National Consumer Disputes Redressal
Lic Of India vs Mamta Rani & Anr. on 25 April, 2014
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 4468 OF 2012 (Against the order dated 02.08.2012 in First Appeal No. 140/2007 of the State Commission Haryana, Panchkula) 1. The Divisional Manager ........ Petitioner Divisional Office LIC of India Yamuna Nagar Haryana Through Shri Balihar Singh Assistant Secretary (Legal Cell) Central Office, LIC of India H-39, Connaught Place, New Delhi - 110001 Vs. 1. Smt. Mamta Rani ......... Respondents w/o Late Shiv Kumar s/o Late Ramji Lal r/o village Chintpur P.O. Lalhari Kalan, Tehsil Chhachhrauli District Yamuna Nagar 2. Miss Sonam d/o late Sh. Shiv Kumar r/o village Chintpur P.O.Lalhari Kalan, Tehsil Chhachhrauli District Yamuna Nagar BEFORE: HON'BLE MR. JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER HONBLE MR.SURESH CHANDRA, MEMBER For the Petitioner : Mr. Mohinder Singh, Advocate For the Respondent : Ex parte PRONOUNCED ON : 25th APRIL, 2014 ORDER
JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER This revision is directed against the order of the State Commission Haryana in First Appeal No. 140 of 2007 whereby the State Commission dismissed the appeal preferred by the petitioner and confirmed the order of the District Forum Yamuna Nagar, operative part of the order of the District Forum reads as under:
We allow the complaint of the complainants and direct the respondents to release the amount under the policy No.172116131 in favour of complainant no.1 alongwith bonus alongwith accident benefit and release the amount of policy No.172116080 in favour of complainant no.2 alongwith bonus alongwith accident benefits and pay interest on the amount at the rate of 12% per annum after three months of the death of insured and Rs.10,000/- as compensation for causing mental agony, harassment and litigation expenses.
2. Notice of the appeal was sent to the respondents, namely, the widow and daughter of the deceased insured. The respondents despite of service of notice through registered AD post, preferred not to appear. They were, therefore, proceeded ex parte.
3. Learned Shri Mohinder Singh, Advocate for the petitioner has submitted that foras below have committed a grave error in granting accident benefit to the respondent against the terms and conditions of the insurance policy. Expanding on the argument, learned counsel for the petitioner has contended that as per clause 10.2 of the insurance policy, accident benefit is payable only if the life assured suffers permanent disability or death as a consequence of an accident. It is contended that foras below have failed to appreciate that the insured died not because of accident but due to heart attack and that the respondents have not even claimed accident benefit in their complaint.
4. We find merit in the contention of the petitioner. On perusal of the copies of the insurance policies placed on record, we find that the terms and conditions of both the insurance policies are similar.
Clause 10.02 of the insurance policy deals with accident benefit cover. Relevant portion of the aforesaid clause is reproduced thus:
Accident Benefit : If accident benefit has been opted for and while if at any time when this policy is in force for the full sum assured, the life assured before the expiry of the period for which the premium is payable or before the policy anniversary of 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 of the Life Assured : (i) to pay in monthly instalments 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 instalments have not been due will be paid along with the claim
(ii) to waive the payment of future premiums.
The maximum aggregate limit of assurance on the same life to which benefit (i) and (ii) above apply shall not in any case exceed Rs.50.00 lacs taking all existing policies of the life assured and under individual as well as group schemes including policies with in-built accident benefit taken with Life insuance Corporation of India and other insurance companies, if there be more policies than one and if the total assurance exceeds Rs.50 lacs, the benefits shall apply to the first Rs.50 lacs sum assured in order of the date of policies issued.
The waiver of all premium shall extinguish all options under this policy except as to such assurance if any, as exceeds the maximum aggregate limit of Rs.50,00,000/- and which may have been kept in force by continued payment of premiums and the benefits covered by (b) of this clause.
(b) Death of the Life Assured : to pay an additional sum equal to the sum assured under this policy if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 180 days of its occurrence solely, directly and independently of all other causes result in the death of the life assured. However, such additional sum payable in respect of this policy shall not in any even exceeds Rs.50 lacs taking all existing policies of the life assured and under individual as well as group schemes including policies with in-built accident benefit taken with Life Insurance Corporation of India and other insurance companies.
5. On reading of the above, it is clear that in case of death of life assured, the additional accident benefit equal to the sum assured is payable only if the life assured dies because of any bodily injury resulting solely and directly from an accident by outward, violent and visible means. In the instant case, as per the record, the life assured died on 01.07.2002 due to heart attack. There is no evidence on record to indicate that the life assured died because of some injury suffered in an accident. Thus, the foras below have committed a material illegality in awarding the accident benefit to the respondents against the terms and conditions of the insurance contract. As such, the order of the fora below regarding grant of accident benefit cannot be sustained.
6. In view of the above, we allow the revision petition and direct the petitioner to release to the respondents a sum of Rs.1,50,000/- assured under the respective policies with the accrued bonus alongwith 12% interest on the aforesaid amount after three months of the death of the insured besides Rs.10,000/- as compensation for mental agony, harassment and litigation expenses. The impugned order is modified to the aforesaid extent.
.Sd/-
(AJIT BHARIHOKE, J) ( PRESIDING MEMBER) Sd/-
(SURESH CHANDRA) MEMBER Am/