State Consumer Disputes Redressal Commission
The Senior Manager, Indian Overseas ... vs Anna Pushpam, Ittamozhi Via, & 2 Ors. on 18 August, 2015
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IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
MADURAI BENCH.
Present: Thiru.A.K. ANNAMALAI, M.A.M.L.,M.Phil., Presiding Judicial Member
Thiru.M.MURUGESAN, B.Sc, B.Ed., Member
F.A.No.07/2012
(F.A.No.50/2011 on the file of State Consumer Disputes Redressal
Commission, Chennai)
(Against the order in C.C.No.12/2010, dated 22.11.2010 on the file of DCDRF,
Tirunelveli.)
THIS TUESDAY THE 18th DAY OF AUGUST 2015.
The Senior Manager,
Indian Overseas Bank,
Trivandrum Road,
Palayamkottai. Appellant/Opposite Party
Vs
1. Anna Pushpam,
W/o Late Lingapandi,
353 Kumaran Street,
Vijaychampadu Post.
Ittamozhi Via,
Tirunelveli District. 1st Respondent/1st Complainant
2. Sujatha,
D/o Late Lingapandi,
353 Kumaran Street,
Vijaychampadu Post.
Ittamozhi Via,
Tirunelveli District. 2nd Respondent/2nd Complainant
3. Manikandan,
S/o Late Lingapandi,
353 Kumaran Street,
Vijaychampadu Post.
Ittamozhi Via,
Tirunelveli District. 3rd Respondent/3rd Complainant
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Counsel for Appellant/Opposite Party : Mr.M. Senthilkumar, Advocate.
Counsel for Respondents/1 to 3/ Complainants 1 to 3 : M/s.V. Karthikeyan, Advocate.
This appeal coming before us for final hearing on 14.08.2015 and on hearing
the arguments of both sides and on perusing the material records this Commission
made the following:
ORDER
THIRU. A.K.ANNAMALAI, PRESIDING JUDICIAL MEMBER.
1. The opposite party is the appellant.
2. The 1st complainant is the wife of late Lingapandi was an employee of M/s V.V.Minerals, Thisayanvilai and joined in Group Insurance Scheme through the opposite party bank covering insurance for the period from 04.05.2007 onwards for the maturity value of Rs.1,00,000/- under the Jeevan Insurance Policy covering the risk and subsequently he died on 16.05.2007 and thereby the complainants as Legal heirs of the deceased Lingapandi claimed the policy amount which was repudiated by the opposite party, since the death was not covered under the policy as death was happened within 45 days of the policy hence a consumer complaint came to be filed claiming payment of Rs.1,00,000/- towards insurance amount with 12 % interest and Rs.1,00,000/- as compensation for mental agony along with costs.
3. The District Forum on the basis of both sides materials allowed the complaint directing the opposite party to pay a sum of Rs.1,00,000/- towards the insurance amount along with Rs.10,000/- as compensation for mental and Rs.5000/- as costs.
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4. Aggrieved by the impugned order, the opposite party/appellant filed this appeal contending that the District Forum erroneously allowed the complaint without taking into consideration of the contents of the appellant, the claim is time barred from the death of the policy holder and as per the terms and conditions of the policy if the death is caused within 45 days and thereby the claim cannot be made and the scheme being the Group Insurance one the terms and conditions are notified in the bank notice board and the company was aware of the same.
5. We have heard both sides contentions, arguments and perused the written submissions made in this regard. It is not in dispute that the 1st complainant's husband late Lingapandi the employee of V.V.Minerals, Thisaiyanvilai, Tirunelveli joined Group Insurance Scheme of I.O.B. Jeevan Insurance policy covering for the period from 04.05.2007 onwards after that within two weeks he died on 16.05.2007. The only contention of the opposite party is since the risk coverage commenced only after the period of 45 days except for accidental death from the date of policy and death caused within 45 days period and thereby the claim was repudiated. The respondents/complainants contended that the deceased policy holder was not intimated about the terms and conditions of the above policy and he was not aware of the same and thereby the claim cannot repudiated and they have also relied upon a precedent in the case of "The Haryana State Consumer Disputes Redressal Commission in the case of Star Health and Allied Insurance Company Limited -Vs- Asha and another reported in II (2015) CPJ 78 (Hariyana)" in which it was observed that "Consumer Protection Act, 1986 - Sections 2(1)(g), 14(1)(d),15 - Insurance - Medical 4 reimbursement - Exclusion clause - Suppression of pre-existing disease alleged - Alleged deficiency in service - District Forum allowed complaint - Hence appeal - Terms and conditions were not explained to insured - Exclusion clause on whose basis claim repudiated not explained to insured - Repudiation not justified". This precedent is passed by Hariyana State Commission and not binding upon this Commission. Further the appellant/opposite party relied upon the terms and conditions of the policy under Ex.B1 and also it was stated that the policy holder being the employee of company joined as Group Insurance Scheme policy covering terms and conditions were made to known to the company and also they relied Exhibits B1 and B6 notice put up on their bank notice board relating to the terms and conditions of the policy.
6. On perusal of the policy details under Ex.B1 with schedule under the condition No.22 as follows: "What are the exclusions under the scheme?: The critical illness excluded by the policy are: and also below that it is mentioned as follows: "In case of death during the first 45 days from the date of joining no claim will be payable except for deaths due to accident" and as per this condition cause of death for the 1st complainant's husband is not due to an accident and only natural case of death and the death certificate of Ex.A4 did not disclose any nature of death in their averments of the complaint stated in para 2 as follows: " While so he passed away on 16.05.2007 leaving behind 1 to 3 petitioners as his legal heirs" even in this complaint it was not stated that the death was due to accident and as per the terms and conditions of the policy if the death is caused due to the accident claim could be entertained irrespective of the conditional period of 45 days from the date of policy, and otherwise it should have been 5 only after 45 days and in those circumstances though the death of the 1 st complainant's husband happened within 45 days from the date of policy unfortunately and as the terms and conditions of the policy must be abide and thereby the policy holder's legal heirs of the complainant cannot claim or not entitled for the policy amount. As far as the refund premium is concerned though the complainant side have paid one premium of Rs.113/- on perusal of Ex.B1 as per condition No.20 it is mentioned as follows: "Since it is a group term assurance there will be no surrender value" and thereby premium also cannot be refunded. The District Forum without taking into consideration of all the relevant materials simply because it is argued that the policy holder was not aware of the terms and conditions of the policy was allowed the claim erroneously and thereby the order of the District Forum is liable to be set aside as erroneous and the appeal to be allowed accordingly.
7. In the result, the appeal is allowed by setting aside the order of the District Forum Tirunelveli passed in C.C.No.12/2010, dated 22.11.2010 and the complaint is dismissed.
There will be no separate order as to costs in this appeal.
The Registry is directed to refund the mandatory Fixed Deposit with accrued interest duly discharged in favour of the appellant/opposite party.
Sd/-xxxxxxxx Sd/-xxxxxxxx
M.MURUGESAN, A.K.ANNAMALAI,
Member. Presiding Judicial Member.
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INDEX: YES/NO
AMS/Mdu.Bench/Orders-2015/August.