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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. B.C. Gupta, Presiding Member and Prem Narain, Member
Life Insurance Corporation of India and Anr. —Petitioners
versus
Ranjeet Singh —Respondent
Revision Petition Nos.954, 955 and 956 of 2015
(Against Order dated 1.1.2015 in Appeal Nos.365 to 367 of 2013 of State Consumer Disputes Redressal Commission Odisha, Cuttack with LA. Nos. 2334 to C 2336 of 2015)
Decided on 28.7.2016
Counsel for the Parties:
For the Petitioners:Mr. Neeraj Gupta, Advocate
For the Respondent:Mr. Santosh Kumar, Advocate
IMPORTANT POINT
In case of accident benefit, sum assured under accident benefit has to be paid in monthly instalments spread over 10 years.
Headnote:Consumer Protection Act, 1986—Sections 15, 17, 19 and 21—Insurance—Permanent disability suffered in road accident—Certificate has been given by competent authority and cannot be disputed on ground that Doctor of Insurance Company has not examined insured—However, as per terms and conditions of policy, insurer is competent to get insured examined to assess condition of disability—Both Fora have ordered payment of insurance amount in lump-sum whereas in case of accident benefit, sum assured under accident benefit has to be paid in monthly instalments spread over 10 years—Orders of Fora below are erroneous to this extent—Sum of Rs. 25 Lakhs which is maximum allowable insurance amount under accident benefit be paid to complainant by petitioner/Insurance Company in monthly instalments. (Paras 16 to 21)
Result: Revision Petition Partly allowed.
Prem Narain, Member—These revision petitions numbers 954 of 2015, 955 of 2015 and 956 of 2015 have been filed against the three similar orders dated 1.1.2015 passed by
| First Policy : | ||
| 1. Policy No. : 585539797 | Sum assured for main plan (Rs.) 5,00,000 | Due Date: 28th Mode of payment |
| 2. Date of commencement | Term Assurance Sum 28.3.2005 Assured (Rs.) | Qly |
| 3. Date of commencement of Risk : 28.3.2005 | Accident Benefit Sum Assured (Rs.) 5,00,000 | Date of Birth : 12.8.1972 |
| 4. Date of Maturity: 28.3.2030 | Premium for main Plan | Age: 33 Whether age admitted : Y |
| 5. Table & Term : 162 25 | (Rs.) 5,825.00 Accident Benefit Premium | Date of last payment 28.12.2020 |
| 6. Premium Paying Term : 16 | (Rs. 181.25 Term Assurance Premium (Rs.) 00 Total Premium (Rs.) 6550.00 | Proposal No. and Date : 7566-30.3.2005 |
Nominee under Section 39 of the Insurance Act, 1938 Rajdip Brar Son
| Second Policy: | ||||
| 1. Policy No. : 586351121 | Sum assured for main Plan Rs. 15,00,000 | Due Date 28th Mode of payment | ||
| 2. Date of commencement : 28.7.2006 | Term Assurance Sum Assured (Rs.) | Qly | ||
| 3. Date of commencement of Risk: 15.9.2006 | Accident Benefit Sum Assured Rs. 15,00,00 | Date of Birth: 12.8.1972 | ||
| 4. Date of Maturity: 28.7.2031 | Premium for main Plan | Age: 34 Whether age admitted : Y | ||
| 5.Table & Term: 162 25 | (Rs.) 75,190.00 Accident Benefit Premium (Rs. 2,175.00) | Date of last payment: 28.7.2021 | ||
| 6 Premium Paying Term : 16 | Term Assurance Premium (Rs.) .00 Total Premium (Rs.) 77,365.00 | Proposal No. and Date : 1097-28.7.2006 | ||
| Nominee under Section 39 of that Insurance Act, 1938 Mandip Brar Son | ||||
| Third Policy: |
| |||
| 1. Policy No. : 589372173 | Sum assured for main Plan (Rs.) 9,00,000 | Due Date: 28th Mode of payment: |
| |
| 2. Date of commencement : 28.3.2007 | Term Assurance Sum Assured (Rs.) | Qly |
| |
| 3. Date of commencement of Risk:31.3.2007 | Accident Benefit Sum Assured (Rs.) 9,00,000 | Date of Birth: 12.8.1972
|
| |
| 4. Date of Maturity : 28.3.2032 | Premium for main Plan (Rs.) 45,335.00 | Age: 33 Whether age admitted : Y |
| |
| 5. Table & Term: 162 25 | Accident Benefit Premium (Rs.) 1305.00 | Date of last payment: 28.3.2022 |
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| 6. Premium Paying Term: 16 | Term Assurance Premium (Rs.) .00 Total Premium (Rs.) 46,640.00 | Proposal No. and Date : 14386-23.3.2007 |
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Nominee under Section 39 of the Insurance Act, 1938 Mandip Brar Son the State Consumer Disputes Redressal Commission, Odisha, Cuttack, (in short ‘the State Commission’).
2. Brief facts are that complainant/respondent-Ranjeet Singh had taken three life insurance policies from the petitioner-Life Insurance Corporation of India as per the following details:—
3. It is the case of the complainant that while coming from Barbil to Rourkela on Motor Cycle the insured met with an accident on 13.5.2007 and was seriously injured. The complainant was engaged in his treatment and he could not be fully cured. He claimed permanent disability and filed the claim under these policies along with all relevant papers such as claim form along with the disability certificate issued by the CMDO Sundargarh dated 1.11.2008, with the petitioner on 15.2.2011.
4. The petitioner placed the matter before Divisional Medical Referee, who advised the life assured to be examined by Ortho-neuro specialists, with a fresh medical report and the same was communicated by the petitioner corporation to the respondent vide letter dated 12.2.2012. Meanwhile the life assured filed the consumer complaint before the District Consumer Disputes Redressal Forum, Sundargarh-II, Rourkela (in short, ‘the District Forum’). The District
