A. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD
FA 8 of 2013 against CC 67 of 2012 on the file of the District Consumer Forum II, Krishna District at Vijayawada.
Between :
Smt. Kanazam Ramadevi,
W/o Late Venkata Krishna Rao Kanazam
Aged 42 years, Occ : Housewife
R/o D. No. 41-1-102, Kottusubba Rao street
Harinadhapuram, Krishna Lanka Vijayawada .. Appellant/complainant
And
01. Birla Sun Insurance Company
Rep. by its authorized Signatory
Tower 1, 15th and 6th floor,
Jupiter Mill compound 841,
Senapathi Bapwet Marg, Elphinstone road,
Mumbai – 400 013.
02. The Customer Service Policy Administration
Birla Sun Insurance Company
Rep. by its Branch Manager, K. P. Towers
1st floor, Near Benz circle, M. G. Road
Vijayawada, Krishna District .. Respondents/Opp. Parties
Counsel for the Appellant : M/s. P. Gopal Das &
D. Vallabha Rao
Counsel for the Respondents : M/s. C. Sudesh Anand
Coram ;
Sri R. Lakshminarasimha Rao… Hon’ble Incharge President
And
Sri T. Ashok Kumar .. Hon’ble Member
Monday, the Twenty Fifth Day of November
Two Thousand Thirteen
Oral Order : ( As per Sri T. Ashok Kumar , Hon’ble Member )
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1. This is an appeal preferred by the unsuccessful complainant as against the orders dated 14th November, 2012 in CC 67 of 2012 on the file of the District Consumer Forum II, Krishna District at Vijayawada . For convenience sake, the parties as arrayed in the complaint are referred to here under :
2. The brief facts of the complaint are that the complainant’s husband, by name, Kanazam Venkata Krishna Rao, took an Insurance policy bearing No. 000747980 and paid premium amount @ Rs.5,561/- semi annual regularly i.e. @ Rs.4,771/- towards flexi save plus Rs,72/- towards accidental death and Rs.718/- towards critical illness plus rider and her husband paid Rs.33,366/- towards premium up to 12.5.2009 and Rs.11,122/- on 10.4.2010 and 14.4.2010 to the 2nd opposite party. Her husband fell ill on 09.09.2009 and was admitted in Latha Super Specialty Hospital in Vijayawada for Kidney problem. After his discharge from the hospital, he made a claim under critical illness plus rider and on return in the month of October, 2009 to resubmit the ill after six months he again submitted the same on 2.4.2010. The Ops paid Rs.1,00,000/- on 7.7.2010 under critical illness. Her husband died on 21.4.2010. The complainant made a claim for Rs. 2 lakhs and made huge correspondence and also a complaint to Grievance cell of Ops and Ombudsman, Hyderabad. As the claim was not settled, she got issued a legal notice on 3.11.2011 and Ops issued reply notice dt.27.11.2011 with false allegations. Hence the complaint to direct the opposite parties to pay Rs.2 lakhs towards death claim under insurance policy, to pay Rs. One lakh towards compensation and to pay interest and costs.
3. OP filed counter opposing the claim of the complainant and denying the allegations made in the complaint and the brief facts of the counter are as under :
The complainant’s husband did not pay premium due amount on 12.10.2009 within the grace period of 30 days and thus the policy had lapsed. The policy holder has the option to revive the policy within two years from the date of lapse, by paying all due premiums and submitting evidence of insurability, satisfactory to the insurance company. The complainant had submitted a certificate of insurability and replied in the negative to the question No. 13(g) of certificate of insurability. The complainant did not give proper explanations for the clarifications called for by them. The policy was not revived before the death of the life assured. The Ops paid Rs.17,681/- towards policy fund value as the life assured died within revival period and Rs.one lakh by way of cheque dt. 7.7.2010 vide letter dated 30.06.2010. There is no deficiency in service on their part and thus prayed to dismiss the complaint.
4.Both sides filed evidence affidavit reiterating their respective pleadings and Ex. A-1 to A -21 were marked on behalf of the complainant and Ex. B -1 to B4 were marked for the OP.
5.Having heard both sides and considering the evidence on record, the District Forum allowed the complaint and directed OPs 1 and 2 jointly and severally to pay Rs.17,682/- with interest @ 12% pa from 7.7.2010 till payment and also costs of Rs.2,000/- within one month and rejected the rest of the claim
6. Feeling aggrieved with the said order the dis-satisfied complainant filed this appeal on several grounds and mainly contended that the District Forum ought to have seen that premiums were received by OP vide Ex. A11 and A12 ie on 10.04.2010 and 14.04.2010 and the policy holder died on 21.04.2010 and that the requirement letter dt.26.4.2010 for lapsed policy was issued on 21.04.2010 and that the Ops did not give notice of lapsed policy during the life time of the policy holder and Ex. A1 is manipulated after the death of the policy holder and that despite the policy holder paid premium sum of Rs.33,360/- for the period from 01.04.2006 to 12.04.2010 and also Rs.11,122/- on 10.04.2010 and 14.04.2010 under Ex. A11 and A12, the Op did not revive the lapsed policy and that the acts of OP amount to deficiency in service and unfair trade practice and thus prayed for allow the appeal setting aside the impugned order and consequently allow the complaint as prayed for.
7.Both sides filed written arguments with reference to their respective contentions in detail.
8. Now the point for consideration is whether the order of the District Forum is sustainable ?
9. There is no dispute that ONE Venkata Krishna Rao, the husband of the complainant had taken a policy No. 000747980 in the year 2006 from the opposite parties covering his life risk for a sum of Rs. Two lakhs, accidental death benefit of Rs. One lakh and critical illness rider for a sum of Rs. One lakh and the semiannual premium was @ Rs.5,561/-.
10. The complainant herself admitted that her late husband paid premium of Rs.33,363/- up to 12.5.2009 and that Ex. A12 premium certificate dt. 12.4.2010 was issued by the Opposite parties in her favour and the said document discloses that the last premium of Rs.5,561/- was paid on 12.5.2009. The defence of the Ops is that the policy holder did not pay the amount in time due on 12.10.2009 and also in the grace of period of 30 days and consequently the policy was lapsed and that in view of the averments in the complaint itself that the deceased did not pay Rs.11,122/- on 10.04.2010 and 14.4.2010. Thus, there is acceptable force in the contention of the OP that after 12.5.2009 no premium was paid till 10.04.2010. It is true that the insured applied for revival of the policy and paid Rs.5,561/- on 10.04.2010 and Rs.5,561/- on 14.4.2010 and the documents in Ex. A11 and Ex. A12 establish the same and the said amount was paid as renewal premium. Describing in detail the terms of the policy regarding lapsing and revival of the policy the District Forum came to a conclusion that payment of arrears and premium would not automatically revive the policy. It was observed by the Forum that the insurance company must be satisfied that there is insurability in the life assured so as to renew the policy. There is no dependable evidence from the side of the complainant that she submitted the requisite certificate of insurability to the Ops as required by the terms of the policy. The opposite party addressed a letter dt. 28.4.2010 to the assured to furnish certificate of insurability saying that such a certificate submitted earlier was not properly filled and thereafter also a letter dt. 11.5.2010 was addressed vide Ex. B-2 but it was not submitted. Therefore, merely because the insurance company received the premiums vide Ex. A11 and A12 it does not mean that the assured had satisfied the other requirements necessary for renewal of the policy. There is no dependable material on record to hold that opposite party issued requirement letter dt. 26.4.2010 for lapsed policy knowing fully well that the assured died prior to it. Therefore, the said ground is also not helpful for the appellant. There is no necessity for the opposite party to give notice of lapsed policy during the life time of the policy holder and it was the duty of the assured to pay the premiums within time or got revived the policy by taking recourse to relevant clauses satisfying the insurance company. The terms and conditions of the policy bind the assured so also the complainant who is claiming the amount under the policy as the legal representative of the assured and when the rules mandate for submission of certificate of insurability to the Ops for renewal of the policy by paying the requisite premiums merely because one of such conditions was complied with the complainant cannot validly say that it is sufficient compliance of the conditions. In such circumstances, the finding of the District Forum that the policy became lapsed by 12.10.2009 and there was no policy covering the life of the assured by the time of his death is upheld. Discussing in detail, the District Forum held that Ops are bound to pay Rs.17,681.65 ps rounded up to Rs.17,682/- along with interest thereon from 7.7.2010 but did not pay so and that to that extent there is deficiency in service on the part of the Ops and accordingly directed the Ops 1 and 2 jointly and severally to pay a sum of Rs.17,682/- with 12% interest per annum from 7.7.2010 till payment and also costs of Rs.2,000/- giving one month time for compliance from the date of receipt of the copy of the order and as against the said finding the Ops did not prefer any appeal and thus it attained finality. Therefore, the appeal filed by the complainant is devoid of merit and is liable to be dismissed confirming the order of the District Forum.
11. In the result, the appeal is dismissed confirming the order of the District Forum. Parties shall bear their own costs. Time for compliance four weeks from the date of receipt of the order.
I/c President
MEMBER
DATED : 25.11.2013.
