State Consumer Disputes Redressal Commission
Yasin Meman vs B.M. Life Insurance Corporation Of ... on 3 September, 2011
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
(A/11/2557)
Appeal No. 276/2011
Instituted on 05.05.11
Yasin Meman, S/o Shri Hazi Abdul Ajij Meman,
R/o: M.P. Battery, Ambikapur Road, Manendragarh,
Tah. Manendragarh,
Dist. KOREA (C.G.) ... Appellant.
Vs.
Branch Manager, Life Insurance Corporation of India,
Branch Office, Chirmiri,
Dist. KOREA (C.G.) ... Respondent.
PRESENT: -
HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT
HON'BLE SHRI V.K.PATIL, MEMBER
COUNSEL FOR THE PARTIES: -
Shri Anupam Dubey, for appellant.
Shri Mukesh Sharma, for respondent.
ORAL ORDER Dated: 03/09/2011 PER: - HON'BLE JUSTICE SHRI S. C. VYAS, PRESIDENT This appeal is directed against order dated 05.04.2011, passed by District Consumer Disputes Redressal Forum, Korea-Baikunthpur (hereinafter called "District Forum" for short) in complaint case No.87/09, whereby the complaint, filed by the appellant herein, seeking accidental benefit under the insurance policy valuing Rs.1,00,000/- from the respondent Life Insurance Corporation, has been dismissed on the ground that accidental benefit was not payable, as per terms of the policy.
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2. In nutshell the case of the complainant before District Forum was that Mr. Yaya Meman was insured by the Life Insurance Corporation of India when he was 15 years of age, on 28.02.2003 by issuing Jeevan Surabhi Money Back Policy with Profits (With Accident Benefit). The said insured Yaya Meman unfortunately died on 27.10.07 in an accident. When claim was preferred before the Life Insurance Corporation, the Corporation has paid the sum assured only and has declined to pay the accidental benefit, therefore complaint was filed before the District Forum. In reply of which it was averred by the LIC that as per terms of the policy, accident benefit were not payable to the insured, being a minor and when he attained the age of majority, a letter was issued that if he was interested in getting accident benefit, then additional premium of Rs.1/- per thousand of sum assured be paid by him, but thereafter nothing was done by the insured in this regard and ultimately he died. So, under the terms of the policy accidental benefit was not payable.
3. District Forum agreed with the contention raised by the LIC and dismissed the complaint.
4. We have heard arguments of both parties and perused the record of the District Forum.
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5. Copy of the insurance policy is available on record, which shows that though in the heading it has been mentioned that it was „Jeevan Surabhi / Money Back Policy With Profits (With Accident Benefit)‟, which may give an impression that accident benefit was also payable under the insurance cover, but under the head „conditions and privileges not applicable‟, it has been noted that condition Nos.10.1, 10.2, 10.3, 10.4, 10.5, 10.6 & 11 are not applicable in the insurance policy. The terms and conditions attached with the insurance policy says that so far as accidental benefit is concerned, the condition No.10.2 is there, which is as under : -
"10.2 Accident Benefit : if at any time when this Policy is in force for the full sum assured, before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the Life Assured is 70, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined 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 (i) to pay in monthly installments spread over 10 years an additional sum equal to the Sum Assured under this Policy, If the policy becomes a claim before the expiry of the said period of 10 years, the disability benefit installments which have not fallen due will be paid along with the claim, (ii) to waive the payment of future premiums.
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(b) Death of the Life Assured: To pay an additional sum equal to the Sum Assured under this policy,-------." These terms will be applicable under the head accidental benefit in case this condition No.10.2 was made applicable in a particular insurance policy, but in the present policy this condition has been // 4 // excluded and it has been specifically stated in the policy document that this conditions and privileges will not be applicable. Therefore, though in the heading of the policy it has been mentioned that it was a policy with accidental benefit, but in the terms and conditions of the policy it has been clarified that the accidental benefit will not be payable. Under this condition, unless after attaining the age of majority the insured had chosen to pay additional premium to opt accidental benefit, it cannot be said that any accidental benefit was payable by the LIC to the insured.
6. In view of this, we find that the District Forum has not committed any error in dismissing the complaint of the appellant. The appeal has got no substance and is dismissed. However, it has been brought to our knowledge that the District Forum, while dismissing the complaint has directed the complainant to pay Rs.2,000/- to the Life Insurance Corporation as cost of litigation. We find that such direction was unnecessary in the peculiar fact of the case, where the heading of the policy document was misleading, and therefore we set aside such direction also. No cost.
(Justice S.C. Vyas) (V.K. Patil)
President Member
/09/2011 /09/2011