Life Insurance Corporation of India vs Sanju Kumar Yadav

THE Respondent/Complainant had taken a policy for Rs. 30,000 with accidental benefit. He met with an accident with a truck while driving bike Heropouch and has been disabled totally. The Respondent/ Complainant claims accidental benefit of Rs. 30,000 with interest. The claim was not settled and the Complainant approached the District Forum. The District Forum held that the Complainant was not entitled to any accidental benefit.

THE Complainant filed appeal before the State Commission. The State Commission allowed the appeal and directed the Insurance Company to pay Rs. 30,000. Besides this it was observed that the applicant had become 100% disabled on account of accidental injuries and as such Insurance Company is required to make payment of accidental benefit claim by relaxing its existing rules if necessary. This order has been challenged in this revision.

BOTH the parties were informed that the matter may be finally disposed of at the admission stage itself. Heard Counsel for the parties.

DELAY of 12 days condoned. The dispute is whether the claimant is entitled to accidental benefit. Learned Counsel for the Petitioner has pointed out that no additional premium was paid for accidental benefit, and the Complainant/Respondent had not applied for accidental benefit policy in the proposal form. It is also mentioned that condition Nos. 10 and 11 of the Policy are not applicable to the case of the petitioner and in the said policy on account of computer error the entries on the first page at the end have slipped down in between two columns. All these contentions were refuted by Counsel for the Respondent.

ADMITTEDLY, no additional premium has been paid for accidental benefit nor the policy shows that it is accidental benefit policy and it is shown "Endowment insurance policy with profit". There was no proposal of the Respondent/Complainant for accidental benefit cover. The contention of Counsel for the Petitioner that the entries on the first page which have been shown in Columns at the end of page 1 are due to computer error in printing is well founded. The entries as against column "Dates when premium payable" is shown on the line in between the said column and the next column. The entries in the column, "Conditions and privileges not applicable" have been shown partly on the line in between the said column and the next column. Taking an overall view of the matter, we are of the opinion that the District Forum had rightly come to the conclusion that the Complainant/Respondent was not covered under accidental benefit. The State Commission, in our opinion, was not right in setting aside the order of the District Forum. In view of the above, the revision is allowed and the order of the State Commission regarding payment of accidental benefits and that the Insurance Company is required to make payment of accidental benefits claimed by relaxing of existing rules, if necessary, is set aside. In the facts and circumstances, there shall be no order as to costs. Appeal allowed.