IN THE HIGH COURT OF KERALA
A. Muhamed Mustaque, J.
Life Insurance Corporation of India - Appellant
Vs.
A. Thresiamma and Ors. - Respondents
W.P. (C) No. 25481 of 2015
Decided On : 17-11-2015
Redressal of Public Grievances Rules, 1998 - Insurance - Ombudsman - Scope of Insurance Ombudsman - Interference in policy contract- Held, It is beyond scope of Insurance Ombudsman to interfere with policy outside ambit of contract - Claim of first respondent has been allowed by Insurance Ombudsman not in terms with respect to contract but on an equitable ground
A. Muhamed Mustaque, J.
1. The petitioner-Life Insurance Corporation of India has approached this Court challenging an award passed by the Insurance Ombudsman, Cochin in a complaint filed by the first respondent. Ext. P. 5 is the said order. The first respondent has a mentally retarded child. She took a Jeevan Aadhaar Policy on 09/03/2003. This policy is mainly meant for the benefit of handicapped dependants. The premium amount will have to be paid for ten years. She paid the entire premium amount. She approached the Insurance Company for payment of Rs. 7000/- every month based on the policy conditions or to grant the surrender value of the policy.
2. As per the conditions in the policy, the benefit is payable on happening of the events stipulated in the policy. In the policy, the benefits payable are on the following conditions:
"Benefits payable and events on the happening of which they are payable:
If the policy is in force for full Sum Assured in the event of death of the Life Assured Twenty percent of the amounts comprising of the Basic Sum Assured, Vested Guaranteed Additions and Terminal Addition if any, such amounts being hereinafter referred to as the Notional Sum Assured, will be payable in lump sum and the balance Eighty percent of the said Notional Sum Assured will be utilised to provide an annuity for 15 years certain and for life thereafter on the life of the handicapped dependent, based on the age last birthday of the said handicapped dependent on the date of claim."
3. The policy terms as above, would clearly show that the petitioner would be entitled for the amount only on the happening of the events referred above.
4. It appears that the learned Ombudsman passed Ext. P. 5 order on the premise that the policy does not offer any real relief, as the benefit is payable only on the death of any one i.e., the life assured or the handicapped nominee. The learned Ombudsman passed the following order:
"6. Considering that the policy was brought out for the benefit of the handicapped dependent, in reality this policy does not offer any real relief. Any benefit is payable only on death of any one i.e., life assured or the handicapped nominee. With the advances in the living standards, longevity has increased, however the costs have also drastically increased. The premium payment is usually at higher ages and both the proposer and the dependent require more medical and other help. Moreover, the guaranteed additions stop when the proposer attains age 65. If, for example, the life assured lives to 70 and the dependent also lives, then the total fund earns nothing after the proposer attains age 65 which, considering the plan features is an irony. The insurer may be right in reiterating that the policy does not carry either a maturity value or surrender value, however there seems to be grave miscarriage of justice."
5. The issue before this Court is whether the Insurance Ombudsman has any power to grant any reliefs, de hors the conditions in the contract. The learned counsel for the petitioner, Shri. R.S. Kalkura citing the judgment in Suraj Mai Ram Niwas Oil Mills (P) Ltd. v. United India Insurance Co. Ltd., 2010 KHC 4760, 2010 (4) KLT Supp 116 (SC), (2010) 10 SCC 567, 2010 (95) AIC 28 argued that the terms of the contract of insurance had to be strictly construed and no exception can be made on ground of equity. In the above judgment the Hon'ble Supreme Court held as follows:
"It is trite that in a contract of insurance, the rights and obligations are governed by the terms of the said contract. Therefore, the terms of a contract of insurance have to be strictly construed, and no exception can be made on the ground of equity. "The terms of the policy have to be construed as it is and we cannot add or subtract something. Howsoever liberally we may construe the policy but we cannot take liberalism to the extent of substituting the words which are not intended". In construing the terms of a contract of insurance, the words us
Login now and unlock free premium legal research
Login to SupremeToday AI and access free legal analysis, AI highlights, and smart tools.
Login
now!
India’s Legal research and Law Firm App, Download now!
Copyright © 2023 Vikas Info Solution Pvt Ltd. All Rights Reserved.