SRI. SAJEESH.K.P : MEMBER
The complainant has filed this complaint under Sec.35 of the Consumer Protection Act 2019, seeking direction against the OP to pay an amount of Rs.2,50,000/- to the complainant with 12% interest thereon from 27/3/2021 till realization and to pay cost and other further relief.
Complaint in brief :-
According to the complaint, complainant’s son who is the insured policy holder of OP met with an accident on 27/3/2021 at Kudiyanmala, Taliparamba and died due to drowning. On medical examination it was found that son of complainant was covid positive. The complainant’s son came from Bangalore due to the pandemic and he was effected with cold and was using ayurvedic medicine to cure the cold. The death was caused while he was taking bath and fell unconscious in the stream and died. Postmortem was done and FIR was registered for unnatural death. The funeral was conducted as per the covid protocol. The health department granted monetary relief to complainant. Further that complainant approach OP to get the insurance coverage and the OP demanded succession certificate and the same was obtained by complainant from Munsiff court Taliparamba. The amount of Rs.2,00,000/- paid by OP without providing accident benefit. At the time of death, complainant’s son has a live insurance policy including accidental benefit which was denied by OP without any reason and hence this complaint.
After filing the complaint, commission has sent notice to both parties. OP entered appearance before the commission and filed their version accordingly .
Version of OP in brief:
All averments denied by OP except those specifically admitted . The OP contended that complaint is bad for non-joinder of necessary parties as the manager L&HPF Dept. is not arrayed as parties. The OP admitted that deceased son of complainant is a policy holder and the policy was alive. The policy was taken by complainant when his son is minor. The sum assured was 2 lakhs and the half yearly premium was collected till death was Rs.4700/- only. As per the policy condition the survival benefit was given to the life assured @Rs.30,000/- each on 28/7/2011,28/7/2015 and 28/7/2019. Further more, OP alleged that deceased son of complainant went for a bath in the stream with his friends after consuming alcohol and postmortem report states that the stomach is full with watery fluid and smell of alcohol. Moreover ,OP denied that the policy has accident benefit because as per Sec.39 of Insurance Act 1938 a minor policy holder cannot opt accident benefit. Subsequently, the son of the complainant after attaining majority, the nomination was registered in the name of mother of policy holder. When the life assured attained majority accident benefit was not opted neither premium was paid to avail the benefit. Even if, there is accident benefit, the benefit will not be payable under the policy condition 11(b)(c), since postmortem reports the smell of alcohol in the stomach. The claim of Rs.2,00,000/- was given to complainant on the production of succession certificate as the nominee died prior to the death of policy holder. Hence there is no merit in the case and is liable to be dismissed.
Due to the rival contentions raised by the OP to the litigation, the commission decided to cast the issues accordingly.
- Whether there is any deficiency in service from the side of OP?
- Whether there is any compensation & cost to the complainant?
In order to answer the issues, the commission called evidence from both parties. The complainant produced documents which is marked as Exts.A1 to A5. Ext.A1 is the copy of insurance policy issued by OP, Ext.A2 is the succession certificate, Ext.A3 is the postmortem certificate, Ext.A4 is the letter issued by OP and Ext.A5 is the copy of transaction statement. The complainant adduced evidence through proof affidavit and examined as PW1. The OP produced document which is marked as Ext.B1 . Ext.B1 is the original policy certificate with conditions. OP filed proof affidavit and examined as DW1. Complainant is not cross examined by OP. OP filed argument note.
In order to answer the issues raised, the commission looked in to the available evidences produced by both parties to the complaint. Ext.A1 and Ext.B1 is one and the same , as there is no dispute with regard to the policy taken or sum assured no detail discussion is necessary. The dispute is with regard to the accident benefit claim. On the perusal of Ext.A1(Ext.B1) it is seen that, complainant’s son Mr.Sabin Joseph is of 14 years and the premium towards accident claim is show s 0(zero). During the cross-examination of complainant, he admits that the premium amount of Rs.4700/- paid twice in a year and it was a money back policy and he availed the benefit ie, complainant gets 15% of the policy amount was received by complainant every four years until the death of his son who died in the year 2021. The complainant received an amount of Rs.90,000/- in total as the benefit of money back policy from the year 2011 to 2019 was clearly admitted during the cross examination. But ,when a specific question put forward with regard to the averment of the accident benefit claim,the complainant answered that he took the benefit and he was not aware of premium he paid and also answered that he paid the amount as per his agent’s instructions. After attaining the majority of complainant’s son, complainant contended that he paid the premium amount of Rs.1520/- which includes the premium to avail the accident benefit claim. But, no evidence brought by complainant before the commission to prove that complainant availed accident benefit by paying the premium amount of Rs.1520/-. Moreover, the commission looked into Ext.A4 dtd.31/12/2021 issued by OP and it apparently stated that the claim of accident benefit cannot be granted as the premium amount was not paid towards accident benefit claim. In Ext.A1(Ext.B1) the clause II states the conditions to avail accident benefit. There is no evidence before the commission to establish that complainant paid premium amount to avail the benefit of accident claim. Furthermore, complainant admitted that he got the sum assured of Rs.2,00,000/- and benefit of money back policy etc. The OP has produced a ruling of the National Consumer Disputes Redressal Commission , New Delhi in Rajendra Kumar Rastogi vs. LIC Raipur, held that Insurance company is not liable to pay accidental benefit if the policy holder not opted when he attained majority as the accidental benefit could not be extended to a minor. In short , in the present case, there is no direct evidence before the commission that complainant or complainant’s son opted for accidental benefit claim after attaining the majority of complainant’s deceased son. Hence the complaint is liable to be dismissed as complainant failed to prove the deficiency in service from the part of OP. Hence issue No.1 is answered in favour of OP.
The issue No.2 regarding compensation and cost, complainant failed to prove the deficiency in service from the part of OP and hence complainant is not entitled to get compensation and cost.
In the result complaint is dismissed with no cost.
Exts:
A1-Copy of insurance policy
A2- succession certificate
A3- letter issued by OP
A4- postmortem certificate
A5- copy of transaction statement
B1- Original policy certificate with condition
PW1-Joseph.K.J-complainant.
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
eva /Forwarded by Order/
ASSISTANT REGISTRAR
