O R D E R
By Sri. C.T. Sabu, President :
The complainant had taken three Policies bearing No.395670970/ 395670971 and 395670969 having date of commencement from 26/06/2012 and the sum assured is Rs.2,00,000/- each. While so, the complainant met with an accident on 03/12/2013 and sustained grievous injuries. The complainant is entitled to get the amount of the above said policies and submitted the claim form. But that was not granted. The complainant is entitled to get Rs.6,00,000/- at the rate of Rs.2,00,000/- each on the above policies. The denial of the amount due to the complainant amount to deficiency in service. The complainant is not able to travel and manage his primary needs by himself. The complaint caused a Lawyer notice to the opposite party on 14/12/14 but no avail. The above complaint is filed for getting Rs.6,00,000/- and interest @ 12% from the date of accident ie.03/12/2013.
2) On receiving complaint notice was issued to opposite parties. Opposite parties appeared through counsel and filed detailed version. The opposite parties contended that the complaint is not maintainable under law and facts. The complaint lacks bonafides and filed with ulterior motive to extract money from LIC of India. The 2nd opposite party is an unnecessary party in the above proceedings. The policies of the complainant are taken and serviced at Branch No.II under Kottayam Division and no part of cause of action has arisen within the jurisdiction of this Hon’ble Forum. Thus the complaint is to be dismissed for lack of jurisdiction. The opposite parties do not admit the contention that the complainant had met with an accident on 03/12/2013. The complainant has not submitted any written request or proof of accident to the opposite party. The claim of the complainant cannot be allowed as the policies are in lapsed condition as on the alleged date of accident ie.03/12/2013.
3) The opposite parties admitted that the complainant has taken 3 policies with Branch II LIC of India Kottayam Division bearing Policy Nos.395670970, 395670971 and 395670969 and the sum assured under the Policies are Rs.2,00,000/- each. The Date of commencement of the policies is 25/06/2012 and the mode of payment of the premium is quarterly. As per the Policy Bond the quarterly premium of Rs.2,933/-, Rs.3,910/- and Rs.2,053/- respectively on the above 3 policies are payable on 25th March, June, September and December of every year till 2032, 2027 and 2032 respectively. The complainant has defaulted in the payment of the premium due on 25/09/2013 under all the above three policies and they are in a lapsed condition since 25/09/13. To claim disability benefit under a policy, the policy has to be in force for the full sum assured at the time of the accident. Since the policies were in a lapsed condition as on the date of accident the complainant is not eligible for the disability benefits.
4) The points for consideration are :
a) Whether the complaint is maintainable or not ?
b) Whether there is any deficiency in service from the side of
opposite parties ?
c) If yes, reliefs and costs ?
5) When the case was came for evidence the complainant filed proof affidavit in which he affirmed and explained all the averments in the complaint and the documents produced from his side are marked as Exts. P1 to P3. Ext. P1 series (3 Nos.) are the Policies; Ext. P2 is the copy of lawyer notice dtd.14/12/14 and Ext. P3 is the Reply Letter dtd. 19/01/15. From the side of opposite parties also filed counter proof affidavit to the tune of averments made in the version. The six documents produced by the opposite parties are marked as Exts. R1 to R6. Ext. R1 series (3 Nos.) are the copies of Policy Certificates; Ext. R2 is the copy of letter sent by the complainant to the opposite parties dtd. 30/09/15; Ext. R3 is the copy of reply sent by opposite party to the complainant dtd.09/10/15; Ext. R4 is the copy of lawyer notice dtd. 14/12/14; Ext. R5 is the Reply Notice issued by the opposite parties dtd.19/01/15 and Ext. R6 series (3 Nos.) are the copies of Status Report of the policies held by complainant.
6) We have thoroughly gone through the contentions of the proof affidavit filed by both parties and perused the documents in detail. Admittedly the complainant is residing at Thrissur District and this Forum is not precluded from entertain the complaint. So we are not discussing with the territorial jurisdiction as contended by the opposite parties. The eligibility of Accident Benefit claim and the details of the (a) Disability to the Life Assured and (b) Death of the Life Assured claims are described in detail in the Policy Clause conditions printed in the Policy Bond and the complainant is fully aware of the same. As per Policy clause 10/11 “ if the Accident Benefit is opted for, at any time when this Policy is in force for the full sum assured, if the Life Assured before the date of maturity or before the policy anniversary on which the age nearer birth day of the LIFE Assured, whichever is earlier is involved in an accident resulting in either permanent disability as herein after designed or death and the same is proved to the satisfaction of the corporation, the corporation agrees in the case of (a) Disability to the LIFE Assured …… (b) Death of the Life Assured ……….
7) It is therefore very clear that no claim disability benefit under a Policy the Policy has to be in force for the full sum assured at the time of Accident. Admittedly, the Policies were in a lapsed condition since 25/09/2013. There is not even an averment that the premium payable to the policies were duly paid without any default. Ext. R6 series (3 Nos.) are the status report of the policies showing premium position of the policies which show that the complainant has defaulted in the payment of the premiums due on 25/09/2013 under all the above three policies and the policies are in a lapsed condition since 25/09/2013. The alleged accident happened on 03/12/2013 and since the policies were not in force at the time of accident, the complainant is not eligible to claim the permanent disability benefit as per policy conditions.
8) As per the Policy condition 2 “if premium is not paid before the expiry of the days of grace the Policy lapses”. It is to be noted that the above stated policies were commenced only on 25/06/2012 and as on the date of alleged accident, premium for the above said policies has been paid only for 1 year 3 months. Thus the policies are in lapsed condition with no benefits payable and hence the claim of the complainant for Disability Benefits also cannot be considered. This has been communicated to the complainant on 04/11/2014 in reply to his e-mails. In addition to the above the opposite parties have sent a Reply Notice dtd. 19/01/2015 (Ext. R5) in reply to the lawyer notice dtd. 14/12/2014 (Ext. P3).
9) It is the case of the complainant that he met with an accident on 03/12/2013 and sustained serious injury. The opposite party has not admitted the allegation of accident and injury in the written objection. Except the interest statement contained in the Notices and lawyer notice and in the proof affidavit there is no document produced from the side of the complainant to prove the Accident. Moreover in order to get the accident benefit under the above policies the insured should sustain permanent disability. There are no documents produced by the complainant to prove this vital aspect. No medical Records has been produced by the complainant. Without proof of permanent disability the complaint cannot claim the accident benefits under the above Policies. Again, it is false to say that the complainant is disabled to the extent of being immobile and jobless. It is reasonably understood that the complainant is having employment and leading a normal life. The complainant has not come to the Commission with clean hands.
10) In LIC Vs Vidhya Devi (RP 1209 of 2015) the Hon’ble NCDRC has held that accidental benefit can be considered only if the policy is in force at the time of accident and not otherwise. The ruling squarely applies to this complaint. We are in the opinion that there is no deficiency in service or unfair trade practice as alleged in the complaint. The complaint is devoid of any merit either in law or facts and we are inclined to dismiss the complaint.
In the result the complaint stands dismissed.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Commission this the 30th day of July 2021.
Sd/- Sd/-
Sreeja S. C. T. Sabu
Member President
Appendix
Complainant’s Exhibits :
Ext. P1 series (3 Nos.) Policies
Ext. P2 copy of lawyer notice dtd.14/12/14
Ext. P3 Reply Letter dtd. 19/01/15.
Opposite Parties’ Exhibits :
Ext. R1 series (3 Nos.) copies of Policy Certificates
Ext. R2 copy of letter dtd. 30/09/15
Ext. R3 copy of reply sent by opposite party to the complainant dtd.09/10/15 Ext. R4 copy of lawyer notice dtd. 14/12/14
Ext. R5 Reply Notice issued by the opposite parties dtd.19/01/15
Ext. R6 series (3 Nos.) copies of Status Report of the policies held by
complainant.
Id/-
President
