State Consumer Disputes Redressal Commission
The Zonal Manager,Life Insurance ... vs Jagjit Singh on 7 June, 2013
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.1668 of 2009.
Date of Institution: 25.11.2009.
Date of Decision: 07.06.2013.
1. The Zonal Manager, Northern Zonal Officer, Life Insurance
Corporation of India, Jeevan Bharti, Connaught Circus, New Delhi.
2. The Divisional Manager, Life Insurance Corporation of India, Jeevan
Parkash Building, near Shop Complex, Ranjeet Avenue, Amritsar-
143001.
3. The Branch Manager, Life Insurance Corporation of India, M.R.
Chopra Complex, Ferozepur Road, Zira, District Ferozepur.
(All through Life Insurance Corporation of India, through its Sr.
Divisional Manager, Jeevan Parkash Building, Sector-17, Chandigarh.
.....Appellants.
Versus
Jagjit Singh, aged 37 years, S/o Sh. Mohinder Singh S/o Bhagat Singh, R/o
Village Joge Wala, Post Office Makhu, Tehsil Zira, District Ferozepur, Punjab.
...Respondent.
First Appeal against the order dated
11.08.2009 of the District Consumer
Disputes Redressal Forum, Ferozepur.
Before:-
Shri Inderjit Kaushik, Presiding Judicial Member.
Shri Vinod Kumar Gupta, Member.
...................................
Present:- Sh. Rajneesh Malhotra, Advocate, counsel for the appellants.
Sh. Parvez Chugh, Advocate, counsel for the respondent.
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INDERJIT KAUSHIK, PRESIDING JUDICIAL MEMBER:-
This order shall dispose of two (2) appeals i.e. First Appeal No.1668 of 2009 (The Zonal Manager, Northern Zonal Officer, Life Insurance Corporation of India & Ors. Vs Jagjit Singh) and Misc. Appl. First Appeal No.1668 of 2009 2 No.441 of 2010 in/& First Appeal No.288 of 2010 (Jagjit Singh Vs The Zonal Manager, Northern Zonal Officer, Life Insurance Corporation of India & Ors.) as both the appeals are directed against the same order dated 11.08.2009 passed by the learned District Consumer Disputes Redressal Forum, Ferozepur (in short "the District Forum"). The facts are taken from First Appeal No.1668 of 2009 and the parties would be referred by their status in this appeal.
2. Facts in brief are that Sh. Jagjit Singh, respondent/complainant (hereinafter called as "the respondent") filed a complaint under section 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the appellants/opposite partiers (hereinafter called "the appellants"), making the averments that he is policy holder of LIC, having policy bearing No.471742124 commencing w.e.f. 28th December, 2006 with its maturity date as 28.12.2022 and the premium was quarterly payable. Another policy bearing No.471974890 (New Bima Gold) commencing w.e.f. 28th May, 2007 with its maturity date as 28th May, 2027 was also issued. The premium of this policy was payable in half yearly installment i.e. in the month of May and November. The respondent purchased the said policies on 28th December, 2006 and 28th May, 2007 respectively and has been paying the premium regularly. Vide the said insurance policies, the accident benefit was also covered. At the time of purchasing the policy from the agent of the appellants, the respondent had disclosed all the relevant facts including the facts regarding 50% disability due to polio defect in the right leg. The agent of the appellants at the time of giving the policy assured that the policy covers the accident benefits.
3. On 18th February, 2008, the left arm of the respondent came in a running 'Kohlu' (seed crushing) machine and was crushed badly. The respondent was taken to Kalra Hospital, Makhu and on the same day, he was referred to Amandeep Hospital, Amritsar where he remained admitted for a period of 21 days and during the treatment in the said hospital, the left arm of First Appeal No.1668 of 2009 3 the respondent was amputated and he was permanently disabled i.e. 100% disable and was not able to do any work. The respondent incurred a sum of Rs.2.00 lacs on the treatment during his admission in Amandeep Hospital, Amritsar. Three operations were conduced. The respondent submitted the claim form with appellant no.3 within time which was referred to appellants no.1 & 2 through proper channel, but vide letter dated 13th January, 2009 appellant no.1 rejected/repudiated the claim on the ground that the respondent was afflicted with polio before issuance of the policy and the disability of the respondent is combination of polio and left arm amputation and the respondent did not disclose about polio at the time of insurance. The repudiation is wrong as the respondent was having 50% disability, but later on he became 100% disabled.
4. The respondent sent representation dated 12th February, 2009 through registered post, but till date no reply has been given. No amount has been released. The respondent suffered a lot of mental tension, agony and financial loss and is entitled to a compensation of Rs.1.50 lacs.
5. It was prayed that the appellants may be directed to pay a sum of Rs.1.50 lacs as compensation and Rs.5500/- as litigation expenses.
6. In the written version filed on behalf of the appellants, preliminary objections were taken that the policy bearing No.471742124 commenced from 28.02.2006 and the same lapsed due to non-payment of the premium due on 28.12.2007 and was not in force at the time of accident on 18.02.2008 or on the day of amputation of left arm below elbow on 26.02.2008 in Amandeep Hospital, Amritsar. As per the terms and conditions of the policy, nothing is payable. In respect of policy no. 471742124 which commenced from 28.05.2007, it was submitted that as per Clause 10.4 of the cover note/policy bond, the disability should be total i.e. 100% permanent and should be the result of the accident. In the present case, the respondent himself stated that he had 50% disability due to polio in the right leg at the time of taking the policy and 50% now at the time of amputation of left arm First Appeal No.1668 of 2009 4 below elbow on 26.02.2008. The 100% disablement is combination of pre- existing defect in the right leg due to polio and amputation and the same does not qualify for the disability benefit. As per Clause 10.4, the claim is not payable. The claim for disability can be considered if there is amputation of two limbs and not in one limb only and the same is not covered under clause 10.4 of the policy. The respondent has concealed the material facts of his disability of 50% at the time of filling the proposal form and answered the questions in negative.
7. On merits, similar pleas as taken in preliminary objections were repeated and denying allegations of the complaint, it was prayed that the complaint may be dismissed with costs.
8. Parties led evidence in support of their respective versions by way of affidavits and documents.
9. The learned District Forum, after hearing the counsel for the parties and going through the record, observed that the policy no. 471742124 has been revived to its original position by the appellants after accepting the balance premium due. The second policy bearing No.471974890 is also in force as on today. Had the appellants any objection on the ground of concealment of any fact of 50% disability of the appellant, then they would not have insisted the respondent for revival of the policy. The respondent had 50% of disability due to polio affect in his right leg, but due to the accident the respondent suffered 100% disability and he is unable to perform any work for his livelihood. The respondent is entitled to the claim as per the policy condition, including waiver of installments as admissible under the policy documents for the policy No.471974890 which was in force at the time of accident. So far as the policy No. 471742124 is concerned, the said accident occurred immediately after the expiry of the grace period for depositing the installment. No notice was given to the respondent that his policy is going to lapse. The complaint was allowed and the appellants were directed to pay sub standard claim to the tune of Rs.50% of the claim which would have been First Appeal No.1668 of 2009 5 admissible if the premium has been paid by the respondent in time. The said amounts and waivers be given to the respondent within 30 days from the receipt of copy of the order, failing which the respondent shall be entitled to 9% p.a. interest from the date of complaint i.e. 25.03.2009 till payment.
10. Aggrieved by the impugned order dated 11.08.2009, the appellants have come up in the present appeal, seeking setting aside of the impugned order.
11. Whereas, the respondent filed the appeal along with application for condonation of delay of 135 days in filing the appeal i.e. Misc. Appl. No.441 of 2010 In/and First Appeal No.288 of 2010 (Jagjit Singh Vs The Zonal Manager, Northern Zonal Officer, Life Insurance Corporation of India & Ors.), for enhancement of compensation.
12. We have gone through the pleadings of the parties, perused the record of the District Forum and have heard the arguments advanced by the learned counsel for the parties.
13. On behalf of the appellants, it was contended that the policy No. 471742124 was lying in lapsed condition on the date of accident as the premium was last due on 28.12.2007. The amputation took place on 26.02.2008 and no claim is payable. As per Clause 10.4 of policy No. 471974890, the claim was payable only if there was permanent disability i.e. 100%, as defined in the policy. The respondent did not inform about 50% of disability due to polio at the time of taking the policy and the claim is not payable and was rightly repudiated. At the time of filling the proposal form, he answered all the questions in negative, partly regarding the bodily defect or deformity. As per Clause 10.4, the amputation of one part is not sufficient to raise the claim. The District Forum has not appreciated the evidence and the law in this regard and no accident benefit was payable as per terms and conditions of the policy. The order passed by the District Forum is not sustainable and the appeal may be accepted.
First Appeal No.1668 of 2009 6
14. On the other hand, learned counsel for the respondent has argued that the impugned order under appeal is legal and valid and the appeal may be dismissed.
15. We have considered the respective contentions advanced by the learned counsel for the parties and have minutely examined the entire record.
16. The respondent Jagjit Singh purchased policy from the Life Insurance Corporation of India, bearing No.471742124 commencing w.e.f. 28th December, 2006 and another policy bearing No.471974890 (New Bima Gold) commencing w.e.f. 28th May, 2007. In both the policies, the accident benefit was also covered. As per respondent no.1, he has disclosed the disability of 50% due to polio in his right leg to the agent, who assured him that the policy covers the accident benefit.
17. The left arm of the respondent came in the running 'Kohlu' (seed crushing) machine on 18th February, 2008 and ultimately, his left arm was amputated and he became disable.
18. The version of the appellants is that the 50% of disability due to polio was not disclosed at the time of taking the policy and the other 50% disability is due to crushing of the arm and, as such, the claim is not payable. The other argument raised on behalf of the appellants is that the amputation of one part is not sufficient as per Clause 10.4 and the amputation has to be of two or more parts of the body. This argument raised is not tenable because such sort of terms and conditions were never explained, nor it has any logic that for getting the claim, the two parts of the body are to be amputated. The other plea taken in the pleadings was that the policies had lapsed, but the District Forum has mentioned that one policy was revived and for the other, no notice was given and just after the grace period, the accident occurred, and reduced the claim to 50% which is reasonable. The argument that the disability of 100% is the result of the 50% polio affect and 50% due to amputation, is not tenable because as per the Disability Certificate Ex.C27 First Appeal No.1668 of 2009 7 issued by the Medical Officer, Civil Hospital, Ferozepur, the respondent Jagjit Singh became disable due to amputation of the forearm and the same is 100% permanent disability. Therefore, it cannot be stated that the disability of 100% was due to adding of both the disabilities, but it was due to crushing of left arm and amputation of the left arm and it has no nexus or concern with the 50% disability which the respondent was suffering due to polio. The order passed by the District Forum is legal and valid and there is no ground to interfere with the same.
19. In view of above discussion, the appeal is dismissed and the impugned order under appeal dated 11.08.2009 passed by the District Forum is affirmed and upheld. No order as to costs.
20. The appellants had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal. This amount with interest accrued thereon, if any, be remitted by the registry to the respondent/ complainant by way of a crossed cheque/demand draft after the expiry of 45 days under intimation to the learned District Forum and to the appellants.
21. Remaining amount as per the order of the District Forum shall be paid by the appellants to the respondent/complainant within 45 days of the receipt of copy of the order.
Misc. Appl. No.441 of 2010 in/& First Appeal No.288 of 2010:-
22. The appellant/complainant has filed cross appeal i.e. F.A. No.288 of 2010 with delay of 135 days and application for condonation of delay has been filed along with the appeal, on the grounds that the copy of the impugned order dated 11.08.2009 was issued on 11.09.2009 and the appeal was filed on 24.02.2010. The appellant/complainant is handicapped person, having 100% disability and is bed ridden and due to mental shock, he could not contact his advocate nor could call his counsel. He could only contact his counsel on 18.02.2010 and, as such, the delay of 135 days occurred in filing the appeal which is bonafide and unintentional. It was prayed that the delay in filing the appeal may kindly be condoned. First Appeal No.1668 of 2009 8
23. The ground taken by the appellant for condonation of 135 days in filing the appeal is that he is a handicapped persons, having 100% disability and is bed ridden and due to mental shock on account the accident, he could not contact his advocate.
24. In view of the 100% disability of the appellant as well as the fact that cross appeal i.e. F.A. No.1668 of 2009 has been filed against the same impugned order under appeal, the Misc. Appl. No.441 of 2010 in/& First Appeal No.288 of 2010, is allowed and the delay of 135 days in filing the appeal (F.A. No.288 of 2010) is condoned.
25. So far as the merit of the appeal is concerned, there is no ground to enhance the relief already awarded by the District Forum.
26. In view of above discussion as well as the reasons and discussion held in First Appeal No.1668 of 2009 (The Zonal Manager, Northern Zonal Officer, Life Insurance Corporation of India & Ors. Vs Jagjit Singh), the First Appeal No.288 of 2010 (Jagjit Singh Vs The Zonal Manager, Northern Zonal Officer, Life Insurance Corporation of India & Ors.) is dismissed. No order as to costs.
27. The arguments in both these appeals were heard on 05.06.2013 and the order was reserved. Now the order be communicated to the parties.
28. The appeals could not be decided within the stipulated timeframe due to heavy pendency of court cases.
29. Copy of the order be placed in First Appeal No.288 of 2010 (Jagjit Singh Vs The Zonal Manager, Northern Zonal Officer, Life Insurance Corporation of India & Ors.).
(Inderjit Kaushik) Presiding Judicial Member (Vinod Kumar Gupta) Member June 07, 2013.
(Gurmeet S)