               PRESIDENT