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.

ORDER

K.B. Sangannanavar, Judicial Member—This is an appeal filed U/s.15 of CPA 1986 by OP.1 to 3/Appellants aggrieved by the order dtd.04.10.2017 passed in CC/143/2015 on the file of Chikmagaluru District Forum.

2. The Commission examined the impugned order, grounds of appeal and heard the learned counsels on record.

3. Learned counsel for Appellant would submit that, son of the Complainant met with an accident on 27.11.2014 and he died on 02.12.2014. On the date of accident, the policy was lapsed for non-payment of premium due on 07.09.2014, was not considered by the Forum below, and to find support placed decision of Hon’ble Supreme Court decided on 29.10.2021 in the case of LIC of India & Anr vs. Sunita reported in Supreme Court of India Record of Proceedings in Special Leave to Appeal (C) No.13868/2019, wherein held “the terms of insurance policy have to be strictly construed, and it is not permissible to rewrite the contract while interpreting the terms of the Policy. Policyholder had with wilful intentions not disclosed the details of the accident at the time of revival. Hence Insurer was justified in rejecting the accidental claim.” Let us come to examine the facts of the case on hand. Mr.M.S.Ravi son of the Complainant obtained life insurance policy called Jeevan Saral in the year 2012 (with profits) for a sum of Rs.1,25,000/-, the said policy is double benefit policy covering the two risk factors first being the sum assured of Rs.1,25,000/- and second benefit is the accident benefit including the death of the life assured. It is not in dispute that such policy was obtained by Mr.M.S.Ravi son of the Complainant and it is also not in dispute that Complainant is the nominee to the said policy. Unfortunately M.S.Ravi met with an accident on 27.11.2014 and was under treatment for head injury till 01.12.2014. He was discharged on 02.12.2014 from Kasturba medical college hospital, Manipal and while he was shifting to Bengaluru Nimhans Hospital, on the way within jurisdiction of Chikmagaluru city lost his breath due to injuries sustained in the accident. It is not in dispute that, policy Jeevan Saral obtained during 2012 was with double benefit. Rs.6,005/- was paid on 01.12.2014 towards premium, thereby with effect from 02.12.2014 policy with lapsed condition was revived, but the facts remain that as on 27.11.2014 it was in lapsed condition and the revival came in to effect from 02.12.2014. In such circumstances, OP.1 & 2 have paid Rs.1,25,000/- plus bonus totalling to Rs.1,36,759/- without giving total accident benefit. But Forum below found, insured paid yearly premiums from 2012 to 2013, and the yearly premium due on September 2014, as OPs provided 30 days grace period for payment of premiums and due to non-payment of yearly premium, the policy was comes into lapsed condition, and as the insured met with accident on 27.11.2014 and died on 02.12.2014, and when on 01.12.2014 premium was paid, the policy came into force and the OPs are liable to settle the claim of the Complainant with double benefits. Accordingly, directed to settle accidental death benefit along with compensation of Rs.10,000/- for the deficiency in service and litigation cost of Rs.1,000/-. But the facts remained could be found from the enquiry, policy was revived on 01.12.2014 on receipt of arrears of premium and late fee only because the lapsed period was within 6 months from the date of first unpaid premium. As the first unpaid premium dtd.07.09.2014 along with late fee was received, the policy was revived and brought into force on 01.12.2014 namely one day before the date of death of policy holder. Therefore, the OPs have rightly paid the basic sum assured to the Complainant and we could not find any deficiency in service on their part as alleged by the Complainant in order to extend accidental claim of Rs.1,25,000/- + bonus amount. OPs have to be held rightly repudiated as on the date of accident the policy was in lapsed condition namely as on 27.11.