State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Satinderjit Kaur on 23 April, 2015
SECOND ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No. 1027 of 2013
Date of Institution : 25.09.2013.
Date of Decision : 23.04.2015
1. Life Insurance Coporation of India, having its Divisional Office,
Jeevan Parkash, Urban Estate, Phase-I, Dugri, Ludhiana,
through its Divisional Manager.
2. Life Insurance Coporation of India, through authorized officer
Manager (L&HPF), Divisional Office Sector 17, Chandigarh.
..... Appellants/ opposite parties
Versus
Satinderjit Kaur widow of Sh. Jaspal Singh R/o H.No. 116, Avtar
Nagar, P.O. Threekay, Tehsil & District Ludhiana.
..... Respondent/complainant
Appeal against order dated 29-07-2013 passed
by District Consumer Disputes Redressal
Forum, Ludhiana.
Quorum:-
Shri Jasbir Singh Gill, Presiding Member.
Mrs. Surinder Pal Kaur, Member.
Present:-
For the appellant s : Sh. B.J. Singh, Advocate
For the respondent : Ex-parte
.............................................................................................
Jasbir Singh Gill, Presiding Member.
ORDER
This appeal has been filed by the appellants/opposite parties (hereinafter referred as OPs) against order dated 29.07.2013 First Appeal No. 1027 of 2013 2 passed in CC No.829 of 2012 by District Consumer Disputes Redressal Forum, Ludhiana (in short, "the District Forum"), vide which the District Forum partly accepted the complaint of the respondent/complainant (hereinafter referred as complainant) directing the OP to settle and pay the claim of the complainant as per the terms and conditions of the policy and also pay Rs.8,000/- as compensation alongwith Rs.2000/- as costs of litigation.
2. The brief facts of the case are that husband of the complainant Late Jaspal Singh (hereinafter referred as life assured) purchased a life insurance policy bearing policy No.301779735 from the OP for a sum assured of Rs.2,00,000/- and she was the nominee in the insurance policy. The policy in question commended from 28.07.2010. That the husband of the complainant paid the premium of Rs.11,107/- to the OP. The husband of the complainant committed suicide and died on 02.09.2011. After the death of her husband complainant lodged the claim with the OP supported by all the necessary documents i.e. police report, post mortem report and death report prepared by the police station Sadar, Ludhiana. Complainant received a letter dated 22.03.2012 from the OP, vide which they demanded copy of DDR, FIR and PMR which were already supplied by her to the OP along with the claim form. She again submitted the documents to the OP i.e. DDR, FIR and PMR. Complainant again received a letter dated 26.03.2012 issued by the OP, wherein they had stated that the claim under the policy was not payable "as the First Appeal No. 1027 of 2013 3 deceased husband of the complainant had committed suicide within one year from the date of policy, the policy had become null and void in terms of the policy contract and therefore nothing was payable thereunder. Complainant further pleaded that her husband had committed suicide on 02.09.2011 after the period of one year from the commencement of the policy i.e. 28.07.2010. Complainant also got served a legal notice dated 24.08.2012 upon the OP calling upon them to consider her claim. But they failed to settle the claim, OP issued letter dated 01.09.2012 to the complainant stating that the date of commencement of risk under the policy in question was 06.09.2010 and not 28.07.2010. Which was totally a false and baseless reasoning given by the OP. Hence, the complainant filed the complaint directing the OP to pay Rs.2,00,000/- alongwith interest 12% p.a. from the date of rejection till the actual payment and Rs.50,000/- as compensation for mental tension and harassment and costs of litigation.
3. Upon notice, OP appeared and filed written reply taking preliminary objections that present complaint is barred as under
Section 26 of the CPA. The present complaint is not maintainable, since immediately on the receipt of the claim it was duly registered entertained and processed. Complainant is not coming to the forum with clean hand and had concealed the material facts from the District Forum and that the complicated questions of law and facts were involved, which requires elaborate evidence, both oral and First Appeal No. 1027 of 2013 4 documentary and only Civil Court is competent to try and decide the complaint. On merits, OP pleaded that as per terms and conditions of the policy suicide clause was applicable for one year from the date of commencement of risks i.e. date of First Premium Receipt (FPR). Date of FPR in this case was 06.09.2010 and the death of life assured was 02.09.2011 and as such the life assured committed suicide within one year from the date of FPR. The commencement of policy date was 28.07.2010 prior to the date of risk covered due to back dating facilities availed by life assured at the time of proposal. The OP rightly repudiated the claim of the complainant as per terms and conditions of the policy and there was no deficiency in service on the part of the OP and prayed for dismissal of the complainant with costs.
4. In order to prove his case, complainant tendered in evidence her affidavit Ex.CW-1/A, copy of first premium receipt 06.09.2010 Ex.C-1, copy of renewal premium receipt dated 06.07.2011 Ex.C-2, copy of DDR/FIR dated 03.09.2011 Ex.C-3, copy of death report Ex.C-4, copy of missing report of the policies Ex.C-5, copy of death certificate of Jaspal Singh Ex.C-6, copy of letter dated 22.03.2012 Ex.C-7, copy of letter dated 26.03.2012 Ex.C-8, copy of legal notice dated 24.08.2012 Ex.C-9, copy of receipt Ex.C-10 and copy of repudiation letter dated 01.09.2012 Ex.C-11 and closed the evidence. On the other hand to rebut the claim of the complainant, OP tendered in evidence affidavit of S.P. Singh, Manager (Legal) First Appeal No. 1027 of 2013 5 Ex.R-A alongwith copy of documents i.e. letter dated 26.03.2012 Ex. R-1, legal notice Ex.R-2, letter dated 01.09.2012 Ex.R-3, letter dated 23.02.2012 Ex.R-4, letter dated 05.03.2012 Ex.R-5, letter dated 22.03.2012 Ex.R-6, report of death Ex.R-7 & R-8, Certificate of DMC dated 14.03.2012 Ex.R-9, letter of intimation Ex.R-10, death certificate Ex.R-11, DDR/FIR dated 03.09.2011 Ex.R-12, death summary Ex.R-13, claimant's statement Ex.R-14, certificate of identity and burial or cremation Ex.R-15, medical attendant's certificate Ex.R-16, certificate of hospital treatment Ex.R-17, claim forms Ex.R18 to R-21, proposal form Ex.R-22, policy bond Ex.R-23, suicide clause Ex.R-24 and first premium receipt dated 06.09.2010 Ex.R-25 and closed the evidence.
5. On conclusion of evidence and documents placed on record, District Forum partly allowed the complaint of the complainant as referred above.
6. Aggrieved by the order of the District Forum, the OPs came up in appeal on the grounds that the policy holder has committed suicide within one year of the acceptance of proposal. Therefore, the claim, was repudiated as per the policy conditions. However, the learned District Forum has misinterpreted the factual position as well as the law point and prayed for setting aside the order under appeal.
7. As per the allegation of the complainant that her husband committed suicide after the period of one year from the First Appeal No. 1027 of 2013 6 commencement of the policy (Ex. R-23) but the official of the OPs were not ready to accept the contentions of the complainant.
8. Learned counsel for the OPs argued that they had repudiated the claim as per the terms and conditions of the policy which was taken by the husband of the complainant and there is no deficiency in service.
9. We have perused the policy document ExR-23, in which the date of commencement of the policy is 28.07.2010. But the main arguments of OPs that date of commencement of the policy is 28.07.2010 but the date of risk cover is from 06.09.2010. The policy commencement date is 28.07.2010 prior to the back date coverage due to back dating facilities availed by the life assured at the time of proposal. In that way the date of risk covered cannot be taken as date of commencement of policy. A reference has been made to the Judgment of Hon'ble National Commission LIC of India Versus Yogender Mittal II(2012 CPJ 556 (NC), in which it was held that -
"date of policy is interpreted to mean the date on which policy was issued and not the date on which risk under policy commenced by way of back dated policy - Policy was approved and accepted after completion of various formalities and on receipt of first premium on 15.01.1994 and not from 28.10.1993 when risk was covered
10. In this case husband of the complainant was admitted in the hospital, the certificate of hospital treatment is Ex.R-17, which First Appeal No. 1027 of 2013 7 shows the patient, was admitted with alleged history of cellphone poison. Which shows that the life assured has committing suicide. As per the policy wherein it has been stated in Clause 15 of policy as under:
"The suicide clause applicable to Corporation's policies provides that the risk of death by suicide would not be covered if such death were to occur at any time on or after the date on which the risk under the policy has commenced but within a period of 12 months from the date of the policy. Nevertheless, in practice, the period of 12 months from the date of the commencement of risk and not from the date of issue of the policy. Where the policy is dated back, the date of commencement of risk, is the date of acceptance or the date of payment of first premium, whichever is later. "Suicide" is excluded for a period of 3 years from the date of commencement, if death due to suicide takes place during the period of the operation of clause 4(b). It is permanent exclusion under DAB Clause."
There is no dispute on the point that deceased had committed suicide. As per terms of the policy benefit of clause 6 is received for suicide would be available to the complainant only in the case where the suicide was not committed by the insured within one year from the issuance of the policy and policy will be issued after receipt of premium. The date of the first premium was paid vide receipt dated 06.09.2010 (Ex.R-25). No risk of insurance commences or policy issued unless the premium is paid. As per the provision of Section 64(B) of Insurance Act the first premium was paid on 06.09.2010 and First Appeal No. 1027 of 2013 8 as such the date of issuance of the policy is 06.09.2010 and not 28.07.2010. The husband of the complainant committed suicide on 02.09.2011 as the risk was to commence from 06.09.2010 which is within one year and this is not covered under the terms and conditions of the policy. So we are of the view that the husband of the complainant had committed suicide within one year from the commencement of the policy. Therefore, the OP was not liable to pay the amount to the insured as per the terms and conditions of the policy.
11. In view of the above discussion, we are of the opinion that the impugned order passed by the Learned District Forum cannot sustain. The complaint was liable to be dismissed but has been wrongly allowed. We accordingly accept the appeal and set aside the impugned order dated 29.07.2013 and dismissing the complaint.
12. The appellant had deposited an amount of Rs. 25,000/- with this Commission at the time of filing of the appeal. This amount of Rs.25,000/- with interest accrued thereon, if any, be remitted by the registry to the appellant by way of a crossed cheque/demand draft after the expiry of 45 days. Subject to stay if any by higher Fora/Court. The OPs should pay remaining amount within 30 days as per the order of the District Forum.
13. Arguments in this appeal were heard on 20.04.2015 and the order was reserved. Now the order be communicated to the First Appeal No. 1027 of 2013 9 parties as per rules. Appeal could not be decided within the statutory period due to heavy pendency of court cases.
(Jasbir Singh Gill) PRESIDING MEMBER (Surinder Pal Kaur) MEMBER April 23, 2015.
(MM)