State Consumer Disputes Redressal Commission
Lic Of India vs Shri. Sanjay Madhukar Kadam on 16 March, 2012
UNDER CERTIFICATE OF POSTING
BEFORE THE
HON'BLE STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MAHARASHTRA, MUMBAI
First Appeal
No. A/01/1036
(Arisen out
of Order Dated 11/06/2001 in Case No. CC/00/310 of District Kolhapur)
1. LIC Of India
Western Zonal Office, Yogakshema, Jeevan Bima Marg,
Mumbai 400 021.
Maharashtra
2. Branch Manager, LIC Of India
Branch No. 949, Kedar Complex, 204/1 E, Near Tourist
Hotel, Station Road,
Kolhapur
Maharashtra
...........Appellant(s)
Versus
1. Shri. Sanjay Madhukar Kadam
R/o. Chimgaonkar Galli, At/Post Nipani, Taluka
Chikodi, Dist. Belgaum (Karnataka)
...........Respondent(s)
BEFORE:
Hon'ble Mr. S.R. Khanzode PRESIDING MEMBER
Hon'ble Mr. Dhanraj Khamatkar Member Hon'ble Mr. Narendra Kawde MEMBER PRESENT:
Rajiv Babasaheb Chavan, Advocate for the Appellant Respondent - Mr.Sanjay Kadam present in person.
O R D E R Per Shri Narendra Kawde Honble Member (1) This appeal takes an exception to an order dated 11.06.2001 in Consumer Complaint No.310/2000 (Sanjay Madhukar Kadam v/s.Branch Manager, L.I.C. of India) passed by the District Consumer Disputes Redressal Forum, Kolhapur (the District Forum in short), thereby allowing the complaint of the Respondent/original Complainant and directed Appellant L.I.C./original Opponent to pay an amount of `5,00,000/- with interest @9% per annum. Aggrieved and dissatisfied with the impugned order the Appellant L.I.C./original Opponent preferred this appeal on the ground that the policy was issued under the Salary Saving Scheme in the name of the deceased Shri Sunil Madhukar Kadam commenced from 28.05.1993. The proposal for issue of policy was dated 16.04.1993, life assured met with an accident on 25.05.1993 and the policy was commenced on 28.05.1993. Though the life assured met with an accident during the scrutiny of the proposal and prior to issue of the policy, the Appellant L.I.C. was never informed of this event. Further, the policy was in lapsed condition for non-payment of premiums, The obligation to deduct premium from the salary by the employer and to pay the premiums to the Appellant L.I.C. was not discharged by the deceased life assured. The impugned order of the District Forum was passed without appreciation of facts on record, therefore, the claim was repudiated on the valid grounds.(2)
Heard Ld.Advocate for the Appellant L.I.C. and Shri Sanjay Kadam, the Respondent in person. Perused the record.
(3)Impugned order came to be passed stating that the life assured Shri Sunil Madhukar Kadam met with an accident on 25.05.1993 and as a result of the accident he was under
intensive treatment for almost for two years i.e. till his death on 29.05.1995. Since he was in coma/unconscious condition, life assured naturally could not verify payment of premiums to the Appellant L.I.C. through employer. Employer of the deceased life assured was under obligation to deduct the premiums for the policy and forward to Appellant L.I.C. for adjustment.(4)
Admittedly the life assured met with an accident on 25.05.1993 and was in unconscious state while undergoing intensive treatment till his unfortunate death that occurred on 29.05.1995. The premiums under the policy after the date of accident remained unpaid. Therefore, the policy occurred the status as lapsed. Amount equal to sum assured of `25,000/- as stated across the bar was paid by Appellant L.I.C. to the Respondent/original Complainant.
(5)On perusal of the terms and conditions covering accidental benefit Clause 10.2
(a)(b) of the policy stipulates that accidental benefit not exceeding `5,00,000/- in aggregate for single life assured and additional sum equal to sum assured will be payable. The District Forum failed to appreciate the terms and conditions of the policy clause in proper perspective in so far as payment of premiums from the salary of the deceased life assured and the accident benefit required to be paid under the policy when the death of the life assured occurred consequent to the accident. There is nothing on record whether amount of `25,000/- i.e. equal to sum assured under the policy was received by the Respondent/original Complainant under protest or otherwise. In case there is no protest to receive the amount then in such a case enhancement as admissible under the policy terms and conditions referred to the policy clause may be payable under the policy provided policy was in force at the time of death of life assured. There is nothing on record to reveal that the efforts of Appellant L.I.C. intimated to employer and to the deceased life assured for non-receipt of premiums as required under the provisions of Salary Saving Scheme Manual. All these issues are required to be enquired de novo including the role of the employer of the deceased life assured, especially for deduction of premiums from the salary and remittance to the Appellant L.I.C. as the employer is not made party. Therefore, we are inclined to allow the appeal by setting aside the impugned order and remanding this case for de novo enquiry in the light of the observations made in the body of the order. We hold accordingly and pass the following order:
O R D E R
(i) Appeal is allowed.
(ii) Impugned order dated 11.06.2001 passed by the District Forum in Consumer Complaint No.310/2000 is quashed and set aside.
(iii) The Complaint is remitted back to the District Forum, Kolhapur for de novo enquiry in the light of the observations made in the body of the order.
(iv) Both the parties shall appear before the District Forum, Kolhapur on 10th May, 2012.
(v) The Forum shall expedite the hearing of the complaint.
(vi) In the give circumstances, parties to bear their own costs.
Pronounced on 16th March, 2012.
[Hon'ble Mr. S.R. Khanzode] PRESIDING MEMBER [Hon'ble Mr. Dhanraj Khamatkar] Member [Hon'ble Mr. Narendra Kawde] MEMBER ep