JUDGMENT

            The complainant has filed this complaint u/sec. 12 of the Consumer Protection Act – 1986 against the OP alleging deficiency in service in not settling the policy claim amount of Rs.2,00,000/-.  Hence prays for the settling of the insurance amount of Rs.2,00,000/- along with compensation of Rs.2,00,000/- for mental agony and for suffering given by the opponent activities.

             Brief averments of the Complaint are as under;

            2.  That, the complainant’s husband Ashok.M.K. had made a policy during his life time in the branch of OP company.  The policy covers under Jeevan Anand policy, its number is 661710789.  The total sum assured of the policy amount is Rs.2,00,000/-.  The commencement of the policy was started on 17-09-2012.  The complainant alleged that the deceased husband of the complainant had paid the premium regularly till his death.

            The complainant further alleged that the complainant died on 31-12-2013 leaving the complainant as his legal heir.  The intimation of the death was given to the opponent on 20-01-2014 and also sought the claim amount of the policy.  The complainant alleged that after the intimation of the claim amount to the OP; the OP did not paid the policy  amount but in turn issued a letter dated: 21-01-2014 and directed the complainant to visit his office and also intimated that the only Rs.1,330/- is paid as the premium amount instead of Rs.1,530/-.  As per the direction of OP the complainant approached and sought claim amount, but the OP did not paid the claim amount to her.  The complainant again on 22-05-2014 filed one more application for her claim amount, but the opponent did not pay the claim amount nor replied her application.

            The complainant further alleged that as per the policy condition, the OP has to pay a sum of assured amount Rs.2,00,000/- and its benefits of the policy.  Instead of paying the claim amount, the OP is prolonging the matter by assigning one or other false reasons.  Hence filed this complaint praying for settling the policy claim amount of Rs.2,00,000/- along with compensation of Rs.2,00,000/- for mental agony and for the suffering given by the opponent activities and cost of the proceedings as prayed above.

            3.  This Forum after admitting the complaint, notice was issued to the opponent and the notice was served upon him.  The opponent appeared before the Forum along with their counsel and filed vakalat and written version to the main petition.

            4.  The objection of Opponent;

            That the OP denied the fact of the compliant in toto. 

            The OP further submitted that in reply to para – 1 of the complaint, it needs no reply as it pertains to the address of the complainant and their counsel.  Hence need no reply.

            The OP further submitted that, it is true that the assured had taken the following policy;

            The first unpaid premium 11/2012 and the said policy is assigned to Vijaya Bank at Gangavathi bank on 17-09-2012.

            The OP further submits that the Para No.3, 4 and 5 of the complaint are false and baseless.  As per copy of death certificate received, the deceased life assured died on 31-12-2013.  In the schedule of the policy bond installment premium payable is clearly mentioned as Rs.1,530/-.  The attested copy of the policy bond is enclosed along with this written statement.  The OP submits that according to the policy condition the life assured has to pay the monthly premium at Rs.1,530/- regularly from w.e.f. 11/2012.  The LIC office has sent authorization letter addressed to the Head Master, Govt.High School, Chellur to recover monthly premium of Rs.1,530/- from November – 2012 to August – 2028.  The attested copy of the authorization letter to Head Master, Chellur is enclosed along with this written statement.

            The OP further submits the life assured himself was the salary drawing officer and has remitted the monthly premium only to the extent of Rs.1,330/- instead of Rs.1,530/- from 12/2012 to 11/2013 per month and there is one initial gap of 11/2012.

            The OP further submits that the information regarding the remittance of short premium was communicated to the life assured through the letter ref. SSS/GSD/63K dated: 05-9-2013 of Gangavathi Branch, stating that we are in receipt of short remittance of monthly premium of Rs.200/- per month and the entire premiums received from 12/2012 to 11/2013 were kept in deposit.  The OP submits that even after due intimation to the life assured neither he paid the correct premium not shortage of premium in respect to the above policy.

            The OP further submits that the life assured immediately after taking the above policy has assigned the said policy to Vijaya Bank at Gangavathi for valuable consideration and he himself being the salary drawing officer, the life assured is very much aware that the installment premium under the policy is Rs.1,530/- and not Rs.1,330/- has mislead the assignee.

            The OP further submits that Smt. Geeta W/o: Late Ashok.M.K. is not the title holder and has no right on this policy as the policy was assigned to Vijaya Bank at Gangavathi against valuable consideration from the said bank by the deceased life assured.  The same is registered in the books of the opponent, i.e., LIC Gangavathi through vide registered No. 4906 dated: 04-10-2012.

            The OP further submits that as per Sec. 38 of Insurance
Act – 1938, after assignment, the assignee has the right to receive the policy moneys payable under the policy as per the virtue of assignment all right, title and interest will be transferred to the assignee.  Therefore, the LIC has not committed any mistake in dealing this claim.

            The OP further submits that the para No. 6,7,8 and 10 are false and baseless.  The contents of para No.9 are false and complainant has no right to claim the policy money under this policy as it is a lapsed and also assigned to Vijaya Bank at Gangavathi.  Hence nothing is payable under the policy.

            The OP further submits that as per condition and privileges under clause – 5 mentioned in the policy bond, forfeiture in certain events which read as

“In case the premiums shall not be duly paid or in case any condition herein contained or endorsed Hereon shall be contravened or in case it is found that any untrue or incorrect statements is contained in the proposal, personal statement, declaration and connected documents or any material information is withheld, then and in every such case but subject to the provisions of Section 45 of the Insurance Act 1938, wherever applicable, this policy shall be void and all claims to any benefit, in virtue hereof shall cease and determine and all moneys, that have paid in consequences hereof shall belong to the corporation, expecting always in so far as relief is provided in terms of the privileges herein contained or may be lawfully granted by the Corporation.”

            The OP further submits that the OP corporation holds the public moneys trustee and the payment of such defective claims will adversely after interest of prudent policy holder.  Hence it has rightly hold the claim, hence prays for the dismissal of the complaint with compensatory costs.

            5.  On the basis of the above pleadings, the following points have been framed.

POINTS

1.  Whether the complainant proves that there is a deficiency in service in not settling the life insurance claim for the death of her husband?
2. Whether the OP proves that the deceased life assured has paid less premium and the said policy is assigned to Vijaya Bank, Gangavathi?

3. Whether the complainant is entitled for the relief sought for?

4. What order?

6. To prove the case of the complainant, the complainant herself examined as PW1 and she got marked documents as per Ex.A.1 to Ex.A.10 and closed their side evidence.  The OP himself examined as RW1 and got marked the documents as per Ex.B.1 to Ex.B.4 and closed their side evidence.

7.  Heard the arguments of both counsel and perused the records.

8.  Our findings on the above points are as under;

Point No. 1 :   Negative

Point No. 2 :  Affirmative

                  Point No. 3 :  Negative

      Point No. 4 : As per final Order for the following

REASONS

9.  POINT No. 1 and 2:  As these two issues are interconnected each other.  Hence they are taken together for common discussion to avoid repetition of facts, evidence documents and arguments.

10.  On perusal of the pleadings, evidence coupled with the documents of respective parties on record, it is the case of the complainant alleging deficiency in service in not settling the claim of the policy amount of Rs.2,00,000/-.  There is no dispute regarding that the complainant’s husband Sri. Ashok.M.K. had obtained a policy plan by name Jeevan Anand with a policy No. 661710789 which commences from 17-09-2012 with a premium amount of Rs.1,530/- per month and the sum assured is Rs.2,00,000/-.  There is a dispute that the premium amount is not paid and less premium amount is paid every month to the tone of Rs.1,350/- instead of Rs.1,530/-.  Being a beneficiary in the policy, the complainant approached and claimed for assured amount along with benefits and submitted the claim form and necessary documents.  But the OP has not settled the claim.  Hence the complainant alleges deficiency in service.

11.  To prove the case f the complainant, the PW1 has reiterated the complainant averments in her examination in chief and in support of her case, she has produced the documents pertains to the letter issued by LIC on 21-01-2014, which is marked as Ex.A.1, the intimation of Death of the deceased LA is marked as Ex.A.2.  Ex.A.1 reveals that the LIC has issued a letter on 21-01-2014 stating that due to less premium amount paid the concerned policy is lapsed.  The death certificate is marked as Ex.A.4.  Ex.A5 is the legal notice issued to the OP and Ex.A.6 to Ex.A.10 is the acknowledgment and the receipts showing the notice is served on the OP.  PW1 has averred and deposed that the husband of the complainant during his life time had made a policy with the OP.  Ex.A.3 clearly reveals that the name of the policy holder is the husband of the complainant and the premium of Rs.1,530/- in the policy.

12.  On the contrary, OP had taken a contention that the less policy premium amount was paid by the deceased LR instead of paying Rs.1,530/- per month, the DLR was paying Rs.1,350/-.  OP has deposed as per there specific defence set up in their written version that accordingly the monthly premium amount of Rs.1,530/- was to be deducted from salary.  Ex.B.2 clearly reveals that a letter of authorization has been sent to the Head Master of Govt. High School, Chellur for salary deduction of the premium amount.  It is clear that the life assured being himself the salary drawing officer and he having full knowledge about the policy details and the monthly premium as Rs.1,530/- ordered only Rs.1,350/- was to be deducted from the salary of DLR.  This intimation regarding the payment of the less premium amount is intimated to the complainant’s husband during his life time.  To substantiate the same, the said letter has been given on that particular date the OP has produced the letter which is marked as Ex.B.4.  Ex.B.4 clearly reveals that the deceased life assured was informed about the less payment of his monthly premium.  But to disprove the said entries in Ex.B.2, the complainant has not produced any other cogent and corroborative evidence except putting suggestion to that the premium is paid regularly.  Such being the fact, these factors are taken in to consideration definitely it goes to show that the monthly premium is not paid correctly and less amount of premium is paid by the DLR during his life time.  The OP has further averred that the complainant after taking the above policy has assigned the said policy to Vijaya Bank at Gangavathi for valuable consideration.  To substantiate the same, the OP has produced the form of Assignment of policy and the notice of assignment to the corporation, which is marked as Ex.B.3.  This form is duly signed by the complainant’s husband during his life time.  The complainant has not spoken a word about this and is silence on the said act.  From this it is clearly shows that the complainant had the knowledge of assigning it to the Vijaya Bank Gangavathi for valuable consideration.  It is crystal clear that, if at all the claim amount is to be given, then the claim amount should be given to the assignee, i.e., Vijaya Bank where the policy is hypothecated by the complainant’s husband during his life time.

13.  It is admitted that Jeevan Anand (with profits) policy was issued by OP in favour of the complainant’s husband.  As per terms and conditions of this policy, grace period of one month was allowed for payment of defaulted premium and if premium is not paid before expiry of the dates of grace, policy lapses.  It is crystal clear that even after issuing a letter by the OP to the complainant husband regarding the less payment of the premium as per Ex.B.4, the deceased life assured did not made any payments to this effect and the policy stood lapsed before his death on 31-12-2013.  The citation reported in IV (2015) CPJ 386 (NC) – Life Insurance Corporation of India & Anr., V/s Manikappa.N.Bhandari, wherein it is held thus;  

“Consumer Protection Act, 1986 – Sections 2(1)(g), 21(b) – Insurance – Death claim – Lapse of policy – Claim repudiated – Alleged deficiency in service – District Forum allowed complaint – State Commission dismissed appeal – Hence revision – Grace period of one month was allowed for payment of defaulted premium – Policy stood lapsed before death – Claim concessions not applicable to policy – Complainant not entitled to get maturity amount – Repudiation justified.”

            14.  As per the norms of the policy and payment of basic sum assured was payable only when policy was in full force on the date of death.  It is clearly mentioned in the policy that if the premium is not paid before the expiry of the days of grace, the policy lapses.  Such being the fact, these factors are taken into consideration definitely it goes to the very root of the complainant case.

            15.  On the contrary as per the oral evidence coupled with the documentary evidence, the complainant fails to prove that by way of filing the present complaint, the respondent have not settled the policy claim amount and have committed deficiency in service on the part of OPs as the complainant alleged in this complaint.  The said allegation has not been proved by them by adducing cogent and corroborative evidence.  Hence in the light of above observations the complainant is not entitled for any relief as prayed for.  Accordingly we constrained to hold issue No.1 in Negative and issue No. 2 in Affirmative.

16.  POINT No. 3 :- In the light of observations made by us on point No.1, 2 and 3, since the complainant has filed this complaint for the relief of not settling the claim amount of the policy with respect to the insurance policy claiming this policy amount of Rs.2,00,000/-.  In the light of observation made by us while answering point No.1in Negative and point No. 2 in Affirmative and the present complainant is not entitled for any relief as prayed for.  Accordingly we constrained to hold point No.3 in Negative.

17.  POINT No. 3 :-  Hence, in the result we proceed to pass the following;

ORDER

1. The complaint filed by the complainant is hereby dismissed.

2. Send the free copies of this order to both parties.

Dictated to the Stenographer, transcribed, typed by her, typescript, corrected by me and then pronounced in the Open Forum on 29^th day of March 2016.

// ANNEXURE //

List of Documents Exhibited for the Complainant.

Witnesses examined for the Complainant / Respondent.