This is an interesting case where the insurance company decision to not pay the claim was upheld because of non payment of premium. The sad part is that the insured did not stop paying the premium but the insurance company did not collect the premium because of a government circular. But the judgement makes it clear that there is no coverage if there is not premium payment irrespective of who has committed the mistake.
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Case Details
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1 Smt Lata Saini W/o Late Shri Jagat ram Saini, Resident of North Oak, Old Building, sanjauli , Shimla-6
2 Ms. Shelly saini Daughter of late Sh.Jagat Ram Saini
3 Ms. Silpa
4 Baby Shweta, daughters of late Shri Jagat Ram Saini.
5 Master Rohit S/o Late Sh. Jagat Ram saini Sr. No. 4& 5 being minor represented by their mother and natural guardian Smt. Late saini W/o Late Jagat Ram Saini. All resident of Northoak Building Sanjauli, Shimla-6.
… Complainant.
Versus
1 The Secretary Education, Govt. of H.P. Shimla-171002.
2 The Director of, Elementary Education, Himachal Pradesh, Near Main Bus Stand , Shimla-1.
3 The Head Master, govt. Middle SchooI, Mool Koti (Mashobra), The. 7 Distt. Shimla ( H.P.)
4 The Divisional Manager, United India Insurance Company Ltd. Timber House,Cart Road, Shimla. …Opposite Parties.
O R D E R:
Sureshwar Thakur (District Judge) President:- This complaint has been filed by the complainant, by invoking the provisions of Section 12 of the Consumer Protection Act, 1986. It is averred that late Shri Jagat Ram Saini, husband of the complainant No.1 and father of complainants No.2 to 5, was serving as Drawing Teacher with the OP No.3, whereas the OPs no.1 & 2 were the employer of the deceased and OP N.4 is the insurance company, with whom the deceased was insured under Personal Accident Scheme, for an amount of Rs.2.00 lacs vide notification dated 24.02.2006. It is alleged that the deceased died in harness on, 10.07.2006 when he was in active service and after his death, the OPs were requested the release the insurance premium in their favour, which they failed to do so. Hence, feeling aggrieved and dissatisfied, it is averred that, there is apparent deficiency in service on the part of the OPs and accordingly relief to the extent as detailed in the relief clause be awarded in favour of the complainant.
2. The OPs No.1 to 3, in their written version, to the complaint, raised preliminary objections vis-à-vis maintainability of the complaint, lack of cause of action, limitation, jurisdiction etc. On merits, it is admitted that Shri Jagat Ram was serving as drawing teacher with the OPs, who died in car accident. They further contend that the deceased was assured for Rs.2.00 lacs on payment of premium of Rs.91/- under group personal accident insurance scheme, hence, group personal accident insurance renewal amount of Rs.70/- could not be deducted from the deceased salary. The OP No.4, in its separate written version, to the complaint, contended that the deceased died after the period of the policy was over and was not covered under the policy, hence the policy has expired on 31.12.2005, while the deceased died on, 10.07.2006. Hence, it is denied, that, there was any deficiency in service on their part or that they have indulged in an unfair trade practice.
3. Thereafter, the parties adduced evidence, by way of affidavits, and, documents in support of their respective, contentions.
4. We have heard the learned counsel for the parties at length and have also thoroughly scanned the entire record of the case.
5. The deceased, who was working as drawing master, with the OP, while in service, met with an accident, on, 10.07.2006. An FIR with regard to the incident came to be registered in the Police Station, Dhalli and is appended as Annexure-B. After the death of the deceased, the complainant being the legal heir of the deceased, lodged a claim before the OPs, for, indemnifying to them the amount of insurance under Group Personal Accident Insurance Scheme.
6. The OP No.4-Company has come to repudiate the claim of the complainant on the ground that since no premium from the salary of the deceased covering his risk, was deducted, as a result of which the policy was not in existence, hence, did not cover the risk of the deceased, as such, the complainants are not entitled to claim the amount of the insurance.
7. Be that as it may, the scheme known as Group Personal Accident Insurance was introduced by the Government of H.P., hence, applicable w.e.f. 01.01.2005 to 31.12.2005, which was renewed on, 01.03.2006, and made effective from 05.04.2006, vide letter No. Fin(F)9-2/2006 dated 12.07.2006, which was circulated to the OPs No.1 to 3 only in the month of August, 2006, and since, the deceased had already expired on 10.07.2006, as such the premium could not be deducted from his salary by the OP No.3, hence, his risk remained not covered.
Hence, in the absence of non-existence of Group Personal Accident Insurance Scheme, in favour of the deceased, the OP No.4-Company was well within its right to repudiate the claim of the complainant. Thus, considering the facts and circumstances of the case, as no insurance policy was in existence, at the time of the death of the deceased, and since, the OP No.3 has assigned good reasons for non-deduction of the premium from his salary, hence, no negligence can be attributed to the OP No.3 for lack of non-deduction of premium from his salary, hence, OP No.4-Company cannot be held liable to indemnify the complainant. Hence, the repudiation of the claim of the complainant cannot be said to be suffering from any infirmity, as such, is legal and valid.
8. In the light of the above, we find no force in this complaint, and the same being without any merit, is liable to be dismissed, hence, we order accordingly. No order as to the costs. The learned counsel for the parties undertook to collect the certified copy of this order from the office, free of cost, as per rules. The file after due completion, be consigned to record room.
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