SUPREME COURT OF INDIA
SANJIV KHANNA, BELA M. TRIVEDI, JJ.
LIFE INSURANCE CORPORATION OF INDIA AND ANOTHER - APPELLANTS
VERSUS
SUNITA - RESPONDENTS
CIVIL APPEAL NO................OF 2021 (@ SPECIAL LEAVE PETITION (CIVIL) NO. 13868 OF 2019)
Decided on : 29-10-2021
Consumer Protection Act, 1986 – Sections 21(b) and 23 – Insurance Act, 1938 – Section 45 – Insurance – Jeevan Suraksha Yojana – No-payment of accident claim benefit – Complaint allowed by National Commission by restoring order passed by District Forum – Terms of insurance policy have to be strictly construed, and it is not permissible to rewrite contract while interpreting terms of Policy – In a contract of insurance there is a requirement of Uberrima Fides i.e. good faith on part of assured – At the time of making payment of premium, it was not disclosed by complainant or her husband to appellant-Corporation about accident which had taken place – Said conduct on part of complainant and her husband in not disclosing about accident to corporation not only amounted to suppression of material fact and lacked bona fides but smacked of their mala fide intention, and accident benefit claim of complainant was liable to be rejected on said ground alone – Apart from fact that respondent-complainant had not come with clean hands to claim add on/extra Accident benefit of policy, policy in question being not in force on the date of accident, claim for extra Accident benefit was rightly rejected by appellant-Corporation – Impugned order passed by NCDRC set aside and claim of respondent towards accident benefit stands rejected. (Paras 8, 9, 10 and 11)
Facts of the case:
Present appeal is directed against the judgment and order dated 24th April, 2019 passed by the National Consumer Disputes Redressal Commission, New Delhi in Revision Petition No. 897 of 2018, whereby the NCDRC while allowing the said Revision Petition, has set aside order passed by the State Commission and has confirmed the order passed by the District Forum.
Findings of Court:
Impugned order passed by the NCDRC setting aside the order passed by Commission and reviving the order passed by the District Forum was highly erroneous and liable to be set aside.
Result : Appeal allowed.
JUDGMENT :
BELA M. TRIVEDI, J.
1. Leave is granted.
2. The present appeal is directed against the judgment and order dated 24th April, 2019 passed by the National Consumer Disputes Redressal Commission, New Delhi (hereinafter referred to as the NCDRC) in Revision Petition No. 897 of 2018, whereby the NCDRC while allowing the said Revision Petition, has set aside the order passed by the State Commission and has confirmed the order passed by the District Forum.
3. The short facts giving rise to the present appeal are that Mr. Pradeep Kumar, the husband of the respondent herein (original complainant) had taken/purchased a life insurance policy under the Jeevan Suraksha Yojana on 14.04.2021 from the appellant-Life Insurance Corporation, under which a sum of Rs. 3,75,000/-was assured by the corporation, and in case of death by accident an additional sum of Rs. 3,75,000/-was also assured. The insurance premium of the said policy was to be paid six monthly. The next premium was due to be paid by the said insured Pradeep Kumar on 14th October, 2011. However, he committed a default. On 06.03.2012, the said Pradeep Kumar i.e. the husband of the complainant met with an accident and succumbed to the injuries on 21.03.2012. In the meantime, he deposited the due premium of October, 2011 on, 09.03.2012 for reviving the policy. The complainant after the death of her husband filed a claim before the appellant-Corporation. The appellant paid a sum of Rs. 3,75,000/- to the complainant, however, did not pay the additional amount of Rs. 3,75,000/-towards the Accident claim benefit. The complainant, therefore, approached the District Forum by filing a complaint seeking the said amount towards the Accident claim benefit. The said complaint was resisted by the Life Insurance Corporation contending, inter alia, that the day when the husband of the complainant met with an accident, the said policy had already lapsed on account of non-payment of the due premium.
4. The District Forum placing reliance upon the Ready reckoner issued by the appellant-Corporation, allowed the said claim of the respondent vide its judgment and order dated 14.10.2013. The appellant-Corporation being aggrieved by the same preferred an appeal before the State Consumer Disputes Redressal Commission. The State Commission allowed the said appeal and set aside the said order passed by the District Forum. The aggrieved complainant preferred a Revision Petition being no. 897 of 2008 under Section 21(B) of the Consumer Protection Act (hereinafter referred to as the said Act), before the NCDRC challenging the order passed by the State Commission. The NCDRC vide the impugned judgment dated 24.04.2019 allowed the said Revision Petition of the respondent and set aside the order passed by the State Commission. Hence, the present Appeal has been filed by the appellant-Corporation.
5. The learned counsel appearing for the appellant-Corporation placing heavy reliance on the condition no. 11 of the policy submitted that the Accident claim benefit was payable only if the policy was in force on the date of accident, however, in the instant case, the policy had already lapsed in October, 2011 and the husband of the respondent-complainant had sought to pay the premium on 09.03.2012, i.e. three days after the occurrence of accident on 06.03.2012. According to him, even the appellant-Corporation was not informed about the said accident when the policy was sought to be revived on 09.03.2012. He has placed reliance on the judgments of this court in case of Vikram Greentech (I) Ltd.& Anr vs New India Assurance Co. Ltd (2009) 5 SCC 599 and in case of Life Insurance Corporation of India Vs. Jaya Chandel (2008) 3 SCC 382 to submit that there is a requirement of good faith on the part of the insured in the contract of insurance.
6. However, the learned counsel appearing for the respondent-complainant submitted that the said terms and conditions of the policy were not brought to the notice of the insured i.e. the
Vikram Greentech (I) Ltd. & Anr vs New India Assurance Co. Ltd (2009) 5 SCC 599 – Referred [Para 5]
Life Insurance Corporation of India Vs. Jaya Chandel (2008) 3 SCC 382 – Referred [Para 5]
(1) Terms of insurance policy have to be strictly construed, and it is not permissible to rewrite contract while interpreting terms of Policy.(2) In a contract of insurance there is a requirement of ....
Inactive Policy – If a policy is not active, the claim for the Accident Benefit is not payable to the complainants as per the terms outlined in the insurance contract.
IMPORTNAT POINT Accident benefit - Accident benefit could have been claimed and availed of only if the accident had taken place subsequent to the renewal of the policy.
A lapsed insurance policy cannot be revived post-death, and the Insurance Ombudsman lacks authority to bypass contract terms based on equity.
Nominee - The nominee / mother of the life assured has to state all the true and relevant facts regarding the health condition of the life assured and in case if something is found untrue to be conta....
Once there is a valid insurance policy available in favour of appellant, claim made by him for reimbursement of expenses incurred is justifiable and deserves to be paid to him.
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