State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India & ... vs Sh. Puran Chand on 20 May, 2010
H
H.P.STATE CONSUMER DISPUTES REDRESSAL
COMMISSION,
SHIMLA-9.
F.A. No. 149 of
2009
Decided on 20.5.2010.
1. Life Insurance Corporation of India
through its
Divisional Manager
Divisional
Office Shimla, H.P.
2.
Life Insurance Corporation
of India
through Manager, LIC Branch,
Tehsil
Office Palampur, District Kangra.
H.P.
....Appellants.
Versus
Sh.
Puran Chand S/o Bhikam chand
R/o
Village Chaluhi, Post Office Rajkot,
Tehsil Baijnath, District Kangra, H.P.
..Respondent.
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Honble Mr. Justice Arun Kumar Goel (Retd.), President.
Honble Mrs. Saroj
Sharma, Member.
Honble Mr. Chander
Shekher Sharma, Member.
Whether
approved for reporting ?
For the Appellant. Mr.
Narinder Sharma, Advocate.
For
the Respondent. Mr. Manohar Lal Sharma, Advocate
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ORDER
Per Mr. Chander Shekher Sharma, Member.
1. This appeal is directed against the order of District Forum, Kangra at Dharamshala, in Consumer Complaint No. 56/2008, decided on 24.2.2009, whereby the complaint of the respondent was allowed and appellants were held jointly and severally to pay the double accident benefit to the respondent minus the basic sum assured which had already been paid, within 30 days after the receipt of copy of this order, failing which it will carry interest @ 9% per annum from the date of complaint till its realization. In addition to this appellants were directed to pay compensation to the respondent quantified at Rs. 5,000/- and litigation cost, assessed at Rs. 2000/-.
2. Facts of the case as they emerge from the record are, that the respondent who is the son of the deceased Sh. Surjeet Katoch who died in accident on 27.4.2007, and respondent being nominee of the Jeevan Suraksha Life Insurance Policy bearing No. 152093451 in the sum of Rs. 50,000/- with double accident benefit filed the complaint against the appellants, as his claim was repudiated by the appellants on the ground that he is not entitled for double accident claim benefit against the captioned Policy in view of clause 85 of the Policy. Reason being the death of the life assured had occurred when he was engaged in hazardous occupation. As such there was no deficiency of service on the part of the appellants.
3. In this background, complaint U/s 12 of the Consumer Protection Act, 1986 was filed against the appellants wherein the respondent claimed double accident benefit alongwith interest @ 12 % per annum till the realization of the benefits and cost in the sum of Rs. 5,000/-, and Rs. 5,000/- was also claimed for mental harassment and torture. Appellants contested the claim of the respondent on the ground that it was rightly repudiated by them.
4. Their plea was that there is no deficiency of service on their part since the respondent was not entitled to double accident benefit against the captioned policy in view of clause 85 of the policy, because the death of the life assured had occurred when he was engaged in hazardous occupation.
5. Appellants filed reply which is supported by affidavit of Sh. Vishwanath, its Manager. Respondent in support of his case has filed his own affidavit, and document Annexure C-1, detail of bills/deductions.
6. Learned counsel for the appellants also argued that in the proposal form, the life assured had given his occupation as business.
7. We have heard learned counsel for the appellants and have also gone through the record of the case minutely. Sh. Narinder Sharma, learned counsel for the appellants argued that there is no deficiency of service on the part of his clients, as such the respondent is not entitled for double accident benefit claim against the captioned Policy as per clause 85 of the Policy. Reason being that the death of the life assured had occurred when he was engaged in hazardous occupation. There is no force in this contention urged on behalf of the appellants that in the proposal form the deceased had mentioned his present occupation being business. A person at a particular point of time may be in business and then can become a driver. There is no legal bar for the change of business or profession.
8. Sh.
M.L.Sharma, learned counsel for the respondent argued that the exclusion clause was not explained to the deceased Surjeet Katoch, who was policy holder in the present case. As such there is non-compliance of Regulation 3 of the Insurance Regulatory and Development Authority (Protection of Policy Holders Interests) Regulations, 2002 and he has supported the order of the lower Fora also. Claus 3 of these Regulations reads as under :-
Relevant portion of Regulation 3 thereof is reproduced as under :
3.Point of Sale-(1) Notwithstanding anything mentioned in Regulation 2(e) above, a prospectus of any insurance product shall clearly state the scope of benefits, the extent of insurance cover and in an explicit manner explain the warranties, exceptions and conditions of the insurance cover and, in case of life insurance, whether the product is participating (with profits) or non participating (without profits).(2)
An insurer or its agent or other intermediary shall provide all material information in respect of a proposed cover to the prospect to enable the prospect to decide on the best cover that would be in his or her interest.
9. After hearing the learned counsel for the parties we are of the view that finding of District Forum below does not call for interference in this appeal. Reason being that there is no evidence was led by the appellants to the effect that the deceased-life assured was engaged in hazardous occupation and as such as per clause 85 of the policy, the nominee-respondent is not entitled for the claim.
10. In this case no evidence had been led by the appellants to prove that the exclusion clause in the policy viz. clause 85 of the policy was explained to the insurer at the time of giving policy by the Insurance Agent/Development Officer.
11. These regulations have been framed by the Insurance Regulatory and Development Authority (IRDA) in exercise of the powers U/s 114A of the Insurance Act, 1938 read with Sections 14 and 26 of the Insurance Regulatory and Development Authority Act, 1999. As such this appeal must fail. For the view that have taken is supported by decisions of National Commission in the case of National Insurance Company Ltd. V/s D.P.Jain, III (2007) CPJ 34 (NC), and United India Insurance Co. Ltd., & Anr. V/s S.M.S. Tele Communication & Anr, III (2009) CPJ 246 (SC).
12. However even clause 85 of the Insurance Policy upon which reliance had been placed by the appellant had not been placed on the record which was essential in the present case.
13. No other point was urged.
14. In view of the aforesaid discussion and keeping in view the legal position explained above, we are of the considered view that there is no ground to interfere the well reasoned order passed by District Forum, Kangra at Dharamshala in Consumer Complaint No. 56/2008, decided on 24.2.2009 and the same is upheld. We do not find any merit in this appeal, as such the same is dismissed leaving the parties to bear their own cost.
15. All interim orders passed from time to time shall stand vacated forthwith.
16. Learned counsel for the parties have undertaken to collect copy of this order free of cost from the Court Secretary as per Rules.
(Justice Arun Kumar Goel) (Retd).
President (Saroj Sharma) Member (Chander Shekher Sharma) Member Suneera 20.5.2010.