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HARYANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, CHANDIGARH
Hon’ble Mr. Justice R.C. Kathuria, President;
Mr. Banarsi Das & Mrs. Shakuntla Yadav, Members
LIFE INSURANCE CORPORATION OF INDIA—Appellant
versus
KAMLA DEVI—Respondent
First Appeal No. 2161 of 2001—Decided on 19.7.2006

Advocates:
Counsel for the Parties :
For the Appellant :Mr. K.K. Doda, Advocate.
For the Respondent: None.

The court emphasized that the interpretation of insurance policy clauses must adhere to the terms and conditions of the policy, and the court cannot rewrite the contract of insurance to direct the insurer to act in violation of the policy terms.

Headnote:

Insurance - Claim Dispute - Accident Benefit - Clause 10 - [Insurance, Claim Dispute, Accident Benefit, Clause 10] - The court discussed Clause 10 of the Insurance policy, which deals with accident benefit. It stated that the clause of 120 days is not applicable to the injury of the brain. The court concluded that the District Forum's interpretation of the clause was incorrect and that the findings of the District Forum could not be sustained as they were beyond the terms and conditions of the policy. The opposite parties were justified in repudiating the claim under one policy due to non-payment of premium, and the complainant was not entitled to double benefit under both policies.

Fact of the Case:

The complainant, as the nominee of two insurance policies, filed a claim for the sum assured after the death of the policyholder due to an accident. The opposite parties repudiated the claim for one policy due to non-payment of premium and denied double accident benefit under both policies.

Finding of the Court:

The court found that the District Forum's interpretation of the insurance policy clause was incorrect and beyond the terms and conditions of the policy. It concluded that the opposite parties were justified in repudiating the claim under one policy due to non-payment of premium and that the complainant was not entitled to double benefit under both policies.

Issues: Interpretation of insurance policy clause, entitlement to double accident benefit, repudiation of claim due to non-payment of premium

Ratio Decidendi: The court's decision was based on the interpretation of Clause 10 of the Insurance policy, which deals with accident benefit. It concluded that the District Forum's interpretation of the clause was incorrect and that the findings of the District Forum could not be sustained as they were beyond the terms and conditions of the policy.

Final Decision: The appeal was allowed, the impugned order was set aside, and the complaint was dismissed.

ORDER

Mr. Justice R.C. Kathuria, President—This appeal is directed against the order dated 7.3.2001 passed by the District Consumer Disputes Redressal Forum, Rewari whereby the complaint filed by the respondent-complainant against the appellant-opposite parties was accepted.

2. In order to focus the controversy involved in the present appeal essential facts need to be noticed briefly. Tek Chand husband of Kamla Devi had taken two polices, Nos. 111617729 and 33023508, with double accident benefit for Rs. 50,000 and Rs. 25,000 on 28.2.1993 and 28.2.1996 respectively from the opposite parties. Said Tek Chand met with an accident on 14.9.1997. At the time of accident he was employed with State Bank of India and was posted at Rewari Branch. On that day at about 8.30 p.m. a Tata Sumo vehicle dashed against scooter bearing registration No. HR-36A-2120 driven by Tek Chand. He fell down from the scooter and suffered grievous as well as simple injuries. A report bearing FIR No. 705 dated 15.9.1997 was lodged with the Police Station, Rewari. He was admitted in the Civil Hospital, Rewari from where he was referred to Safdarjung Hospital, New Delhi on 16.9.1997. He was shifted to Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi in the state of coma for further treatment. He was treated there with the diagnosis of severe head injury, temporal contusion and haemotoma, etc. He remained under treatment in the said hospital from 16.9.1997 to 21.4.1998 continuously for a period of seven months as indoor patient as per medical certificate dated 7.1.1999 issued by the Hospital Authorities in which it is stated that “he is unconscious and is likely to remain so far many years and he will not be able to join his duties for ever. His thumb impression may be accepted as his identity.” Another medical certificate of Quadriplera paralysis of all the four limbs, with 100% disability/handicap was also issued by the hospital authorities on 15.12.1998. On 6.5.1999 the condition of Tek Chand was deteriorated and for that reason he was again taken to ‘Sir Ganga Ram Hospital, New Delhi’ and his diagnosis were still the same as was about 1½ years ago. He was in state of coma, but since no bed was available in ICU ward of the said hospital, Tek Chand was referred to ‘Ram Manohar Lohia Hospital, New Delhi’ where he died on 7.5.1999. The complainant being nominee of both the policies submitted her claim with the opposite parties for the sum assured. The opposite parties repudiated the claim in respect of policy No. 330235088 for Rs. 25,000 while in respect of claim under policy No. 111617729 for Rs. 50,000 the opposite parties made only single payment. Under both the policies double accident benefit was denied to her. She claimed that at the time of accident the policy No. 330235088 was enforced upto 27.9.1998 and premium due thereafter was paid on 25.7.1998 and on the other policy No. 111617729 the premium due on 22.2.1999 was also paid. Therefore, at the time of death both the policies were in force. Aggrieved by the non-payment of the claim made as stated above, the complainant invoked the jurisdiction of the District Forum wherein she made the following claims:

“(a) The respondents may kindly be directed to pay the claim of Rs. 50,000 under policy No. 11617729, as of double accident benefits and under Policy No. 330235088, as a basic sum assured Rs. 25,000 plus Rs. 25,000 as of double accident benefits with accrued bonus and interest thereon and with costs of the complaint.

(b) It is further prayed that the respondents may kindly be directed to pay interest on the delayed claim amount at the rate of 24 per cent per annum from the date of due date i.e., from the date of death i.e., 7.5.1999 till the realisation of the amount.

(c) It is further prayed that a sum of Rs. 25,000 may kindly be awarded in lieu of financial loss and mental agony suffered and other expenses spent thereupon.

(d) Any other relief, which this Hon’ble Forum may deem just and proper, may












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